Prostate-specific antigen screening in a high-risk population: lessons from the community and how they relate to large-scale population-based studies.
OBJECTIVE
To estimate the incidence of prostate cancer among African-American men and Caribbean immigrants to the United States, to assess the applicability of large-scale prostate screening trials to a community screening program, and to recruit unscreened men.


METHODS
African-American and Caribbean-American men were targeted with a community-based prostate cancer screening program in Jamaica, New York. Serum prostate-specific antigen determination and digital rectal examination were used to determine abnormal findings. The incidence of an abnormal screening examination was used to project the incidence of prostate cancer, which was compared with that in other reported trials.


RESULTS
The projected incidence of prostate cancer among African-Americans and Caribbean-Americans older than 50 years was 8% and 7%, respectively, similar to that reported in other trials of African-American men. The projected incidence of prostate cancer in Caribbean-American men aged 40 to 49 years was 1%, the same as the high rate reported among Caribbean men. As in other trials, a family history of prostate cancer and age were strong predictors of abnormal findings. Of the recruited men older than 50 years, 58% had never been screened compared with 42% nationally.


CONCLUSIONS
Large population-based screening trials have identified ethnic groups at high risk of prostate cancer. This trial detected high rates of abnormal screening findings by targeting ethnicity. The incidence of an abnormal examination was high in Caribbean-American men younger than 50 years old. Finally, this trial successfully recruited underscreened men.
Shelton
Jeremy B
JB
Department of Urology, Cornell University Weill Medical College and New York Presbyterian Hospital, New York, New York 10021, USA.
Barocas
Daniel A
DA
Conway
Frances
F
Hart
Kathleen
K
Nelson
Kinloch
K
Richstone
Lee
L
Gonzalez
Ricardo R
RR
Raman
Jay D
JD
Scherr
Douglas S
DS
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D017691:Caribbean Region / Q000208:ethnology; D005006:Ethnicity / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D010173:Palpation; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000208:ethnology*
D017430:Prostate-Specific Antigen