Black men are at increased risk for prostate cancer and may benefit from more vigilant screening.
Cancer does not discriminate, except when it does. Prostate cancer takes a harsher toll on Black men than other American men, including other men of color.
In April 2024, the Prostate Cancer Foundation (PCF) tried to help close the gap by issuing new guidelines, published in NEJM Evidence, recommending that Black men consider PSA screening starting between the ages of 40 and 45.
MSK experts discuss the possible causes of the increased risk of prostate cancer in Black men and what can be done about it. There are three main points to consider:
Black men both get and die from prostate cancer at a higher rate. The reasons are complex and not fully understood.
Black men are 70% more likely to develop prostate cancer in their lifetime and twice as likely to die from the disease. Urologic surgeon Vincent Laudone, MD, MSK’s Chief of Surgery at the Josie Robertson Surgery Center, explains that there are many factors that can increase the risk and worsen the outcome of prostate cancer — not just being of African descent. These include age, family history, smoking, limited physical activity, and obesity.
Andrew Laccetti
“The higher risk may be related to social and environmental issues involving nutrition, access to health care, and exposure to environmental pollutants,” he says. “Disparities in outcomes also can be affected by differences in when the cancer is diagnosed and how the men are treated after diagnosis.”
Additionally, prostate cancer in Black men may have biological characteristics associated with more aggressive disease. “There is evidence suggesting that this is partly related to inherited genetic factors,” says medical oncologist Andrew Laccettii, MD. “There may be differences in tumor biology that cause this cancer in Black men to progress faster or be harder to treat, but we need to investigate this possibility further to learn more.”
Black men should be screened for prostate cancer more proactively.
Given the higher risk of developing prostate cancer and dying from the disease, Black men are more likely to have early cancer detection through screening. The main prostate cancer screening tests are a digital rectal exam, in which a doctor checks for an enlarged prostate, and a PSA test, which measures the level of prostate specific antigen (PSA) in the blood.
“Screening guidelines have been based on studies that included very few Black men, so they may underestimate the screening benefit for this group,” Dr. Laccetti says. “Overall, Black men may need earlier and more frequent screening than the general guidelines would suggest.”
This recognition of the increased risk led to the new PSA screening guidelines from the PCF.
“This new recommendation reflects the medical community’s awareness that Black men should be especially vigilant about prostate cancer and consider starting screening at a younger age than non-Black men in the general U.S. population,” says MSK epidemiologist Sigrid Carlsson, MD, PhD, who collaborated with the PCF and is a co-author on the NEJM Evidence study.
Al Roker’s Message to Black Men About Their Health
More Black men should consider joining clinical trials and research studies.
Despite the increased risk of developing prostate cancer and dying from it, Black men are underrepresented in clinical trials that test new therapies — making up only 6.7% of patients.
“The biggest barrier seems to be a lack of awareness – both of the trials themselves and the possible benefits they offer,” Dr. Laccetti says. He is now involved in efforts to increase enrollment of black men in these trials being led by the nonprofit organization Prostate Cancer Health Education Network (PHEN).
“It’s become clear that we need a personalized approach to get people interested in clinical trials,” he says. “PHEN has developed webcasts called Clinical Trial Learning Sessions that explain how these trials work. I have a personal interest in trying to help overcome disparities, not just for the disease itself but for access to promising clinical research.”
In addition to getting access to new prostate cancer treatments through clinical trials, Black men can also join studies to help improve understanding of the disease. In 2018, the National Cancer Institute and Prostate Cancer Foundation launched a launched a large-scale research effort to study underlying factors that put Black men at a higher risk. The five-year study is called RESPOND (Research on Prostate Cancer in Men of African Ancestry: Defining the Roles of Genetics, Tumor Markers, and Social Stress). The study will enroll 10,000 Blacks with prostate cancer. Those interested in participating can contact the study’s leaders to learn more.
This story was originally published in 2022 and has been updated.
