How are African American Men Affected by Prostate Cancer?
There is a well-documented disparity between the development of prostate cancer, as well as the risk of dying as a result of prostate cancer, between African American men and men of other races. For example, African American men are roughly 70% more likely to develop prostate cancer when compared to their white male counterparts, and are over two times more likely to die as a result of their prostate cancer.1 Although no factors have been definitively proven to cause this disparity, there are many reasons why this difference could occur. Some of these potential factors are outlined below, but it’s important to note that this is not an exhaustive list of all possibilities that could contribute to these differences.
Although much more research is needed to understand the genetic mechanisms that lead to prostate cancer, several genes thought to be related to the development of prostate cancer or prostate cancer metastasis have been found to be up-regulated, or more active, in African American men. This could be a potential reason why African American men are more likely to have early metastasis of prostate cancer or die as a result of their prostate cancer. Also, genes that are thought to be related to familial inheritance of prostate cancer, including the MXI1 and HPC1 genes, are known to be more commonly mutated in African American families.
Additionally, although not well understood, it has been hypothesized that genes needed to maintain adequate vitamin D levels are also commonly implicated in African American men, and can lead to vitamin D insufficiency. This could potentially lead to an increased risk of developing prostate cancer. Much more research is needed to determine these genetic factors and their association with prostate cancer in African American men.2
PSA testing differences
Some resources suggest that African American men may have lower serum levels of PSA, even when they have more aggressive forms of prostate cancer, due to genetic variations or other sources. While PSA testing may still be beneficial for this group, interpretation of results may need to be adjusted. For example, a man with a PSA level that appears to be in normal range, may actually still have prostate cancer, and this cancer may be aggressive. Misinterpreting PSA test results in African American men could lead to missing a case of prostate cancer, and not diagnosing it until the cancer has progressed to life-threatening stages.2
Lack of access to high-quality treatment facilities and care
This area of disparity is concerning and not well understood, however, it has been suggested that African American men are less likely to frequent high-quality care centers and to experience quality care. There are several reasons this may occur. One reason is that African American men have a greater chance of living in lower economic areas that have facilities that mirror these conditions. For example, inner-city, poorer areas may have hospitals and treatment facilities that are also financially struggling, and may not be able to provide the highest standard of care. These areas typically have a larger proportion of African American men, and this population may be the one that experiences these deficits the most.
Additionally, African American men who are financially struggling or who are at a lower socioeconomic level may not have access to health insurance or may not be able to pay for medical appointments or treatments. This inability to afford care may prevent these men from attending regular well-visits or pursuing early signs of prostate cancer. Because of this, prostate cancer may be found when it has progressed to concerning stages. Finally, racial prejudice and bias may impact African American men more than other ethnicities and races. This is a harder metric to understand and study, however, provider bias can exist, and can impact the quality of care a man receives. If you are concerned that your provider may be demonstrating a bias related to your identity or characteristics, having an open communication with them, as well as potentially finding a new provider, may be beneficial.2,3