From the Guidelines
African American men with a family history of prostate cancer, such as a father diagnosed in his early 70s, should begin prostate cancer screening at age 45, as recommended by the American Cancer Society guideline published in 2010 1. This guideline suggests that men at higher risk, including African American men and those with a family member diagnosed with prostate cancer before age 65, should receive information about the benefits, risks, and uncertainties associated with prostate cancer screening starting at age 45. The screening typically involves a prostate-specific antigen (PSA) blood test and possibly a digital rectal examination (DRE). Some key points to consider when making a decision about prostate cancer screening include:
- The benefits and limitations of screening, including the possibility of false positives leading to unnecessary procedures
- The potential harms of screening, such as overdiagnosis and overtreatment
- The individual's personal risk factors, including family history and racial background
- The individual's overall health status and life expectancy It's essential to have a thorough discussion with a doctor about these factors to make an informed decision about prostate cancer screening. The decision to screen should be individualized, weighing personal risk factors against potential harms of screening. If screening is pursued, it should continue until about age 70-75, depending on overall health status and life expectancy, as recommended by the American College of Physicians guidance statement 1. Some key considerations for screening frequency include:
- Initial PSA results
- Age and health status
- Family history and racial background
- Potential harms of screening, such as overdiagnosis and overtreatment.
From the Research
Prostate Cancer Screening for African American Males
- The American Cancer Society recommends that African American men discuss prostate cancer screening with their doctor starting at age 45, as they are at higher risk for developing prostate cancer 2.
- A study published in the Journal of the National Cancer Institute suggests that African American men should be screened for prostate cancer at younger ages (e.g., 45-50 years) and at more frequent intervals relative to other racial groups in the United States 2.
- The Prostate Cancer Foundation recommends that Black men, including those with a family history of prostate cancer, obtain information about PSA screening for prostate cancer, and that baseline PSA testing should occur between ages 40 and 45 3.
- A study published in the NEJM evidence found that lowering the age for baseline PSA testing to 40 to 45 years of age, followed by regular screening until 70 years of age, could reduce prostate cancer mortality in Black men by approximately 30% relative risk reduction 3.
Family History and Prostate Cancer Screening
- Having a family history of prostate cancer, such as a father or brother with prostate cancer, doubles the risk of developing prostate cancer for African American men 4.
- A study published in Cancer epidemiology, biomarkers & prevention found that African American men with a self-reported family history of prostate cancer were more likely to report having a recent PSA test, but not a digital rectal exam 4.
- The African American Hereditary Prostate Cancer Study Network found that high-risk African American men with a positive family history had lower rates of prostate cancer screening compared to African American men without a family history 5.
Decision-Making Factors for Prostate Cancer Screening
- A study published in Cancer nursing found that African American men's decision to undergo prostate cancer screening is influenced by their relationship with their healthcare provider, as well as information and support from family and friends 6.
- The study also found that having a trusting relationship with their healthcare provider was necessary for African American men to undergo prostate cancer screening 6.