“It was a gut punch.” That was Secretary of Defense Lloyd Austin in January following his prostate cancer diagnosis. He said the news had not only affected him but also shocked many others “especially in the Black community.”
Austin’s diagnosis–which was made public on Jan. 9 about a week after he had been hospitalized with complications from a previous surgery–has renewed public discussion around prostate cancer in the Black community. All men are at risk of prostate cancer, the second most common cancer among men in the U.S. according to the Centers for Disease Control and Prevention (CDC). The American Cancer Society estimates there are nearly 300,000 new cases of prostate cancer and just over 35,000 deaths this year.
A disease far more aggressive in Black men
Both the CDC and the American Cancer Society confirm the disease is more aggressive in Black men who are two times more likely to die from the disease than White men.
The prostate is part of the male reproductive system. It is a small gland that sits directly beneath the bladder and plays a role in hormone and semen production and helps to regulate urine flow.
Statistics from the National Center for Biotechnology reveal that Black men are less likely to see a physician regularly. Many report that doctor visits are often stressful and that physicians do not provide adequate information on how to make prescribed behavior or lifestyle changes. This may underscore the need for patients to ask questions and seek clarity during their doctor visits. Also, there are stigmas and hurdles that Black men face, such as mistrust of the healthcare system, fear of diagnosis, cultural beliefs that may discourage seeking medical help, lack of awareness about the importance of regular checkups, economic barriers, limited access to healthcare, and–particularly in the Black community–a certain level of “shame” surrounding mental health.
“Not all prostate cancer is lethal but we have seen that Black men do have a higher risk of dying from prostate cancer,” said Dr. Abhinav Khanna, a urologist at the Mayo Clinic in Rochester, Minn.
Lack of screening tied to socioeconomic status
One potential reason, Khanna suggested, is that Black men–depending on their socioeconomic status–may not get screened as vigilantly as White and Asian men do in the U.S., thereby leading to more advanced cancer diagnoses and worse outcomes. The Journal of Cancer published a study two years ago which revealed that outcomes for Black men with prostate cancer are worse because they are less likely to be screened or to receive timely treatment.
Like all cancers, prostate cancer occurs when cells in the prostate grow out of control. This happens when there are changes in the DNA of prostate cells. The CDC says some potential causes of prostate cancer include inherited genes that increase the risk of developing cancer and acquired mutations often from exposure to toxic chemicals.
Doctors do not fully understand why Black males have a higher risk of getting and dying from prostate cancer than other males. However, they believe that genetics plays a role. Some people with prostate cancer report having other family members with a history of the disease.
A family history as risk factor
Sometimes if your immediate paternal/relative have been diagnosed with prostate cancer, or even secondary-degree relatives, your risk of the disease can increase. This is true with related cancers that run in families like breast cancer, ovarian cancer and other germline (germ cells that continue through successive generations) genetic mutations that can increase your risk for cancer.
The American Cancer Society notes that one in six African-American men will develop prostate cancer in their lifetime, compared to one in eight men overall. While prostate cancer can be treated, the lack of regular medical care can contribute significantly to worse health outcomes.
Prostate cancer is a very sensitive subject for men of any creed or color. It’s only after they are diagnosed–or come to terms with their diagnosis or undergo treatment–that most men are comfortable talking about their diagnosis. For a majority of men, there won’t be any outward symptoms of prostate cancer until the disease is more progressed. That’s one reason why it is so fatal among Black men. It’s too late to treat it. The major symptoms include frequent and painful urination; inability to maintain an erection; painful ejaculation or a decrease in the amount of ejaculate; pain in the back, hips or thighs; blood in semen or urine; a weak urine stream and unintentional weight loss.
Prostate cancer can lead to the onset of urinary and fecal incontinence. Incontinence is a condition in which a person is unable to control the movements of their bladder and bowels. This causes urine or stools to leak involuntarily.
Make a decision to get screened
Before symptoms begin to appear, the only screening for prostate cancer is a blood test called a prostate-specific antigen, or PSA. In 2018, the U.S. Preventive Services Task Force recommended that men ages 55 to 69 years make an individual decision whether to get a PSA test. The task force advised against prostate screening for men 70 years and older. Screening tests can raise any clinical suspicion of prostate cancer. A prostate biopsy is almost always needed to confirm the diagnosis.
There are risk factors that might account for the more aggressive prostate cancer in Black males:
–Obesity: Non-Hispanic Black males are more likely than non-Hispanic White males to have obesity. The International Journal of Environmental Research and Public Health has reported that racism, racial trauma and socioeconomic factors may increase the rate of obesity among Black people.
–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.
–Delayed care: Some African-American males may be afraid of getting a prostate exam or may have difficulty accessing or paying for healthcare due to various factors such as residing in an underserved community.
One man’s successful journey
Among Black urologists who diagnose and treat prostate cancer, they say it is important to note that the stress of enduring racism and racist systems may play a part in developing the disease beyond genetic factors. Regardless of longstanding racial barriers in medical care, early detection is critical as prostate cancer is always treatable and often curable. Because prostate cancer can remain symptomless for a long time, people need to educate themselves about the risks and have regular screenings with a doctor.
For example, Michael Downer an employee with Kaiser Permanente—was slowing down. He thought it was just a part of getting older. Suspecting a vitamin deficiency and the need to lose a little weight, he expected his doctor to prescribe something during his next annual physical. Following his diagnosis, doctors suggested something called “active surveillance” or monitoring as a treatment option. Downer said he was fortunate as his level of the disease would never develop into anything that would require treatment.
Downer emphasizes the importance of being proactive about health and believes in never hesitating to ask questions and seek clarity when consulting your doctor.
“Understanding your health and the treatments available is crucial in making informed decisions and taking control of your health journey,” Downer said. “No one will advocate for you better than yourself. For men, particularly African-American men, overcoming stigmas and hurdles to seeking health screenings and care is crucial for better health outcomes.”