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Why Race Makes a Difference in Men With Prostate Cancer

September 25, 2020

Prostate cancer kills thousands of men every year, but healthcare disparities – the way people of different races, addresses, income and education levels are treated differently by the system – contribute to statistics that show Black men die twice as often from the disease.

This is particularly true of Black men with low-grade prostate cancer, or disease that has not progressed or attached itself to other organs. Men are often put on “active surveillance” at this stage, and monitored closely for disease advancement.

“As we mark Prostate Cancer Awareness Month, it’s imperative that we address the fact that prostate cancer incidence and mortality rates are higher with African American men,” said Dr. Keith O’Brien, a urologist with the Hartford HealthCare Tallwood Urology & Kidney Institute at St. Vincent’s Medical Center in Bridgeport.

According to a University of California-San Francisco study published in the Journal of the American Medical Association, doctors may be “underestimating the risk” of death from low-grade prostate cancer in Black males. Typically, men with low-grade forms of the disease will die of something other than the cancer.

This research, Dr. O’Brien said, points to the need to acknowledge that certain biological factors may cause low-grade prostate cancer to grow and spread faster in Black men than men of other races.

Racial disparity with prostate cancer extends even further. According to the National Institutes of Health, of every 100,000 men, 105.7 Caucasians will be diagnosed with prostate cancer, compared to 178.3 Blacks. The latter group, studies show, also presents with more advanced, or higher grade, disease and at younger ages.

“Genetically, we’ve discovered that Black men are more likely to have six different biomarkers for prostate cancer than other men. All of these factors combined make it even more critical that we get the awareness message out to the Black community,” Dr. O’Brien said.

The best screening tool for prostate cancer is a blood test for the level of prostate specific antigen (PSA). United States guidelines suggest all men between the ages of 55 and 70 be tested regularly, and those at higher risk, like African American men, consider screening at even younger ages (40-54) through consultation with their urologist.

“The goal is to diagnose the disease at its earliest stages when there are more management options available and treatment is more likely to be successful,” he said.

Treatment for prostate cancer, which depends on the stage of the disease, includes:

• Active surveillance, in which PSA levels are monitored closely.
• Surgery.
• Radiation.
• Hormone deprivation therapy.
• Chemotherapy.

“Prostate cancer is the second-leading cause of cancer death in American men and 1 in 39 men of all races will die of it,” Dr. O’Brien said. “The PSA is a simple blood test, and the conversation with a primary care provider or urologist can proceed from there. Most times, prostate cancer has no symptoms. I cannot stress the importance of starting a discussion with your doctor about prostate cancer screening, especially for Black men.”