Prostate cancer is the second most common type of cancer in the United States, representing approximately 13 percent of new cancer cases in 2021.

Proactive screening efforts and effective treatment options mean that many people diagnosed with prostate cancer have a good prognosis. From 2012 to 2018, the estimated 5-year survival rate for prostate cancer (that is, the percent of people who are alive 5 years after diagnosis) was 96.8 percent.

But prostate cancer affects everyone differently, and there’s clear evidence that differences in prostate cancer occurrence and outcomes vary based on race.

In this article, we examine the link between prostate cancer and race, including the social and biological factors that may drive these differences.

Language matters

Sex and gender exist on spectrums. This article uses the terms “men” and “males” to refer to sex assigned at birth. Your gender identity may not align with how your body responds to this disease.

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Among all American males, the estimated number of new cases of prostate cancer is 112.7 per 100,000 people, but these rates vary drastically by race.

According to the data from the National Cancer Institute, the number of new prostate cancer cases in the United States per 100,000 people is:

  • 183.4 for Black males
  • 110 for white males
  • 88.6 for Hispanic males
  • 70.3 for Native American and Alaska Native males
  • 59.6 for Asian American and Pacific Islander (AAPI) males

The prostate cancer death rate is also more than twice as high in Black men than in white men, and over four times higher than in AAPI men.

Despite having a lower reported case rate than white men, Native American and Alaska Native men are also slightly more likely to die from prostate cancer than white men.

Disparities in access to and quality of healthcare may explain racial differences in the estimated number of prostate cancer cases and the outcomes of these cases.

According to a 2021 study that looked at outcomes for people undergoing active surveillance of prostate cancer within the Veterans Affairs (VA) Health System, where all individuals have more equal access to care, disease outcomes were similar for Black and white people.

Another 2019 study compared data from 300,000 people with prostate cancer and found that in systems with standardized care such as the VA and clinical trials, disease outcomes are similar regardless of race.

These results suggest that access to care and appropriate treatment options may drive differences in prostate cancer outcomes, particularly for Black Americans.

Compared with white men, Black men are 45 percent less likely to receive follow-up care after a prostate-specific antigen (PSA) test suggesting the potential presence of prostate cancer.

Additionally, a 2015 study from the Centers for Disease Control and Prevention (CDC) found that prostate cancer screening rates were substantially lower among Native Americans and Alaska Natives than they were among Black and white males.

Research suggests that Native American males often present for prostate cancer care with more advanced disease, which likely contributes to the higher rate of negative outcomes observed in this population.

Efforts to reduce healthcare disparities and promote early screening in high risk populations may therefore help improve outcomes for Black and Native Americans.

Social and behavioral differences may also increase the risk of developing prostate cancer in some groups.

For example, exposure to certain pesticides often used in agriculture has been linked to an increased likelihood of developing prostate cancer.

According to the United States Bureau of Labor Statistics, Hispanic people make up over one-quarter of workers in the agricultural, forestry, fishing, and hunting industries, meaning that they may be more likely to be exposed to harmful, cancer-causing chemicals.

Diet is another factor that may contribute to the likelihood of developing prostate cancer. Cultural background often influences the types of foods we eat and can vary for different racial and ethnic groups.

Some specific dietary factors that have been linked to possible prostate cancer risk include:

  • calcium and vitamin D intake
  • lycopene intake
  • red meat intake

Although prostate cancer outcomes may be improved in Black Americans by reducing health inequities, some research suggests that the likelihood of developing prostate cancer may be higher for Black Americans than white Americans, regardless of socioeconomic risk factors.

These differences may be explained by biological factors like genetics. Research has shown that the genetic mutations that lead to prostate cancer in white populations are not the same as those in Black or Asian populations.

Different types of mutations may influence the likelihood of prostate cancer development and how quickly cancer progresses. They may also influence how people respond to treatment.

A recent 2022 study found that among Asian American men, Pacific Islander and Chinese men have the best outcomes after prostatectomy, or removal of the prostate.

Some small studies have found that Black Americans may actually respond better to certain types of therapies than white Americans, including immunotherapy and hormone-based therapy.

While these results are encouraging, it’s hard to know how they apply to the wider population of Black and Asian individuals in the United States. Racial and ethnic minorities have historically been underrepresented in prostate cancer clinical trials.

A 2020 analysis of 72 clinical trials found that Black men accounted for less than 5 percent of clinical trial participants on average. Other non-white races and ethnicities were included in even lower numbers.

Prostate cancer is a common but highly treatable disease in the United States. Certain populations, including Black and Native Americans, are more likely to develop prostate cancer and have poor disease outcomes.

Racial differences in prostate cancer numbers and outcomes in the United States are mostly driven by healthcare inequities, but a variety of social and biological factors contribute as well.

More diverse clinical trial participation is needed to understand the link between race and prostate cancer so that we can better treat our diverse population.