Reducing Rates of Prostate Cancer Among African American Men

Prostate cancer is the most diagnosed cancer and the second most common cause of cancer death in American men. Prevalence specifically among African American men is even more alarming.

According to the American Cancer Society, prostate cancer has a 76% higher incidence rate among African American men than white men. Additionally, African American men are 2.2 times more likely to die from the disease.

What is prostate cancer?

The prostate is a gland in men that sits below the bladder and in front of the rectum. It makes fluid that, together with other secretions from the seminal vesicles, makes semen. Prostate cancer occurs when cells in the prostate gland become abnormal and multiply.

Prostate cancer often grows slowly. Detecting it early often makes it easier to treat. If the prostate cancer is confined to the prostate and quickly found and treated, it may not seriously impact a person’s health.

Many men do not experience symptoms or signs of prostate cancer in the early stages. That’s why preventive screening is so important. Some signs of prostate cancer in its later stages include blood in the urine or semen, loss of bladder or bowel control, problems urinating, trouble getting an erection, and weakness in the legs or feet.

Why does this disparity exist?

The disparity in prevalence and mortality is not entirely understood. However, it could be due to genetics, access to care and awareness.

Genetics: Family History Increases Risk

According to the American Cancer Society, Black men have the highest cancer incidence rate among any racial/ethnic group in the United States. This affects rates of prostate cancer because men who have a family history of any type of cancer are at a greater risk for developing the disease.

“If you or a family member have the BRCA2 gene mutation, you are at a greater risk of developing prostate cancer,” explains Humphrey Atiemo, MD, a urologist with ProMedica Genito-Urinary Surgeons – Toledo. “If you have a mother, aunt or sister who had breast cancer, you’re at a greater risk for prostate cancer. If your father had prostate cancer, you have two times the relative risk of developing prostate cancer yourself, and if your brother had prostate cancer, you have three times the relative risk to develop the disease.”

Access to Care: Removing Potential Barriers

Another possible contributor to the disparity is access to care. African American men are less likely to receive preventive health care, such as regular well-visits, than white men. This may be because of barriers such as limited access to facilities, lack of health insurance and medical mistrust.

Addressing these barriers is key to detecting prostate cancer early when its likely easier to treat.

“Studies have shown that even when there is equal access to care, African Americans still have a higher risk of prostate cancer compared to white men,” Dr. Atiemo shares.

African Americans are also more likely to be diagnosed with more advanced and aggressive cancers than white patients. With this in mind, African American men should consult with their doctor regarding personalized screening and treatments.

Awareness: Advocating for Early Screenings

“Patients need to take their health into their own hands,” Dr. Atiemo shares. “Knowledge is power. You are your own advocate.”

Know your risk for cancers and other health conditions related to your family history and/or race. Schedule yearly preventive visits and bring up cancer screenings if your provider doesn’t.

Current screening guidelines for prostate cancer recommend that men with an average risk begin screening between the ages of 50 and 55.

However, the latest research¹ indicates that prostate cancer develops three to nine years earlier in African American men compared to non-African American men. Therefore, regardless of family history, African American men should begin screening for prostate cancer between the ages of 40 and 45.

Because it’s a preventive screening, most states (including Ohio and Michigan) require that prostate cancer screenings be covered by insurance.

What is a prostate cancer screening?

Screening tests for prostate cancer are quick and easy. The three parts include a physical exam, an optional digital rectal exam (DRE) and a prostate-specific antigen (PSA) blood test. PSA tests asses the level of a protein made by the prostate gland. High PSA levels above 4.0ng/mL can indicate prostate cancer or other prostate conditions.

A physical exam and DRE can be done with your primary care provider. A DRE is a quick test so your provider can check for any physical abnormalities.

If screening tests are normal, men should continue with follow-up screenings every year to monitor for potentially new developments.

If there’s an abnormal result, your provider may recommend additional testing, such as a prostate ultrasound, prostate MRI or biopsy, to determine if treatment is necessary.

It’s important to remember that not all prostate issues are cancer. An enlarged prostate, for example, could be a sign of benign prostatic hyperplasia. This condition is noncancerous, affects the ability to urinate, and is relatively common in men over the age of 55.

How is prostate cancer treated?

The treatment for prostate cancer depends on many factors, including a person’s overall health and age, and the severity of the cancer. Cancer treatments may include chemotherapy, radiation therapy and surgery.

ProMedica urologists may use robotic technology to surgically remove the prostate via a minimally invasive technique. Robotic prostate surgery has been shown to reduce bleeding and the length of hospital stay.

Depending on the person’s age and severity of prostate cancer, a physician may even recommend active monitoring. This would include more frequent, routine testing.

How can we lower prostate cancer prevalence?

Reducing the prevalence of prostate cancer among African American men is vital. Educating around family history, removing potential barriers to care and advocating for earlier screenings can help.

One in every eight men will develop prostate cancer in their lifetime. It’s important that men know their prostate cancer risk, even if they are feeling healthy.

“Prostate cancer is often silent with no symptoms,” Dr. Atiemo shares. “Early detection saves lives.”

Learn more about prostate cancer screenings at ProMedica.

References

1. Garraway IP, Carlsson SV, Nyame YA, Vassy JL, Chilov M, Fleming M, Frencher SK, George DJ, Kibel AS, King SA, Kittles R, Mahal BA, Pettaway CA, Rebbeck T, Rose B, Vince R, Winn RA, Yamoah K, Oh WK. Prostate Cancer Foundation Screening Guidelines for Black Men in the United States. NEJM Evid. 2024 May;3(5):EVIDoa2300289. doi: 10.1056/EVIDoa2300289. Epub 2024 Apr 23. PMID: 38815168.

Humphrey Atiemo, MD, Dr. Atiemo is a urologist with ProMedicaGenito-Urinary Surgeons. View his profile.