Prostate cancer is more prevalent in African American men compared to other racial groups, with the disease often presenting in more aggressive forms and leading to higher fatality rates. The Prostate Cancer Foundation approximates that African American men have a 1.6 times greater chance of developing prostate cancer and twice the likelihood of dying from it. The stresses of systemic racism and societal biases may contribute to this increased risk beyond just genetic predisposition.
The prostate, a small gland located below the bladder, is an integral part of the male reproductive system. This gland, responsible for hormone and semen production and managing urine flow, can harbor cancerous cells for a long time without showing symptoms. Hence, awareness about the risks and regular screening is crucial. Prostate cancer is always treatable and often curable if detected early.
The ensuing sections delve into the risk factors, statistics, symptoms, treatment options, and prognosis of prostate cancer in Black males. We will refer to the sex assigned at birth when discussing gender.
Various studies highlight an elevated risk of prostate cancer in Black males, albeit with slight statistical variations. When this cancer manifests in Black individuals, it tends to be more aggressive and progress faster. A 2020 study investigating the effectiveness of active surveillance—a strategy involving careful monitoring over months or years—found that 59.9% of African American men with low-risk prostate cancer saw disease progression over 7.6 years, compared to 48.3% of non-Hispanic white men. This difference suggests a more aggressive nature of prostate cancer in African American men.
Despite this higher disease progression, the study found no elevated risk of dying from prostate cancer among African American men. This could be attributed to the active monitoring of disease progression in the study participants, ensuring prompt treatment. However, the study calls for more research for validation. It also underscores the potential of active surveillance in delaying definitive treatment and averting severe consequences in some men. Yet, some health professionals express concerns about the suitability of this strategy for Black men with aggressive forms of prostate cancer, mainly due to the lack of black representation in many active surveillance studies.
The reasons for the heightened risk of prostate cancer in Black males are not fully understood, but genetics is believed to play a significant role. A 2021 study identified 86 new genetic risk variants linked to prostate cancer, with men of African ancestry having a genetic risk score over two times higher than those of European ancestry. Other risk factors potentially contributing to aggressive prostate cancer in Black individuals include obesity, socioeconomic status, racial bias in healthcare, and delayed care due to various factors.
The Centers for Disease Control and Prevention recommend all males aged 55-69 to consider Prostate Specific Antigen (PSA) screening and regular prostate exams. For high-risk Black males under 45, early screening may be beneficial. These tests can raise suspicion of prostate cancer, which is then typically confirmed through a prostate biopsy. It is also important to communicate any family history of prostate cancer to the doctor.
The severity of a person’s prostate cancer is assessed through the Gleason score, ranging from 2-10, based on cells from the biopsy tissue. Cancers with a score lower than 6 are considered lower risk, although they may be more aggressive in Black males. For lower-grade cancers, active surveillance could be the best course of action. However, for higher risk cancers, treatment options include surgery, chemotherapy, radiation therapy, immunotherapy, targeted drugs, cryotherapy, and hormone therapy.
Despite African American males having a higher mortality rate from prostate cancer, the American Cancer Society’s data from 2010-2016 indicates that the absolute risk of death is low, with a 5-year survival rate of about 98%. The risk depends on how extensively the cancer has spread. If confined to the prostate or nearby regions, the survival rate with treatment is nearly 100%. However, if the cancer has metastasized to other body parts like bones, the 5-year survival rate drops to about 30%. This advanced stage of prostate cancer is rare.
Without screening tests, it is impossible to know whether one has prostate cancer as the disease typically shows no symptoms. African American males bear a higher risk due to various factors like genetics, racial bias, and socioeconomic status. Consequently, it is crucial for Black males to discuss the pros and cons of testing with a doctor who understands their specific needs.