We know the numbers, and we have known them for years.
Black men are about 1.7 times more likely to be diagnosed with prostate cancer than white men and about twice as likely to die from it. They tend to develop prostate cancer at younger ages and are more likely to present with advanced or aggressive disease.
But here is the number that should really get our attention: when prostate cancer is detected early and appropriately treated, outcomes for Black and white men can be similar.
So I think we, particularly Black physicians, have to ask ourselves an uncomfortable question:
Are we doing enough to make sure our Black male patients are being screened appropriately?
The numbers suggest we are not.
Less than half of Black men report ever discussing prostate cancer screening with their physician. Even more troubling, fewer than one-third of physicians report routinely informing Black male patients about their increased risk.
Yet when physicians actually have the conversation, something important happens. About 85 percent of Black men who discuss prostate cancer screening with their doctor go on to have a PSA test. When that conversation doesn’t occur, the screening rate drops dramatically.
That tells me something.
We talk a lot about mistrust of the healthcare system, health literacy, access to care, and social determinants of health. Those are real problems. But sometimes the problem is much simpler:
We didn’t bring it up.
Part of the problem has been confusion about PSA screening.
For years, physicians received mixed messages. Concerns about false positives, unnecessary biopsies, overdiagnosis, and overtreatment caused the pendulum to swing away from routine PSA testing.
Those concerns were legitimate. But I believe Black men got caught in the backswing.
A Black man in his 40s is not necessarily an average-risk patient. Yet too often our approach to prostate cancer screening treats him as though he is.
Then there is the reality of everyday medical practice. We are busy. The patient comes in for hypertension, diabetes, back pain, or a medication refill. We have limited time, and prostate cancer screening gets pushed down the list.
One visit becomes two visits. Two become five.
And the conversation never happens.
Current recommendations increasingly recognize that Black men are at higher risk and deserve an earlier and more deliberate discussion about prostate cancer screening.
For many Black men, that conversation should begin around age 40 to 45, particularly when there is a family history of prostate cancer.
That doesn’t mean every Black man automatically needs a PSA test.
It means every appropriate patient deserves the conversation.
Explain what PSA testing can and cannot tell him. Discuss the possibility of additional testing if the PSA is elevated. Explain the potential benefits and risks. Then make the decision together.
That is what shared decision-making is supposed to mean.
And don’t necessarily look at PSA as a single isolated number. A baseline PSA in a man in his 40s may help identify future risk. Follow the patient. Know the trend. Know his family history.
Most importantly, know who in your practice is at increased risk.
We can blame insurance barriers. We can blame mistrust. We can blame access, socioeconomic conditions, and a healthcare system that has not always treated Black patients fairly.
And there is plenty of blame to go around.
But there is one thing completely under our control:
We can open our mouths and start the conversation.
A patient cannot make an informed decision about a screening test that nobody has ever discussed with him.
So I am asking my colleagues — especially Black physicians — to look at our own practices.
How many Black men between 40 and 55 are in your patient population?
How many have had a documented discussion about prostate cancer risk?
How many have a family history recorded?
And how many have simply passed through our offices year after year without anybody bringing it up?
This isn’t about guilt. It’s about changing what happens next.
At the African American Wellness Project (AAWP), we believe improving Black health requires patients to become stronger advocates for themselves. But advocacy works both ways. Physicians also have to recognize when the system — or our own routines — is failing our patients.
The prostate cancer mortality gap has been staring us in the face for decades.
The data has done its job.
The guidelines have done theirs.
Now we have to do ours.
By subscribing, you consent to receive emails from BlackDoctor.pro You may unsubscribe at any time. Privacy Policy & Terms of Service.
Are you a healthcare professional? Register with us today!
