Black Men at a Higher Risk for Prostate Cancer
According to the National Cancer Institute, prostate cancer is the second most common type of cancer among men in the United States. Black men in the United States are more likely to be diagnosed with and to die from prostate cancer vs. men of other backgrounds. They are diagnosed at a younger age and with more advanced disease.
A higher risk
According to the American Cancer Society, Black men are 70% – 110% more likely to develop prostate cancer in their lifetime and twice as likely to die from the disease vs. men of other backgrounds. They are diagnosed at a younger age and with more advanced disease. This is the largest racial disparity for any type of major cancer for men or women. The reasons for this are not definitively known, but studies are currently underway and there have been a lot of retrospective studies (studies using existing data) that examine genetic and environmental factors to determine why prostate cancer is more common and aggressive in Black men.
Prostate cancer has one of the largest racial disparities of any cancer in the United states
Prostate cancer is the leading cause of cancer among Black men. All Black men are at high-risk of being diagnosed with and dying from prostate cancer.
Each year about 41,600 Black men are expected to be diagnosed with prostate cancer. Approximately every 13 minutes a Black man is diagnosed with prostate cancer.
One in six Black men will develop prostate cancer in their lifetime —compared to one in eight men overall.
Black men are 1.7 times more likely to be diagnosed with — and 2.1 times more likely to die from — prostate cancer than white men.
Everyday nearly 17 Black men die of prostate cancer and each year approximately 6,040 Black men are expected to die.
Black men are also slightly more likely than white men to be diagnosed with advanced stages of the disease.
Black men are diagnosed at a rate 77% higher than white men and die at a 120% higher rate – This is the largest racial disparity for any type of major cancer for men or women.
impacting factors
While there is no clear reason for these differences, several factors can impact cancer risk and outcomes in the Black community. There is still work that remains to be done in terms of genetics, access to care, addressing social determinants, and further education and outreach into communities. Understanding these factors is a first step in closing the gaps in prostate health for Black men.
Because of historical context, race in the United States is correlated with socioeconomic status, and lower socioeconomic status is correlated with increased cancer risk and worse outcomes.
Black men may be harmed by racial bias in preventive care. They are less likely than white men to be offered the option of having a PSA test and are more likely than white men to be told that the benefits of the PSA test are uncertain.
Genetics. Some studies have shown that prostate cancer in Black men presents a different genetic profile — mutations have been found that are different.
Environmental factors. Social and environmental issues involving nutrition, mental health, financial stability and even exposure to environmental pollutants are impacting factors for all cancers. Benzene, asbestos, vinyl chloride, radon, arsenic, and trichloroethylene are examples of toxic substances that can increase the risk of cancer when people are exposed to them.
Because of a bias in the community, lack of trust in the healthcare system, or lack of access to health centers or health insurance. Or sometimes, it’s the outreach, or lack thereof, into a particular community to ensure they’re getting cancer screenings.
Black men are usually not well represented in clinical trials due to low enrollment and recruitment.
A recent study found that Black men diagnosed with early-stage prostate cancer were less likely than white men to receive any type of treatment for that cancer.
Prostate cancer is curable if detected early and the 10-year survival rate when detected early is more than 95%. Efforts are being made to understand and address the above factors, so the incident rates of prostate cancer among Black men can actively be addressed.
risk factors for black men
Although all men are at a risk for prostate cancer, Black men are at higher risk. A risk factor is anything that affects your chance of getting a disease. Different cancers have different risk factors. Some risk factors, like smoking or diet, can be changed. Others, like a person’s age or family history, can’t be changed.
Having one or several risk factors does not mean that you will get the disease. Many people with one or more risk factors never get cancer, while others who get cancer may have had few or no known risk factors. However having risk factors does increase the probability of developing the disease.
Age & Family History
Age is one of the main risk factors for prostate cancer in Black men, and the disease is rare in men younger than 45. Black men with a father or brother who had prostate cancer when they were younger than age 65 should start screenings at age 45, and Black men with more than one close relative who had prostate cancer when they were younger than age 65 should start screenings at age 40.
Geography
Prostate cancer is most common in North America, northwestern Europe, Australia, and the Caribbean islands. Black men in the United States and the Caribbean have the highest prostate cancer incidence rates in the world. It is less common in Asia, Africa, Central America, and South America.
The reasons for this are not clear. More intensive screening in some developed countries probably accounts for at least part of this difference, but other factors such as lifestyle differences – one example being diet – are likely to be important as well.
Race
Prostate cancer more common in Black men than in Caucasian men. Black men are 1.7 times more likely to be diagnosed with — and 2.1 times more likely to die from — prostate cancer than white men. See the Impacting Factors section to the left for more information on why Black men are affected more.
Certain Prostate Changes & Inflammation
Men with cells called High-Grade Prostatic Intraepithelial Neoplasia (PIN) may be at increased risk. These prostate cells look abnormal under a microscope. Some studies have suggested that prostatitis (the inflammation of the prostate gland) may be linked to an increased risk of prostate cancer, but other studies have found no such link. Inflammation is often seen in samples of prostate tissue that also contain cancer. The link between the two is not yet clear and is an active area of research.
Genetics
Inherited, biological factors could be a factor. Black men tend to have a more aggressive cancer and, usually at diagnosis, Black men present with a more advanced stage. Some studies have shown that prostate cancer in Black men presents a different genetic profile — scientists have discovered genetic mutations that are unique and could help explain why Black men are at a higher risk than other ethnicities. These findings could lead to a test to identify those at greatest risk of developing the disease, enhancing survival rates.
Low Enrollment in Clinical Studies
and Lack of Adequate Access to Health Care
Black men are usually not well represented in clinical trials and recruitment is low, so the results of many prostate cancer clinical trials don’t necessarily apply to Black men since they weren’t accurately represented in the clinical trial. Initiatives need to be created to boost clinical trial participation in many cancers such as breast, colorectal, lung and prostate cancers, as these cancers are more likely to result in death for Black people when compared to other racial and ethnic groups.
The American health care system is beset with inequalities that have a disproportionate impact on the Black community and other marginalized groups. Inequalities create gaps in health insurance coverage, uneven access to services, and poorer health outcomes among certain populations and ethnic groups. Black communities bear most of these health care challenges.
Black men tend to get less active treatment and less surgical solutions than other men. It’s probable there are a combination of multiple factors that contribute to this, such as: bias in the community, lack of trust in the healthcare system, or lack of access to health centers of excellence.
PSA screening for black men
For more general information on PSA screening and Biopsy visit the Understanding Prostate Cancer page.
Black men are at a high risk for prostate cancer and the benefits of screening generally outweigh the risks. Each man should engage in shared decision-making with their healthcare team and other trusted sources. If you do not fall into one of the above high-risk categories, you should start getting screened at age 50. Every man should continue to get screenings every year or every other year.
Patients should get comfortable advocating for themselves. It is important to ask questions and learn about the pros and cons of screening. PSA screening should be considered as the first line of defense for prostate cancer screening. Many providers will also recommend a digital rectal exam (DRE) in addition to the PSA.
Black men who are at even higher risk due to a strong family history and/or known carriers of high-risk genetic variants should consider initiating annual PSA screening and DRE as early as age 40.
Visit the resources section for prevention tips, screening locations, support groups, and more!