A new study indicates that higher prostate cancer death rates among black men in the US may be due to a higher risk of developing preclinical prostate cancer as well as a higher risk of that cancer progressing more quickly to advanced stages. The study suggests that screening policies may need to be tailored to the higher-risk status of this population, such as screening at an earlier age and more frequently.

Among black men in the United States, the incidence of prostate cancer is 60% higher than that of white men, and their mortality rate from prostate cancer is more than twice as high. A team of researchers used three models of prostate cancer incidence and prostate specific antigen (PSA) screening in the United States to estimate disease onset and progression based on prostate cancer data from 1975 to 2000.

The investigators estimated that 30% to 43% of black men develop preclinical prostate cancer by age 85, a risk that is 28% to 56% higher than that among men of any race. Among men with preclinical disease, black men have a similar risk of being diagnosed with prostate cancer (35% to 49%) compared with the general population (32% to 44%) in the absence of screening. The interval from getting preclinical cancer to being diagnosed is long—10 years or more on average—and is similar in black and white men. But for black men, the risk of progression to advanced disease by the time they’re diagnosed is 44% to 75% higher than in the general population (a 12% to 13% risk in black men vs a 7% to 9% risk in the general population).

An accompanying editorial noted that the study’s findings imply that the risk/benefit trade-offs of PSA screening may be quite different for black men when compared with the general population. 

The study, “Is prostate cancer different in black men? Answers from three natural history models,” was published in CANCER, a peer-reviewed journal of the American Cancer Society (http://doi.wiley.com/10.1002/cncr.30687 [8]).