Black Men and Prostate Cancer.
Black men, we must do better. No, I am not going into a scolding mode about anything except this — prostate cancer. This disease is the second highest cancer-related cause of death in men in the United States.
While we have made significant progress for several cancers, there has recently been a troubling trend of more advanced stage prostate cancer at diagnosis. Only about one-third will be alive at the five-year mark for those with a distant spread — metastasis — of cancer.
African-American males have the highest mortality rate for prostate cancer, being twice as likely to die from it than white men. We must do better at making sure all have excellent outcomes.
Prostate-specific antigen (PSA) screening is more controversial today than decades ago. Critics of PSA screening point to the potential harms of unnecessary treatment. Proponents of the intervention offer a direct relationship between PSA screening and diagnosing prostate cancer at an earlier (and more curable) stage.
The critics and proponents of PSA screening come together in recognizing that for the diagnosis and management of prostate cancer, patient-physician shared decision-making is critical. There is so much to consider, including personal preferences, evidence-based management strategies, patient health, risk category, and more.
The problem? Today, access to PSA screening can be challenging. In 2012, the United States Preventative Services Task Force made PSA screening a lower priority. I won’t get into the flawed analysis that got us to this place.
Today, we see more men found with cancer in later stages compared to before the change. States with greater drops in PSA screening had more significant increases in metastatic prostate cancer at diagnosis.
I find this trend of rising advanced stage disease at diagnosis to be troubling. While I welcome the shared-decision making approach advocated by a 2018 United States Preventative Task Force update, not all insurers are entirely on board for payment of the PSA test.
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