Dealing with Disparities: African American Men and Prostate Cancer

Why prostate cancer is a growing issue among black men

February is Cancer Prevention Month. According to new research from the American Cancer Society, black men are more likely to develop prostate cancer in their lifetime than men of other races. With insight from Jeanny Aragon-Ching, MD, Clinical Program Director of Genitourinary Cancers at the Inova Schar Cancer Institute, Inova spotlights why early intervention may be key to helping prevent and treat prostate cancer in black men.

In the United States, African American men are nearly twice as likely (1.8 times) to be diagnosed with prostate cancer than white men. They are also 2.2 to 2.5 times more likely to die from the disease. African American men face a significant barrier to screening, and researchers are investigating reasons for this disparity.

Since 2012, the U.S. Preventive Services Task Force has recommended against prostate cancer screening for men of all races who have “average risk.” This recommendation has proven problematic, given that African American men are at a statistically higher risk than white men of having prostate cancer, developing it at an earlier age and dying from it.

“The current recommendations made by the U.S. Preventative Services Task Force on prostate cancer screening do not take into account ethnic differences,” says Jeanny Aragon-Ching, MD, Clinical Program Director of Genitourinary Cancers at the Inova Schar Cancer Institute. “Everyone is different — their family history, personal risks and previous health history. When it comes to adhering to the screening guidelines, I believe they should be individualized, in a way, to cater to the patient’s circumstances.”

Screening for Prostate Cancer

The best way to detect prostate cancer is with a prostate-specific antigen (PSA) blood test. Higher than normal levels of a particular protein could be due to many causes, including bacterial infection of the prostate, urinary tract infection or recent sexual activity, but it could also signal prostate cancer. The provider might recommend repeating the test after a few months have passed to see if the level is rising, leveled off or lowered, especially in men around the age 40, when prostate cancer is unlikely.

“When it comes to PSA levels, it’s not always about the absolute value, but how fast it is rising,” says Dr. Aragon-Ching. “Even after a digital rectal exam [examining the area of the prostate to see if any bumps can be felt], a physician is not going to be able to determine if cancer is present without a prostate biopsy — no matter how high the PSA is.”

The American Cancer Society recommends that most African American men begin PSA screening at age 45 or age 40 if they have more than one first-degree relative who was diagnosed with prostate cancer at an early age; white men at average risk are advised to start screening at age 50. It is important for African American men to discuss with their healthcare provider the ideal age for them to get a PSA screening and any treatment that follows if cancer is detected.

Differences in Disease Course

The majority of prostate cancer is detected at a stage where cell changes are very localized. Prostate cancer can be very slow-growing and not cause any serious symptoms for years. Doctors and patients may adopt a “wait-and-see” or active surveillance approach before attempting proactive therapeutic measures.

Some studies, however, have shown that in African American men, prostate cancer can become more aggressive earlier than in their white counterparts.

Lifestyle Factors Make a Difference

There is no single preventive action for men to take, but a healthy diet — especially one low in fat — is strongly recommended because of an association between high-fat diets and prostate cancer metastasis (cancer spreading to other organs).

“Dietary factors, environmental factors or even genetic susceptibilities could be one of the many reasons why African American men are at greater risk,” Dr. Aragon-Ching says. “Access to healthcare must be increased to improve mortality rates for our African American patients.”

Exercise, avoiding tobacco and moderation of alcohol intake are other lifestyle factors that can help prevent cancer in general and prostate cancer specifically.

“We strive to do everything we can for our patients with prostate cancer, and I believe we are making headway in the field. But we certainly need to do more,” Dr. Aragon-Ching says. “There are still a lot of men dying from this dreaded disease, so early intervention and prevention, if possible, are really key.”

Inova provides primary care at over 20 locations across Northern Virginia. Find a doctor and make your appointment today.

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