Ask the Expert

Dr. Shaal Patel, a board certified physician in hematology, oncology, and internal medicine, spoke with Healthline about how prostate cancer affects Black men, including rate of diagnosis, survival, the role of genetics, and screening guidelines.

One in 6 Black men will have prostate cancer in their life compared to 1 in 8 men overall.

Prostate cancer is the second most common cancer in men, at 14.1% of new cancer cases annually. Among all men, prostate cancer accounts for 6.8% of cancer deaths annually. This makes prostate cancer the fifth highest cause of cancer mortality in men.

Prostate cancer accounts for 37% of all cancer diagnoses among Black men. It also accounts for 17% of cancer mortality, which is the second highest after lung cancer.

In 2020, there were nearly 1.4 million new cases of prostate cancer worldwide. According to a 2022 review, African American men have the highest incidence of prostate cancer in the world.

In the United States, Black men have the highest incidence and mortality rates from prostate cancer than any other ethnic group. Specifically, the incidence and mortality rates of prostate cancer among Black men are more than twice as high (60%) as rates among white Americans and 3 to 4 times higher than rates among Asian Americans.

African American men develop prostate cancer at a younger age and have more active or aggressive forms of prostate cancer compared to their white counterparts. On average, the diagnosis of prostate cancer in an African American man occurred 3 years earlier than it did in white men of a similar age in the United States.

One explanation for this is that Black men may develop symptoms from their prostate cancer earlier (for example, symptoms of an enlarged prostate) compared to other racial groups.

Another explanation points to African American men experiencing puberty earlier than their white counterparts. This can be a risk factor because prostate cancer is fueled by testosterone. When males go through puberty, there’s a testosterone surge. If a man experienced puberty earlier in life, they have been exposed to testosterone for a much longer period than someone who began puberty later on.

Prostate cancer has the second highest death rate of all cancers among Black men. It accounts for approximately 17% of the cancer deaths in Black men. However, the discrepancy in survival rates by stage for Black men versus white men who have prostate canceris not as large as in other types of cancer.

The 5-year survival rates for prostate cancer at various stages are as follows:

  • Localized and regional: Around 99% for both Black and white men.
  • Advanced disease: Around 30% in Black and white men.

Yes, but not all of the time. Inherited gene mutations (those you’re born with) can be found in up to 10% of patients with prostate cancer. Family linkage in a diagnosis of prostate cancer does exist, but it’s not always strong.

However, a man who has a father or brother with prostate cancer is more than twice as likely to be diagnosed with prostate cancer. The risk is higher for men with a brother as opposed to a father who has had prostate cancer.

The higher number of relatives who have been affected by the disease increases a person’s risk of developing prostate cancer. This is especially the case if your relative with prostate cancer was diagnosed when they were young.

The death rate of prostate cancer is 2.3 times higher in African American men compared to white men. Risk factors that influence the higher death rate of prostate cancer in African American men compared to the other racial groups include:

  • lower socioeconomic status
    • lack of quality medical care available (lack of early screenings or delayed access to medical care when a diagnosis is made)
    • exposure to environmental risk factors
    • lifestyle (poor diet, smoking, lack of exercise, etc.)
  • genetic behavior (aggressiveness) of the cancer

In general, prostate cancer screening is controversial and is a decision between the patient and the physician.

The American Urological Association recommends prostate cancer screening for Black men around age 40, which is earlier than other racial groups. Other cancer organizations recommend that discussion about screening start around age 45. This is earlier than age 50, which is the recommended age to begin discussions about prostate cancer screening in a man with no risk factors.

There are no specific recommendations for frequent screenings simply because a patient is Black.

Dr. Sheel Patel is an ABMS board certified physician in hematology, oncology, and internal medicine. Dr. Patel is a practicing physician at the Orlando VA Medical Center in Florida. He specializes in genitourinary oncology.