Prostate Cancer Screening and Mortality in Blacks and Whites: A Hospital-based Case-Control Study.
BACKGROUND
Prostate cancer incidence and mortality are substantially higher in Black than in white men. Prostate cancer screening remains controversial. This study was conducted to assess the impact of, and racial differences in, prostate cancer screening on prostate cancer mortality.


METHODS
This was a case-control study of Black and White men in eight hospitals. Cases were deaths related to prostate cancer; controls were hospital-based subjects that were frequency-matched to cases based on age and race. Multivariable logistic regression was used to test the association between screening and prostate cancer mortality.


RESULTS
Cases had fewer PSA (prostate-specific antigen) tests than controls (1.73 vs. 3.98, p<0.001). White controls had higher rates of PSA tests than other sub-groups. There was no difference in PSA testing between Black cases and controls. Mean co-morbidity was 10.3 in cases and 2.63 in controls. Prostate cancer mortality was 55 to 57% lower among the screened persons. Individuals who died of prostate cancer related causes were less likely to have received PSA testing (OR=0.65; 95% Cl 0.56-0.75).


CONCLUSIONS
The odds of dying from prostate cancer were lower among white men receiving screening tests. Having less co-morbidity was associated with lower odds of mortality in both races. This study raises the possibility that screening for prostate cancer with the PSA test may be more effective in white than in Black men.
Department of Public Health, Western Kentucky University.
William N
WN
Mkanta
Department of Community Health and Preventive Medicine, Morehouse School of Medicine.
Yassa
Y
Ndjakani
Department of Epidemiology and Biostatistics, University of Florida College of Public Health and Health Professions.
Frank C
FC
Bandiera
Department of Community Health and Preventive Medicine, Morehouse School of Medicine. Electronic address: dblumenthal@msm.edu.
Daniel S
DS
Blumenthal
Department of Urology, University of Florida College of Medicine.
Unyime O
UO
Nseyo
Department of Epidemiology and Biostatistics, University of Florida College of Public Health and Health Professions.
Nabih R
NR
Asal
Mortality; Prostate cancer; co-morbidity; digital rectal examination; prostate specific antigen