Racial Disparities in the Future Development of Lethal Prostate Cancer Based on PSA Levels in Midlife

Research Mentor Name

Firas Abdollah, MD

Research Mentor Email Address


Institution / Department

Vattikuti Center for Outcomes, Research, Analytics, and Evaluation (VCORE)

Document Type

Research Abstract

Research Type


Level of Research




This study examined racial disparities in PCa mortality based on midlife PSA results in a North American population.


White and Black men aged 40-59 years, with their first PSA test (baseline) between 1995 and 2019 were included. Patients were divided into 4 age categories; 40 to 44, 45 to 49, 50 to 54, and 55 to 59. Baseline PSA was categorized based on median and 90th percentile for each age category. Fine-Gray regression was used to examine the impact of baseline PSA on the risk of developing prostate cancer-specific mortality (PCSM) by race.


A total of 112,967 men met inclusion criteria, of whom 82,084 (73%) were White and 30,883 (27%) were Black. Median and 90th percentile PSA were respectively 0.7 and 2.0 ng/ml in White men compared to 0.7 and 2.1 ng/ml in Black men. Median and 90th percentile PSA increased with respect to age. The estimated rate of lethal PCa at 20 years was significantly higher in Black men when using the 90th percentile PSA cutoff in these age groups. Median follow-up was 6.7 and 9.9 years for White and Black men, respectively.


Black men are significantly more likely to experience PCSM. This suggests that a lower midlife PSA cutoff could be considered amongst Black men. To our knowledge, this report is the first to examine the racial disparities in PCSM based on baseline PSA results in a diverse North American cohort.


Medicine and Health Sciences

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