Calling All Men 40-49: Don't Forget That Prostate Test

According to a group of researchers, one-fifth of young men aged 40 to 49 reported having had a prostate-specific antigen (PSA) test within the last year. Although young, black, non-Hispanic men are more likely than young, white, non-Hispanic men to report having a PSA test, the screening rates in this high-risk group of black men are still considered less than optimal.
Lead author Dr. Charles Scales from Duke University in Durham, North Carolina and colleagues used the 2002 Behavioral Risk Factor Surveillance System to study prostate-cancer screening in a group of 58,511 men aged 40 years and older. The men did self-reports of a PSA test in the previous year."Our findings provide an important baseline assessment of PSA test use among young men as physicians debate whether to expand use of the PSA test in young men with risk-stratification strategies," Dr. Scales said in statement.
Only 22.5 percent of men aged 40 to 49 years reported having had a PSA test in the previous year, compared with 53.7 percent of men aged 50 years or older. Black men in there forties were found to be 2.4 times more likely to have a PSA test than white men, yet only 33.6 percent of them reportedly have the test and the group is at higher risk for prostate cancer. For young men an annual household income of $35,000 or more plus an ongoing relationship with a physician and the presence of health care coverage were associated with the PSA testing.
"Our findings for black men are discouraging," commented Judd W. Moul, M.D., a co-author who is also from Duke University in Durham, North Carolina, in a written statement. "We've been encouraging black men to get screened at age 40 or 45 for more than a decade, yet only one-third of these high-risk men reported being tested."
Blood levels of the protein PSA usually rise when a man has prostate cancer, so PSA testing is often used to screen for the disease. However, experts are in disagreement as to the use of PSA tests for cancer-risk stratification in young men in the United States. Little is known about the use of PSA testing in these men.
The U.S. Preventive Health Service Task Force has recently recommended that men discuss PSA screening for prostate cancer with their physician beginning at age 50. However, the American Cancer Society recommends screening at age 45 for African American men, or earlier if there is a strong family history. The Task Force says there is not enough evidence of benefit, compared with risk, to make such a recommendation.
The authors did acknowledge several limitations of the study including reliance on self-reporting, inability to determine whether PSA tests were performed for reasons other than cancer diagnosis, absence of information about family history, and no data on screening in men younger than 40.
In an accompanying editorial, urologist Robert Nadler, M.D., of Northwestern University in Chicago, said the Duke study adds to existing evidence that serial PSAs starting at age 40 years will allow practicing clinicians to determine which patients are at higher risk for developing prostate cancer and, specifically, allow clinicians to calculate and follow the PSA velocity initially at a time when BPH is less prevalent and PSA more predictive of cancer. This, in turn, should allow for early detection in young men, who should benefit the most.
The new study can be found in the online journal Cancer.