Overcoming Barriers to Better Outcomes

Since the 1990s, prostate cancer death rates have dropped for all men — most of all for African Americans. That’s progress, for sure, but it’s not the full picture.

Black men have a greater risk of getting prostate cancer — and a more aggressive type — than white men, says Brandon A. Mahal, MD, a radiation oncologist with the Dana-Farber Cancer Institute. It takes a grim toll: Black men are more than twice as likely to die from the disease.

What’s behind numbers like these? And what needs to change? Many things come into play, including access to care, genetics, environment, and lifestyle.

What We Know — and Don’t Know

“We now have a lot of data about prostate cancer outcomes in Black men,” says Kosj Yamoah, MD, PhD, a radiation oncologist at Moffitt Cancer Center. “And this may help us provide better treatment.”

Still, research in African Americans is lacking. In some cases, researchers haven’t even reported the race or ethnicity of men in their prostate cancer studies. When they have, fewer than 5% of those who’ve taken part are Black.

You can partly trace this low participation to what’s required to enroll in a trial, such as lab test results. “Normal lab results” are often based on a group that’s not diverse, Mahal says. But what’s “normal” can differ across race, gender, and age. And when studies are done mostly in white people, it’s hard to tell if the results apply to others.

Where Differences Arise

Black men don’t just get this disease more often than white men. They also tend to get it at an earlier age. And their cancer tends to spread more quickly. “A prostate cancer that starts at age 40 and spreads by age 50 is unlike one that shows up first at age 70 — one you never have to worry about,” says Yamoah.

Genetics also comes into play with prostate cancer — more so than for any other type of cancer. “Part of the difference in prostate cancer rates — and, therefore, deaths — may be due to these inherited factors,” says Lorelei Mucci, ScD, an associate professor of epidemiology at the Harvard School of Public Health.

Screening, Active Surveillance, and Biopsies

Early detection is important for everyone with prostate cancer. But Mucci says Black men face unique barriers when it comes to diagnosis.

One hurdle for Black men is lack of access to insurance and medical care, Yamoah says. Another is the fact that their tumors tend to start sooner and spread faster. Even when their cancer is the slow-growing (low-grade) type, Black men have twice the risk of death as that of other races, although it’s still small.

Treatment Delivery and Response

“We know that Black men have delayed diagnoses — and, therefore, treatment,” Mucci says. “They also tend to get different types of treatment, and their access to care is different,” she says. Yamoah cautions that “We’re not asking doctors to treat Black men with prostate cancer differently … we need to treat [people] based on their biology.”

We still don’t know whether certain prostate cancer treatments work as well for Black men, Mucci says. But Mahal points out that “In radiation trials where patients had the same disease status and equal access to care, Black men actually had a better prostate cancer survival rate than others.” He adds that their overall death rates were higher, but that this may have been due to having more than one illness.

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’re an African American man, do these things too:

• Push for early, frequent prostate cancer screening tests.
• Ask your doctor about tests that may better spot prostate cancer in Black men.
• Find out which tests and treatment your insurance covers.
• Learn about your treatment options. Partner with your doctor to get the very best results you can.
• Enroll in a prostate clinical trial.