Did you know that Black men have higher rates of prostate cancer than men of other races? Here’s what you need to know about your risk factors.
In honor of National Prostate Cancer Awareness Month, the African American Wellness Project is teaming up with Linkwell Health, the premier digital content marketing and consumer experience technology company in healthcare, to help spread the word about prostate cancer risks, treatment, and prevention in the African American community.
It’s not every day that you wake up, grab a cup of coffee, and then think about your prostate. It’s a small gland, about the size of a pingpong ball, located deep inside your groin area. It sits between your rectum and the base of your penis and produces part of your reproductive fluid. But as you get older, the prostate grows larger, and its cells can form a slow-moving type of cancer.
As slow as prostate cancer may progress, it can still be dangerous and even deadly.
So what’s your risk of developing prostate cancer?
In the U.S., the most commonly diagnosed cancer in Black men is prostate cancer. While the rate of Black men dying from the disease has dropped by more than 50% since 1993, that decline is slowing. And prostate cancer deaths are more than twice as high among Black men compared with white men.
That said, prostate cancer is actually one of the most survivable forms of cancer, especially when it’s detected and treated early. As long as the cancer hasn’t spread to other parts of the body, almost 100% of prostate cancer patients are still alive after five years, according to the American Cancer Society. And the disease has a 15-year relative survival rate of 95%.
Those are some pretty hopeful statistics. But don’t let them fool you into thinking that prostate cancer isn’t worth your attention.
“You have to understand just how hard Black men are hit by this disease,” says Dawud Lankford, M.D. He’s a urologist based in Oakland and Walnut Creek, California.
Knowing your risk factors and advocating for yourself can go a long way toward keeping you either cancer-free or in that group of prostate cancer survivors. Here are five things to know about prostate cancer in Black men — and what you can do to cut your risk.
1. Keep track of your family history
Prostate cancer can affect men under the age of 40, but it’s rare. That risk level increases rapidly, though, after 50. About 6 in 10 cases of prostate cancer are found in men older than 65.
If you have a big family, the other men in it — your grandfather, father, brothers, and cousins — may also be at risk for developing prostate cancer. Doctors don’t fully understand why Black men have a higher risk of getting and dying from the disease compared to men of other races. But studies suggest genetic factors play a role.
“It’s important to know if you have family history,” Dr. Lankford says. “The risk level goes way up if you have relatives with prostate cancer.”
In a 2021 study, for example, researchers found 86 new genetic risk variants associated with prostate cancer. And Black men had an estimated genetic risk score (GRS) more than two times higher than men of European ancestry.
Also important to know: While prostate cancer is normally slow-moving, it appears to grow faster in Black men. So by the time a doctor diagnoses prostate cancer in a Black man, it has already advanced further than it would in the average non-Black patient.
2. Talk to your doctor about getting screened
One of the most frustrating things about prostate cancer is that in its early development, it’s hard to tell if you even have it. The reason is that symptoms don’t usually show up until the cancer has advanced.
That’s why it may be important to get a prostate cancer screening. The American Cancer Society recommends that you start talking to your doctor about a screening at:
- Age 45 for men with a high risk of developing prostate cancer. That includes Black men and men who have a first-degree relative (father or brother) diagnosed with prostate cancer at an age younger than 65.
It also recommends consulting your doctor about potential screenings at:
- Age 50 for men at average risk of prostate cancer who are expected to live at least 10 more years
- Age 40 for men with an even higher risk (those with more than one first-degree relative who had prostate cancer at an early age)
If your doctor suggests screening for prostate cancer, they may perform one of these tests on you:
- Digital rectal exam (DRE). Your doctor puts a gloved finger inside your rectum to check for bumps or inflammation in the area of your prostate (that “digital” part refers to your doctor’s “digit,” or finger).
- Prostate-specific antigen (PSA) test. This test measures the level of PSA, a type of protein, in your blood. If you have a high level of PSA, it may be a sign that you have prostate cancer.
If your doctor notices anything unusual during these tests, they may recommend another type of test that might provide a clearer answer about whether you have cancer. These include:
- Magnetic resonance imaging (MRI). During this painless, noninvasive procedure, you lie down on a movable table, and the MRI machine takes detailed pictures of your prostate using a powerful magnet, radio waves and a computer. A traditional MRI exam does involve a closed-in space, so if you have claustrophobia, you may be given medication to help keep you calm. An MRI tends to take between 45 and 60 minutes but can sometimes last up to two hours.
- Transrectal ultrasound (TRUS). For this procedure, a thin device is inserted into your rectum. It uses sound waves to check for possible signs of prostate cancer. These often take less than 10 minutes and can be done at your doctor’s office.
- Biopsy. In this case, your doctor will remove a small piece of tissue from your prostate and check it for cancer cells. It normally takes about 10 minutes and can be done in your doctor’s office.
One thing to note: Some prostate cancer screenings aren’t 100% accurate (see: DRE or PSA test), and studies on the benefits of screenings haven’t always provided clear results. So you might not need a test right away or at all. It’s always a good idea to consult your doctor before getting any type of procedure. They’ll be able to walk you through what it’s all about, and you can make an informed decision together.
3. Know your risk factors
Family history isn’t the only factor for Black men’s high risk of developing prostate cancer.
For example, Black men are more likely than white men to deal with obesity. Racism and socioeconomic factors, including limited access to affordable and nutritious foods (sometimes called “food deserts”), may increase the risk of obesity in marginalized groups such as Black men. That’s according to a 2019 article in the International Journal of Environmental Research and Public Health.
Case in point: Obesity is a risk factor for more aggressive forms of prostate cancer.
Other risk factors include:
- Chemical exposures. If you’re a Vietnam War veteran and were exposed to Agent Orange, some studies suggest that it may increase your risk. The same goes for a firefighter who’s been exposed to certain chemicals.
- Diet. The exact role that diet plays in prostate cancer risk is unclear, but some studies indicate that men who consume a lot of dairy may be at a higher risk for developing the disease than others.
- Inflamed prostate. Researchers aren’t sure whether prostatitis, or an inflamed prostate gland, can increase your risk of developing prostate cancer. But biopsy samples often show inflammation in prostate tissue that has cancer in it.
- Sexually transmitted infections (STIs). If you have an STI such as gonorrhea or chlamydia, it may increase your risk of prostate cancer. The reason? Those infections can inflame your prostate.
- Smoking. Most studies don’t link smoking to getting prostate cancer, but some suggest that people who smoke may be at a greater risk of dying from the disease.
- Vasectomy. Some research indicates that a vasectomy (a procedure to make you infertile) may increase your risk of developing prostate cancer. But the research remains unclear.
4. Get the care you deserve
If you’ve experienced racial bias, whether at the doctor’s office, hospital, or anywhere else in the health care system, it can anger and frustrate you. And for some, it might mean they avoid getting treatment.
“It’s hard to say exactly why disparities in health care exist,” Dr. Lankford says. “Across races, there is a difference in poverty levels and access to quality health care. Is it racism that creates these disparities? It’s hard to say. But there are certain impediments to Black people getting proper care.”
For example, researchers at Georgia Tech’s School of Economics found that Black men were at least 23.6% less likely than white men to receive an MRI follow-up to a PSA test. (The study didn’t determine whether doctors did not refer Black patients for MRIs, or if the patients opted out of further testing.)
That said, data shows that Black people (and people of color in general) have a much tougher time gaining access to good health care, getting the proper coverage, and using it.
So it’s vital that Black men take an active role in their health. Some ways to make that happen:
- If you don’t have health insurance, learn how to find a plan that may better fit your budget through the Affordable Care Act (healthcare.gov) or Medicaid (medicaid.gov).
- Once you find coverage, make sure to choose a doctor you trust and feel comfortable talking to about personal matters.
- Take your doctor’s advice if they suggest that you get screened for prostate cancer (and don’t forget to schedule follow-up visits).
5. Be vigilant
Because prostate cancer tends to move slowly, some doctors may decide to take a step back when it comes to treatment. Sometimes they choose the “active surveillance” or “watchful waiting” approach.
Your doctor will closely monitor your prostate cancer symptoms without providing any active treatment. Watchful waiting can last years. Many people choose active surveillance to avoid the potential side effects of treatment for as long as possible.
But research suggests that such an approach may not be appropriate for everyone, given that Black men are more than twice as likely to die from prostate cancer.
In a 2020 JAMA study, researchers compared how prostate cancer progressed among Black men compared with white men who chose the active surveillance method. In a follow-up period of 7.6 years, 59.9% of Black men diagnosed with low-risk prostate cancer saw progression of their disease compared with 48.3% of white men.
Some doctors believe that faster, more aggressive treatment of prostate cancer in Black men could result in better health outcomes for them. But it’s not a one-size-fits-all approach, according to Dr. Lankford.
“I have tons of African American patients who are on active surveillance, and I repeat the biopsy and I watch them closely and everything is fine,” he says. “Active surveillance is basically a treatment of doing nothing. That way, you can go on living your life, and you don’t have to treat the prostate cancer until it becomes a problem.”
Bottom line: Prostate cancer is highly survivable — if you catch it early enough. And because Black men are at a higher risk of dying from it, it’s a good idea to talk to your doctor about getting a screening. If you’re worried that you might be at risk, schedule an appointment with your doctor today.
Sources:
“More black women die from breast cancer than any other cancer.” American Cancer Society, February 14, 2022, available at https://www.cancer.org/latest-news/facts-and-figures-african-american-black-people-2022-2024.html. Accessed August 1, 2022.
“Prostate cancer prognosis.” Johns Hopkins Medicine, available at https://www.hopkinsmedicine.org/health/conditions-and-diseases/prostate-cancer/prostate-cancer-prognosis. Accessed August 1, 2022.
“Survival rates for prostate cancer.” American Cancer Society, March 1, 2022, available at https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/survival-rates.html. Accessed August 1, 2022.
“Prostate cancer risk factors.” American Cancer Society, June 9, 2020, available at https://www.cancer.org/cancer/prostate-cancer/causes-risks-prevention/risk-factors.html. Accessed August 1, 2022.
Conti DV, Darst BF, Moss LC, et al. “Trans-ancestry genome-wide association meta-analysis of prostate cancer identifies new susceptibility loci and informs genetic risk prediction.” Nature Genetics, January 2021; 53(10: 65-75.
“Tests to diagnose and stage prostate cancer.” American Cancer Society, March 24, 2022, available at https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/how-diagnosed.html. Accessed August 1, 2022.
Bell CN, Kerr J and Young JL. “Associations between obesity, obesogenic environments, and structural racism vary by county-level racial composition.” International Journal of Environmental Research and Public Health, March 2019; 16(5): 861.
Abashidze N, Stecher C, Rosenkrantz AB, et al. “Racial and ethnic disparities in the use of prostate magnetic resonance imaging following an elevated prostate-specific antigen test.” JAMA Open Network, 2021; 4(11): e2132288.
“Key facts on health and health care by race and ethnicity.” Kaiser Family Foundation, January 26, 2022, available at https://www.kff.org/racial-equity-and-health-policy/report/key-facts-on-health-and-health-care-by-race-and-ethnicity/. Accessed August 1, 2022.
“Association between African American race and clinical outcomes in men treated for low-risk prostate cancer with active surveillance.” JAMA Network, November 3, 2020; 324(17): 1747-1754.
