Overcoming obstacles to achieve better results

Since the 1990s, prostate cancer death rates have fallen for all men—most of all for black men. That’s progress, but it’s not the full picture.

Black men are more likely to develop prostate cancer—and a more aggressive type—than white men, says Brandon A. Mahal, MD, a radiation oncologist at the Dana-Farber Cancer Institute. It takes a heavy toll: Black men are more than twice as likely to die from the disease.

What is behind such numbers? And what should change? Many things come into play, including access to care, genetics, environment, and lifestyle.

“We now have a lot of data on prostate cancer outcomes in black men,” says Kosj Yamoah, MD, PhD, a radiation oncologist at Moffitt Cancer Center. “This may help us provide better treatment.”

Research in black men is still not available. In some cases, the researchers didn’t even report the race or ethnicity of the men in their prostate cancer studies. When they do, less than 5% of those who participate are black.

This is due in part to low participation in what is required to enroll in a trial, such as lab test results. Often “normal lab results,” Mahal says, are based on a non-variety population. But what is “normal” can vary by race, gender, and age. And when the studies are done mostly on white people, it’s hard to know if the results apply to others.

Black men do not get prostate cancer more often than white men. They also tend to acquire it at an early age. And their cancer tends to spread more quickly. “Prostate cancer that starts at age 40 and spreads by age 50 is different than one that first appears at age 70, and it’s a cancer you don’t have to worry about,” Yamoah says.

Genes also play a role with prostate cancer, more than any other type of cancer.

“Part of the difference in prostate cancer rates — and therefore deaths — may be due to these inherited factors,” says Lorelei Moshi, MD, associate professor of epidemiology at Harvard School of Public Health.

Early detection is important for everyone diagnosed with prostate cancer. But Mochi says black men face unique barriers when it comes to being diagnosed.

One hurdle, Yamoah says, is for those without access to insurance and Medicare. Another is the fact that prostate tumors in black men tend to appear sooner and spread faster. Even when the cancer is of the indolent (low-grade) type, black men’s risk of dying is twice as high as that of men of other races, although it’s still small.

“We know that black men have delayed diagnosis — and therefore treatment,” Mochi says. “They also tend to have different types of treatment, and their access to care varies.”

Yamoah warns that “we’re not asking doctors to treat black men with prostate cancer differently…we need treatment.” [people] based on their biology.

We still don’t know if certain prostate cancer treatments work well for black men, Mochi says. But Mahal points out that “in radiological trials where patients had the same pathology and equal access to care, black men had a better survival rate from prostate cancer than did non-black men.” Overall death rates were higher, he adds, but that may have been because more than one disease was present.

Lifestyle changes can help reduce your risk. Exercise, maintain a healthy weight, reduce your intake of red meat and alcohol, and stop smoking. If you’re a black man, do these things, too:

• Pay for early and frequent prostate cancer screening.
• Ask your doctor about tests that might best detect prostate cancer in black men.
• Find out what tests and treatments are covered by your insurance.
• Learn about your treatment options. Partner with your doctor to get the best results.
• Enrollment in a prostate clinical trial.