Abstract C85: Do African-American veterans need distinct “Prostate Cancer Screening Guidelines” to overcome outcome disparities?

Abstract

Abstract Background: The United States Preventive Task Force recommended against the prostate-specific antigen (PSA)-based screening for prostate cancer in 2012, a recommendation that applies to all American men. African-American men, however, have the highest incidence of prostate cancer and are more likely to be diagnosed with an advanced stage and poor prognostic-form of prostate cancer. The incidence of prostate cancer is almost 60% higher, and the mortality rate is two- to three-times greater among African Americans than that of Caucasian men1. The Veteran's Health Administration is an unbiased, race-color blind, equal and open access, single-payor, government run health care system2. Yet, due to complex interactions of ethnicity, biology, comorbidities, environmental interactions, as well as social causes, African-American veterans are present with more aggressive disease and carry a worse outcome. Therefore African-American veterans need specific interventions to improve prostate cancer outcomes; i.e., improve survivals and quality of life. We hypothesize that by developing specific and structured prostate cancer screening recommendations, we can improve the overall prostate cancer outcomes among African-American veterans. Methods: We performed a PubMed search using the keywords: African American, African American veterans, Prostate cancer, Outcomes, Molecular markers, Prostate-specific Antigen velocity, and PSA density to derive data relevant to our hypothesis. Results: 1. Men over the age of 65 are most susceptible to prostate cancer, and the average age of veterans is 582. So, they are at a nearly optimal age for preventative prostate cancer screening. 2. The USPSTF guidelines were based on two studies, and one of these studies reported that only 4% of its participants were African American. So, it is inappropriate to use the same guidelines for African American veterans. 3. Several aspects of prostate cancer are different between African Americans and Caucasians. These differences include prostate cancer incidence and outcome, genetic differences, comorbidity, PSA levels, social barriers, and course of the disease. 4. Prior to the new USPSTF guidelines, African American veterans were just as likely as white veterans to undergo PSA testing3. 5. Among the diseases linked to comorbidity with prostate cancer, cardiovascular disease is the most frequent. Hence, the leading cause of death in both the African-American population and the African-American veteran population is cardiovascular disease.2 Conclusion: 1. Because there is no cure for metastatic prostate cancer, early diagnosis and intervention for African-American veterans will lead to saving lives; specific guidelines for prostate cancer will be very beneficial. 2. This will also decrease the costs of treating recurrent and metastatic disease and conserve the resources of the VA Health System. 3. Because the Veterans Health System is equal access, it is an optimal environment to test different prostate cancer screening guidelines for African Americans. 4. Specific draft guidelines will be presented.