Knowing Your Risk: Cancer Disparities in the Black Community

As the second leading cause of cancer deaths in the United States behind lung cancer, prostate cancer is a legitimate concern for many men as they age. But Blacks and African Americans should be especially concerned, experts say. Not only are they diagnosed with prostate cancer in larger numbers than White men, but they are also more likely to die from the disease.

Mark Kelly, M.D., a urologic oncologist at Baptist Health Miami Cancer Institute, says this is in part because Blacks and African Americans in the U.S. have been chronically underserved in many areas of healthcare, as have many Hispanics, too.

“Prostate cancer affects all races and nationalities. Unfortunately, it hits the Black community harder,” Dr. Kelly says. “For every 10 White men diagnosed with prostate cancer in this country, 17 Black men are diagnosed with the disease.”

Mark Kelly, M.D., a urologic oncologist at Baptist Health Miami Cancer Institute

From 2022 estimates by the National Cancer Institute (NCI) and the American Cancer Society (ACS), there were 41,600 cases of prostate cancer diagnosed among African American men that year, resulting in 7,090 deaths.

“For Black men diagnosed with prostate cancer, it tends to develop earlier and more aggressively, and there’s a higher death rate,” Dr. Kelly notes. Even though Black men constitute only slightly more than 13 percent of the at-risk population in the U.S., they account for 30 percent of all prostate cancer deaths.

“That’s a disparity that needs to be corrected,” Dr. Kelly states. “The medical profession hasn’t done a good enough job alerting Black men to their risk for prostate cancer or the benefits of being aware of that risk and taking proactive measures to lessen it.”

Screening for prostate cancer

The prostate is a gland – the largest in the body – that sits just below the bladder. “It serves as a junction between the urinary tract and the reproductive tract in men,” says Dr. Kelly. The prostate’s location is not one that allows for easy examination, however, and doctors for years have relied on rectal exams, which he says are “very non-specific,” as well as PSA tests.

“The PSA test is a blood test that measures a protein in your blood, prostate-specific antigen, that is produced primarily by the prostate,” explains Dr. Kelly. “When PSA levels are elevated, that tells us something’s going on in your prostate. It could simply be an enlarged prostate, a common condition known as benign prostatic hyperplasia, it could be inflammation or it could be cancer.”

Doctors have relied on the PSA test for decades, adds Dr. Kelly, and while it has many flaws, he says it is an effective first step in helping identify those men at higher risk. “It has helped us detect many cancers even when they weren’t clinically apparent. And at the very least, it can trigger sophisticated additional testing when PSA levels are shown to be elevated.

Now, thanks to the science of genetics, there are new tests that can provide doctors with “more granular insights” into whether a man should have further testing for prostate cancer, according to Dr. Kelly.

“We have tumor markers that are indicative of what enzymes and proteins are produced by cancer cells compared to men without cancer,” he says. “This not only reduces unnecessary biopsies, but we can also now tell a man with near certainty if he merits further evaluation for prostate cancer.”

Black men benefit most from screening

Stepping up screenings within Black and African American populations is a clear pathway to solving the problem of disparities in prostate cancer care, Dr. Kelly believes. He points to a 2022 study from the University of California. It showed that when African American men engaged in regular annual screening, they experienced a dramatic reduction in prostate cancer-specific mortality – far greater even than the White men they were compared to.

“These men, who have the highest risk of dying of prostate cancer, have now been shown to benefit the most from aggressive annual screening,” Dr. Kelly says.

Screening guidelines for prostate cancer state that PSA testing should begin at age 50. For African American men, it is recommended to start PSA testing at age 45, and some medical groups even recommend starting at age 40 for men with strong family histories of prostate cancer.

“The earlier prostate cancer is detected, the better the outcome for the patient,” says Dr. Kelly. “The survival probabilities are dramatically higher when we find it before it’s escaped the prostate into surrounding tissue.”

Treatment options for prostate cancer

Patients diagnosed with prostate cancer typically have several treatment options, Dr. Kelly says. “When we find cancers that are small or non-aggressive, we don’t necessarily have to treat them. Active surveillance is appropriate for up to 60 percent of newly diagnosed patients where treatment is not immediately necessary and may not ever be necessary.”

Some small aggressive cancers can be managed with an emerging therapy called partial gland ablation, says Dr. Kelly. “It’s an outpatient procedure that essentially uses heating or cooling or even electrical field generation to destroy or ablate the cancer,” he explains. “This preserves the sexual function and bladder control that are the feared consequences of the more aggressive therapy we generally reserve for men with more advanced, more extensive disease.”

Other options for men with advanced prostate cancer include radical prostatectomy – surgically removing the entire prostate – and radiation therapy, in which the prostate and surrounding area are irradiated to control the cancer from spreading elsewhere.

The importance of clinical trials

Dr. Kelly says that Black and African American patients who participate in clinical trials at Miami Cancer Institute or elsewhere for new prostate cancer therapies often do just as well and sometimes have even better outcomes than patients of other races.

Historically, though, Blacks and other minority populations have been excluded from those studies, says Dr. Kelly. “Here at Miami Cancer Institute, we’re focused on opening the window of opportunity for more Black men with prostate cancer to join clinical studies,” he says. “Study after study has demonstrated that when they do participate, they do better.”