Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla.
VA San Diego Healthcare System, La Jolla, California.
JAMA Oncol. 2022 Oct 1;8(10):1471-1476. doi: 10.1001/jamaoncol.2022.2970.
Black men have higher prostate cancer incidence and mortality than non-Hispanic White men. However, Black men have been underrepresented in clinical trials of prostate-specific antigen (PSA) screening; thus, there is a lack of data to guide screening recommendations for this population.
To assess whether PSA screening is associated with reduced risk of prostate cancer-specific mortality (PCSM) among non-Hispanic Black men.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from the US Veterans Health Administration Informatics and Computing Infrastructure for men aged 55 to 69 years who self-identified as non-Hispanic Black or non-Hispanic White and were diagnosed with intermediate-, high-, or very high-risk prostate cancer from January 1, 2004, to December 31, 2017. Data were analyzed from August 2021 to March 2022.
Prostate-specific antigen screening rate, defined as the percentage of years in which PSA screening was conducted during the 5 years before diagnosis of prostate cancer.
The primary outcome was risk of PCSM among Black men and White men. The association between PSA screening and risk of PCSM was assessed using Fine-Gray regression analysis. Risk of PCSM was also assessed categorically among patients classified as having no prior PSA screening, some screening (less than annual), or annual screening in the 5 years before diagnosis.
The study included 45 834 veterans (mean [SD] age, 62.7 [3.8] years), of whom 14 310 (31%) were non-Hispanic Black men and 31 524 (69%) were non-Hispanic White men. The PSA screening rate was associated with a lower risk of PCSM among Black men (subdistribution hazard ratio [sHR], 0.56; 95% CI, 0.41-0.76; P = .001) and White men (sHR, 0.58; 95% CI, 0.46-0.75; P = .001). On subset analysis, annual screening (vs some screening) was associated with a significant reduction in risk of PCSM among Black men (sHR, 0.65; 95% CI, 0.46-0.92; P = .02) but not among White men (sHR, 0.91; 95% CI, 0.74-1.11; P = .35).
In this cohort study, PSA screening was associated with reduced risk of PCSM among non-Hispanic Black men and non-Hispanic White men. Annual screening was associated with reduced risk of PCSM among Black men but not among White men, suggesting that annual screening may be particularly important for Black men. Further research is needed to identify appropriate populations and protocols to maximize the benefits of PSA screening.
黑人男性的前列腺癌发病率和死亡率高于非西班牙裔白人男性。然而，在前列腺特异性抗原（PSA）筛查的临床试验中，黑人男性代表性不足；因此，缺乏数据来指导该人群的筛查建议。
评估 PSA 筛查是否与非西班牙裔黑人男性前列腺癌特异性死亡率（PCSM）降低相关。
设计、地点和参与者：这项回顾性队列研究使用了美国退伍军人健康管理局信息学和计算基础设施的数据，纳入了年龄在 55 至 69 岁之间、自我认定为非西班牙裔黑人和非西班牙裔白人且被诊断为中危、高危或极高危前列腺癌的男性。数据于 2021 年 8 月至 2022 年 3 月进行分析。
PSA 筛查率，定义为在诊断前列腺癌前 5 年内每年进行 PSA 筛查的年份百分比。
主要结局是非西班牙裔黑人男性和白人男性的 PCSM 风险。使用 Fine-Gray 回归分析评估 PSA 筛查与 PCSM 风险之间的关联。还根据诊断前 5 年内无 PSA 筛查、有一些筛查（少于每年一次）或每年筛查的患者进行分类，评估 PCSM 风险。
该研究纳入了 45834 名退伍军人（平均[标准差]年龄，62.7[3.8]岁），其中 14310 名（31%）为非西班牙裔黑人男性，31524 名（69%）为非西班牙裔白人男性。PSA 筛查率与黑人男性（亚分布危险比 [sHR]，0.56；95%CI，0.41-0.76；P=0.001）和白人男性（sHR，0.58；95%CI，0.46-0.75；P=0.001）的 PCSM 风险降低相关。在亚组分析中，与一些筛查相比，每年筛查（sHR，0.65；95%CI，0.46-0.92；P=0.02）与黑人男性 PCSM 风险显著降低相关，但与白人男性无关（sHR，0.91；95%CI，0.74-1.11；P=0.35）。
在这项队列研究中，PSA 筛查与非西班牙裔黑人男性和非西班牙裔白人男性的 PCSM 风险降低相关。每年筛查与黑人男性的 PCSM 风险降低相关，但与白人男性无关，这表明每年筛查对黑人男性可能特别重要。需要进一步研究以确定适当的人群和方案，以最大限度地提高 PSA 筛查的益处。
