NMA Statement on Prostate Cancer Specific Antigen

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The National Medical Association's Urology Section's Experts Speak to the Recent Changes in the Recommendations for Prostate Cancer Screening

The National Medical Association (NMA) is the nation's oldest and largest association of African American physicians, representing over 50,000 physicians and the millions of patients that they serve.  The NMA is the trusted resource of the nation on issues of health for disadvantaged and communities of color.

Prostate cancer continues to pose a significant health concern in the United States.  It is estimated that 240,890 American men will be diagnosed with prostate cancer in 2011.  Additionally, approximately 33,720 men are expected to succumb to this disease. It is second only to lung cancer in cancer-related deaths.(1)

Significant racial disparities exist for African American men diagnosed with prostate cancer. In fact, African American men have a 60% higher incidence of the disease and 2-fold higher mortality compared to other ethnic groups in the United States. Efforts at early detection of the disease are particularly critical in African American men as they are  approximately 3 - 4 times more likely to present with distant and incurable cancer than Caucasian men.(2,3)

Recently, there have been concerns that PSA screening results in over diagnosis and overtreatment of prostate cancer along with harmful effects to patients. Recommendations have been made by a federal panel to limit the use of PSA as a screening test. These recommendations are primarily based on observations from large clinical studies performed in Europe, Canada, and the United States; very few African American men participated in these studies. As a result, the findings of these studies may not be generalizable to the African American community.

Since PSA testing was initiated, a clear trend toward declining mortality rates among prostate cancer patients has been observed. Although PSA screening cannot readily separate aggressive from indolent cancers, it currently represents the best method to detect early stage, curable prostate cancers. The R. Frank Jones Urological Society and the Urology section of the NMA therefore support the use of PSA in the early detection of prostate cancer as a means to support health promotion in African American men. Moreover, we endorse the American Urologic Association's best practice statement on prostate cancer early detection, which includes:

1.      Initial PSA testing at 40 years

2.      Both DRE and PSA as part of screening

3.      An informed decision making process

4.      A multi-factorial assessment of risk based on age, ethnicity, family history, PSA kinetics and density.

In keeping with the NMA's mission, the Urology Section also strongly supports a community based approach to early detection of prostate cancer that features education, improved access, and patient-provider dialogue, as well as the promotion of health seeking behavior in underserved populations.

"The NMA is committed to decreasing health disparities in African Americans; this includes disparities in prostate cancner.  As a national organization, comprised of the nation's leading experts in minority health, we support the AUA's best practice statement regarding the PSA blood test to detect prostate cancer at its earliest stages.  As a primary care physician, I have been testing African American males with PSA screening starting at age 40, and in my 20 years of practice I have detected prostate cancer in men as young as 42.  With the prevalence of prostate cancer disproportionally affecting our men, we must be vigilant to ensure aggressive testing continues for this most vulnerable population," Cedric M. Bright, M.D., President of the National Medical Assocation.

The Urology Section of the NMA includes African American urologists in academia, private practice, and in the military. Our mission is to eliminate health care disparities in urologic diseases among underserved populations through education, research, legislation and diversity. The NMA was created in 1895 to represent the interests of African-American physicians.  As the leading force of parity and justice in medicine and the elimination of disparities in health, the NMA is committed to improving the health status and outcomes of minorities and the underserved.  While the NMA has historically focused on health issues related to African American's, its principles, goals, initiatives, and philosophy address and benefit improved health for all Americans.

References:

1. Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin 2011;61:212-36.
2. Powell IJ, Bock CH, Ruterbusch JJ, Sakr W. Evidence supports a faster growth rate and/or earlier transformation to clinically significant prostate cancer in black than in white American men, and influences racial progression and mortality disparity. J Urol 2010;183:1792-6.
3. Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER 9 Regs Limited-Use, Nov 2007 Sub (1973-2005) <Katrina/Rita Population Adjustment> - Linked To County Attributes - Total U.S., 1969-2005 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2008, based on the November 2007 submission.


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