Advances in screening rates, genomic testing, imaging, and treatment have led to a 98% 5-year survival rate among men with prostate cancer. Nevertheless, prostate cancer remains the leading cancer diagnosed in American men. Black men suffer from prostate cancer with a higher incidence and decreased survival. On average, they are diagnosed at a younger age, have more advanced disease at the time of diagnosis, and present with significantly higher prostate-specific antigen (PSA) levels than white men.
One disparity in the diagnosis of prostate cancer is the use of PSA screening. PSA screening was recommended broadly for men younger than 75 in 2008. The resulting over-treatment of benign conditions and lack of survival benefit in two large studies led to a reversal of the previous recommendation in 2012. The change in guidance has resulted in a decrease in screening in underserved populations and an increase in regional and metastatic disease.
The recommendations changed again in 2018 to reflect this reality and advocate for an informed discussion between the patient and provider. Low health literacy and lack of consistent information can lead to Black men having lower prostate cancer screening rates and delays in diagnosis and treatment.
Despite disparities in access to appropriate treatment, the data show that cancer outcomes have improved since the 1970s, and gaps in prostate cancer incidence and survival rates between Black men and white men have narrowed. To further improve outcomes for Black men, prostate cancer education, genetic testing, screening, diagnostic testing, and increased enrollment of Black men in prostate cancer clinical trials are necessary.
Mistrust of the medical system is prevalent in the Black community, partially due to events such as the Tuskegee syphilis study where poor Black men infected with syphilis were left untreated. These misgivings must be acknowledged and addressed while communicating the medical advances that are reaped by the Black community through greater Black representation in clinical trials.
There are many promising developments in the management of prostate cancer, with data pointing to an improvement in racial disparities in treatment. However, there is still room for improvement. Improving prostate cancer outcomes in the Black community requires more genetic testing, screening, and diagnostic testing for the disease and more Black participation in clinical trials. Prostate cancer education and consistent messaging are crucial in achieving these goals .
Source: Carthon, B., Sibold, H. C., Blee, S., & D. Pentz, R. (2021). Prostate Cancer: Community Education and Disparities in Diagnosis and Treatment. The Oncologist. https://doi.org/10.1002/onco.13749