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. MSK experts discuss this discrepancy, the possible causes, and what can be done about it. There are the four 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 should be screened for prostate cancer more proactively.
- Black men and their doctors may need to be more cautious about active surveillance.
- More Black men should consider joining clinical trials and research studies.
1. Black men both get and die from prostate cancer at a higher rate. The reasons are complex and not fully understood.
Black men are 50% more likely to develop prostate cancer in their lifetime and twice as likely to die from the disease. Vincent Laudone, 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.
“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 Laccetti. “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.”Back to top
Given the higher risk of developing prostate cancer and dying from the disease, Black men are more likely to be saved by screening. The main prostate cancer screening tests are a digital rectal exam, in which a doctor checks for swelling and inflammation, 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.”Back to top
Active surveillance is an approach in which low-risk prostate cancer is not treated with surgery or radiation therapy. Instead, it is monitored very closely for any changes over months or years and treated only if there are signs the disease has progressed. Active surveillance is increasingly the treatment option of choice for low-risk prostate cancer. Many men embrace this approach because it avoids the potential side effects of treatment.
Black men, however, are more likely to develop more-aggressive prostate cancer. Because of that, active surveillance may be less appropriate for some Black men. “As with screening guidelines, there is limited evidence to provide guidance one way or the other because Black men have been underrepresented in active surveillance studies as well,” Dr. Laccetti says. “This question needs to be studied more before we can come to firm recommendations.”Back to top
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.
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