The unequal burden: Prostate cancer hits Black men harder. Can the gap be closed?

Last updated: 2 October 2024

Although it affects all men, Black men are twice as likely to develop prostate cancer. The statistics are striking — 1 in 4 Black men will be diagnosed in their lifetime, compared to 1 in 8 men from all backgrounds. Unfortunately, Black men are disproportionately diagnosed at later stages of prostate cancer or with the more aggressive forms, which reduces treatment options and shortens survival lengths. Studies suggest that genetic factors play a role in why Black men are at a higher risk of developing prostate cancer. However, socioeconomic disparities, as well as systemic barriers and biases, unfortunately also contribute to fewer Black men accessing early screening and timely treatment. Prostate cancer diagnosed in the earliest stage is almost entirely survivable, but the odds of survival fall steeply for later stages where the cancer has spread to other parts of the body.

It is essential that all Black men know about their elevated risk. Efforts to engage Black communities and raise awareness are beginning to make a positive impact in addressing these disparities, helping to improve detection, treatment, and survival rates in prostate cancer.

In the US, it was reported in 2022 that just under half of Black Americans had private health insurance, compared to 73% of non-Hispanic White Americans. Even for those that are insured, studies have shown that even the smallest amount in cost-sharing is a barrier for many, leading to too many men in vulnerable groups not accessing tests for prostate cancer when it is in an early and therefore curable stage. The HIM (High-risk Insured Men) Act is a recent legislative effort in the US addressing this disparity in screening, aimed at high-risk groups including Black men. The bill seeks to remove financial barriers by requiring that insurers cover a widely used prostate cancer screening tool, the Prostate-Specific Antigen (PSA) test, without co-pays, deductibles, or other out-of-pocket costs.

In the UK, every Black man over the age of 45 years is eligible to have the PSA test from their GP. The NHS and charity Prostate Cancer UK run targeted awareness campaigns aimed at Black communities, collaborating with leaders and influencers to break the stigma surrounding prostate health and encourage regular testing for those at greater risk. High profile clinical trials evaluating the effectiveness of diagnostic and treatment programs, such as the PROSTAGRAM and TRANSFORM studies, are also designed to address racial and socioeconomic disparities by recruiting a larger proportion of Black men.

It is important that awareness campaigns and health screening programs, whether in the US or UK, are able to reach Black men who might not engage with traditional healthcare systems due to fear of racism and a well-described distrust of medical practice and research. Many groups harbor unspoken fear regarding medical visits, and this fear is often heightened for Black men who may feel the healthcare system is not designed to prioritize them. When patients do not trust the system, they may delay addressing symptoms until it is too late. Support groups and collaborations with regional trusted organizations play an important role in spreading awareness to local communities, ensuring that men are getting the information, support and care they need.

Advocacy groups and charities like Prostate Health Education Network (PHEN), ZERO Prostate Cancer, PCRI (Prostate Cancer Research Institute), Prostate Cancer Education Council (PCEC), Prostate Cancer Research UK, and many others are leading efforts to close the gaps by proactively engaging communities as well as primary and secondary care providers.

Promoting equity of access to PSA testing is a lofty initial goal, yet it is a far from perfect screening tool by itself. In 2023, we at Oxford BioDynamics launched the EpiSwitch Prostate Screening Test (PSE) to more accurately detect prostate cancer. The routine blood test boosts the accuracy of prostate cancer testing to 94%, which can save valuable time in getting underserved populations a correct diagnosis.

Without the PSE, using a standard PSA test alone, as high as 3 in 4 men with a positive result do not have cancer and are often unnecessarily sent for more complex hospital procedures, such as an MRI or prostate biopsy. We believe that using the PSE test can reduce the reliance on these hospital visits. The PSE uses a small blood draw, which is more accessible for all communities, and available anywhere with minimal resources. By improving the accuracy of screening, fewer patient journeys may need to be made, cutting the disruption to working lives and patient burden.

We developed the PSE using samples from the diverse PROSTAGRAM study, which was equally representative of Black, Asian, and other ethnicities. Oxford BioDynamics is also involved in another collaboration with the Imperial NHS Trust in the UK which is specifically looking at use of the PSE in Black Men.

As a company, we support and work with several charities who are active in raising prostate cancer awareness in the community, including ZERO Prostate Cancer in the US, and Cancer Research UK and Macmillan Cancer Support in the UK.

By acknowledging and confronting these disparities, we can work towards equitable care for all men. We would urge all Black men over forty, or who know someone in the family has had prostate cancer, to be aware of their increased risk and seek advice about getting tested.

About the Author: Chidiebube Chikezie was born in Porthacourt, Nigeria and completed her undergraduate studies at Georgia State University in Atlanta. She is currently pursuing a master’s degree in biotechnology from Georgetown University while conducting a Capstone internship at Walter Reed Army Research Institute. Chidiebube’s academic interests include biotechnology, project management, neuroscience and precision medicine.

Proof Sources:

Cancer Support and Awareness Organizations:

EXPLORE US Patient Advocacy Groups (PAGs)

ZERO Prostate Cancer:

ZERO Prostate Cancer is the leading national nonprofit with the mission to end prostate cancer. ZERO advances research support and creates solutions to meet the most critical needs of prostate cancer patients and their families.

Prostate Cancer Foundation (PCF):

As the Global Public Square of Prostate Cancer, PCF brings together patients, researchers, caregivers, and clinicians into a singular community focused on reducing death and suffering from PCa.

American Cancer Society (ACS):

Provides a wide range of support services, including patient transportation, lodging assistance, and a 24/7 helpline. ACS works to improve the lives of people with cancer and their families through advocacy, research, and patient support.

Prostate Health Education Network (PHEN):

Their mission is to eliminate the African American prostate cancer disparity, and to increase the overall support and resources for a war on prostate cancer that will lead to a cure for the disease for the benefit of all men.

Prostate Cancer Education Council (PCEC):

As the leading innovative organization, saving and improving the lives of men and their loved ones, PCEC focuses on early detection, research, education and awareness for prostate cancer and all prostate conditions. PCEC is not only the national leader in providing prostate cancer screenings for men in all stages of the disease; PCEC is also the national leader in increasing awareness and education on prostate disease.

Prevent Cancer Foundation:

The only U.S.- based nonprofit organization solely dedicated to cancer prevention and early detection. Our mission is to empower people to stay ahead of cancer through prevention and early detection. Our vision is a world where cancer is preventable, detectable and beatable for all. The Prevent Cancer Foundation® was founded in 1985 and carries out its mission by focusing its work in four areas: Research, Education, Outreach and Advocacy.

Prostate Cancer Research Institute (PCRI):

As the Global Public Square of Prostate Cancer, PCF brings together patients, researchers, caregivers, and clinicians into a singular community focused on reducing death and suffering from PCa.

EXPLORE UK PAGs

Prostate Cancer UK:

Prostate Cancer UK’s mission is to stop prostate cancer from killing men. By funding research to develop better treatments and early detection tests, they aim to save thousands of lives and potentially establish a national screening program.

Graham Fulford Charitable Trust (GFCT):

Founded by Graham Fulford, GFCT promotes awareness of prostate cancer and offers a range of blood tests for health screening. They organize PSA testing events and broader health tests to catch various conditions early.