“Prostate cancer remains the most commonly diagnosed cancer among Black men in the United States, with an estimated 57,300 cases expected in 2025, accounting for 44 percent of all cancer diagnoses in Black men. Black men have the highest prostate cancer death rate of any other racial or ethnic group, and are over twice as likely to die from prostate cancer as white men,” reports the American Cancer Society’s Cancer Action Network. Early detection is especially important because Black men often are diagnosed so late that the cancer is inoperable. Advanced imaging, genetic testing, biomarkers, targeted therapies, and theranostics are helping clinicians save lives. For clinicians seeing Black men, age ranges may need to be lower in order to request adequate testing and identify high-risk patients. Here’s what physicians say
Justin Houman, MD, FACS, Assistant Professor of Urology at Cedars-Sinai Medical Center, said that in the world of prostate cancer treatment, more has changed in the last ten years than in the forty before it. “The biggest shift was PSMA PET, which let us see disease we used to miss entirely, and once we could see it, we could target it.” He noted that lutetium-177 PSMA 617 (also called Pluvicto) is a radiation therapy that targets a surface molecule on prostate cancer cells. Essentially, it homes in on the tumor and delivers radiation from the inside. It is approved with hormonal therapy in the metastatic hormone-sensitive setting, not just at the end of the treatment line.
“We also learned to hit the disease harder and earlier,” he said. Drugs like abiraterone (a CYP17 inhibitor that blocks androgen production and is given with prednisone) and the androgen receptor inhibitors enzalutamide and darolutamide used to be reserved for men who had already failed hormone therapy, he said. But now these medications are prescribed as frontline drugs.
Genetic testing is more routine, too. This is important for clinicians to know when to prescribe PARP inhibitors for men with BRCA (Breast Cancer gene) and related mutations. “On June 12, 2026, the Food and Drug Administration approved capivasertib (Truqap, AstraZeneca) in combination with abiraterone and prednisone for adults with metastatic androgen pathway modulation-naïve or -sensitive (mAPMN/S) prostate cancer (previously referred to as metastatic hormone-sensitive prostate cancer) that is PTEN-deficient as detected by an FDA-authorized test,” reads the FDA’s approval. Dr. Houman said this new approach is helpful because roughly one in four men with prostate cancer is PTEN-deficient.
Surgical, radiation, and immunotherapies are also faster and more effective than people might remember from just a few decades ago. Now, clinicians have many more tools in their toolkit, especially when the cancer is diagnosed early.
Charles Oyesile, M.D., Ph.D., Founder of NucleoBio Corp, said that because Black men face a higher risk, guidelines from the Prostate Cancer Foundation and American Cancer Society urge doctors to start screening conversations at age 45. But if a man has a father, brother, or multiple family members with a history of prostate, breast, or ovarian cancer, screening should start at age 40. And Black men need to know that screening has evolved. Detection goes beyond the famed finger exam that his father might have feared. “Doctors should emphasize that a simple blood test, the prostate-specific antigen (PSA) test, is now the primary screening tool, and the digital rectal exam (DRE) is completely optional,” he explained.
Dr. Houman added that establishing a baseline PSA is one of the most useful reasons for earlier risk assessment. For clinicians, these conversations may seem awkward to initiate, but they are a key component of an effective annual physical. An electronic health record (EHR) may prompt questions based on age and risk factors, but clinicians should consider disparities and family history to determine when screening should begin for each patient.
At the same time, an elevated PSA should not automatically lead to a biopsy. Dr. Houman advised against biopsy based on a single elevated PSA. Instead, he opts for repeated testing and moving away from a universal PSA cutoff of 4.0 ng/mL. An abnormal test result should prompt further inquiry, not be seen as a cancer diagnosis.
MRI is an important part of diagnostics before moving to a biopsy, which many men fear. Physicians say they have many more tools at their disposal these days.
“The GÖTEBORG-2 trial showed an MRI-guided pathway cut the diagnosis of insignificant cancer roughly in half while still finding the aggressive tumors,” Dr. Houman said. That distinction is critical for clinicians to explain to patients. After all, prostate biopsy can identify cancer, but not all prostate cancers require immediate intervention. Current guidance supports MRI before the initial biopsy, reporting PI-RADS, and targeted sampling of any suspicious lesion; together, this information can help a clinician move forward with a treatment plan. Similarly, he said, “A negative MRI in a genuinely high-risk man is not permission to stop.” Instead, systematic biopsy is still the recommended approach.
Brandon Mancini, MD, MBA, FACRO, Medical Director at BAMF Health, adds that “Active surveillance is an evidence-based management strategy, not ‘doing nothing,’ for appropriately selected men with low-risk disease. It typically involves serial PSA measurements, imaging and, when appropriate, repeat biopsy so that treatment can be initiated if the cancer shows evidence of becoming more aggressive.” It may seem contradictory to ask for early detection and then to advise against surgery or intervention, but modern care increasingly attempts to determine which tumors are really dangerous. Biomarker tests can provide additional information and help determine which treatments could be most effective.
New drugs like Pluvicto can travel through the bloodstream to destroy prostate cancer cells with less off-target damage than systemic chemotherapy, making it the approach of choice for some types of patients who might have been sent for biopsies and surgery just a few years ago.
Risk varies based on many factors, including race, family history, genetics, and age. “A Black man, a BRCA2 carrier, and a man whose father had prostate cancer at 72 are three different conversations,” Dr. Houman explained. “For Black men, mortality is roughly twice as high, and modeling suggests the risk curve shifts three to nine years earlier, which is why we start five to ten years sooner.” He said it is important to screen earlier and screen more often, but not screen forever. Instead, he says that genetic testing can help determine real risk, as genes are not interchangeable.
Dr. Oyesile added that doctors need to ask about both sides of the family. “A mother’s history of breast or ovarian cancer is just as critical to a man’s prostate health as a father’s history of prostate cancer.” Furthermore, Dr. Houman added that two or more affected first-degree relatives roughly quadruple the risk, and that this reality should trigger genetic testing. Overall, we know much more about cancer today than we used to, and detecting prostate cancer today does not automatically mean treating it. These are the things clinicians should explain to all patients who might think a prostate cancer diagnosis has a one-size-fits-all treatment approach.
“With thoughtful screening, increasingly precise diagnostic tools and rapidly improving therapies, we have more opportunities than ever to find the cancers that matter and treat them effectively while avoiding unnecessary treatment of those that don’t,” Dr. Mancini underscored.
For clinicians hoping to improve prostate cancer outcomes for Black men, some of the fixes are simple: test early, schedule an MRI and biopsy in one referral, and follow up.
More patient education about the changes in early testing and the quality-of-life improvements for men who are diagnosed can help men overcome fear and stigma — and the information may need to reach them outside doctors’ offices. Instead, word of mouth from trusted family or friends can move the needle. And awareness campaigns that meet men where they are (i.e., in faith-based settings, barbershops, sports arenas, and gyms) can make all the difference.
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