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Racial Disparities in Referral Rates and Appointment Completion among Black and White men with Elevated Prostate-Specific Antigen; 7-year Outcomes of Duke Cancer Institute PSA-Screening Algorithm
Mahdi Mottaghi, MD, Sudharshanan Balaji, MBBS, Jingchen Chai, MS, Alireza Ghoreifi, MD, Samantha M. Thomas, MS, Sriram Deivasigamani, MBBS, Eric S. Adams, MD, Mark Gregory, MS, Steven Patierno, MD, PhD, Andrew J. Armstrong, MD, Daniel J. George, MD, Rajan T. Gupta, MD, Glenn M. Preminger, MD, Judd W. Moul, MD, Kevin Shah, MD, Kevin C. Oeffinger, MD, Thomas J. Polascik, MD.
Duke, Durham, NC, USA.
BACKGROUND:Duke Cancer Institute developed an institutional risk-stratified PSA screening algorithm, which was implemented in the Electronic Health Records in 2/2017. We aimed to compare urology referrals, appointment completion(AC), and PCa detection between Black and White men.
METHODS: Design: Retrospective cohort; Setting: Duke Primary Care Network; Participants: Consecutive Black and White men aged 40-75 years who elected PSA screening, had elevated PSA (ePSA) between 2/2017-18; Exposure: ePSA prompting urology referral; Main Outcomes: Urology Referral rates at 3 and 12 months, AC rates at 9 and 18 months, and PCa detection rates [any PCa and Grade Group≥2(GG2+) PCa] were compared. Participants were followed through 5/2025.
RESULTS: Median follow-up was 7.3(IQR 7.0-7.7) years among all 1,812 men, including 29% Black men(n=532) and 71% White men(n=1,280).
Urology referral rates within 3 months(51% vs. 50%) and 12 months(59% vs. 58%) of screening date were similar between Black and White men, respectively. Similarly, age-stratified referral rates within three-month and nine-month intervals from PSA screening between black and white men were not statistically significant [referred within 3-month: 40-49 years: 44% vs. 51% (p=0.184), 50-69 years:52% vs. 49% (p=0.289), and 70-75 years:63% vs. 51% (p=0.310); referred within 12-month: 40-49 years:51% vs. 58% (p=0.186), 50-69 years:61% vs. 58% (p=0.342), and 70-75 years: 67% vs. 63% (p=0.753)]. AC rates within nine months were 46% vs. 52% (p<0.001), and AC rates for 18 months of PSA screening were 56% vs. 64% (p<0.001), for Black and White men, respectively. The rates of any PCa detection were 30% and 19% [159/532 vs. 237/1,280;p<0.001], and csPCa were 19% and 13% [103/532 vs. 162/1,280;p=0.01] for Black and White men, respectively.
CONCLUSIONS: Duke Health
PSA screening algorithm showed comparable referral rates between Black and White men with ePSA. Despite a lower AC rate, Black men were more likely to be diagnosed with any PC and GG2+PCa.
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