Researchers from UCLA have reported that the proportion of disadvantaged men with low-risk prostate cancer at diagnosis is lower than in the general population, indicating that a greater proportion of disadvantaged men are diagnosed with more advanced disease. These data suggest that inadequate PSA screening leads to more advanced disease at diagnosis. The details of this study were published in the February 2009 issue of the Journal of Urology.[1]

Although PSA screening is not recommended by any medical authority, most U.S. men over the age of 50 years who are insured or are on Medicare have PSA screening performed every 1-2 years. This has led to an increasing proportion of men diagnosed with organ-confined, low-risk prostate cancer (as opposed to advanced-stage diagnosis). Many researchers have suggested that PSA screening has led to lower prostate cancer mortality, while others have suggested that PSA screening leads to over diagnosis of cancers that were not destined to kill. The latter group suggests that PSA screening does not improve survival of men with prostate cancer.

The current study looked at the association between low income and insurance status and prostate cancer diagnosis in 570 disadvantaged men. These men were diagnosed with prostate cancer while being enrolled on a California program for the disadvantaged. They found that 51% of disadvantaged men had PSA levels that exceeded 10 ng/ml, 50% had a Gleason score of 7 or greater, and 43% had T stage T2 or greater, and 19% had metastatic prostate cancer. Only 24% of disadvantaged men had tumors with low-risk features. All these adverse features were higher in the disadvantaged than in the general U.S. population. For instance, only 4% of men with prostate cancer in the general population present with metastatic disease. Furthermore, the proportion of patients with localized disease with low-risk features continues to increase in the general population, while the rate of low-risk tumors remained stable at 24% for disadvantaged men. These authors suggest that “our findings suggest that for low income, uninsured men underdetection and undertreatment remain significant concerns.”

Comments: These data seem to validate the benefit of PSA screening in detecting early treatable prostate cancers.

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