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A Review of Prostate Cancer Screening Guidelines for African American Veterans

Objectives: Prostate cancer is the one of the commonest cancers in American men and the second leading cause of cancer deaths. In 2012, the US Preventative Task Force recommended against the prostate specific antigen-based screening test for prostate cancer due to overtreatment of low-risk disease and lack of impact on outcomes. In the general population, African-American men have 60% higher incidence and 200-300% greater mortality rate from prostate cancer than Caucasian men. Additionally, many veterans have been exposed to chemicals that increase incidence of high-risk prostate cancer. Considering these factors, we examine whether or not it is appropriate to screen African-American veteran males for prostate cancer. Methodology: We performed a PubMed and Google Scholar search using pertinent terms, such as African-American veteran, prostate cancer, mortality, PSA density, molecular markers, and Agent Orange. The articles that were relevant to the clinical, molecular, social, and health policy aspects of the diagnosis and treatment of prostate cancer in African-American veterans were analyzed. The data was then summarized. Results: After surveying the literature, there were several areas where the African-American veteran population differed from their Caucasian counterparts: Incidence, clinical course, social differences, PSA levels, mortality rate, and molecular markers. A subset of the veteran population was also exposed to Agent Orange, which has been shown to increase the incidence of aggressive forms of prostate cancer. Lastly, the current USPTF guidelines recommending against prostate cancer screening were based on patient cohorts containing disproportionately low numbers of African-Americans, limiting their extension to the African-American veteran population. Conclusion: After reviewing and summarizing the literature, we contend that a need exists to develop and implement more targeted prostate cancer screening guidelines for African-American veterans.