Study of Prostate Cancer Screening and Mortality in Blacks and Whites

Objectives: Despite recent declines in prostate cancer incidence and mortality, early detection is still a controversial topic; and effectiveness of screening in reducing mortality has not been established. We assessed whether screening with the Prostate Specific Antigen (PSA) and Digital Rectal Examination (DRE) reduce mortality from prostate cancer.

Methods: A case-control study of black and white men (404 cases, 404 controls) in Atlanta and North Florida was completed. Cases were prostate cancer deaths (1998-2001) linked to hospitals of admission prior to death. Hospital controls were age/race frequency-matched to cases. Unadjusted odds ratio and logistic regression tested the association between screening and prostate cancer deaths after controlling for age, race, and co-morbidity.

Results: Cases had fewer PSA tests taken (1.73 vs. 3.98, p<0.001). There was no difference in the number of PSA tests among blacks, but white controls had significantly more PSA tests. No racial differences in DRE tests were detected (p=0.414). Mean number of co-morbidity was 10.3 in cases and 2.63 in controls. Odds ratio illustrated that mortality from prostate cancer is 55-57% lower among persons who had DRE and PSA tests. Logistic model showed cases were less likely to receive PSA test (OR=0.65; 95 CI 0.564-0.754). Greater number of co-morbidities increased the odds of death from prostate cancer (OR=1.15; 95% CI 1.106-1.201).

Conclusion: The odds of dying from prostate cancer were lower among persons receiving screening tests. Although more research is required to establish efficacy of the tests, promoting regular screening may reduce deaths associated with prostate cancer.