Since the 1990s, death rates from prostate cancer have decreased in all men – especially African Americans. That is certainly progress, but it is not the full picture.
Black men are at higher risk of developing prostate cancer – and a more aggressive type – than white men, says Brandon A. Mahal, MD, a radiation oncologist at the Dana-Farber Cancer Institute. It takes a dire toll: Black men are more than twice as likely to die of the disease.
What is behind such numbers? And what has to change? Many things play a role including access to grooming, genetics, the environment, and lifestyle.
What we know – and don’t know
“We now have a lot of data on the consequences of prostate cancer in black men,” says Kosj Yamoah, MD, PhD, a radiation oncologist at the Moffitt Cancer Center. “And this can help us provide better treatment.”
Still, there is a lack of research on African Americans. In some cases, researchers did not even report race or ethnicity of men in their prostate cancer studies. If so, less than 5% of the participants are black.
You can attribute this low participation in part to what it takes to participate in a study, such as: B. Laboratory Test Results. “Normal laboratory results” are often based on a group that is not heterogeneous, says Mahal. But what is “normal” can differ depending on race, gender and age. And when studies are mostly done on whites, it’s hard to tell if the results apply to others.
Where differences arise
Not only do black men develop this disease more often than white men. You also tend to get it at an earlier age. And your cancer tends to spread faster. “Prostate cancer that starts at age 40 and spreads by age 50 is different from one that doesn’t show up until age 70 – one not to worry about,” says Yamoah.
Genetics also play a role in prostate cancer – more than in any other type of cancer. “Part of the difference in prostate cancer rates – and therefore deaths – may be due to these inherited factors,” said Lorelei Mucci, ScD, associate professor of epidemiology at the Harvard School of Public Health.
Screening, active monitoring and biopsies
Early detection is important for anyone with prostate cancer. But Mucci says black men face unique barriers to diagnosis.
One hurdle for black men is the lack of access to insurance and medical care, says Yamoah. Another is the fact that their tumors tend to start earlier and spread faster. Even if their cancer is the slow-growing (low-grade) type, black men are twice as likely to die as other races, although it is still low.
Screening can save more lives for black people than people at lower risk. When screening tests for prostate specific antigen (PSA) began in the 1990s, death rates fell the most among black men. Early – and frequent – checkups are critical because of the strong association between mid-life PSA levels and the risk of black men developing aggressive prostate cancer.
These are the American Cancer Society’s guidelines for high-risk groups:
- Start PSA at the age of 45 for African Americans and men whose father or brother had prostate cancer when they were younger than 65.
- Start PSA at age 40 for men with more than one close relative who had prostate cancer when they were younger than 65.
For white men whose PSA levels are above normal, doctors typically choose active monitoring or “watchful waiting”. With repeated PSA tests, rectal exams, and biopsies, they can check for signs of the cancer’s growth. This approach is not used as often in black men because the risks are much higher.
That can change. MRI-guided biopsies – and genome tests – can now help rule out cancer that is spreading faster. Taking additional tissue samples with a saturation biopsy is another option. This type of biopsy involves taking 20 or more tissue samples in one test, compared to the usual 12-14.
If you are a black guy, the biopsy technique is crucial. That’s because your tumor tends to sit in the front of the prostate, Mahal says. “This zone tends to harbor more aggressive cancers, but standard biopsy techniques often overlook it.”
“If these newer tests indicate a low-risk cancer, I think it is safe to use active surveillance then,” Mahal says. Studies following patients with this approach will help doctors get a better idea.
Treatment delivery and response
“We know that black men have delayed diagnosis – and thus treatment,” says Mucci. “They also usually receive different treatment methods and have different access to medical care,” she says. Yamoah warns: “We are not asking doctors to treat black men with prostate cancer differently … we have to treat them” [people] based on their biology. “
We still don’t know if certain prostate cancer treatments will work in black men, says Mucci. However, Mahal points out that “in radiation studies where patients had the same disease status and access to care, black men actually had better prostate cancer survival rates than others.” He adds that her overall death rate was higher, but it may be because she had more than one disease.
What you can do
Lifestyle changes can help lower your risk. Exercise, maintain a healthy weight, cut down on red meat and alcohol, and quit smoking. If you are an African American, do these things too:
- Push for early, frequent prostate cancer screening tests.
- Ask your doctor about tests that can better detect prostate cancer in black men.
- Find out which examinations and treatments are covered by your insurance.
- Find out about your treatment options. Work with your doctor to get the best results possible.
- Sign up for a prostate clinical trial.
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