Chicago researchers are rolling out a new “Smart PSA” game plan that zeroes in on prostate-specific antigen screening in men at higher risk, especially Black men, in an effort to spot aggressive cancers earlier without fueling a surge in overdiagnosis. The risk-adapted protocol was piloted across UI Health's Mile Square primary-care clinics, where primary-care doctors used age, family history, prior PSA results, and African ancestry to decide who should be tested. Study authors say the early numbers show a big jump in targeted testing and in the detection of potentially lethal tumors in neighborhoods that have long been under-screened.
What the trial found
The trial, published in the American Cancer Society journal Cancer, ran as a 15-month intervention and compared screening and biopsy outcomes to a matched historical period. During the intervention, screening increased by about 76%, the rate of cancer found at biopsy rose from roughly 43% to 74%, and the incidence of cancers with aggressive features climbed about five-fold, with the largest screening bump seen in Black men ages 40-49. According to the authors, those shifts are most consistent with a large pool of occult disease in under-screened communities rather than the test suddenly overcalling cancer.
Local researchers weigh in
Peter Gann, the study's lead author, said “the trial demonstrated two main things: first, that PCPs practicing in high-risk communities can adopt and sustain risk-adapted prostate cancer screening,” according to the University of Illinois Cancer Center. He and his co-authors also noted that the initial surge in aggressive cancers likely reflects the large pool of previously undiagnosed disease and that the guidelines will need fine-tuning if intensified screening is continued.
Voices from Mile Square
Karriem Watson, CEO of UI Health's Mile Square network, said “age, family history as well as African ancestry are the risk factors that determine when we should screen our population,” in an interview with CBS Chicago. A participant in the program, Dr. Josef Ben Levi, told the station he was diagnosed more than a decade ago and is now cancer-free after non-surgical treatment, an outcome researchers point to as the potential upside of earlier detection.
Benefits, risks and next steps
Authors caution that PSA screening carries a longstanding tradeoff: it can save lives by catching fast-growing tumors, but screening the wrong men leads to overdiagnosis and overtreatment. The paper says Smart PSA should not be viewed as definitive and calls for randomized or longer-term studies to determine whether targeted screening reduces deaths without producing excess low-risk diagnoses, as detailed in Cancer.
A national problem
National data underline why the Chicago trial matters: Black men in the U.S. remain roughly twice as likely to die from prostate cancer as White men, a disparity documented in the American Cancer Society's report on cancer disparities. That analysis and federal surveillance point to unequal access to early detection and high-quality treatment as major drivers of the mortality gap.
Trial details and next steps
The Smart PSA intervention is registered at ClinicalTrials.gov (NCT04782713); the study ran from November 11, 2020 to February 28, 2022 across Mile Square clinics. Investigators say next steps include longer follow-up and trials in other health-care settings to see whether the short-term jump in aggressive cancer detection ultimately translates into fewer deaths over time.
For Chicago clinicians and community advocates, the Smart PSA results offer an early, locally rooted model for narrowing a long-standing racial gap in prostate mortality, but the authors stress the work is unfinished. Researchers and health systems will now need to balance more targeted testing with measures that avoid unnecessary treatment as they test whether Smart PSA truly saves lives.
