Age
Most prostate cancer diagnoses occur in men who are 65 or older. According to the American Cancer Society, the average age of a diagnosed man is now 67. That said, there has been an increase in men diagnosed in their 40s, with a former member of the FFTC website team diagnosed at age 38.
There has also been an increase in the percentage of men diagnosed across all age groups with later-stage disease, likely due to PSA screenings deferred or skipped altogether due to both governmental recommendations and in the 2020-21 years due to Covid.
Race/Ethnicity
African American men are about 75% more likely to be diagnosed than non-Hispanic whites and nearly 2.5 times as likely to die of the disease.
Family History
Men with a father or brother who had prostate cancer are at a risk of developing the disease that is twice that of a man with no affected family members. If two close male relatives have been diagnosed, a man’s lifetime risk of developing prostate cancer increases five-fold.
The BRCA gene increases a man’s odds of developing prostate cancer, especially the BRCA2 gene. Studies have shown that men with a BRCA2 mutation have a 20% to 40% chance of prostate cancer in their lifetimes, possibly higher. The presence of a BRCA mutation may also increase the risk for a diagnosis of an aggressive case of prostate cancer.
Increasingly, men are including a consultation with a genetic counselor as part of their due diligence both during the prostate cancer screening process or following a diagnosis. Genetic testing can be of significant value, given that the presence of a BRCA mutation can influence the treatment options and choices available to a man and his specific case of prostate cancer.
Prostate Cancer in African American Men
Overall cancer incidence and mortality rates in the United States have continued to decline through the first decade of the 21st century. This is most likely a result of: a reduction in tobacco use; early detection; improved prevention measures; and improved treatments. However, African Americans continue to have higher cancer mortality rates and shorter survival times than their white counterparts. This holds true in all of the screenable cancers – colon cancer, breast cancer, cervical cancer, and prostate cancer.
These statistics represent stark and significant health inequity issues that must be seriously addressed by physicians, researchers, public health officials, and elected leaders.
Facts and Stats
Prostate Cancer remains a particularly unique challenge with regard to health disparities. African American men are more likely to present with advanced disease, are administered different treatment regimens, have shorter progression-free survival following treatment, and have more treatment-related side effects when compared to their white male counterparts.
According to Memorial Sloan Kettering, Black men are 70% more likely to develop prostate cancer in their lifetime and twice as likely to die of the disease. The higher risk may well be related to environmental issues involving nutrition, access to healthcare, and exposure to pollutants. According to urologic surgeon Vincent Laudone, “Disparities in outcomes can be affected by differences in when the cancer is diagnoses and how the men are treated after diagnosis.”
Keys to Addressing Prostate Cancer in the African American Community: Education and Screening
Education and screening play critical roles in addressing the health disparity related to cancer – and prostate cancer, in general. It is essential that African-American men are aware of their increased risk of developing and dying of prostate cancer and that they take steps that may help lower their risk, including getting to and staying at a healthy weight, exercising regularly, eating a healthy diet, avoiding tobacco, and limiting alcohol consumption. It is also important for African-American men to know the medical history of close family members (i.e., father, brother, son). Having a close family member who was diagnosed with prostate cancer (particularly at an early age) may increase a man’s risk of developing the disease.
Know Your Score
Statistically, prostate cancer has a five-year relative survival rate of about 99%. Men have more treatment options and achieve best outcomes when the cancer is detected early, before the disease can spread outside the margins of the prostate.
The vast majority of diagnosed prostate cancer cases (well over 90%) are localized, relatively slow moving, and non-lethal. There are, however, cases of prostate cancer that are extremely fast-moving and aggressive, identified as such via Gleason scores, PET scans, and other evaluative tools.
Early-stage prostate cancer rarely carries symptoms and most often comes to the attention of physicians as the result of a prostate-specific antigen (PSA) screening, a simple blood test. Men who are at average risk (See RISK FACTORS above) for prostate cancer should begin discussing the PSA test with their doctors starting at age 45-50. Men who are at a higher risk for developing prostate cancer – and this includes African-American men, men with the BRCA gene mutation, and men with a close blood relative diagnosed with prostate cancer before age 65 – should consult with their primary care doctor or with a urologist. These men should strongly consider having a PSA blood test between the ages of 40 and 45.
