Why Do Black Men Face The Greatest Risk Of Prostate Cancer?

Prostate cancer is the second most common cancer in the US, accounting for 14% of all new cancer cases.¹

An estimated 288,300 men in the US will be diagnosed with prostate cancer in 2023 — but diagnoses are not evenly distributed across the population. Men from minority racial and ethnic backgrounds, including Black men, have disproportionately high prostate cancer prevalence and mortality.²

What is prostate cancer?

Prostate cancer is a type of cancer that occurs when cells in the prostate grow out of control.³

The prostate is a gland found below the bladder. As part of the male reproductive system, its role is to produce fluid that makes up part of semen. It also has muscles that force the semen into the urethra and expel it during ejaculation.⁴

Types of prostate cancer include the following:⁵

• Adenocarcinoma — the most prevalent type of prostate cancer, develops from the gland cells

• Small cell carcinoma — a fast-growing subtype of neuroendocrine cancer⁶

• Neuroendocrine tumors — an aggressive type of prostate cancer that typically arises in later stages⁷

• Transitional cell carcinoma — a rare type that starts in the urethral cells (the urethra is a tube that carries urine to the outside of the body)⁸

• Sarcomas — a very rare cancer subtype with a poor prognosis⁹

The prevalence of prostate cancer in Black men

Prostate cancer does not affect all races equally. According to the Surveillance, Epidemiology, and End Results Program (SEER), the prostate cancer rates per 100,000 men are as follows:¹⁰

• 179.9 Black men

• 111.6 White men

• 81.6 Hispanic men

• 81.6 American Indian/Alaskan Native men

• 58.3 Asian/Pacific Islander men 

Compared to other races, Black men are significantly more affected by prostate cancer. They are also 2.3 times more likely to pass away from the disease than White men.¹¹

Furthermore, the average age of diagnosis in Black men is three years younger than in White men. A study found that African American men were twice as likely to be diagnosed with prostate cancer before the age of 45 than White American men.¹² ¹³

Research shows that many factors contribute to racial disparities in prostate cancer. These include genetic predisposition and tumor biology, environmental factors, diet, lifestyle-related socioeconomic factors, and worse access to healthcare services for screening and treatment.¹⁴ ¹⁶

Biological differences that predispose Black men to prostate cancer also increase the risk of the cancer being more aggressive and a higher grade at diagnosis.¹⁶

Less access to early diagnosis and quality care

Black men experience disparities in accessing quality healthcare and early prostate cancer diagnosis. Despite having earlier disease progression, Black men have lower prostate-specific antigen (PSA) testing rates (a screening tool for prostate cancer).¹⁷ ¹⁸ ¹⁹

Black men are more likely to have comorbidities, such as cardiovascular disease and diabetes. Comorbidities can affect treatment choice due to potential complications. For example, men with comorbidities are less likely to receive curative treatment.²⁰ ²¹ 

Below are some of the reasons why Black men have less access to these services:

Distrust in the healthcare system

Compared to men from other races, Black men have higher levels of distrust in the healthcare system. They are more likely to believe that screening won’t be thorough enough to result in a diagnosis.²²

This distrust in healthcare stems from institutional racism, historical segregation, and medical mistreatment of Black people.²³

Lack of cultural diversity and representation among healthcare professionals

A study found that almost half of Black men find it important to have a physician who shares a similar culture to them. However, Black people are underrepresented in the healthcare system. Data from the Association of American Medical Colleges found that in 2019, only 5% of physicians identified as Black/African American.²⁴ ²⁵

This means Black people don’t have adequate access to physicians who share a similar culture, leading to them not seeking healthcare in some cases.

Underrepresentation in clinical trials

Black men are underrepresented in clinical trials. This may be due to a lack of awareness and diversity in the trial research team, difficulty accessing trials, the bias of healthcare providers when recommending trials, and medical mistrust.²⁶

Insufficient Black representation in potentially life-saving trials makes it more difficult to understand how Black men are affected by prostate cancer and the most effective treatments for them. 

Socioeconomic status

In low-income populations, Black men are less likely to receive PSA monitoring. They also report having fewer treatment options based on their insurance plan. They are more likely to experience financial hardship from cancer debt, leading to medical nonadherence, refusing treatment, and not seeking medical advice.²⁷

Genetics and prostate cancer in Black men 

Genetic mutations contribute to prostate cancer disparities in Black men. Despite this, there is a lack of racial diversity in genomic and precision medicine studies. Research shows that only 37% of studies use race as a variable, and of these studies, only 14% of participants were Black.²⁸ ²⁹

Knowing your family history is important. Research shows that men who have a first-degree relative (such as a father, son, or brother) with prostate cancer are twice as likely to develop the disease.³⁰

Several genetic mutations associated with prostate cancer incidence are more common in Black men than White men. Research found that 6.8% of Black men with metastatic prostate cancer had more than 20 mutations.³¹

Research also shows that Black men with and without prostate cancer have higher PSA levels than White men. Therefore, it’s important to consider PSA screening times and recommendations based on these biological racial differences.³²

Lifestyle and environmental factors linked to greater risk of developing prostate cancer

Prostate cancer is associated with several lifestyle and environmental factors, such as:

Diet

A study published in 1999 linked increased consumption of animal fats to a greater risk of prostate cancer and more advanced/high-grade disease in Black American people. However, more up-to-date research is needed.³³

It would be best to follow the general guidance of the World Cancer Research Fund: consume no more than 500g of cooked red meat per week and avoid processed meat.³⁴

Physical activity

Research shows that an energy imbalance created by low physical activity levels can fuel the growth of established prostate cancers. This is particularly concerning for Black men living in poor urban neighborhoods, who face barriers to physical activity due to inadequate open spaces and fears of violence.³⁵

Other studies show that obesity and consuming a high-fat diet cause inflammation, increasing the risk of prostate cancer itself.³⁶

Tobacco smoking

Research suggests that tobacco smokers have an 11–22% greater chance of developing prostate cancer than those who have never smoked and a 9% greater chance than ex-smokers.³⁷

Tobacco smoking also increases prostate cancer mortality.

Chronic inflammation and infection

Research shows that chronic inflammation contributes to prostate cancer development. Chronic inflammation may also influence the progression and spread of prostate cancer.³⁸ 

Sexually transmitted diseases and prostatitis (inflammation and swelling of the prostate gland) may increase your risk of prostate cancer.

Chemical exposure 

Exposure to various chemicals increases the risk of prostate cancer. For example:

• Cadmium: This natural element increases the risk of prostate cancer in men who are exposed to it occupationally.³⁹

• Herbicides: A study of Vietnam War veterans found twice as many prostate cancer cases in those who were exposed to a herbicide during the war compared to those who were not. They were also more likely to have metastasized prostate cancer, have a higher-grade tumor, and present at a younger age.⁴⁰

• Pesticides: Research indicates that men who are occupationally exposed to pesticides are between 12–28% more likely to get prostate cancer than those who are unexposed. This was more evident in people with a family history of the disease, suggesting chemicals in the pesticides may interact with genetic risk factors.⁴¹

Ways to reduce disparities in prostate cancer prevalence and death rates in Black men

It’s important to focus on reducing these disparities to ensure fair healthcare for all. Here are some of the ways this can happen:

Increase diversity in clinical trials 

Efforts are needed to increase diversity and encourage Black participation in clinical trials. This will help make trials more representative of the population, facilitating the development of new treatment options that are suitable for all.

Possible methods include creating public policies and legislation requiring diversity.

The Diverse and Equitable Participation in Clinical Trials (DEPICT) Act aims to diversify clinical trials by enhancing data reporting on participation demographics, targets, and the rationale behind those targets. The act also requires researchers to create a diversity action plan to outline how they will reach and engage with minority communities.⁴² ⁴³

Improve screening and treatment recommendations

Black men have lower prostate cancer screening rates than White men. Because of this, targeted screening and treatment recommendations should be offered.⁴⁴

The American Cancer Society currently recommends that Black men should start discussing prostate cancer screening with their doctors from the age of 45. However, specific guidelines for Black men are needed.

In the absence of strong patient–doctor relationships and limited access to healthcare, research suggests that Black men rely on receiving information about screening from family and community members. Inviting people to speak about their own experiences of cancer at community events has been suggested as a way to boost screening attendance.⁴⁵

The benefits of reaching out to men via women in the community have also been explored. Male African American participants in a study observed that women tend to be more open and communicative about healthcare and preventative measures. Many reported being encouraged by female partners to attend screening.⁴⁶

Some interviewees also suggested that they may feel more comfortable speaking about prostate cancer to the women in their lives rather than men in their community.

This research highlights the need for culturally suitable healthcare outreach programs, taking note of patients’ feedback and what they feel comfortable with within their communities.

Improve access to quality healthcare

A study found that Black men with prostate cancer who were treated in the Veterans Affairs health system did not present with more advanced disease, experience treatment delays, or have worse outcomes. Notably, the Veterans Affairs health system is an equal-access medical system.⁴⁷

Improving access to quality healthcare is essential. Since insurance can also dictate treatment options, action needs to be taken to provide equitable insurance coverage for all.⁴⁸

Focus on culturally competent care

It’s important to teach medical professionals about the barriers Black men face to accessing screening and treatment for prostate cancer. It’s also important to encourage physicians to ask questions and listen to the concerns of Black men regarding their healthcare.⁴⁹

In 2019, only 6.2% of medical school graduates and 5% of active clinicians were Black. Actions need to be taken to increase Black people’s access to medical schools and postgraduate education so that healthcare in the US is culturally representative.⁵⁰

Improve prostate cancer education

According to research, nearly half of Black men are uneducated about prostate cancer screening. Further studies found many Black men had no knowledge of the signs of prostate cancer, post-treatment quality of life, and the severity of their disease.⁵² ⁵²

Moving forward, improving how Black men receive information about prostate cancer is crucial. Community-based outreach programs, in collaboration with clinicians and facilities, can effectively increase knowledge of prostate cancer and the importance of screening in Black people.⁵³

Dietary and lifestyle changes

Studies show that reducing animal-based dietary fat could decrease incidence and mortality rates for prostate cancer in Black men.⁵⁴

Physical activity should also be encouraged. A study found that walking or cycling for more than 30 minutes each day reduces the risk of developing prostate cancer.⁵⁵

Overall, maintaining a healthy weight through diet and physical activity is beneficial and should be promoted by clinicians, including among low-income men in rural and urban areas.⁵⁶

The lowdown

The latest findings show that genetics, systemic racism, environmental factors, and socioeconomic factors all play an important role in prostate cancer development, diagnosis, and treatment in Black American men. Further research is needed to explore how these factors interact to cause prostate cancer.

To reduce the prevalence and increase prostate cancer survival rates in Black men, lifestyle interventions and programs to reduce healthcare disparities need to be enhanced and promoted by designated specialists. 

Frequently asked questions

Do most men survive prostate cancer?

The five-year survival rate of prostate cancer is 97.1%, showing that most men face positive outcomes. However, prostate cancer survival rates are greatly influenced by factors such as cancer stage and race.⁵⁷ 

Who should be screened for prostate cancer, and when?

The American Cancer Society recommends the following ages for starting discussions with healthcare providers about screening:⁵⁸

• Men at average risk of prostate cancer: age 50

• Men at high risk (Black men and/or having a first-degree relative who was diagnosed with prostate cancer before the age of 65): age 45

• Men at higher risk (having more than one first-degree relative who was diagnosed with prostate cancer before the age of 65): age 40

Are there any drugs that reduce the risk of prostate cancer?

Finasteride (Proscar) and dutasteride (Avodart) are 5-alpha reductase inhibitors that block the enzyme responsible for growth in the prostate gland. Research has found that these drugs might reduce the risk of prostate cancer, as men who took them had fewer low-grade prostate cancers.⁵⁹

The Food and Drug Administration (FDA) has not approved finasteride or dutasteride for preventing prostate cancer, but doctors can prescribe them off-label.

What specialists can offer guidance for diagnostic options and lifestyle changes for prostate cancer prevention?

The best place to start is your family doctor. They can assess your risk level for prostate cancer and talk to you about lifestyle changes and screening. A nutritionist or dietician can help you make healthy dietary choices.