Common prostate cancer tests may put black men at increased risk of overdiagnosis

A widely used prostate cancer test may increase the risk of overdiagnosis in black men, a new study by experts at the University of Exeter has found.

prostate specific antigen In the UK, the PSA test is routinely used as a first step in investigating men with urinary symptoms such as blood in the urine or frequent urination. Men over the age of 50 without symptoms can also request a blood test from their primary care physician.

New research published in BMC Medicinesought to investigate the performance of the PSA test in identifying prostate cancer in men of different ethnic groups. It is well known that black men in the UK are more likely to be diagnosed with prostate cancer. What is not yet clear is whether the outcomes for these men are worse than for white British men.

The study, funded by the National Institute for Health Research (NIHR), Cancer Research UK and the Higgins family, looked at the patient records of 730,000 men who were diagnosed with prostate cancer following elevated PSA test results. We evaluated the number of men who received . More than 80 percent of the men in the study had normal PSA levels, regardless of ethnicity. However, this study is the first in a robust UK dataset to report that PSA levels vary by ethnicity, with black men having higher PSA levels than white men and Asian men having the lowest PSA levels.

Further analysis found that prostate cancer diagnoses after elevated PSA results were highest in black men compared to white and Asian men. However, when the research team looked at the number of men with advanced prostate cancer in each group, they found that the levels in black and white men were very similar, with relatively higher PSA levels found in black men's prostates. It was suggested that this may have an impact on cancer diagnosis.

Prostate cancer accounts for around a quarter of new cancer cases in men, with around 52,000 men diagnosed with prostate cancer each year in the UK alone. It is the second most common cause of cancer death for men in the UK and if diagnosed at the earliest stage, he is twice as likely to survive five years compared to the most advanced stage. Because symptoms are common and easily misdiagnosed, an estimated 14% of prostate cancer deaths could be avoided if diagnosed early.

The PSA test has long been under scrutiny because only one in three men with a positive PSA test has cancer, and one in seven men with prostate cancer do not have elevated PSA levels. was. This latest study suggests that black men may be significantly more likely to undergo diagnostic tests such as prostate MRIs and biopsies because their natural PSA levels are higher anyway.

Black, Asian and other minority ethnic groups in the UK have historically been underrepresented in cancer research. Therefore, previous research findings, including information about PSA testing and prostate cancer diagnosis, may not fully reflect their perspectives, needs, and experiences. Our study provides important messages for health professionals, policy makers, charities, and advocacy groups promoting prostate cancer screening.

Cancer overdiagnosis may not sound as worrisome as underdiagnosis, but prostate cancer can be more accurate and precise to avoid unnecessary biopsies that can lead to psychological distress and sepsis. Making a diagnosis requires rebalancing the evidence base. More research is needed to ensure that everyone, regardless of ethnicity, has access to the best possible diagnosis. ”

Dr Tanimora Martins, Senior Research Fellow and Lecturer, University of Exeter

Nasser Turabi, head of evidence and practice at Cancer Research UK, said: 'Overall, research shows that PSA testing in men without prostate symptoms does not reduce the number of deaths from prostate cancer. “This study highlights that testing may be contributing to prostate cancer deaths.” This may be because black men naturally have higher levels of the PSA protein, making tests even less accurate at finding prostate cancer that requires treatment.

“The PSA test is not suitable for men who have no symptoms of prostate cancer. Further research is needed to find an effective and accurate test that can save lives and reduce unnecessary treatment from prostate cancer. ”

The study included 649,445 white men, 37,827 black men, and 31,053 Asian men. The study consistently found that Asian men had the lowest PSA levels, lowest cancer diagnoses, and lowest rates of advanced prostate cancer.

This study used data from patients registered in UK general practices contributing to the Clinical Practice Research Datalink Aurum dataset. Participants were men aged 40 years or older with recorded ethnicity, a PSA test result recorded between 2010 and 2017, and no previous cancer diagnosis.

“The association between patient ethnicity and prostate cancer diagnosis after prostate-specific antigen testing: a cohort study of 730,000 men in primary care in the United Kingdom.'' BMC Medicine. The University of Exeter is a member of the NIHR Primary Care Research School and contributed to the funding.