One in six Black men will be diagnosed with prostate cancer at some point, compared to 1 in 8 men overall. They’re also more than twice as likely to die from the disease.
One reason is that prostate cancer tends to be more aggressive in men of African descent. A 2022 study in the scientific journal Nature Communications found that they’re more likely to have two gene markers linked to aggressive prostate cancer: pleiotrophin and TNFRSF9.
“We saw those markers even among [Black] men without cancer,” says Clayton Yates, PhD, a professor of pathology, oncology, and urology at Johns Hopkins Medicine in Baltimore.
But there are also hurdles to care that add to poor outcomes. One example is some men avoiding prostate cancer screening tests that could catch the disease early.
“All these factors together create a perfect storm where aggressive prostate cancer can thrive,” Yates says.
Here’s a look at some of the most common roadblocks and what men of African descent can do to push past them.
Screening Barriers
One of the best – and less invasive – ways to check for prostate cancer is a blood test called a prostate-specific antigen (PSA) test, says Isaac Powell, MD, Director, ProstateCancer Population Health Disparities Program, Wayne State University School of Medicine, Detroit.PSA is a protein made in the prostate. High levels may mean prostate cancer.
Yet only about 33% of Black men get screened, according to the American Cancer Society.
“Part of the problem is very few primary care providers routinely screen for prostate cancer,” Yates says.
In 2012, the U.S. Preventive Services Task Force published guidelines advising against PSA screening for prostate cancer in all men. They changed again in 2017, recommending men between the ages of 55 and 69 decide for themselves if screening is necessary.
Yates says that because of this, screening often isn’t on a primary care doctor’s radar even though organizations like the American Cancer Society now recommend that all African-American men discuss screening with their doctors once they turn 45. The Prostate Cancer Foundation recommends starting at age 40.
Fear of being misled or taken advantage of are also obstacles to care.
“In general, Black men have a lack of trust in the health care system,” Yates says.
Much of this stems from the Tuskegee experiment, a 40-year study that left Black male patients with syphilis untreated. Although it ended in 1972, distrust remains more than four decades later.
“Anytime I go out into the community to talk to men about prostate cancer screening, someone mentions it,” said Yates.
How to Take Action
Powell says all Black men should begin PSA screening at age 40, especially if they already have a family history of prostate cancer. He also recommends a rectal exam.
“About 15% of men with prostate cancer have a normal PSA, even those with aggressive cancer. A rectal exam can reveal changes in prostate cancer tissue, such as extreme firmness,” Powell says.
That’s why doctors typically recommend both. Powell also suggests seeing a urologist for more tests, such as a biopsy, if you didn’t get screened at a urologist’s office and your PSA levels are high. That’s anything above 4 ng/mL. You should also see one if your PSA levels are still normal, but have gone up one or two points since last year.
Even if your PSA levels are borderline, it’s important to stay on top of things. That’s because Black men with a PSA of 4 have the same risk of prostate cancer as white men with a PSA of 13.4, according to a 2023 study published in the journal Cancer.
Treatment Barriers
African American men don’t always get the same high-quality treatment as others. Those with advanced prostate cancer, for example, are 24% less likely to be prescribed the highly successful novel hormone replacement therapy, according to a 2023 study in JAMA Network Open. Here are some key reasons why:
Fear of treatment. Along with distrust of the health care system, some Black men worry about side effects.
“Men – even very educated ones – believe that if they do any treatment, they’ll lose all of their sexual function,” Powell says. “We have to sit down and explain to them that there are many therapies out there to help prevent that.”
Cost concerns. Black men with lower incomes are less likely to get screened for prostate cancer, which means they may not get diagnosed until the advanced stages, Yates says. On average, the yearly cost of treatment for metastatic prostate cancer is about $31,000, according to a 2023 study in Urology Practice.
A 2022 journal review also found that African American men reported having fewer prostate cancer treatment options based on their health insurance plans. They also reported more financial hardship. Those with financial problems were more likely to limit their care.
Implicit bias. Some doctors may not recommend certain treatments because they assume the person won’t cooperate or can’t afford it because of their race.
Less access to care. Black men are less likely to get treatment from a National Cancer Institute-Designated Cancer Center, which often provides the most cutting-edge care, Yates says. They also tend to travel longer distances for care and are less able or willing to do so.
How to Take Action
Ask for a referral to a patient navigator. Your primary care provider or urologist can recommend one.
“They are usually available even at rural hospitals or medical centers, and can serve as your advocate as you make your way through the system,” Yates says.
They can help you identify the nearest NCI-Designated Cancer Center, assist with making appointments, and talk through your treatment options more, among other services.
Do your own research. Trustworthy websites include:
- ZERO Prostate Cancer
- National Cancer Institute
- Prostate Cancer Foundation
- Johns Hopkins Medicine
These sites can also direct you to clinical trials for experimental treatments.
“There’s a lot of resistance among Black men with advanced prostate cancer to participate in research studies, due to mistrust of the health care system,” Yates says. “But it’s important to make sure these therapies work within this population.”
Cover your financial bases. If your insurance won’t cover part of the cost of your treatment, you may be able to get help through the drug company’s pharmaceutical assistance plan. Groups like the PAN Foundation and the Patient Advocate Foundation Co-Pay Relief program also offer financial assistance for out-of-pocket treatment costs.
Find doctors you identify with. You’ll be more likely to listen to what they say and take their advice, Powell says. The National Medical Association (NMA) is the country’s oldest and largest organization that represents African American doctors. They have an online directory where you can search for Black doctors in your area.
Even if you don’t care about your provider’s skin color, their bedside manner is important. You want someone who’ll take the time to listen and walk you through all your concerns. That way, you’ll know that you’re both invested in your care.
Show Sources
Photo Credit: Moment/Getty Images
SOURCES:
Clayton Yates, PhD, John R. Lewis endowed professor of pathology, oncology, and urology, Johns Hopkins Medicine, Baltimore.
Isaac Powell, MD, MS, director, Prostate Cancer Population Health Disparities Program, Wayne State University School of Medicine, Detroit.
American Cancer Society: “American Cancer Society Recommendations for Prostate Cancer Early Detection,” “Prostate Cancer and Black Men.”
Canadian Cancer Society: “Prostate-Specific Antigen (PSA) Test.”
Cancer: “Association Between Prediagnostic Prostate-Specific Antigen and Prostate Cancer Probability in Black and non-Hispanic White Men,” “Racial Disparities in Black Men with Prostate Cancer.”
CDC: “About the Untreated Syphilis Study at Tuskegee,” “Screening for Prostate Cancer.”
JAMA Network: “Changes in Prostate-Specific Antigen Testing Relative to the Revised US Preventive Services Task Force Recommendation on Prostate Cancer Screening.”
JAMA Network Open: “Racial and Ethnic Disparities in Use of Novel Hormonal Therapy Agents in Patients with Prostate Cancer.”
National Cancer Institute: “Prostate-Specific Antigen (PSA) Test.”
Nature Communications: “Serum Proteomics Links Suppression of Tumor Immunity to Ancestry and Lethal Prostate Cancer.”
Rural Health Information Hub: “Patient Navigators.”
Urology Practice: “The Cost of Metastatic Prostate Cancer in the United States.”
ZERO Prostate Cancer: “Black Men and Prostate Cancer.”
Journal of General Internal Medicine: “Physicians and Implicit Bias: How Doctors May Unwittingly Perpetuate Health Care Disparities.”
