Although all men are at a risk for prostate cancer, Black men are at higher risk. They are about twice as likely to get and die from prostate cancer than white men. The reasons for this, however, are not definitively known.
“It could be a combination of factors, from genetics to access to care,” says Firas Abdollah, M.D., a urologist with Henry Ford Health, who has published extensive research on the impact of race in prostate cancer. Here, Dr. Abdollah explains the factors that might lead to an increased risk of prostate cancer in Black men, and what they can do to stay vigilant.
“Inherited, biological factors could be a factor,” says Dr. Abdollah. “Studies have shown that prostate cancer in Black men has a different genetic profile—the mutations they have are different. It’s a more aggressive cancer and, at diagnosis, they present with a higher stage of cancer.”
2. Low enrollment in clinical trials.
Countless clinical trials are conducted to further research and reduce the likelihood and severity of cancer. “However, Black men are usually not well represented in clinical trials,” says Dr. Abdollah. “Recruitment is low, so the results of a prostate cancer clinical trial don’t necessarily apply to Black men if they weren’t represented in the clinical trial.” There are, however, a lot of retrospective studies (studies using existing data) that examine genetic and environmental factors to determine why prostate cancer is more common and aggressive in Black men.
“And we have an initiative to increase minority participation in cancer clinical trials,” Dr. Abdollah adds. The initiative is especially trying to boost clinical trial participation in breast, colorectal, lung and prostate cancers, as they are more likely to result in death for Black people when compared to other racial and ethnic groups.
3. Access to care.
“Black men tend to get less active treatment and less surgical treatments than other men,” says Dr. Abdollah. “I don’t know if that’s because of a bias in the community, because of a lack of trust in the healthcare system, or because of a lack of access to health centers of excellence. It could be a combination of these things.”
A lack of access to care, he adds, could also include not having health insurance. Or sometimes, it’s just being able to reach a particular community to ensure they’re getting cancer screenings. “Our data shows that Black men get fewer prostate cancer screenings than white men,” says Dr. Abdollah. “Right now, we have a grant to improve gaps in access to care and prostate cancer screenings in Black men. We’re planning on going into communities to inform people why they need to get prostate cancer screenings and when they need them.”
When To Start Prostate Cancer Screenings
According to the American Cancer Society, Black men with a father or brother who had prostate cancer when they were younger than age 65 should start screenings at age 45, and Black men with more than one close relative who had prostate cancer when they were younger than age 65 should start screenings at age 40. If you do not fall into one of these high-risk categories, you should start getting screened at age 50. Everyone should continue to get screenings every year or every other year.
Screening typically consists of a prostate-specific antigen blood test (PSA) and a digital rectal examination (DRE). If either test is abnormal, further testing is done with a prostate biopsy, which involves obtaining a small sample of prostate tissue.
The PSA and DRE are how people have been screened for decades, but a more recent option is the use of prostate MRI, which has been shown to improve the detection of cancers that are likely to be aggressive and cause harm.
“It’s so important that all men get screened, because prostate cancer is a silent disease until it spreads to other parts of the body and it can’t be cured,” says Dr. Abdollah. “The PSA screening is the alarm bell. Before you feel anything, it tells you something is wrong. It’s a simple blood test, and it’s so important. It can save lives.”
Firas Abdollah, M.D., is a urologist with Henry Ford Health. He specializes in robotic surgery for prostate cancer (as well as kidney, adrenal and bladder cancer) and is the vice-chair of academics and research for the department of urology. He has published extensive research on the impact of race in prostate cancer. He sees patients at Henry Ford Cancer - Detroit, Henry Ford Hospital in Detroit and Henry Ford Medical Center in Sterling Heights.