What to know about prostate cancer in Black males

African American males are more likely to develop prostate cancer than males from other racial groups. They are also more likely to develop aggressive forms of prostate cancer and die from the disease.

The Prostate Cancer Foundation estimate that African American men are about 1.6 times more likely than all other men to get prostate cancer, and twice as likely to die from it.

It’s important to note that the stress of enduring racism and racist systems may play a part in developing the disease beyond genetic factors.

The prostate is part of the male reproductive system. It is a small gland that sits directly below the bladder. It plays a role in hormone and semen production and helps manage urine flow.

Prostate cancer can remain symptomless for a long time, so people need to educate themselves about the risks and have regular screening with a doctor.

Early detection is critical as prostate cancer is always treatable and often curable.

Keep reading to learn more about prostate cancer in Black males, including the risk factors, more statistics, symptoms, treatment options, and outlook.

Sex and gender exist on spectrums. This article will use the term male to refer to a person’s sex assigned at birth.

Learn more about the prostate gland here.

Different studies assign slightly different prostate cancer risk statistics to Black males. However, they all agree that Black males are more likely to develop prostate cancer than those from other racial backgrounds.

When prostate cancer appears in Black people, it tends to be more aggressive and progress faster.

For example, a 2020 study assessed whether active surveillance is a safe and effective option for African American males with low-risk prostate cancer.

Active surveillance, or watching and waiting, involves closely monitoring an individual for months or years. Many people opt to do this, as treatment can have severe side effects.

The study found that over a median follow-up period of 7.6 years, 59.9% of African American men diagnosed with low-risk prostate cancer experienced progression of the disease compared to 48.3% non-Hispanic white men.

This suggests that prostate cancer may be more aggressive in African American men.

Although African American men saw more significant disease progression, this study found they were not at an increased risk of dying from prostate cancer.

This might be because the researchers actively monitored the participants for disease progression, meaning that treatment was always close at hand. However, the study concluded that further studies are needed to confirm this finding.

The study also highlights how regular checks and active surveillance may delay the need for definitive treatment and prevent severe consequences in some men.

However, some doctors and other health professionals think that active surveillance may not be suitable for Black men who develop a more aggressive type of prostate cancer.

There is little evidence to confirm this because many studies in active surveillance for prostate cancer have typically not included many Black people.

Where active surveillance does take place, doctors must adhere to protocols and closely follow the progress of prostate cancer in African American males, as they may not be as low risk as they appear.

Why the increased risk?

Doctors do not fully understand why Black males have a higher risk of getting and dying from prostate cancer than other males. However, they believe that genetics plays a role. Some people with prostate cancer report having other family members with a history of prostate cancer.

A 2021 study into the heredity of prostate cancer found 86 new genetic risk variants. The study found that men of African ancestry had an estimated mean genetic risk score (GRS) more than two times higher than men of European ancestry.

Below is a list of risk factors that might account for the more aggressive prostate cancer in Black people.

  • Obesity: Non-Hispanic Black males are more likely than non-Hispanic white males to have obesity. An article in the International Journal of Environmental Research and Public Health notes that racism, racial trauma, and socioeconomic factors may increase the risk of obesity.
  • Socioeconomic status: African American men are more likely to have a lower socioeconomic status than other men. Low socioeconomic status has links to a higher chance of cancer due to reduced access to medical care and the ability to pay for it.
  • Racial bias in health care: African American men may face racial bias in healthcare, and in some cases, may avoid treatment because of it. For example, African American men are less likely to receive prostate screenings or Prostate Specific Antigen (PSA) tests. They are also less likely to be offered prostate cancer screenings.
  • Delayed care: Some Black males may be afraid of getting a prostate exam or may have difficulty accessing or paying for healthcare due to various factors, such as socioeconomic status.

Learn more about prostate exams and what to expect here.

Prostate cancer can remain symptomless for many years because the tumor growth is relatively slow and does not push on structures that can cause pain.

Prostate cancer can progress to an advanced stage before a person notices any symptoms. The best way to identify prostate cancer is with early screening.

When prostate cancer does cause symptoms, a person might notice:

  • frequent or painful urination
  • painful ejaculation or a decrease in the amount of ejaculate
  • pain in the back, hips, or thighs
  • blood in semen or urine
  • weak urine stream
  • unintentional weight loss

Learn more about advanced prostate cancer here.

The Centers for Disease Control and Prevention indicate that all males between 55-69 years should consider PSA screening and have regular prostate exams.

Although prostate cancer is rare in males under 45 years, a 2020 article indicates that Black males at high risk should consider prostate screening at around this age.

These screening tests can raise any clinical suspicion of prostate cancer. A prostate biopsy is almost always needed to confirm the diagnosis.

It is also important to tell a doctor about any family history of prostate cancer.

Learn more about PSA tests here.

Like all cancers, prostate cancer occurs when cells in the prostate grow out of control. This happens when there are changes in the DNA of prostate cells. Some potential causes of prostate cancer include inherited genes that increase the risk of developing cancer and acquired mutations, from exposure to toxic chemicals, for example.

Learn more about prostate cancer and its causes here.

Doctors determine how severe a person’s prostate cancer is by assigning it a Gleason score. The score ranges from 2–10, and a specialist determines the score by assessing the cells from the biopsy tissue.

Doctors consider cancers graded lower than 6 as lower risk, though research suggests even these cancers may be more aggressive in Black males.

When a person has a lower grade prostate cancer, the doctor may decide that active surveillance is the most suitable option, as these cancers tend to grow slowly, if at all. Doctors must take

If a cancer poses a higher risk, some treatment options include:

  • surgery to remove the prostate
  • chemotherapy to kill cancer cells
  • radiation therapy to kill cancer cells
  • immunotherapy, a type of immune system treatment that helps the immune system fight the cancer
  • targeted prostate cancer drugs
  • cryotherapy, which uses cold treatment to freeze prostate cancer cells
  • hormone therapy to suppress androgens, a group of hormones, including testosterone, that promote the growth of prostate cancer

Learn more about Zytiga used to treat two types of prostate cancer.

African American males are more likely than members of other racial groups to die from prostate cancer. Even so, figures from the American Cancer Society indicate that between 2010–2016, a person’s absolute risk of death is low. The overall 5-year survival rate of prostate cancer is about 98%.

An individual’s risk depends on how far the prostate cancer has metastasized (spread throughout the body). Cancer that remains in the prostate or nearby regions has a survival rate of nearly 100% with treatment.

A person who has cancer that has spread to other regions of their body, such as bone, has about a 30% 5-year-survival rate. However, this type of prostate cancer is rare.

Learn more about metastatic prostate cancer here.

Prostate cancer does not typically cause symptoms. A person cannot know whether or not they have prostate cancer without a screening test.

African American males have a higher risk of prostate cancer due to a range of factors, including genetics, racial bias, and socioeconomic status.

It is essential that Black males discuss the risks and benefits of testing with a doctor who understands their specific needs.

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