According to the American Cancer Society Black men have an estimated 70% to 110% higher incidence and mortality rate for prostate cancer than white men overall in the U.S.
To Dr. Jonathan Fainberg, assistant professor at Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College it is good that September is designated to spread awareness of the disease, but the real key all year round is early detection. “Early detection of cancer is critical across nearly every cancer because we know that treatment of early cancer can be minimal treatment with few side effects. Whereas if we wait, treating things that are more advanced tend to require more aggressive treatments with more side effects.” In the Black community, though, there is a reason it affects men more often than white men.
“Historically, it was always thought that African American men or men of African and Caribbean ancestry had more aggressive prostate cancer than white or European men because they tended to die more often from prostate cancer than their non-black counterparts,” Fainberg explained.
However, as the science in genetics has studied the disease, it’s become clear that a tremendous portion of the reason that Black men dying more often from prostate cancer than their non-Black men is linked to screening.
“Biologically there are many similarities between Black and white men with prostate cancer,” he said. “[This] goes back to the importance of screening and access to health care and access to high quality doctors that an individual man can have an individualized approach to managing his cancer. We know that screening saves lives and in communities that have historically had little access to screening, the importance of screening must be overstated.”
Prostate cancer occurs when abnormal cells located within the prostate gland divide and grow in an uncontrolled manner. Over time, this can impact other parts of the body.
Early signs of prostate cancer can include: blood in the urine and semen, needing to urinate more frequently or difficulty urinating, and waking up at night to urinate. Detecting prostate cancer early can be done in a variety of ways. A digital rectal exam involves a healthcare provider checking for possible areas of the prostate that may indicate cancer. The prostate makes a protein called protein-specific antigen (PSA) which if elevated could indicate cancer or some other disease of the prostate.
Fainberg says patients are usually referred to a urologist after their primary care doctor administers a blood test called a PSA (prostate specific antigen) for the cancer. Most commonly, the primary care doctor will order the test to check the blood. If the PSA level comes back elevated, they’ll refer you to a urologist.
“If [the PSA] is elevated, the next step is to wait and repeat the PSA because about half of patients will have a normal PSA. If the PSA remains elevated on the repeat test, typically then we need to start doing more to both image the prostate gland and to decide if there’s cancer inside of it, and further to decide if that cancer warrants treatment.”
He added that a healthcare provider may also suggest a biopsy, which involves inserting a needle to get a sample of prostate tissue to examine in a lab.
“The most common way that we diagnose prostate cancer is with a prostate biopsy, which is a procedure where we put needles inside of the prostate to take out small fragments of tissue and then look at that tissue under the microscope.”
Estimates are that in 2025, approximately 313,780 new cases of prostate cancer will be diagnosed in the United States and there will be 35,770 deaths from prostate cancer. Also, there is a 12.9% lifetime probability of being diagnosed with prostate cancer.
“We know that not all prostate cancers need treatment. What’s really important is an individualized approach to PSA screening and prostate cancer management because we know that prostate cancer is very common … the decision of whether or not to treat a man with prostate cancer is very nuanced and detailed and involves a lot of thinking and discussion with the urologist and the patient to try and decide what’s best for the individual patient.”