Study Reveals Disparities in Prostate Cancer Screening for Black Men

A recent study published in JAMA Network Open highlights significant barriers that Black men face when seeking prostate cancer screening through primary-care providers. Despite the alarming statistic that Black men in the United States die from prostate cancer at twice the rate of their non-Black counterparts, many primary-care clinicians often overlook this critical issue during consultations about the prostate-specific antigen (PSA) test.

Lead author Jenney Lee, a senior research scientist in urology at the University of Washington School of Medicine, emphasized the urgency of this matter. She stated, “There is an often-used phrase, ‘Prostate cancer is a cancer one dies with; it’s not a disease you die from.’ And to a point that is true in that, in many cases, prostate cancer is slow growing.” However, the study revealed that many Black men perceive their primary-care providers as the gatekeepers to receiving the PSA test, which is essential for early detection of prostate cancer.

The study involved interviews with 29 Black men from the Puget Sound region of Washington state. Participants expressed concerns that their primary-care clinicians frequently dismissed the PSA test as unnecessary, lacking awareness of the heightened risk factors for Black men. The research showed that Black men are often diagnosed at an earlier age and at more advanced stages of the disease compared to other groups, underscoring the need for timely screening.

Lee noted, “If we can get Black men screened in their 40s rather than in their 50s, the mortality rate due to prostate cancer drops by up to 30%.” The incidence of prostate cancer among Black men is reported to be 60% to 80% higher than in men of other races, with a mortality rate that is double that of non-Black men.

The study also highlighted a troubling lack of trust between Black patients and their primary-care clinicians. Interview participants indicated that they did not feel their opinions were valued in shared decision-making regarding their health care. While both urologists and primary-care professionals were familiar with the U.S. Preventive Services Task Force guidelines, the former were significantly more likely to recognize the importance of PSA testing and early detection in reducing prostate cancer-related mortality.

In fact, only 6% of primary-care clinicians surveyed believed that PSA testing played a significant role in decreasing prostate cancer mortality. This finding surprised Lee, who pointed out that mixed messages about prostate cancer screening have contributed to this gap in understanding among primary-care providers.

The study, conducted from September 1, 2021, to December 31, 2023, involved online surveys distributed to 63 physicians and urologists in the Pacific Northwest and Alaska. The findings indicate that while the American Urological Association recommends screening for high-risk men, including Black men, beginning at ages 40 to 50, the USPSTF only provides a “C” rating for the PSA test, suggesting it is recommended in some cases but does not specifically address high-risk groups.

Dr. Yaw Nyame, a urologist with UW Medicine and senior author of the study, advocates for a reassessment of how prostate cancer screening is approached, particularly for underserved populations. He stated, “Healthy Black males should have a screening if they wish. In our study, we found that this request was often met with resistance, as primary-care providers didn’t believe in PSA testing.”

Nyame hopes that the USPSTF will consider updating its recommendations to better serve communities at higher risk, such as Black men. He acknowledged that discussions about prostate cancer screening can be contentious within medical circles but stressed the necessity of addressing this issue.

Lee pointed out that some primary-care providers may hesitate to recommend the PSA test due to concerns about potential false positive results, which could lead to more invasive testing. However, given the high-risk status of Black patients, such caution may need to be reconsidered. “We know this is a hot button issue in many medical communities. But this is a discussion that needs to be had,” she said.

This study underscores the urgent need for improved communication and trust between Black patients and their health care providers to ensure timely and appropriate prostate cancer screening.