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.

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.