Prostate Cancer Crisis Among Black Men

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Why are black men at an increased risk of developing and dying from prostate cancer?

The U.S. Senate passed a resolution Thursday acknowledging that awareness and prevention of the disease is as critical as it’s ever been for African American men.

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The Senate resolution, which was introduced by Sen. John Kerry (D-Mass.), urges federal agencies to address what they’re now calling an “epidemic” by supporting education, awareness outreach and research specifically focused on how prostate cancer affects black men.

Prostate cancer is the leading type of cancer in men in the United States, with over 240,000 men diagnosed and 30,000 thousand dying from it each year. Also, for reasons that are not completely understood, African-American men have the highest rates of prostate cancer in the U.S, as 1 in 5 will get prostate cancer in their lifetime. African-Americans are also 60% more likely to be diagnosed with prostate cancer and 2.5 times likely to die of the disease.

When caught early, prostate cancer can be treated, usually successfully. But, because many men experience no symptoms, it is often identified only by an abnormal result on a basic prostate cancer screening called the PSA test. The PSA test is a blood test that measures prostate-specific antigen (PSA), a protein produced by the prostate gland. An increase in the PSA level is often the only sign of early prostate cancer. The PSA test is also valuable in monitoring patients after treatment.

In May 2012, despite tremendous opposition from prostate cancer experts, legislators, healthcare advocates and cancer survivors across the country, a US Preventative Services Task Force (USPSTF) Committee announced a recommendation that PSA testing should no longer be performed routinely on men in the United States. The task force came to this decision based on studies performed in the United States and Europe suggesting that prostate cancer screening does not appear to improve survival in patients with this disease.

One of the major concerns raised by opponents of the recommendation is the fact that the studies that were sited lacked representation by African-American participants. Thus, their results may not be applicable to that group of men. The USPSTF committee also failed to acknowledge the impact of screening on declining cancer death rates. Opponents of this recommendation felt that the bottom line is that fewer men are dying of prostate cancer and it is very likely that early detection has played a role in this outcome. Despite the decrease in death rates, African-American men continue to carry a disproportionately higher death rate and, among men under the age of 60, are 4 times more likely to have metastatic disease at diagnosis.

There is currently ongoing research to find better screening strategies than the PSA test. However, until these tests have been confirmed, the PSA test continues to be important part of early detection and should not be blatantly discarded, especially as it applies to high risk populations such as African-American men. It is comparable to “throwing the baby out with the bathwater,” and in this case, African-American men are being thrown out with the bathwater.

Any man that is 40 and older should have meaningful dialogue with his healthcare provider to understand the details of the PSA test, its value, and possible shortcomings. Prostate cancer screenings are not provided under the Affordable Care Act, so make sure you choose a health insurance policy that covers PSA screenings. Please note that regular prostate cancer screenings are provided by Medicare, so if you are retired, take advantage of this benefit. If you are diagnosed with prostate cancer, also consider all options for treatment before making a decision or, if the cancer is not aggressive, talk to your doctor about active surveillance. As with any illness, make sure you get a second opinion before proceeding with any post-diagnosis path.