It’s not every day that you wake up, grab a cup of coffee, and then think about your prostate. It’s a small gland, about the size of a Ping-Pong ball, deep inside your groin area. As you get older, the prostate grows larger. Sometimes it creates cancer cells. And that can be dangerous and even deadly.

In the U.S., prostate cancer is the most diagnosed cancer in Black men. And prostate cancer deaths are more than twice as high among Black men as white men. That said, prostate cancer is one of the most survivable forms of cancer. That's especially true when it’s found and treated early: If the cancer hasn’t spread to other parts of the body, almost 100% of prostate cancer patients are still alive after 5 years. And the disease has a 15-year relative survival rate of 95%.

Those are some hopeful statistics. But prostate cancer is still worth your attention. Knowing your risk factors and speaking up for yourself can go a long way toward staying cancer-free. Here are 5 things to know about prostate cancer in Black men — and what you can do to cut your risk.

1. Track your family history.

Experts don’t fully understand why Black men have a higher risk of getting and dying from prostate cancer. But studies suggest genetics play a role. One 2021 study looked at the estimated genetic risk score (GRS) of Black men. It was 2 times higher than in men of European ancestry.

“It’s important to know if you have family history,” says Dawud Lankford, M.D., a urologist based in Oakland and Walnut Creek, California. “The risk level goes way up if you have relatives with prostate cancer.”

2. Talk to your doctor about getting screened.

Symptoms of prostate cancer don’t usually show up until the cancer has advanced. That’s why screening may be important. The American Cancer Society advises that you start talking to your doctor about a screening at:

• Age 50 if you are at average risk of prostate cancer and expect to live at least 10 more years.
• Age 45 if you have a high risk of prostate cancer. That includes Black men and men who have had a first-degree relative (parent or brother) diagnosed with prostate cancer at an age younger than 65.
• Age 40 if you have an even higher risk. That includes Black men with more than 1 first-degree relative who had prostate cancer at an early age.

If your doctor suggests screening for prostate cancer, they may do one of these tests:

• Digital rectal exam (DRE). Your doctor puts a gloved finger inside your rectum to check for bumps or inflammation around your prostate. (“Digital” refers to your doctor’s “digit,” or finger.)
• Prostate-specific antigen (PSA) test. This blood test measures the level of PSA, a type of protein. If you have a high level, it may be a sign of prostate cancer.

If your doctor notices anything unusual during these tests, they may recommend other tests that might provide clearer answers. Options include:

• Magnetic resonance imaging (MRI). For this test, you lie down on a table while the MRI machine takes pictures of your prostate. Many MRI exams are in a tight space. You may be given medicine to help stay calm. An MRI usually takes between 45 and 60 minutes. Sometimes it can last up to 2 hours.
• Transrectal ultrasound (TRUS). A thin device is inserted into your rectum. It uses sound waves to check for signs of prostate cancer. This test takes less than 10 minutes. It’s done at your doctor’s office.
• Biopsy. Your doctor will remove a small piece of tissue from your prostate. They will check it for cancer cells. It normally takes about 10 minutes. It’s also done in your doctor’s office.

3. Know your risk factors.

Family history isn’t the only factor for Black men’s high risk of prostate cancer. For example, obesity is linked to more aggressive forms of the disease. And Black men are more likely than white men to deal with obesity. Research suggests that’s partly due to factors such as limited access to affordable and healthy foods.

Other risk factors include:

• Chemical exposures. Are you a Vietnam War veteran? If you were exposed to Agent Orange, it may add to your risk. Chemicals that firefighters work with can also raise risk.
• Diet. Some studies have found that eating a lot of dairy raises your risk.
• Sexually transmitted infections (STIs). Gonorrhea or chlamydia can add to your risk. Other STIs can, too.
• Smoking. Smokers may be at a greater risk of dying from the disease.
• Vasectomy. This is an operation to make you infertile. It may add to your risk of getting prostate cancer. But the research remains unclear.

4. Get the care you deserve.

Racial bias at the doctor’s office, hospital, or anywhere else in the healthcare system can be frustrating, to say the least. And for some, it prevents them from getting the proper care.

For example, researchers at Georgia Tech’s School of Economics found that Black men were at least 23.6% less likely than white men to get an MRI follow-up to a PSA test. (The study didn’t determine whether doctors did not refer Black patients for MRIs. It also didn’t find out if the patients chose not to have further testing.)

Other data shows that people of color have a much tougher time gaining access to good healthcare, getting the right coverage, and using it. So it’s vital that Black men take an active role in their health. Some ways to make that happen:

• If you don’t have health insurance, look for a plan that fits your budget. Check out the Affordable Care Act (healthcare.gov) or Medicaid (medicaid.gov).
• Make sure to choose a doctor you trust. You want to feel comfortable talking about personal matters.
• Take your doctor’s advice if they suggest that you get screened for prostate cancer. And don’t forget to schedule follow-up visits.

5. Be vigilant.

Because prostate cancer tends to move slowly, some doctors take a step back when it comes to treatment. Sometimes they choose the “active surveillance” or “watchful waiting” approach. That’s when they closely watch your prostate cancer symptoms without giving any active treatment.

Watchful waiting can last years. Many people choose this to avoid the possible side effects of treatment for as long as possible. But research suggests it may not be appropriate for Black men given that they’re more than twice as likely to die from prostate cancer.

In a 2020 JAMA study, researchers looked at how prostate cancer progressed among Black men. They compared it to white men who chose the watchful waiting method. In a follow-up period of 7.6 years, 59.9% of Black men diagnosed with low-risk prostate cancer saw their illness advance. That’s compared with 48.3% of white men.

Some doctors believe in a faster, more aggressive treatment of prostate cancer in Black men. That could result in better health results for them. But it’s not a one-size-fits-all approach, says Dr. Lankford.

“I have tons of African American patients who are on active surveillance. I repeat the biopsy. I watch them closely. And everything is fine,” Dr. Lankford says. “Active surveillance is basically a treatment of doing nothing. That way, you can go on living your life. And you don’t have to treat the prostate cancer until it becomes a problem.”

The bottom line: Prostate cancer is highly survivable — if you catch it early enough. And because Black men are at a higher risk of dying from it, it’s a good idea to talk to your doctor about getting a screening. If you’re worried that you might be at risk, schedule an appointment today.

[Sources:]

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[8] Abashidze N, Stecher C, Rosenkrantz AB, et al. “Racial and ethnic disparities in the use of prostate magnetic resonance imaging following an elevated prostate-specific antigen test.” JAMA Open Network, 2021; 4(11): e2132288.

[9] “Key facts on health and health care by race and ethnicity.” Kaiser Family Foundation, January 26, 2022, available at https://www.kff.org/racial-equity-and-health-policy/report/key-facts-on-health-and-health-care-by-race-and-ethnicity/. Accessed August 1, 2022.

[10] “Association between African American race and clinical outcomes in men treated for low-risk prostate cancer with active surveillance.” JAMA Network, November 3, 2020; 324(17): 1747-1754.