Prostate Cancer Doesn’t Have to Be a Leading Killer of Black Men
September is Prostate Cancer Awareness Month, bringing national attention to the second-most-common form of cancer in men. It’s also the second-leading cause of death for American men.
According to the American Cancer Society, an estimated 288,000 men in the U.S. will develop the disease in 2023, and almost 35,000 of them will die from it. But the good news is that prostate cancer is one of the most survivable forms of cancer—if detected and treated early enough.
Early intervention saves lives
Symptoms of prostate cancer often go unnoticed and undiagnosed. Many men have no symptoms during the early stages. So, by the time symptoms do become obvious, the disease may have progressed to a level that calls for aggressive treatment. The good news is that those diagnosed and treated early have an almost 100 percent survival rate five years out.
The prostate gland is approximately the size of a walnut, and is located in the interior portion of the groin. While it’s not essential for life, the prostate is essential for reproduction because it produces part of the seminal fluid that sperm need to remain healthy and motile. Physicians examine the levels of PSA—prostate-specific antigen—in seminal fluid as part of routine prostate cancer screenings.
In cases of advanced or symptomatic prostate cancer, men typically feel the need to urinate more often—especially at night. They may experience difficulty beginning urination, or a diminished or interrupted flow. There may be blood in the urine or semen, or a man may experience painful ejaculation or persistent pain in the pelvic or back regions. These symptoms can also be associated with completely benign prostate problems, or with other medical issues. But anyone experiencing them should be seen by a doctor.
When cancer discriminates
And here’s where systemic racial disparities in this country once again leave their ugly marks: Black men are 50 percent more likely to develop prostate cancer—and twice as likely to die from it—than men of other ethnicities, even other men of color. “Cancer does not discriminate,” says the team at Memorial Sloan Kettering Cancer Center. “Except when it does.”
About 11 percent of men overall in the United States are expected to develop prostate cancer over their lifetimes. That figure is a staggering 25 percent for Black men. The incidence of the disease is, in fact, more than 60 percent higher for Black men than Caucasian men.
Being a Black man isn’t the only factor involved in developing prostate cancer, for sure: Other risk factors include obesity, smoking, and a lack of regular, healthy exercise. Experts say that both genetics and socioeconomic factors—in effect, systemic racism—play the strongest roles.
The racial disparities in who gets diagnosed, and who gets the best care, were highlighted in a study published in 2023 by a team at the Fred Hutchinson Cancer Center at the University of Washington in Seattle. The team found that the biggest reasons for these disparities were “structural and social determinants,” including “systemic racism.” The study, which appeared in the peer-reviewed journal Cancer, is among the very few studies ever conducted that seek to uncover the reasons behind these systemic factors’ influence on prostate cancer in the Black community.
The researchers examined a cohort of people receiving Medicare and undergoing treatment for prostate cancer. They conducted a retrospective study, using information on Medicare claims covering more than 31,000 people, to analyze patient data. They found that Black men represented 6.7 percent of those 31,000 patients. The Black men were statistically of lower socioeconomic status. Among other characteristics, they were younger when first diagnosed, and waited longer to receive surgery after diagnosis. This, despite the fact that Black men with prostate cancer overall tend to show higher levels of prostate-specific antigens, a typical screening biomarker.
Black men were also less likely to obtain care from a hospital or physician in the top-volume percentile or in a National Cancer Institute hospital, and less likely to travel 50 or so miles to receive care. The level of surgical volume was a key metric in evaluating the connection between patients’ race and the quality of care they received. Higher-volume physicians and institutions are more likely to be well-resourced, to be board-certified, and to have specific and novel diagnostic and treatment resources available to target prostate cancer.
When adjusted for age, comorbidities, disease progression, and factors like prostate-specific antigen levels, the Black men in the study who got their care from lower-volume institutions showed a higher risk of dying from prostate cancer.
How to increase equity of care
The study concluded that Black men on Medicare typically receive medical care for their prostate cancer from lower-volume providers. This situation likely has an effect on the quality of the surgical interventions offered to them, and their post-surgery outcomes. The researchers further concluded that opening up access to better-quality care would even out existing racial inequities.
Experts also note that Black men, given these obvious disparities, should be screened earlier and more frequently for prostate cancer.
Black men are also disproportionately underrepresented in research into prostate cancer.
Part of the problem here is the generations-long legacy of medical experimentation conducted on Black communities without their knowledge or informed consent—just insert the word “Tuskegee” here. The medical community today needs to do better outreach to Black men, as well as raise awareness of the importance of representation in clinical studies and trials.