Summary of key questions regarding prostate cancer screening using PSA among African American men
| Question . | USPSTF guidelinea . | Literature guidance . | Future research needs . | Levels of evidence (20) . |
|---|---|---|---|---|
| 1. Should we screen African American men with PSA levels for prostate cancer? | The USPSTF guideline states that the decision to test PSA levels should be a shared decision between patients and their clinicians. African American men and men with a family history of prostate cancer are acknowledged to experience higher prostate cancer risk, but no guidance on clinical care is provided for these groups. | African American men should be screened for prostate cancer, using PSA to lower prostate cancer–specific mortality. In consideration of potential harms, PSA can be used in conjunction with other information to stratify prostate cancer risk, and magnetic resonance imaging can be incorporated before to biopsy. | Data that support how the use of PSA, alone or in combination with other markers, may help improve the benefit-risk trade-off of screening among African American men. | Level 3 |
| 2. When should screening for prostate cancer be initiated among African American men? | The USPSTF guideline states that although the decision to screen for prostate cancer should be made through shared decision making with a clinician, this discussion should not be initiated until the patient is 55 y of age. | African American men could consider initiation of prostate cancer screening at earlier ages (approximately 45-50 y) relative to men at average risk of prostate cancer. Family history of prostate cancer and inherited genetic risk may also be potential considerations in initiating prostate cancer risk assessment among African American men. | Data that support the initial age at which the benefits and harms are in equipoise for specific risk groups, including those defined by genetics, family history, age, and other factors. | Level 3 |
| 3. How often should African American men be screened for prostate cancer? | The USPSTF guideline states that men who have made the decision to screen should do so “periodically.” | There is a lack of evidence regarding the optimal screening interval among African American men. The cadence of screening may be based on a midlife PSA value to direct whether and how often future PSA measures will be needed. | Data that support the value of midlife PSA testing in predicting future rises in PSA and lethal prostate cancer diagnosis by age and risk level. | Level 3 |
| 4. When should screening for prostate cancer be stopped among African American men? | The USPSTF guideline recommends against conducting prostate cancer screening using PSA among men aged 70 y or older. | There is a paucity of data pertaining to screening cessation. PSA measurement after age 70 or when patient life expectancy is low may increase the risk of overdiagnosis among African American men. | Data support the latest age at which the benefits and harms are in equipoise for specific risk groups, including those defined by genetics, family history, age, and other factors. | Level 3 |
| 5. Which modalities should be used for prostate cancer screening among African American men? | The USPSTF guideline recommends prostate cancer screening using PSA only following shared decision making. Digital rectal examination is not recommended for use in prostate cancer screening. No other modalities for screening are considered in the recommendation. | There are limited data to define the relative value of PSA testing vs other screening modalities in African American men. | Direct comparison of test characteristics for various forms of PSA, 4Kscore, and other tools to determine whether the tests perform similarly in African American men as in other groups. | Level 3 |
| Question . | USPSTF guidelinea . | Literature guidance . | Future research needs . | Levels of evidence (20) . |
|---|---|---|---|---|
| 1. Should we screen African American men with PSA levels for prostate cancer? | The USPSTF guideline states that the decision to test PSA levels should be a shared decision between patients and their clinicians. African American men and men with a family history of prostate cancer are acknowledged to experience higher prostate cancer risk, but no guidance on clinical care is provided for these groups. | African American men should be screened for prostate cancer, using PSA to lower prostate cancer–specific mortality. In consideration of potential harms, PSA can be used in conjunction with other information to stratify prostate cancer risk, and magnetic resonance imaging can be incorporated before to biopsy. | Data that support how the use of PSA, alone or in combination with other markers, may help improve the benefit-risk trade-off of screening among African American men. | Level 3 |
| 2. When should screening for prostate cancer be initiated among African American men? | The USPSTF guideline states that although the decision to screen for prostate cancer should be made through shared decision making with a clinician, this discussion should not be initiated until the patient is 55 y of age. | African American men could consider initiation of prostate cancer screening at earlier ages (approximately 45-50 y) relative to men at average risk of prostate cancer. Family history of prostate cancer and inherited genetic risk may also be potential considerations in initiating prostate cancer risk assessment among African American men. | Data that support the initial age at which the benefits and harms are in equipoise for specific risk groups, including those defined by genetics, family history, age, and other factors. | Level 3 |
| 3. How often should African American men be screened for prostate cancer? | The USPSTF guideline states that men who have made the decision to screen should do so “periodically.” | There is a lack of evidence regarding the optimal screening interval among African American men. The cadence of screening may be based on a midlife PSA value to direct whether and how often future PSA measures will be needed. | Data that support the value of midlife PSA testing in predicting future rises in PSA and lethal prostate cancer diagnosis by age and risk level. | Level 3 |
| 4. When should screening for prostate cancer be stopped among African American men? | The USPSTF guideline recommends against conducting prostate cancer screening using PSA among men aged 70 y or older. | There is a paucity of data pertaining to screening cessation. PSA measurement after age 70 or when patient life expectancy is low may increase the risk of overdiagnosis among African American men. | Data support the latest age at which the benefits and harms are in equipoise for specific risk groups, including those defined by genetics, family history, age, and other factors. | Level 3 |
| 5. Which modalities should be used for prostate cancer screening among African American men? | The USPSTF guideline recommends prostate cancer screening using PSA only following shared decision making. Digital rectal examination is not recommended for use in prostate cancer screening. No other modalities for screening are considered in the recommendation. | There are limited data to define the relative value of PSA testing vs other screening modalities in African American men. | Direct comparison of test characteristics for various forms of PSA, 4Kscore, and other tools to determine whether the tests perform similarly in African American men as in other groups. | Level 3 |
Note that USPSTF guidelines do not themselves constitute evidence but are presented here to provide context in which our evidence base can be used to develop future guidelines. PSA = prostate-specific antigen; USPSTF = United States Preventive Services Task Force.
Summary of key questions regarding prostate cancer screening using PSA among African American men
| Question . | USPSTF guidelinea . | Literature guidance . | Future research needs . | Levels of evidence (20) . |
|---|---|---|---|---|
| 1. Should we screen African American men with PSA levels for prostate cancer? | The USPSTF guideline states that the decision to test PSA levels should be a shared decision between patients and their clinicians. African American men and men with a family history of prostate cancer are acknowledged to experience higher prostate cancer risk, but no guidance on clinical care is provided for these groups. | African American men should be screened for prostate cancer, using PSA to lower prostate cancer–specific mortality. In consideration of potential harms, PSA can be used in conjunction with other information to stratify prostate cancer risk, and magnetic resonance imaging can be incorporated before to biopsy. | Data that support how the use of PSA, alone or in combination with other markers, may help improve the benefit-risk trade-off of screening among African American men. | Level 3 |
| 2. When should screening for prostate cancer be initiated among African American men? | The USPSTF guideline states that although the decision to screen for prostate cancer should be made through shared decision making with a clinician, this discussion should not be initiated until the patient is 55 y of age. | African American men could consider initiation of prostate cancer screening at earlier ages (approximately 45-50 y) relative to men at average risk of prostate cancer. Family history of prostate cancer and inherited genetic risk may also be potential considerations in initiating prostate cancer risk assessment among African American men. | Data that support the initial age at which the benefits and harms are in equipoise for specific risk groups, including those defined by genetics, family history, age, and other factors. | Level 3 |
| 3. How often should African American men be screened for prostate cancer? | The USPSTF guideline states that men who have made the decision to screen should do so “periodically.” | There is a lack of evidence regarding the optimal screening interval among African American men. The cadence of screening may be based on a midlife PSA value to direct whether and how often future PSA measures will be needed. | Data that support the value of midlife PSA testing in predicting future rises in PSA and lethal prostate cancer diagnosis by age and risk level. | Level 3 |
| 4. When should screening for prostate cancer be stopped among African American men? | The USPSTF guideline recommends against conducting prostate cancer screening using PSA among men aged 70 y or older. | There is a paucity of data pertaining to screening cessation. PSA measurement after age 70 or when patient life expectancy is low may increase the risk of overdiagnosis among African American men. | Data support the latest age at which the benefits and harms are in equipoise for specific risk groups, including those defined by genetics, family history, age, and other factors. | Level 3 |
| 5. Which modalities should be used for prostate cancer screening among African American men? | The USPSTF guideline recommends prostate cancer screening using PSA only following shared decision making. Digital rectal examination is not recommended for use in prostate cancer screening. No other modalities for screening are considered in the recommendation. | There are limited data to define the relative value of PSA testing vs other screening modalities in African American men. | Direct comparison of test characteristics for various forms of PSA, 4Kscore, and other tools to determine whether the tests perform similarly in African American men as in other groups. | Level 3 |
| Question . | USPSTF guidelinea . | Literature guidance . | Future research needs . | Levels of evidence (20) . |
|---|---|---|---|---|
| 1. Should we screen African American men with PSA levels for prostate cancer? | The USPSTF guideline states that the decision to test PSA levels should be a shared decision between patients and their clinicians. African American men and men with a family history of prostate cancer are acknowledged to experience higher prostate cancer risk, but no guidance on clinical care is provided for these groups. | African American men should be screened for prostate cancer, using PSA to lower prostate cancer–specific mortality. In consideration of potential harms, PSA can be used in conjunction with other information to stratify prostate cancer risk, and magnetic resonance imaging can be incorporated before to biopsy. | Data that support how the use of PSA, alone or in combination with other markers, may help improve the benefit-risk trade-off of screening among African American men. | Level 3 |
| 2. When should screening for prostate cancer be initiated among African American men? | The USPSTF guideline states that although the decision to screen for prostate cancer should be made through shared decision making with a clinician, this discussion should not be initiated until the patient is 55 y of age. | African American men could consider initiation of prostate cancer screening at earlier ages (approximately 45-50 y) relative to men at average risk of prostate cancer. Family history of prostate cancer and inherited genetic risk may also be potential considerations in initiating prostate cancer risk assessment among African American men. | Data that support the initial age at which the benefits and harms are in equipoise for specific risk groups, including those defined by genetics, family history, age, and other factors. | Level 3 |
| 3. How often should African American men be screened for prostate cancer? | The USPSTF guideline states that men who have made the decision to screen should do so “periodically.” | There is a lack of evidence regarding the optimal screening interval among African American men. The cadence of screening may be based on a midlife PSA value to direct whether and how often future PSA measures will be needed. | Data that support the value of midlife PSA testing in predicting future rises in PSA and lethal prostate cancer diagnosis by age and risk level. | Level 3 |
| 4. When should screening for prostate cancer be stopped among African American men? | The USPSTF guideline recommends against conducting prostate cancer screening using PSA among men aged 70 y or older. | There is a paucity of data pertaining to screening cessation. PSA measurement after age 70 or when patient life expectancy is low may increase the risk of overdiagnosis among African American men. | Data support the latest age at which the benefits and harms are in equipoise for specific risk groups, including those defined by genetics, family history, age, and other factors. | Level 3 |
| 5. Which modalities should be used for prostate cancer screening among African American men? | The USPSTF guideline recommends prostate cancer screening using PSA only following shared decision making. Digital rectal examination is not recommended for use in prostate cancer screening. No other modalities for screening are considered in the recommendation. | There are limited data to define the relative value of PSA testing vs other screening modalities in African American men. | Direct comparison of test characteristics for various forms of PSA, 4Kscore, and other tools to determine whether the tests perform similarly in African American men as in other groups. | Level 3 |
Note that USPSTF guidelines do not themselves constitute evidence but are presented here to provide context in which our evidence base can be used to develop future guidelines. PSA = prostate-specific antigen; USPSTF = United States Preventive Services Task Force.
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