When it comes to prostate cancer, Black men are classified as a high-risk group: They are about twice as likely as white men to be diagnosed with and die from prostate cancer. Genetics has been thought to play a role, but recent research has shown this is probably not the case. Instead, it is likely due to healthcare disparities.
“While there are prostate cancer mutations specific to Black men, there’s no strong evidence to show these mutations are related to a higher incidence of mortality,” says Firas Abdollah, M.D., a urologist at Henry Ford Health. “And Black men are also more likely than white men to die from other causes (like heart disease, for example). But if Black men are genetically predisposed to developing aggressive prostate cancer, they shouldn’t die more frequently from other causes, right? If they’re dying more frequently from other causes, too, it’s because they don’t have good healthcare. Even if genetics is a factor, it’s likely a smaller factor. The big issue is access to care, quality of care."
To investigate this further, Dr. Abdollah and a team of researchers created a model to group together Black and white men based upon health status, or those who had similar risks of dying from causes other than prostate cancer.
“From there, we compared prostate cancer-specific mortality and found that it was essentially equal between white and Black men,” says Dr. Abdollah. “Suddenly, in our model, Black men die just about as frequently as white men from prostate cancer. If it really were genetic, matching for other-cause mortality shouldn’t change the outcome. Black men should still die more frequently from prostate cancer. But that wasn’t the case.”
Understanding Healthcare Disparities In Prostate Cancer
Black men are less likely to live near healthcare centers of excellence. They are less likely to have health insurance and more likely to experience healthcare bias. They are also less likely to see a doctor, whether due to a lack of time or transportation. This, in turn, means they are less likely to know about prostate cancer screening – as it’s something your primary care doctor will discuss with you – and less likely to be proactive about their health.
Health disparities like living in a food desert (or an area with limited access to fresh, healthy food) may also play a role. “A recent report showed that a healthy diet may prevent low-grade prostate cancer from advancing,” says Dr. Abdollah. “Patients with low-grade prostate cancer who ate unhealthy diets were more likely to have their cancer advance than those who ate healthy diets.”
Screening Guidelines For Prostate Cancer
The American Cancer Society recommends that Black men begin prostate cancer screening at age 45 if they don’t have a family history of prostate cancer or at age 40 if they do have a family history of prostate cancer. Screenings consist of a prostate-specific antigen blood test (PSA) and a digital rectal examination (DRE).
While you should also see your primary care doctor if you have symptoms of prostate cancer – like frequent urination or blood in your urine – the goal is to have prostate cancer diagnosed without symptoms. That’s why it’s important to get regular screenings.
“Most of my patients see me because their PSA was abnormal,” says Dr. Abdollah. “They tell me, ‘my primary care doctor told me to come to you, but I don’t have any symptoms.’ And this is how it should be – you don’t want to wait for cancer to be advanced and causing symptoms before you see a doctor.”
Reviewed by Firas Abdollah, M.D., a urologist who sees patients at Henry Ford - Cancer in Detroit, Henry Ford Hospital and Henry Ford Medical Center – Sterling Heights. Dr. Abdollah specializes in robotic surgery for prostate cancer (as well as kidney, adrenal and bladder cancer) and is the vice-chair of academics and research for the department of urology. He has published extensive research on the impact of race in prostate cancer.
