According to the American Cancer Society, prostate cancer remains the most commonly diagnosed cancer among Black men in the United States. Black men are more than twice as likely to die from the disease as white men, according to Nicholas Shungu, MD, MPH, Associate Professor in the Department of Family Medicine at the Medical University of South Carolina.
But the disparity isn’t simply a matter of biology or genetics. Differences in access to screening, early detection, and high-quality treatment may play a significant role in determining who survives prostate cancer. “The main driver of that disparity is related to differential access to screening and high-quality treatment of prostate cancer,” Dr. Shungu told BlackDoctorPro.
Dr. Shungu pointed to research examining prostate cancer outcomes within the Veterans Affairs health system. He said the research found that Black men were not more likely to die from prostate cancer than white men within that system, suggesting that access to care may play an important role in closing the mortality gap.
For providers, that finding carries an important message: improving outcomes for Black men requires examining not only patients’ individual risk factors, but also the gaps within the healthcare system that can prevent them from receiving timely, high-quality care.
Prostate cancer screening can help detect the disease before symptoms develop, when treatment may be more effective. Yet Black men are screened at lower rates than white men, according to Dr. Shungu. “Lifesaving early detection cannot occur if screening does not occur,” he said.
The issue is complicated by current screening recommendations, which generally call for patients and providers to discuss the potential benefits and risks of prostate cancer screening and make an individual decision. But those conversations aren’t always happening.
Dr. Shungu said research from his team and others has found that prostate cancer screening discussions occur in only about half of routine care visits. That means some patients may assume that if screening were necessary, their provider would automatically order it. In focus groups conducted by Dr. Shungu’s research team, some Black men were surprised to learn about the racial disparity in prostate cancer mortality — and that their doctors had never discussed screening with them.
Misconceptions about what screening involves can create another barrier. Some men believe prostate cancer screening automatically requires a digital rectal exam. However, screening can begin with a prostate-specific antigen, or PSA, blood test. Others may mistakenly believe that having a colonoscopy means they have also been screened for prostate cancer. For providers, clearing up these misconceptions may be just as important as recommending screening itself.
The American Cancer Society estimates that about one in 35 Black men will die from prostate cancer. Yet Dr. Shungu believes some providers may not fully recognize the magnitude of the racial disparity — or communicate that risk to their Black patients. “The fact that Black men are dying at over two times the rate of white men from prostate cancer should be horrifying and unsettling,” he said.
Another challenge is the evidence underlying prostate cancer screening recommendations. Dr. Shungu noted that Black men have historically been underrepresented in studies used to inform screening guidelines, despite carrying a disproportionate burden of the disease.
But detecting prostate cancer is only one part of improving outcomes. Once Black men are diagnosed, disparities in treatment can create another barrier to survival.
According to Parth K. Shah, MD, a board-certified urologist at Texas Oncology, Black men may face delays in beginning treatment because of barriers such as taking time off from work, traveling for care, and mistrust of the medical system. They may also be less likely to receive care from highly experienced surgeons and high-volume treatment centers.
Providers can help close those gaps by ensuring patients with curable, high-risk cancers are offered appropriate definitive treatment, referring patients to experienced centers when needed, and closely following patients throughout treatment. Helping patients navigate the financial and logistical challenges associated with care is also important.
Communication matters, too. Dr. Shungu said some participants in his team’s focus groups viewed the absence of those conversations through the larger history of inequities and mistreatment of Black patients within medicine. For providers, proactively addressing prostate cancer risk can therefore be an opportunity to improve early detection while strengthening patient trust.
If Dr. Shungu could make one immediate change, it would be simple: make prostate cancer screening conversations a routine part of caring for Black men. “I would want providers to discuss prostate cancer screening with every Black man as part of routine care,” he said.
Because many health systems do not have electronic reminders prompting clinicians to address prostate cancer screening, the conversation can easily fall through the cracks. Providers may need to intentionally incorporate it into preventive care visits rather than waiting for a patient to ask. Those discussions should include the disproportionate burden Black men face, what screening involves, and the potential risks and benefits so patients can make informed decisions about their care.
Providers can also examine how they communicate with patients after diagnosis. Dr. Shah recommends talking “with patients, not at them,” using clear decision aids, diagrams, and educational materials that include Black patients and families.
Patient navigators and community outreach can also help patients overcome scheduling, transportation, and paperwork barriers that might otherwise delay care.
Increasing Black men’s access to clinical trials is another opportunity. Dr. Shah noted that Black patients are less likely to be offered access to cutting-edge treatments through clinical research.
Providers should also consider the larger factors affecting a patient’s prostate cancer risk and outcomes. Social drivers of health — including where patients live, employment, and environmental exposures — can influence cancer risk and access to care. Diet, exercise, and genetics can also play roles.
But Dr. Shungu cautioned against treating the disparity as something inherent to Black men.
Research showing comparable prostate cancer mortality between Black and white men when access to care is more equitable suggests something much more actionable: the healthcare system can change these outcomes.
Dr. Shah described it as a “nurture” problem rather than a “nature” problem — a disparity that is solvable rather than inevitable. For providers, closing the gap starts with ensuring Black men aren’t overlooked at any point in their care. Talk about their risk. Discuss screening. Correct misconceptions. Address barriers that could delay treatment. Make sure that once prostate cancer is detected, patients have access to timely, high-quality care. When early detection and appropriate treatment can save lives, what providers do matters differently.
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