Prostate cancer screening between low-income African-American and Caucasian men

African-Americans (AA) are more likely than Caucasians (CA) to be diagnosed with advanced prostate cancer, perhaps due to delayed detection. We investigated racial differences in prostate cancer screening according to age and socioeconomic and demographic indices in a large and predominantly low-income population.

In-person interviews were conducted with 12,552 men, 84% AA, recruited during 2002 through 2004 from 25 community health centers in the southern United States. Prostate specific antigen test (PSA) and digital rectal examination (DRE) histories, and socioeconomic and demographic indices (i.e., education, household income, health insurance, and marital status) were determined. Odds ratios (OR) from logistic regression summarized the screening and race association as a function of age, while controlling for socioeconomic status (SES).

Racial differences in screening prevalence varied with age. Of men older than 65 years, CA were significantly more likely to report a PSA test (OR = 1.4) or DRE (OR = 1.5) within the past 12 months. However, these disparities were reduced with control for SES (PSA: OR =1.2; DRE: OR = 1.3, P > 0.05). In contrast, at ages younger than 65, CA were equally or less likely to have received a recent PSA test or DRE, particularly at ages 45-49 years (PSA: OR = 0.7; DRE: OR = 0.9), with little change after SES adjustment.

Consistent with several screening recommendations, younger AA men, especially those younger than age 50, are more likely than CA to have had a recent PSA test or DRE, independent of SES. Of men older than age 65, less frequent use of screening among AA than CA seems partly attributable to SES and factors other than race.