Urgent Call for Prostate Cancer Screening in Black Men

A recent study highlights a significant gap in prostate cancer screening for Black men, who experience mortality rates twice that of their non-Black counterparts. The qualitative research, published in JAMA Network Open, reveals that Black men often rely on primary-care clinicians to access prostate-specific antigen (PSA) tests, a crucial first step in screening for this disease.

The study, led by Jenney Lee, a senior research scientist in urology at the University of Washington School of Medicine, involved interviews with 29 Black men from the Puget Sound area. Participants indicated that their healthcare providers often dismissed the necessity of the PSA test, lacking awareness of the heightened risk that Black men face regarding prostate cancer. Lee noted, “There is an often-used phrase, ‘Prostate cancer is a cancer one dies with; it’s not a disease you die from.’ While that may be true for some cases due to the slow-growing nature of the disease, early detection is vital.”

Black men tend to be diagnosed at younger ages and typically present with more advanced stages of the disease compared to other racial groups. Lee emphasized the importance of proactive screening, stating that if Black men could begin PSA testing in their 40s rather than their 50s, the mortality rate could decrease by up to 30%. Alarmingly, the incidence of prostate cancer among Black men is 60% to 80% higher than among men of other races, underscoring the urgency of this issue.

Among the primary-care providers surveyed for the study, only 6% recognized the role of PSA testing in reducing mortality from prostate cancer. This statistic surprised the researchers, as they expected greater awareness of the test’s significance. The data was collected between September 1, 2021, and December 31, 2023, through interviews and online surveys sent to 63 physicians and urologists in the Pacific Northwest and Alaska.

Despite the U.S. Preventive Services Task Force (USPSTF) acknowledging the PSA test as a “C” recommendation—meaning it is advised in some cases—there is no specific guidance for high-risk groups like Black men. In contrast, the American Urological Association recommends screening every 2 to 4 years for men aged 50 to 69 with average risk, while advising that high-risk men, including Black men, should start at ages 40 to 50. The American Cancer Society further suggests that Black men initiate discussions about screening at age 45, or 40 if there is a family history of cancer.

Dr. Yaw Nyame, a urologist at UW Medicine and co-author of the study, advocates for a revision of the USPSTF guidelines to specifically address underserved communities such as Black men. He stated, “This paper shows that we are not applying this lens to Black patients as much as we should.” Nyame stressed that healthy Black males should have the option to request PSA screenings, which are often met with resistance from primary-care providers who doubt the test’s value.

Lee pointed out that concerns about false positives may deter providers from recommending the PSA test, potentially leading to unnecessary procedures. However, given the high-risk status of Black patients, these concerns should be re-evaluated. “We know this is a hot-button issue in many medical communities. But this is a discussion that needs to be had,” she remarked.

In light of these findings, it is clear that improving awareness and communication regarding prostate cancer screening among primary-care providers could significantly impact Black men’s health outcomes. As the medical community continues to navigate the complexities of prostate cancer screening, prioritizing the needs of high-risk populations remains imperative.