Prostate cancer is the most common cancer in men, and African American men have the highest incidence and mortality rates from the disease. It is also known that African American men with aggressive, life-threatening prostate cancer are more likely to be under-treated, and those with “low-risk” disease (which is not life threatening) are often over-treated.
Early detection of life-threatening prostate cancer is possible and can reduce mortality in high-risk men. But the primary test for prostate cancer, the PSA blood test, has been controversial and there are currently no guidelines to inform systematic testing. The debate is due to the fact that all prostate cancers are not the same. Yet the PSA test cannot differentiate between “low-risk” disease that does not threaten life, and “high-risk” disease that is aggressive, will spread, and can be fatal. Because the majority of prostate cancers are low-risk, past large-scale PSA testing in the general population led to extensive over-treatment of low-risk disease, often with debilitating side effects.
SF CAN will use the latest evidence to greatly reduce any harms of screening by focusing on high-risk men, by appropriate monitoring and follow-up of low-risk disease, and by ensuring that treatment, when required, is of the highest quality, thus avoiding over- and under-treatment. Education prior to screening, navigation to advanced diagnostic and treatment services, and survivorship programs will also be employed to reduce disparities.
Goal: Increase rates of early detection of aggressive prostate cancer in high risk men
Method: With guidance from African American community leaders, provide education and screening in the community by means, and in locations, most accessible and acceptable to high-risk men. Develop follow-up protocols to navigate men with abnormal tests into and through their respective health care systems.
Goal: For all men, reduce under-treatment of high-risk disease and unnecessary treatment of low-risk disease.
Method: Convene a “quality collaborative” that brings together medical teams throughout San Francisco to collaborate in the development of best practices – targeted screening and treatments tailored to each patient’s disease. Encourage active surveillance for low-risk men, a less-invasive approach that avoids overtreatment while tracking any changes that warrant additional treatment, and ensure appropriate and timely treatment for men with high-risk prostate cancer.