Black men and prostate cancer: With worse outcomes, a need for more outreach

Black men are at higher risk of developing prostate cancer, and they are more likely to die of the disease than white men.

William Dahut, chief scientific officer of the American Cancer Society, says he'd like to see more discussions with Black men about the value of blood tests to determine risks for prostate cancer.

Researchers have found that Black men are 68% more likely to develop prostate cancer than white men, according to data published in January in CA: A Cancer Journal for Clinicians. Black men are twice as likely to develop prostate cancer as Hispanic men, and they are three times more likely to develop the disease than Asian Americans.

Black patients are twice as likely to die of prostate cancer than white patients, researchers say.

• Read more: Despite progress, too many are dying of prostate cancer

William Dahut, MD, chief scientific officer of the American Cancer Society, acknowledged the troubling disparity in outcomes. He says there should be greater outreach to Black patients about the greater risks, and doctors should have more conversations with their Black patients about being screened for prostate cancer.

Dahut points out the need to make sure Black patients, and all patients, understand that the initial test to determine a higher risk for prostate cancer is a simple blood test to determine prostate-specific antigen (PSA) levels. A recent American Cancer Society survey found that 60% of respondents incorrectly think the initial screening involves a rectal exam.

“I think getting the message out again, the digital rectal exam is not required as part of initial screening,” Dahut says. “This is something that I think people don't like to sign up for, and so it's something that if people know that's not required for additional screening for prostate cancer, I think that's important information.”

While men in their 50s should consider periodic screenings, Dahut says doctors should have conversations with their patients about undergoing the blood tests at an earlier age.

“Black men, certainly between ages 40 to 45, should be having those discussions, particularly if you have a strong family history,” he says.

Prostate cancer has a fairly high genetic component and is “probably the disease that has one of the strongest links to family history,” Dahut says.

“If you do have a strong family history, you know a brother, a father, or a cousin, then you definitely should talk to your physician about starting screening earlier,” he says.

After years of declines, more Americans of all races are being diagnosed with prostate cancer. The number of men being diagnosed with advanced prostate cancer has risen by 5% annually since 2014, according to the American Cancer Society.

Some doctors have been leery of pushing prostate cancer screenings on patients, Dahut says. The U.S. Preventive Services Task Force said in 2018 that periodic screening for men between 55 and 69, via a blood test, should be an individual decision, and noted the risks of “overdiagnosis and overtreatment.” (The task force is in the midst of reviewing its guidelines.)

Some researchers suggest screening guidelines should be reevaluated for Black men. A 2022 study published by NEJM Evidence suggests “the need to account for the increased value of screening in Black men in clinical guidelines.”

“We also estimate that the net benefit of PSA screening is greater for Black men than the general population,” the researchers wrote. “The potential for overdiagnosis and overtreatment remains, although these harms may be mitigated by contemporary protocols for triaging men before biopsy and active surveillance for men with low-risk disease. These data should prompt policy makers to reconsider the utility of PSA-based prostate cancer screening, particularly for Black men.”

The Prostate Cancer Foundation published new guidelines in April 2024, recommending Black men between the ages of 40 and 45 should consider taking the initial blood test. The guidelines were published in NEJM Evidence. The foundation revised earlier guidelines, which suggested Black men should first consider blood tests between the ages of 50 and 55.

While Dahut calls for more screening and better education of the greater risks of prostate cancer for Black patients, he also acknowledges that much work remains to improve outcomes.

• Read more: Black patients have higher mortality in most cancers, and gaps persist at higher incomes

There’s likely a combination of factors contributing to the higher mortality rate among Black men diagnosed with prostate cancer, including genetics and perhaps environmental factors, he says.

But Dahut also suggests the access to care, and the right treatments, play a role in the higher risk of death for Black men.

“There are some biases in our system,” he says. “We know Black men with the same cancer risk, cancer burden, tend to be offered different therapies than white men. So I think there continues to be biases in our system.”

Researchers also need to work harder to ensure Black patients are included in studies of new therapies for prostate cancer.

“We haven't done a great job of enrolling Black men in prostate cancer clinical trials,” Dahut says. “Clinical trials can tend to increase the overall standard of care for that practice or that group. So that's something we need to work out.”

• Read more: Sustained commitment needed to brighten prostate cancer picture for Black men

Dahut also says he’d like to see much more awareness of the disease. September is Prostate Cancer Awareness Month, but Dahut says he doubts that it's widely known in the general public.

“I think getting that awareness about prostate cancer, knowing that it's much easier to do a blood test to understand your risk of prostate cancer,” he says.

“That first blood test can really let people know what their risk is, and then layer that into their age, their family history, their race … I think it's really important then to give them the tools they need, what they need to know to prevent advanced prostate cancer from developing.”