VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, Michigan.
Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy.
J Urol. 2024 Oct;212(4):560-570. doi: 10.1097/JU.0000000000004118. Epub 2024 Jul 30.
Randomized studies assessing the effect of PSA screening on mortality in non-Hispanic Black (NHB) men are lacking. We aimed to assess the association between PSA screening and survival among NHB men in comparison to non-Hispanic White (NHW) men in a racially diverse real-world North American population.
The study cohort included 6378 men who self-identified as NHB or NHW and were diagnosed with prostate cancer (PCa). Patients received PSA screening and subsequent PCa treatment and follow-up at our institution. Patients were sorted based on PSA testing intensity for the 5 years prior to diagnosis, as follows: never, some (<1 test/y), and annual testing (1 test/y). The primary outcome was risk of prostate cancer-specific mortality (PCSM). Competing risk cumulative incidence curves estimated PCSM rates. Competing risk regression analyses examined the impact of PSA testing on PCSM. An interaction term was incorporated to assess the impact of race on the outcome.
Median (IQR) age and PSA at diagnosis were 67 (60-73) years and 5.8 (4.4-9.6) ng/mL, respectively, and 2929 (46%) men were NHB (Kruskal-Wallis values < .001). Annual PSA testing was more frequent in NHW (5%) than in NHB (3%) men (χ value < .001). On cumulative incidence analysis, in the never, some, and annual PSA testing groups, the 10-year PCSM was respectively 12.3%, 5.8%, and 4.6% in NHW and 18.5%, 7%, and 1.2% in NHB patients (Gray's test values < .001). At competing risk regression, PSA screening rate was associated with more favorable PCSM rates (HR: 0.47; 95% CI 0.33-0.68; < .001). The interaction term for race did not show statistical significance ( = .2).
PSA testing was associated with a reduced risk of PCSM in both NHB and NHW men diagnosed with PCa. Additionally, the positive impact of the screening rate seemed to be independent of race.
缺乏评估前列腺特异性抗原（PSA）筛查对非西班牙裔黑人（NHB）男性死亡率影响的随机研究。我们旨在评估在种族多样化的北美真实人群中，与非西班牙裔白人（NHW）男性相比，PSA 筛查与 NHB 男性生存之间的关联。
研究队列包括 6378 名自我认定为 NHB 或 NHW 并被诊断患有前列腺癌（PCa）的男性。患者在我们的机构接受 PSA 筛查以及随后的 PCa 治疗和随访。根据诊断前 5 年 PSA 检测强度，患者被分为以下三组：从未、部分（<1 次/年）和每年检测（1 次/年）。主要结局是前列腺癌特异性死亡率（PCSM）的风险。竞争风险累积发生率曲线估计 PCSM 率。竞争风险回归分析检查了 PSA 检测对 PCSM 的影响。纳入了一个交互项来评估种族对结果的影响。
中位（IQR）年龄和诊断时 PSA 分别为 67（60-73）岁和 5.8（4.4-9.6）ng/ml，2929 名（46%）男性为 NHB（Kruskal-Wallis 值<.001）。每年 PSA 检测在 NHW（5%）中比在 NHB（3%）男性中更常见（χ 值<.001）。在累积发生率分析中，在从未、部分和每年 PSA 检测组中，10 年 PCSM 分别为 NHW 患者的 12.3%、5.8%和 4.6%，以及 NHB 患者的 18.5%、7%和 1.2%（Gray 检验值<.001）。在竞争风险回归中，PSA 筛查率与更有利的 PCSM 率相关（HR：0.47；95%CI：0.33-0.68；<.001）。种族的交互项没有统计学意义（=.2）。
PSA 检测与被诊断为 PCa 的 NHB 和 NHW 男性的 PCSM 风险降低相关。此外，筛查率的积极影响似乎独立于种族。
