Targeted screening for prostate cancer in African-American men

African-American men and black men throughout the world have a higher rate of prostate cancer than other ethnic groups. They also are most likely to present at a younger age with more advanced disease and have historically had a poorer prognosis. Whether this observed difference is due to behavior, lack of access, environmental factors or genetics is hotly debated. Whatever the cause or causes, there is growing concensus that targeting screening to this high-risk group is justified. Focused education about risk and screening in black men can be effective and demonstration screening programs in African-American community settings have been successful. There is much debate about the proper normal values of PSA to be used in screening high risk black men. Some have argued for a very low normal range such as less than or equal to 2.0 ng/ml to improve sensitivity for detection of curable disease. Others, recognizing the balance between sensitivity (cancer detection) and specificity (avoiding unnecessary prostate biopsies), have proposed age-adjusted PSA ranges. Until randomized or prospective screening trials are completed, it seems reasonable to encourage black men to start screening at age 40 using a PSA threshold of less than or equal to 2.0 to 2.5 ng/ml to prompt further evaluation.