Presentation Authors: Jeffrey Arace*, Viktor Flores, Dennis Robins, Thomas Monaghan, Andrew Winer, Jeffrey Weiss, Brooklyn, NY
Introduction: In 2012, the USPSTF recommended to exclude prostate specific antigen (PSA) screening from routine primary care for all patients. The Brooklyn VA Hospital serves ~50% African-American patients, who are more likely to develop and die from prostate cancer (PCa) than the general population. We compared the impact of the 2012 USPSTF recommendation on PCa detection rates and biopsy patterns in African-American patients and Caucasian patients.
Methods: Demographics, PSA, transrectal ultrasonography (TRUS) volume, and pathologic data were collected on patients who underwent their first prostate biopsy at the Brooklyn VA Hospital between January 2007 and June 2018. The period from January 2007 to May 2012 was considered pre-guideline, and the period from June 2012 to June 2018 was considered post-guideline. PCa detection rates and biopsy patterns were compared using Chi-square testing.
Results: 609 biopsies were analyzed pre-guideline (113 per year), and 487 were analyzed post-guideline (81 per year), indicating a 28% decline in biopsy rate. There was no significant difference in the detection rates of low, intermediate, or high grade PCa in Caucasians. In contrast, African-Americans were significantly more likely to be diagnosed with PCa in the post-guideline group (56% vs. 66%, p=0.016), and significantly more likely to be diagnosed with intermediate-high grade PCa (38% vs. 47%, p=0.038). Before the 2012 USPSTF recommendation, African-American and Caucasian patients undergoing their first biopsy were equally likely to be diagnosed with high-grade PCa (11% AA vs. 11% CA). After the 2012 decision, we found that African-Americans were 50% more likely than Caucasians to be diagnosed with high-grade PCa on first biopsy (10% AA vs. 15% CA, p=0.008).
Conclusions: Our study demonstrates that African-American patients have been disproportionately impacted by the 2012 USPSTF recommendation against PCa screening. In the 6 years following the recommendation, detection rates of intermediate-high risk disease remained unchanged for Caucasian patients but have increased significantly for African-Americans. Whether these observations reflect improved selection of patients to biopsy or an increased number of undiagnosed patients remains unclear. The results of our study strongly support the role of routine PSA screening, particularly in higher risk patients.