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Prostate Cancer Risk Greatest in African American Men

Following the death of Dexter King, Morehouse School of Medicine Chief of Surgery Dr. John Stewart discusses prostate cancer prevalence and risk factors.

By Donovan Thomas, The Atlanta Journal-Constitution

News that the Rev. Martin Luther King Jr.’s son, Dexter King, had died of prostate cancer at age 62 shook Atlanta Monday.

According to the Centers for Disease Control and Prevention, all men are at risk for prostate cancer, but older men, African American men, and those with a family history of prostate cancer have a greater risk.

The most common risk factor is age. The older a man is, the greater the chance of getting prostate cancer. According to the American Cancer Society, about one in eight men will be diagnosed with prostate cancer during their lifetime. But each man’s risk of prostate cancer varies based on age, race or ethnicity, and other factors.

African American men are more likely to get prostate cancer than other races and ethnicities and are more than twice as likely to die from it than other men. In 2020, out of every 100,000 white men, 95 were diagnosed with a new case of prostate cancer, while out of 100,000 Black (non-Hispanic) men, 154 were diagnosed, according to the U.S. Cancer Statistics Working Group.

For Dr. John Stewart, chief of surgery for Morehouse School of Medicine at Grady Health System, raising awareness about prostate cancer is paramount to improving outcomes.

“We’ve got to make sure to get the word out about prostate cancer screenings,” Stewart said. “As Black men, we aren’t exactly fond of interactions with the medical system. We see it in prostate cancer, we see it in colonoscopy screenings. We have to create a better agenda for men’s health in our community.”

It’s not clear what makes Black men more likely to be diagnosed with prostate cancer, but they also account for a high proportion of advanced cases of the disease, regardless of age, Stewart said.

While 62 is relatively young to most, it is not an unusual age for patients to die from the disease, Stewart said. Also, many people are diagnosed in their 50s or 60s, but may live 10 to 15 years after a diagnosis.

Dr. Wayne Harris, an associate professor in Emory School of Medicine’s department of hematology and medical oncology, said that prostate cancer tends to be a disease of older men, but this isn’t always true for Black men.

“In the African American community, it [prostate cancer] is known to have an earlier onset and have a more aggressive profile for reasons that are not fully clear,” Harris said. “There’s this broad spectrum of contributing factors, but not one specific thing that says this is why there are disparities.”

For detecting prostate cancer, the prostate-specific antigen (PSA) blood test is used, but the ACS notes it’s not a perfect test for finding prostate cancer early. It misses some cancers, and sometimes it finds cancers that are so slow growing they would probably never need to be treated.

The American Cancer Society recommends Black men ask about PSA screenings at 45. This recommendation is five years earlier than other groups.

Harris noted contrasting recommendations by different organizations regarding the PSA screening, stating, “The consensus is that there should be an individualized discussion with the patient’s physician,” for every case to ensure age-appropriate health screenings are conducted. Along with PSA screenings, digital rectal exams can detect prostate cancer, rectal cancer, and other abnormalities.

While some risk factors for the cancer can’t be controlled, Harris said that avoiding smoking, using alcohol in excess, a high fat diet and other lifestyle factors are beneficial for not only prostate, but many different types of cancer.

Morehouse School of Medicine’s Stewart said the sad news of King’s death marks a moment for the Black community. “This is an opportunity to continue to educate our community and let people know that prostate cancer is not a respecter of social status. It’s not a respecter of position,” Stewart said. “It is a real issue that we have to address head on.”

Risk Factors for Prostate Cancer

According to the American Cancer Society, about one in eight men will be diagnosed with prostate cancer during their lifetime. But each man’s risk of prostate cancer varies based on age, race or ethnicity, and other factors.

Age: About six in 10 prostate cancers are diagnosed in men who are 65 or older, and it is rare in men under 40. The average age of men when they are first diagnosed is about 67.

Race: Prostate cancer develops more often in African American men and in Caribbean men of African ancestry than in men of other races. And when it does develop in these men, they tend to be younger.

Heredity: The ACS reports prostate cancer seems to run in some families, which suggests that in some cases there may be an inherited or genetic factor. Having a father or brother with prostate cancer more than doubles a man’s risk of developing this disease. (The risk is higher for men who have a brother with the disease than for those who have a father with it.) The risk is much higher for men with several affected relatives, particularly if their relatives were young when the cancer was found.

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