Racial and ethnic differences in prostate cancer screening outcomes in the United States: A secondary analysis of the prostate, lung, colorectal, and ovarian cancer trial.

Authors

Joung HH, Martin DN, Jones RA

Affiliations

• University of Virginia School of Nursing, 202 Janette Lancaster Way, Charlottesville, VA 22903, United States of America. Electronic address: xks8kp@virginia.edu.
• University of Virginia School of Medicine, 1350 Jefferson Park Avenue, Charlottesville, VA 22908, United States of America.
• University of Virginia School of Nursing, 202 Janette Lancaster Way, Charlottesville, VA 22903, United States of America.

Abstract

OBJECTIVE: Despite racial/ethnic disparities in prostate cancer (PCa) outcomes, evidence on screening-specific outcomes across diverse populations remains limited. This study examined racial/ethnic differences in PCa screening, tumor characteristics, and mortality, among White, Black, Hispanic, and Asian men Methods: Secondary analysis of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (1993-2022) in the United States (N = 73,158). Chi-square tests compared screening outcomes, tumor characteristics, and mortality across racial/ethnic groups. Adjusted rate ratios (aRRs) were estimated for incidence through 2017, and mortality through 2022, and survival was assessed using Kaplan-Meier and Cox models.

RESULTS: Screening outcomes differed by race and ethnicity. Black men had elevated false-positive prostate-specific antigen rates, biopsy rates, and prostate cancer-specific mortality (aRR = 1.97, 95% CI = 1.53, 2.53 vs. White). Asian men had the highest rate of high-grade tumors (p < 0.01) despite the lowest mortality. However, these mortality differences for Black and Asian men relative to White men were not observed in 2013-2022. Hispanic men had false-positive patterns similar to White men but lower biopsy conversion.

CONCLUSIONS: PCa screening disparities reflected distinct risk profiles and tumor biology across groups. While mortality gaps attenuated over time, persistent differences underscore the need for population-specific screening strategies and research.