Besides skin cancer, prostate cancer is the most common cancer in men. Approximately 1 in 8 men will be diagnosed with prostate cancer in their lifetime. Family history, being over 65, and being African American are all risk factors for prostate cancer.
Located just in front of the rectum and between the bladder and the penis is the walnut-sized prostate gland. The prostate produces secretions that help protect and maintain sperm. Urine is released from the body via the urethra which runs from the bladder through the prostate to the penis. The unique location of the prostate is the reason why, if it is enlarged, men can have problems with urinary issues such as hesitancy, night awakenings to urinate, and occasional dribbling.
The prostate produces a protein called PSA and this protein can be measured in the blood. Elevations in PSA can be indicative of prostate cancer, but it can also be associated with an enlarged prostate, called benign prostatic hypertrophy, BPH. Prostate enlargement is present in essentially all men over the age of 50. There are numerous medications that help relieve symptoms caused by BPH.
The FDA, Federal Drug and Administration, approved PSA as a screening test in 1994. Scientists and doctors were using it to screen for prostate cancer even before then, however.
In the past, most doctors believed that a PSA greater than 4.0 indicated cancer. We now realize that cancer can be present even with levels below 4.0 and the opposite is also true as mentioned above in the examples of the enlarged prostate. Therefore, prostate cancer is not solely based on a one-time PSA level.
There are newer calculations such as the Prostate Health Index or 4KScore that may be obtained following an abnormal initial PSA. A digital rectal exam and imaging studies such as ultrasound or MRI may also be utilized in determining a diagnosis.
Black men are 60% more likely to be diagnosed with prostate cancer, more likely to have a higher tumor grade upon diagnosis, and they are more likely to be diagnosed at a younger age. There have been some genes identified in Black men that increase their risk, but this gene is absent in most Black men with prostate cancer. More research is needed in this area.
Socioeconomic factors play a huge part in this cancer disparity. Black men are more likely to be uninsured or underinsured which then results in delays in screenings and treatment. It has also been shown that Black patients often are not aware of the multitude of options available to them regarding cancer care. Education is another component that contributes a crucial dynamic within the outcome paradigm of prostate cancer for Black men.
The American Cancer Society and other organizations agree that the discussion regarding prostate cancer screening should begin at age 45 for Black men. This early discussion allows the provider and patient to make informed decisions that are appropriate for that patient. Disease burdens are different for certain groups of people and as a society we must acknowledge that fact and fervently work to ascertain the reasons for such disparities.
Denise Hooks-Anderson, M.D., FAAFP is an associate Professor, SLUCare Family Medicine and interim assistant dean of Diversity Equity and Inclusion