In 2024, it was estimated that 35,250 men would die from prostate cancer. Black men were twice as likely to be among them than those from any other racial or ethnic group.
Not much has changed. Not only are men of African descent more likely to get prostate cancer, it’s often more advanced by the time it’s diagnosed.
“While differences in genetics and environment surely play a role, the American Medical Association has stated that if you got rid of the screening and treatment gaps, you could almost eliminate disparities in outcome,” says Kelvin Moses, MD, PhD, Director, Comprehensive ProstateCancer Clinic, Vanderbilt University Medical Center, Nashville, TN.
Moses researches the unequal impact of prostate cancer on Black men and ways to address the problem.
Screening More Black Men Means Saving More Lives
When you catch prostate cancer early, the five-year survival rate, or the percentage of people still alive five years after they were diagnosed, is quite high: almost 100%.
“When you detect it later after there are symptoms, oftentimes, it’s advanced or metastatic prostate cancer, and five-year survival rates range from 30 to 40%,” says Brandon Mahal, MD, Radiation oncologist, University of Miami Sylvester Comprehensive Cancer Center. “If Black men have a higher rate of prostate cancer and more aggressive cancers, then by simple math, PSA [prostate-specific antigen, a type of protein made in the prostate] screening is more effective for them.”
The Strides Made So Far
“Greater awareness of these disparities has really taken hold over the last decade,” Mahal says.
That was the first critical step. The next was creating risk-specific screening guidelines that take into account Black men’s higher odds of advanced disease.
“Before, screening guidelines were a lot softer in their recommendations for Black men than they should have been,” Mahal says.
In 2024, the Prostate Cancer Foundation issued new guidelines recommending that people with certain known risk factors start screening at age 40, while people with average risk should start at 45.
This is a move in the right direction, but there’s still a ways to go to achieve racial equality in prostate cancer survival. What needs to happen now, Mahal says, is continued effort to make health care providers and Black men themselves aware of these new guidelines.
For example, the University of Miami hosts educational meetings about prostate cancer in the surrounding Black communities. At these presentations, African American doctors and scientists talk about risk, screening, and the unique impacts of prostate cancer on men of African descent, Mahal says.
Setting the Record Straight
There have been some challenges in getting the word out to health care providers. Some doctors question whether it’s necessary to test every year. That’s because many prostate cancers grow so slowly that they don’t need treatment, just routine monitoring (also called watchful waiting). But for Black men, once-a-year screening and its ability to catch cancer early has undeniable benefits.
“We have to convince our primary care colleagues that PSA screening is valuable in the right population of men,” Moses says.
It’s also important to make clear what a PSA screening is and is not. It’s a simple blood test. It is not a digital rectal exam (DRE).
“The digital rectal exam is not a great screening tool,” Mahal says. “Men avoid getting prostate cancer screening because they are worried about that test, but you only need a blood test.”
Bringing Screening Where It’s Needed Most
Mobile clinics go a long way to address racial disparities in health and financial barriers to care.
“In these neighborhoods in our catchment area, three-quarters of the men who come to get screening have never gotten a PSA screening before,” Mahal says. “So we are going to meet these high-risk men where they are.”
A recent study published in the International Journal of Health Equity found that nearly 60% of people seen in these clinics-on-wheels belong to racial and ethnic minority groups. Around 40% have no health insurance. Just over 40% are on public insurance, such as Medicaid.
Eliminating Financial Barriers
PSA screenings can be too expensive for people who are uninsured or under-insured. Research shows that Black people are more likely to be uninsured and are the second most likely to live in poverty, after Native Americans.
“Some states have advocated for making PSA testing free,” Moses says. “I’ve testified here in Tennessee about that.”
If passed, The PSA Screening for HIM Act would require health insurance to cover PSA testing without any out-of-pocket cost for the insured person.
Unequal Access to Care
We know that getting Black men screened for prostate cancer at the same rate as other men would go a long way to improve survival rates.
But even among men who get screened and diagnosed, men of African descent “are less likely to get treatment overall, and as severity of disease increases, likelihood of getting treatment decreases,” Moses says. If they do begin prostate cancer care, the time between diagnosis and start of treatment tends to be longer than it is for other groups.
Research suggests that these disparities are also explained by unequal access. In studies where everyone has the same access to treatment, Black men are just as likely to get the same care as others and sometimes better results.
But the barriers to getting the same care are many, including geographic location, cost, and insurance coverage. For example, if you live far from the best hospitals and don’t have the means to travel for care, you may avoid treatment.
Men treated at National Cancer Institute-Designated Comprehensive Cancer Centers (NCI-CCCs), have better five-year survival rates than others. But those who are uninsured, have a lower income, or are Black are less likely to get their cancer care at these centers.
The Need for More Black Men in Clinical Trials
Cancer clinical trials, in many ways, may offer the best care. At the very least, people in clinical trials get standard care with more monitoring and follow-up. Some of them might have the chance to try a new, more effective treatment that isn’t available anywhere else.
But less than 5% of people in cancer clinical trials are men of African descent.
“That’s nothing. When about 15% of the U.S. population self-identifies as Black, that’s an underrepresentation in trials,” Mahal says. “When you’re studying a disease that has a greater impact on the Black community, your study group should at least be representative of the U.S. population, but maybe even more.”
Recruiting more African American men for clinical trials might improve the quality of care they have access to. And any discoveries during the clinical trials could boost the quality of care for Black men with prostate cancer in the future.
Researchers have pointed out numerous ways clinical trials could reach more African Americans. For starters, trials need to be available at the clinics and hospitals that have the most Black patients, Moses says. Typically, they’re only at major cancer centers, which are less likely to have Black patients.
Those publicizing the trials and meeting with people who may be in them need to look like the people they’re trying to recruit. And diverse and inclusive participation should be required for financial backing.
“For government-sponsored trials, there’s a paragraph that says you’re going to make every effort to reflect the population, but there’s no penalty if you don’t,” Moses says.
Two drug companies recently showed that it’s not only possible to recruit Black men for prostate cancer trials, but that it can also lead to better understanding of the best treatment options for them.
The PANTHER trial, funded by Janssen Pharmaceuticals, found that a drug combination that showed little benefit in White men with advanced prostate cancer had a much bigger effect in Black men with the disease. A trial of Dendreon Pharmaceuticals’ prostate cancer drug sipuleucel-T (Provenge) showed that Black men who received the drug lived longer than White men who took it.
Improvements on all fronts, from screening to treatment and taking part in clinical trials, would help save the lives of African American men.
“We have to advocate for better screening and treatment, education of physicians, and diversification of clinical trials,” Moses says.
Show Sources
Photo Credit: E+/Getty Images
SOURCES:
Kelvin Moses, MD, PhD, director, Comprehensive Prostate Cancer Clinic, Vanderbilt University Medical Center, Nashville, Tennessee.
Brandon Mahal, MD, radiation oncologist, University of Miami Miller School of Medicine (MSOM)-Sylvester Comprehensive Cancer Center, Miami.
American Cancer Society: “Rectal Exam or Blood Test? 60% of U.S. Men Ages 45+ Have Misconceptions About Prostate Cancer Screening, as Rates of Late-Stage Diagnosis Increase,” “Congress Introduces PSA Screening for HIM Act.”
Memorial Sloan Kettering Cancer Center: “Why Black Men Should Consider Earlier Screening for Prostate Cancer.”
CDC: “U.S. Cancer Statistics Prostate Cancer Stat Bite.”
International Journal for Health Equity: “Mobile health clinics in the United States.”
Kaiser Family Foundation: “Health Coverage by Race and Ethnicity, 2010-2022.”
National Alliance to End Homelessness: “Homelessness and Black History: Poverty and Income.”
Cancer: Racial disparities in Black men with prostate cancer: A literature review.”
Johns Hopkins Medicine: “Clinical Research? Why take part?”
Journal of the American Medical Association: “Racial and Ethnic Representation of Participants in US Clinical Trials of New Drugs and Biologics.”
Duke Health: “Black Men with Metastatic Prostate Cancer May Benefit From Drug Combination.”
Dendreon: “Study Shows African American Men With Advanced Prostate Cancer Treated With PROVENGE (Sipuleucel-T) Live Longer Than Caucasian Men.”
