1. Black men under 65 are less likely to receive recommended diagnostic follow-up testing after an elevated prostate specific antigen (PSA) result than white men of the same age.
2. Poor diagnostic follow-up may help explain higher rates of prostate cancer mortality among black men.
Study Rundown: This study found that black men under 65 were significantly less likely to receive appropriate follow-up testing after an elevated PSA screening test compared to white men of the same age. This is concerning because black men are at higher risk for developing prostate cancer and experience higher rates of prostate cancer mortality. These findings generate questions regarding whether racial differences in follow-up to the racial disparity in mortality due to treatment delay and whether racial differences in access to care is responsible since this racial disparity in follow-up was significant only in men >65, ineligible for Medicare.
A key limitation of this study is that the reason for lack of follow-up was not assessed, whether it was due to patient non-compliance, lack of provider recommendation, or lack of access. Without clear characterization of the barriers to follow-up, interventions cannot be developed. Moreover, PSA screening is a limited test and only represents one step of many in the diagnosis and treatment of prostate cancer. Further studies are needed to definitively link lower rates of follow-up testing to differences in mortality.
In Depth [secondary analysis of a prospective, randomized trial]: The study used data from the screening arm of the Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening trial to evaluate the relationship between race and diagnostic follow-up care after an elevated PSA (prostate-specific antigen) level. Men who had a PSA level >4 ng/mL at any time during the study were included and follow-up was a composite variable defined as repeat PSA, a prostate biopsy or both within 9 months. Self-identified racial group and multiple secondary variables were included in a mixed-effect multivariable model. Results were stratified by age, (<65 or >=65) to account for Medicare eligibility.
Of the 6924 eligible men with an elevated PSA, 4,413 (70%) underwent follow-up within 9 months. Black men <65 years were 45% less likely to undergo follow-up than white men of the same age (OR=0.55, 95% CI, 0.37-0.82, p=.003). There was no racial difference seen in men 65 and older.
By Maren Shapiro and Leah Hawkins
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