Black men are half as likely to die of prostate cancer today as they were a few decades ago. That’s good news. Still, there are racial disparities when it comes to early detection, treatment, and deaths.
Talk to your doctor about your risk. Experts recommend Black men discuss that and plans for future screenings by age 45. Here’s more about how prostate cancer impacts Black men.
How Does Prostate Cancer Affect Black Men?
Prostate cancer makes up about 37% of all cancers in Black men. Around 1 in 6 will be diagnosed with the disease at some point in life. It’s more common in Black men than other racial/ethnic groups.
The disease is also deadlier for Black men. They’re twice as likely to die from prostate cancer compared to men of other races. That’s the biggest racial disparity in deaths from any cancer in the United States.
When it comes to prostate cancer, Black men are also more likely than other races to:
- Be diagnosed at an earlier age
- Have fast-growing, or high-grade, tumor cells
- Have prostate cancer that has spread to other parts of the body (called advanced or metastatic cancer)
We have a better understanding about prostate cancer in Black men than we used to, but more research is needed. Racial minorities are often left out of clinical research for various reasons. But there’s a growing push to include more Black men in clinical trials.
Why Does Prostate Cancer Affect Black Men Differently?
Health disparities are largely blamed on decades of racial bias and discrimination. You may hear this called systemic or structural racism. It can impact every part of life, including access to healthy food, jobs, housing, and medical care.
But experts are still trying to find answers for exactly why prostate cancer is more common and fatal in Black men. Some theories include:
Barriers to care. Black men often have less access to health insurance and high-quality medical care. Access to medical services, education, employment, and income all impact how healthy you are. If you’re a Black man with prostate cancer, racial and socioeconomic barriers can contribute to:
- Delays in treatment
- Lower rates of prostate cancer screenings
- Less health education about treatment choices
- Lower quality care
- Less high-benefit treatments, such as surgery
Bad advice. From 2012 to 2018, the U.S. Preventive Services Task Force (USPSTF) said they didn’t think the PSA test should be used for routine prostate cancer screening. That’s a blood test commonly used to detect early signs of prostate cancer. They’ve changed their guidance since then, saying that men should make that decision with their doctors based on their personal risk of prostate cancer. But some researchers think the recommendation against PSA screening likely took a heavier toll on Black men compared to other races.
Medical mistrust. Black people are often less trusting of the health care system. There are cultural and historical reasons for this.
Fewer Black doctors. People may feel more comfortable with a doctor who shares their race. While 13% of the population is Black, only 5% of the workforce includes Black doctors. And only 2% of urologists are Black. Urologists are specialists who often diagnose and treat prostate cancer.
Other health problems. Your lifestyle, such as what you eat and whether you exercise or smoke, along with your genes, impact your health. And the ongoing stress of systemic racism can also make you sick.
Certain medical conditions occur more often in Black men. Some that can negatively affect prostate cancer outcomes include:
- Heart disease
- Diabetes
- Overweight or obesity
Genetic variants. Genes are passed down through families. And there’s some evidence that Black men may inherit the risk for more aggressive types of cancer or certain genetic mutations, or changes.
There’s ongoing debate about how much biology impacts prostate cancer in Black men. We may know more in the future as genetic testing becomes widely available.
Prevention, Screenings, and Active Surveillance
Early detection is key in prostate cancer. Nearly 100% of men from any race will live 5 years past their diagnosis when prostate cancer is found early. But the disease is a lot harder to treat when it spreads to other parts of the body.
The 5-year-survival rate for men of all races drops to 30% when they’re diagnosed with advanced, or metastatic, prostate cancer.
Experts think prostate cancer screenings could save more Black lives than those at lower risk. That’s because there’s a strong link between midlife PSA levels in Black men and aggressive prostate cancer later on.
The American Cancer Society guidelines recommend the following for higher-risk groups:
Discuss prostate cancer screening at age 45 if you’re a Black man or you have a father or brother diagnosed with prostate cancer before age 65.
Discuss prostate cancer screening at age 40 if you have more than one first-degree family member (a parent, sibling, or child) who had prostate cancer before age 65 or you test positive for a BRCA1 or BRCA2 gene mutation.
Go over the pros and cons of active surveillance. This is when your doctor monitors your prostate cancer but doesn’t give you treatment right away. This is also called watchful waiting. It’s a common approach for low-risk tumors, but it might not work as well for Black men.
Prostate cancer may be more likely to grow and spread in a Black man during active surveillance. But if you choose this option, your doctor will likely:
- Check your PSA levels every 6 months
- Give you a digital rectal exam at least once a year
- Go over treatment options when your tests change
How Do Black Men Respond to Treatment?
Scientists don’t know if certain prostate cancer treatments work better for men of different races. But there’s evidence that Black men do just as well or better than men of other races when the same kind of care is available.
Black men with prostate cancer that hasn’t spread to other parts of the body (called nonmetastatic) tend to live just as long as white men when both groups get the same kind of treatment. Radiation therapy may work better for Black men with early prostate cancer. And hormone-based therapy may be more effective for Black men with metastatic castration-resistant prostate cancer (mCRPC). That’s a type of aggressive prostate cancer that no longer responds well to testosterone-lowering therapy.
Make sure your doctor goes over all your treatment choices. Black men with aggressive prostate cancer can benefit from surgery or radiation therapy. But they’re less likely than other races to get it. If your doctor doesn’t suggest these treatments, ask them why.
You can also get a second opinion from another doctor.
What You Can Do
To lower your chances of prostate cancer, you should:
- Exercise at least 150 minutes a week to get your heart rate up
- Eat plenty of fruits, vegetables, and whole grains
- Maintain a healthy body mass index (BMI)
- Limit red meat, alcohol, and highly processed foods
If you smoke, quit. Current smokers are more likely than nonsmokers to have aggressive tumors or cancer that comes back after treatment. Smoking also raises your odds of dying from prostate cancer.
You can also:
- Learn all you can about your treatment options.
- Find out which tests and treatments your insurance covers.
- Ask your doctor about genetic testing.
- Enroll in a prostate cancer clinical trial.
If you’re a Black man who’s been diagnosed with prostate cancer, you can share your experience with researchers leading the RESPOND study. These experts hope to uncover what’s behind disparities in prostate cancer for Black men.
The study is supported by the National Cancer Institute and the National Institute on Minority Health and Health Disparities along with the Prostate Cancer Foundation. Find more information at Respondstudy.org.
