Social Determinants of Health: Prostate Cancer Risk

Medically Reviewed by Nazia Q Bandukwala, DO on May 04, 2022
5 min read

Prostate cancer is the second most common cancer type. Each year, more than 250,000 men in the U.S. find out that they have it. The good news is that most people with prostate cancer will live for 5 years or more. That’s because doctors can screen for prostate cancer and catch it before it spreads. Also, many prostate cancers grow slowly.

But prostate cancer also has the biggest racial disparities of any cancer. Non-Hispanic Black men are more likely than non-Hispanic white men to find out they have prostate cancer. In fact, Black men get prostate cancer more often than people of other races or ethnicities.

While most people who get prostate cancer don’t die from it, death rates are highest in Black men. Their death rate from prostate cancer is more than double that of white men. It isn’t clear exactly why these disparities exist, but it’s likely due to a mix of social and environmental factors, or social determinants of health.

Social determinants of health refer to the conditions in all the places you spend time. They include conditions where you live, where you work, and where you go to school. They also include the places where you spend your free time.

Social determinants can affect your health in lots of ways. Some examples of these factors are:

  • Housing
  • Transportation
  • Neighborhoods
  • Racism and discrimination
  • Violence
  • Education
  • Job opportunities
  • Income
  • Access to healthy foods
  • Access and ability to exercise
  • Pollution
  • Education
  • Language and literacy

Together, these can affect your prostate cancer risk and outcome.

Experts still don’t know exactly why Black men get prostate cancer more than white men. There are some studies that tell us more about this and help explain why it might happen.

One thing to keep in mind is that doctors don’t really know why anyone gets prostate cancer. It happens when cells in the prostate change in ways that make them grow more than they should. As the cells grow, they can invade other tissues nearby. They also can break away from the tumor and spread to other parts of the body.

Some factors that increase prostate cancer risk include:

Studies have shown that a person’s socioeconomic status affects prostate cancer risk, too. Socioeconomic factors include:

  • Income
  • Education
  • Employment
  • Community safety
  • Social support

Because race and socioeconomic status are often linked, it’s possible that these factors explain why Black men more often get prostate cancer. People of lower socioeconomic status are at greater risk for overall poor health and cancers, including prostate cancer. At the same time, though, prostate cancer is more often diagnosed in people of higher socioeconomic status. This may be because people with more income, education, and support are more likely to have access to health care and screening.

It’s hard to say how social determinants of health and race affect screening and care for prostate cancer. Some experts suggest that Black men may be less likely to have PSA screenings. PSA stands for prostate-specific antigen. It’s a protein that both normal and cancerous prostate cells make. People with prostate cancer often have high PSA. So doctors use it to find people who may need more testing. Because there are risks and benefits, it isn’t clear who should have PSA testing. Current guidelines say that men should talk it over with their doctors to help them decide whether to have PSA testing and at what age they should start.

It makes sense that people with less access to health care due to a lack of insurance or other factors would be less likely to get PSA testing. They might also get PSA testing less often or later, making it more likely to find prostate cancer after it’s advanced and harder to treat. Social determinants have been shown to play a role in the stage of prostate cancer at diagnosis. These factors include:

  • Poverty
  • Lack of education
  • Immigration status
  • Lack of support
  • Social isolation

But some studies that have looked at PSA testing in Black men suggest they’re actually more likely than white men to have PSA testing. Young Black men also were more likely to be screened for prostate cancer compared to white men the same age. Among Black men, PSA testing is more likely if you have spent more time in school and go to the doctor regularly. Because doctors know that Black men are at greater risk for prostate cancer, they may be more likely to recommend earlier PSA testing.

Another study found that Black men were more likely to get a referral to a urologist, a doctor who specializes in urinary tract conditions. Even though Black men are screened more often, it’s possible they still aren’t screened as much as they should be given their increased prostate cancer risk. There’s also some evidence that Black men don’t get treated for their prostate cancer as much as white or Asian men do.

Socioeconomic factors affect the likelihood of surviving prostate cancer. People who live in poorer communities are more likely to die from it. What’s more, Black men are more than twice as likely as white men to die of prostate cancer. But there’s evidence that these differences linked to race vanish when income is taken into account.

A study found that Black men weren’t at increased risk of dying from prostate cancer compared to white men, however, when their prostate cancers were at similar stages. They concluded that differences in prostate cancer outcomes result not from race, but from other external factors often linked to race. Black men also are more likely to die from some other health conditions, such as heart disease. This is, again, likely related to differences in social determinants of health, including access to health care and treatment.

In light of all this, you may be wondering if you should get screened for prostate cancer, especially if you are at greater risk due to your race, socioeconomic status, or other factors. The U.S. Preventive Services Task Force recommends that men aged 55 to 69 should decide for themselves. That’s because even though screening can catch prostate cancers before they get worse or spread, it also can lead to unnecessary biopsies and treatment for cancers that wouldn’t have caused a problem.

Treatment for prostate cancer also has risks for complications, including incontinence and erectile dysfunction. So men need to work with their doctors to decide what’s right for them. These guidelines also say it’s not clear whether Black men will benefit more from screening than someone with an average risk for prostate cancer. The guidelines for screening don’t take other social determinants of health into account.

The National Comprehensive Cancer Network does say that Black men should start talking with their doctors about prostate cancer screening at an earlier age. If you think you’re at greater risk for prostate cancer due to your race or any other factors, consider talking about it with your doctor as early as age 40. Your doctor can help you weigh the risks and benefits of prostate cancer screening in your case.

PSA testing is covered by health insurance. If you don’t have health insurance and want to get screened, look for free prostate cancer screenings in your area.