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Racial Disparities in Future Development of Lethal Prostate Cancer Based on Midlife Baseline Prostate-Specific
Giuseppe Chiarelli1,2, Matthew Davis1, Alex Stephens3
1VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, Michigan, USA.
Background:
Previous studies found that Midlife Baseline PSA (MB PSA) predicts the risk of developing lethal prostate cancer (PCa), although the cohorts were homogenous in terms of racial compositions. We aimed to investigate racial disparities in the predictive value of MB PSA for lethal PCa in a diverse, contemporary, North American population.
Methods:
Our cohort included White and Black men aged 40-59 years, who underwent MB PSA through our health system. Cumulative incidence curves depicted lethal PCa stratified by race and MB PSA above/below the median. We utilized time-dependent Receiver Operating Characteristic (ROC) curves and Area Under the ROC Curve (AUC) to compare the performance of MB PSA in predicting lethal PCa based on race. Multivariable regression (MVA) was used to examine the impact of the MB PSA in predicting lethal PCa by race.
Results:
We included 112,967 men, of whom 27% were Black. The cumulative incidence estimate with MB PSA values equal to the median at 15 years of follow-up was 0.13 (0.04, 0.32) for White men and 0.55 (0.24, 1.11) for Black men. AUCs comparison showed no statistically significant differences in the predictive role of MB PSA for lethal PCa between White and Black men. At MVA, using White patients with PSA ≤ median as the reference group, the HR of lethal PCa for White men with PSA > median aged 40-44, 45-49, 50-54, and 55-59 was respectively 2.98 (1.59-5.57), 3.01 (1.89-4.81), 5.10 (3.38-7.70), and 3.38 (2.32-4.92). While for Black men was respectively 5.50 (2.94-10.27), 4.19 (2.59-6.78), 9.79 (6.37-15.04), and 7.53 (5.03-11.26) (all p < 0.001).
Conclusion:
Our findings indicate that for the same MB PSA and within the same age category, Black men have a greater risk of developing lethal PCa than White men. A separate cut-off should be created for MB PSA, if this is to be used to guide PSA screening in clinical practice.
Insights
Midlife Baseline PSA predicts lethal prostate cancer risk, but Black men face higher risks than White men with similar PSA levels. Separate screening cut-offs may be needed for Black men.
Area of Science:
- Urology
- Oncology
- Public Health
Background:
- Midlife Baseline PSA (MB PSA) is a known predictor of lethal prostate cancer (PCa).
- Previous studies lacked racial diversity, potentially limiting generalizability.
- Investigating racial disparities in MB PSA's predictive value is crucial for equitable PCa screening.
Purpose of the Study:
- To assess racial differences in the predictive accuracy of MB PSA for lethal PCa.
- To evaluate MB PSA's performance in predicting lethal PCa across racial groups in a diverse North American population.
Main Methods:
- Analysis of a cohort of White and Black men aged 40-59 with MB PSA data.
- Utilized cumulative incidence curves, time-dependent ROC curves, and AUC for predictive performance comparison.
- Multivariable regression analysis examined MB PSA's impact on lethal PCa risk by race.
Main Results:
- Included 112,967 men (27% Black). At 15 years, cumulative incidence of lethal PCa was higher for Black men (0.55) vs. White men (0.13) at median MB PSA.
- No significant difference in AUCs, indicating similar overall predictive ability of MB PSA between races.
- Multivariable regression showed significantly higher hazard ratios for lethal PCa in Black men compared to White men across all age groups for PSA > median.
Conclusions:
- Black men have a disproportionately higher risk of lethal PCa than White men, even with similar MB PSA levels and age.
- Current MB PSA thresholds may not be optimal for all racial groups.
- Separate MB PSA cut-offs may be warranted for guiding PCa screening in clinical practice to address racial disparities.
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