Prostate cancer test may lead to overdiagnosis in black men, study suggests

A widely used test for prostate cancer may leave black men at increased risk of overdiagnosis, a study has suggested.

Prostate-specific antigen (PSA) testing is routinely used as the first step in the UK to investigate men with urinary symptoms such as blood in urine or urinating very frequently.

Men aged over 50 years without symptoms are also able to request the blood test from their GP.

Academics at the University of Exeter sought to investigate the performance of the PSA test in identifying prostate cancer among men in different ethnic groups.

It is well-known that black men in the UK are more likely to be diagnosed with prostate cancer but what remains less clear is whether outcomes are worse for these men than their British white counterparts.

More than 80% of the men in the study had normal PSA levels, regardless of ethnicity.

The study found for the first time in a robust UK dataset that PSA levels vary by ethnicity, with black men found to have higher PSA levels than white men, and Asian men having the lowest PSA levels.

Further analysis found diagnoses of prostate cancer after the raised PSA result was highest in black men, compared with white men and Asian men.

When the team looked at how many men in each group had advanced prostate cancer, levels between black men and white men were very similar – suggesting the relatively higher PSA levels may be influencing prostate cancer diagnosis in black men.

Around 52,000 men are diagnosed each year with prostate cancer and it is the second most common cause of cancer death in men in the UK.

Symptoms are common and easily misdiagnosed, and an estimated 14% of prostate cancer deaths could be avoided if they were diagnosed earlier.

PSA testing has been under scrutiny before as only one in three men with a positive PSA test have cancer and one in seven men with prostate cancer do not have raised PSA levels.

Dr Tanimola Martins, from the University of Exeter, said: “The British black, Asian and other ethnic minority groups are historically under-represented in cancer research.

“As such, findings from previous research, including those informing PSA testing and prostate cancer diagnosis, may not fully reflect their perspectives, needs or experiences.

“Our study provides an important message for providers, policymakers, charities, and advocacy groups campaigning for prostate cancer screening.

“Overdiagnosis of cancer may not sound as worrying as under-diagnosis, but we need to redress the balance in the evidence base to get more precise and accurate prostate cancer diagnosis to avoid unnecessary biopsies which can lead to psychological distress and sepsis. We need more research to ensure everyone gets the best diagnosis, regardless of their ethnicity.”

The study comprised 649,445 white men, 37,827 black men, and 31,053 Asian men.

In Asian men, the study found consistent results of the lowest PSA levels, lowest cancer diagnoses and also the lowest rates of advanced prostate cancer.

Dr Matthew Hobbs, director of research at Prostate Cancer UK, said: “While we welcome any research that attempts to address the historic under-representation of black men in prostate cancer research, we do not feel that this data supports the claims being made here.

“There are too few black men with advanced cancer involved and those who were analysed were significantly younger overall.

“The study also didn’t analyse stage or grade of the disease, making it impossible to draw concrete conclusions on overdiagnosis.

“In fact, the findings that black men are likely to be diagnosed younger could just as easily be interpreted as good news that these men are being diagnosed when their cancer is still curable.

“What this research does do is add weight to the argument that more needs to be done to understand the true outlook for black men with prostate cancer.

“Existing research shows that using the PSA test regularly can reduce the number of prostate cancer deaths by 20%, so it’s important that we don’t over-interpret these results.

“At this stage we simply cannot say whether we should be celebrating men being diagnosed in time or be concerned about overtreatment.”

– The study, Association between patient ethnicity and prostate cancer diagnosis following a prostate-specific antigen test: a cohort study of 730,000 men in primary care in the UK, is published in the journal BMC Medicine.