For African-American men, the risk of dying from low-grade prostate cancer is double that of White men.

The new findings come from a study conducted by the National Cancer Institute (NCI) which revealed that doctors may be “underestimating the risk” of death from low-grade prostate cancer in Black men. This finding, recently discussed during a June Men’s Health Month event, has proven to be consistent with other reports that have identified racial differences in the biology and presentation of the disease.

Biological factors can contribute

A growing body of evidence tends to support the idea that certain biological factors may make low-grade prostate cancer more likely to grow and spread in Black men than in men of other races. The NCI study analyzed data from the institute’s Surveillance, Epidemiology and End Results program. A special database contained information on more than 190,000 men with prostate cancer who underwent active surveillance (or watchful waiting) between 2011 and 2016.

Patients were followed for a median of three years. During the process, researchers looked at socioeconomic status—a measurement of a person’s income, education, and occupation. Socioeconomic differences, they reported, can lead to health disparities such as less access to treatment.

They also looked at tumor genomics as a possible variable in biological differences (i.e. the features of prostate tumors). More Black men with low-grade prostate cancer had tumor genomic characteristics linked to metastasis (the spread or transfer of any disease, especially cancer) than White men. Characteristics were higher in African-Americans, suggesting that differences in tumor genomics may make low-grade prostate cancer more aggressive in Black men.

A lack of access to health care

“We must reach these patients long before they reach the late stage of the disease,” said Dr. Dana Richardson-Heron, chief patient officer with Pfizer. “It is a similar story among African-Americans with health maladies; the lack of access to quality health care results in many people waiting too long to be diagnosed. Physicians must meet patients ‘where they are’ to better serve their needs. This can help establish a pathway to health equity.”

The prostate is part of the male reproductive system. It is a small gland that sits directly below the bladder. It plays a role in hormone and semen production and helps to manage urine flow. Prostate cancer occurs when cells in the prostate grow out of control. This happens when there are changes in the DNA of prostate cells. Some potential causes of prostate cancer included inherited genes that increase the risk of developing cancer, and acquired mutations from exposure to toxic chemicals.

Clinical trials overlook Black men

Prostate cancer can remain symptomless for a long time. Richardson-Heron said people need to educate themselves about the risks and have regular screenings with a doctor. Clinical trials are a great way to determine who may be at greater risk of prostate cancer, but gaining access to these studies isn’t always easy.

African-American men may also be harmed by racial bias in preventative care, as they are less likely than White men to be offered the option of having a PSA test (prostate-specific antigen). They are more likely than White men to be told that the benefits of the PSA test are uncertain. Also, African-American men diagnosed with early-stage prostate cancer are often less likely than White men to receive any type of treatment for the disease.

“Prostate cancer clinical trial participants are overwhelmingly White,” Richardson-Heron said. “While Black men are twice as likely to die from the disease, those men are usually not included in these trials. And this goes to early detection—screening—that can lead to an early diagnosis that is the key to saving lives.”

The risk factors

Doctors don’t fully understand why Black males have a higher risk of getting and dying from prostate cancer than other males. Genetics may play a role. Some people with the disease report having other family members with a history of prostate cancer. Unlike other cancers with modifiable risk factors (e.g. smoking and lung cancer, sunlight and skin cancer, and alcoholism and liver cancer), experts only know of three “fixed” risk factors for prostate cancer: age, race and family history.

The Prostate Cancer Foundation this year released findings from a study that found that men of African ancestry had an estimated mean genetic risk score (GRS) more than two times higher than men of European ancestry. There are risk factors that may account for the more aggressive prostate cancer in Black people:

—Obesity. Non-Hispanic, Black males are more likely than non-Hispanic White males to have obesity. Among the possible reasons for this are racism, racial trauma and socioeconomic factors;

—Socioeconomic status. African-American men are more likely to have a lower socioeconomic status than other men. Low socioeconomic status has links to a higher chance of cancer due to reduced access to medical care and the ability to pay for it;

—Racial bias in health care. African-American men may face racial bias in healthcare, and in some cases, may avoid treatment because of it. For example, Black men are less likely to receive prostate screenings or PSA tests.

—Delayed care. Some Black males may be afraid of getting a prostate exam or may have difficulty accessing or paying for healthcare due to a lack of insurance coverage.

Get screened beginning at age 45

Diet can also play a role. An excess of charred, fried and grilled meat can contribute to prostate cancer. So can dairy products high in calcium (e.g. cheese and ice cream).

“It is highly recommended that men be screened for prostate cancer beginning at age 45. Black men tend to start at age 55…that’s too late,” said Mark Kennedy, senior program manager with Boston Public Health. He said doctors may be underestimating the levels of low grade prostate cancer among Black men. The aggressive nature of prostate cancer in Black men, he said, justifies earlier screening which offers doctors the chance to catch the disease before it spreads outside of the prostate or grows to an advanced stage.

Kennedy suggested that some men don’t always understand medical terminology which can complicate one-on-one discussion regarding a possible diagnosis.

Speaking with your doctor

“Common and basic medical terms are not always fully understood by many patients,” Kennedy explained. “An example would be the difference between ‘urination’ and ‘urinary frequency’–two terms that would come up during a discussion about prostate cancer.”

Kennedy said this terminology is often specific to the symptoms of prostate cancer when a person might notice frequent or painful urination; painful ejaculation or a decrease in the amount of ejaculate; pain in the back, hips or thighs; blood in semen or urine; weak urine stream and unintentional weight loss.

There are alarming statistics regarding the frequency of prostate cancer among Black men. The American Cancer Society this year reported that one in seven Black men will be diagnosed with prostate cancer in their lifetime. It is estimated that 29,750 African-American men will be diagnosed with prostate cancer in 2021. Some 5,350 of these men will die of the disease this year.

Advance in treatment options

Despite these dire statistics, the good news is that, with early screening, nearly 97 percent of African-American men diagnosed with prostate cancer in its early stages are still alive five years after the diagnosis.

The many treatment options and learning choices for prostate cancer can help Black men make the right decision. Types of standard treatment include active surveillance, surgery, radiation therapy, hormone therapy, chemotherapy, immunotherapy and ultrasound. Some clinical studies are evaluating new treatments such as cryosurgery and Focal Laser Ablation. Researchers are testing new drugs, different combinations of treatments, and new approaches to radiation therapy or surgery.

“If you catch prostate cancer early on, you can live a healthy and productive life,” Kennedy said. “The screening process is a simple and painless procedure that can definitely save your life.”