PHEN: How Black Men Can Survive Prostate Cancer

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African American men suffer the highest prostate cancer incidence and mortality rates among men of all racial and ethnic backgrounds in the United States. This racial disparity is the largest for any major cancer and all African American men are deemed to be at high – risk for prostate cancer. The United States Senate passed a resolution in 2012 recognizing prostate cancer among African American men to be of epidemic proportions.

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Recent guideline statements and recommendations regarding the use of prostate – specific antigen (PSA) testing for the early detection of prostate cancer, and the resulting controversy, have led to confusion and a lack of clarity for the men most at risk for suffering and dying from prostate cancer.

Despite high-level evidence for the use of PSA testing as an aid to early prostate cancer detection, and also for its role as a predictor of future risk, the U.S. Preventive Services Task Force (USPSTF) has called for PSA testing to be abandoned completely. The American Urological Association (AUA) and National Comprehensive Cancer Network (NCCN) support a role for PSA testing but with somewhat conflicting recommendations. The guideline statements have endorsed the role of shared decision-making for men considering PSA testing. However, media reports on the PSA test controversy are confusing and preventing many African American men from even having a discussion with physicians about early detection, thereby negating any opportunity for shared decision-making, and in the absence of discussion most men do not have PSA testing.

African American men and certain other men deemed to be at high – risk for prostate cancer, including men with a family history and men exposed to agent orange [4], were not included in sufficient numbers in the two main randomized clinical trials [5] used as the scientific evidence to formulate the PSA test guidelines. Few men, if any, of African ancestry and obviously no African Americans were included in the European trial. Consequently, some guidelines do not directly or clearly address the needs of African American men.

The Prostate Health Education Network (PHEN)* has formulated a set of consensus statements for PSA testing to address the need for providing clear guidance on PSA testing for African American and other high – risk men. These statements rely on “The Melbourne Consensus Statement on Prostate Cancer Testing” adopted by leading prostate cancer experts from around the world at the 2013 Prostate Cancer World Congress in Melbourne, Australia. The three statements herein were excerpted from this statement with modifications.

The PHEN consensus statements are not inconsistent with the AUA Early Detection of Prostate Cancer guidelines, which “invites the consideration of PSA testing for African Americans under the age of 55.” The statements are consistent with the NCCN Prostate Cancer Early Detection guidelines [8], which state: “Although age 50 has traditionally been the age for starting to consider PSA testing, researchers have recognized that high-risk groups such as African Americans and men with a family history of prostate cancer may benefit from beginning testing at an earlier age.”

Absent scientific evidence from randomized clinical trials, guidance on PSA testing for high – risk men must be provided through expert opinion. Studies have shown that African American men as a group are diagnosed with life threatening prostate cancer at an earlier age and with a more advanced stage of the disease. It is believed that these factors contribute to a death rate that is 2.45 times higher than for white men and even higher compared to men of other racial and ethnic groups. Expert opinion has historically held that African American men should begin PSA testing at an earlier age, and the two main randomized clinical trials provided no scientific evidence that disproves this opinion.

The signatories to this consensus statement are medical specialists with extensive experience diagnosing and treating prostate cancer patients. For many, this experience spans the period before the PSA test was adopted, which provides them with a perspective on how African American men presented with prostate cancer before the era of wide-spread PSA testing and more than two decades later today.

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