Advancing Health Equity for Prostate Cancer Screening Diagnosis and Treatment for Black Men
- May 13, 2024
- 5 min read
Healthcare disparities and poorer healthcare outcomes exist for several minority groups because of barriers such as education, limited insurance, institutional bias within the healthcare system, poverty, and lack of access to adequate primary care. The same barriers exist in terms of black men and prostate cancer.
In 2022, there was an estimate of at least 268,490 cases of prostate cancer that will occur in the United States. Black men are disproportionally affected and have the highest incidence rate in the United States, with 183.4 new cases per 100,000. The prevalence of prostate cancer is significantly higher among black men, with 37% of new cancer diagnoses, yet black men in the United States make up only 13.4% of the population. Black men are also twice as likely to die from prostate cancer than other men. The positive side of prostate cancer is that if caught early, there is a 96% survival rate. However, black men are more likely to be diagnosed at more advanced stages of the disease, highlighting the need for more outreach, early diagnosis, and treatment.
Prostate cancer is one of the most common cancers. The prostate is a small walnut-shaped gland that produces the fluid that nourishes and transports sperm. Prostate cancer cells occur when abnormal cells grow. Many prostate cancer cells grow slowly and are confined to the prostate. Still, the aggressive types can grow more quickly and spread to other organs.
According to the Mayo Clinic, the major risk factors are:
Race - Black individuals have a greater chance of developing prostate cancer.
Age - Most cases occur after 50 years of age.
Family History – History of family members that have prostate cancer or family members that have breast cancer and have the BRCA1 or BRCA2 gene.
Obesity may also put an individual at greater risk and increase their chances of getting a more aggressive case of cancer.
Symptoms of prostate cancer:
Difficulty urinating
Decreased force in the stream of urine
Blood in urine or semen
Bone pain
Erectile Dysfunction
Losing weight without trying.
Diagnosis:
Digital Rectal Exam (DRE) – displays any changes to the prostate.
Prostate Specific Antigen (PSA) – a blood test to ascertain PSA levels in the blood with high levels suggesting the presence of prostate cancer.
Ultrasound – provides a view of the prostate.
Magnetic Resonance Imaging (MRI) – provides a more detailed prostate image.
Biopsy of Prostate Tissue – determines the presence of cancer cells.
Treatment for prostate cancer:
Surveillance includes periodic PSA tests and exams for prostate cancer at very early stages.
A prostatectomy is needed if the cancer cells are contained in the prostate and have not metastasized. Surgical removal of the prostate is the most definitive treatment.
Radiation therapy may be needed to kill existing cancer cells.
Freezing cancer cells may also be an option.
Heating cancer cells may be an option.
Chemotherapy
Hormone Therapy
Fewer black men undergo intensive therapy or definitive surgery such as prostatectomy.
Health Care and Knowledge Access/ Barriers:
Despite earlier disease progression, PSA screenings were lower among black men versus white men. For this reason, the American Cancer Society recommends that black men begin discussing PSA testing with their physician at 45 – 50 years of age.
There is not enough data on the prevalence of prostate cancer among Black gay, bisexual, or transgender men. Existing data suggests that screening among this population is even lower than cisgender black males. All black males experience barriers to access, such as lower socioeconomic status, poor health care coverage, poor health-seeking behavior, and limited knowledge of prostate cancer.
Black men, citing historical incidents, exhibit heightened distrust of the healthcare system, leading to a reduced likelihood of seeking prostate cancer evaluation. Limited access to culturally similar clinicians also contributes to the reluctance of black men to seek care. Although black men comprise 13.4% of the US population, only 5% of active primary physicians are black. Increasing the number of black and culturally competent physicians available to provide services to underserved communities may be one step in facilitating safe medical spaces and promoting better communication. A study of 1308 men with prostate cancer found that decisions among black men rely heavily on community, family, and interpersonal sources like barbers and pastors for information (Lillard et al., 2022). Nearly one-half of Black men report being uneducated about PSA screening, PSA testing, or digital rectal examination, leading to them being less likely to get screened for prostate cancer.
Treatment Access:
The quality of care and treatment outcomes for prostate cancer patients can be impacted by the type of healthcare facility available. Many low-income black men reside in neighborhoods with under-resourced hospitals, leading to delays in diagnosis and treatment. National Cancer Institute-designated Comprehensive Care Centers (NCI-CCCs) were implemented to provide structured care processes and have been shown to improve 5-year survival rates. However, these centers are often located away from areas with high black populations, contributing to geographic disparities in care. Additionally, black men were less likely to undergo prostate magnetic resonance imaging compared with white men. Financial hardship significantly impacts treatment options for cancer survivors across all demographics. Black men report fewer treatment options due to limitations imposed by their health insurance plans. Moreover, a higher proportion of black survivors compared to white survivors experience financial hardships stemming from cancer treatment. Those facing financial burdens are 4.4 times more likely to limit their care through medication non-adherence.
Black Enrollment in Clinical Trials:
A correlation exists between clinical trial participation and outcomes among advanced prostate cancer patients without access to clinical trials. Several factors contribute to the low representation in trials, including low health literacy associated with economic status, lack of trial information, and reluctance due to medical research disparities. The United States Food and Drug Administration guidance suggests enrolling diverse participants in government-funded trials. To enhance the recruitment of black men, proposed strategies include educating clinicians and recruiters, diversifying clinicians, offering financial aid to reduce travel barriers, and engaging with community and faith-based organizations.
Staying On Top Of Your Health:
Black men must prioritize their health, particularly by undergoing cancer screenings, specifically for prostate cancer. Statistics reveal a troubling trend that black men are disproportionately affected by prostate cancer, facing higher incidence rates and more aggressive forms of the disease compared to other racial groups. Despite this heightened risk, many black men delay or forgo screenings, often because of cultural stigmas, fear, or a lack of awareness. However, early detection is essential for successful treatment and improved outcomes. By taking proactive steps such as regular screenings, black men can detect prostate cancer at its earliest stages when it's most treatable. It's crucial for black men to recognize the importance of their health and to overcome any barriers preventing them from seeking timely medical care. By doing so, they can safeguard their well-being and potentially save lives.
References:
Lillard, J. W., Moses, K. A., Mahal, B. A., & George, D. J. (2022). Racial disparities in Black men with prostate cancer: A literature review. Cancer, 128(21), 3787–3795. https://doi.org/10.1002/cncr.34433
Rosser, B. R. S., Hunt, S. L., Capistrant, B. D., Kohli, N., Konety, B. R., Mitteldorf, D., Ross, M. W., Talley, K. M., & West, W. (2019). Understanding Prostate Cancer in Gay, Bisexual, and Other Men Who Have Sex with Men and Transgender Women: A Review of the Literature. Current Sexual Health Reports, 11(4), 430–441. https://doi.org/10.1007/s11930-019-00234-7
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