Why Are Black Men Harder To Diagnose With Prostate Cancer?

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African-American prostate cancer is often more aggressive than diagnosed according to the latest studies. Black men need to follow their prostate cancer more closely and may need different diagnosis and treatment plans from white patients. According to a Johns Hopkins study (published in the Journal of Clinical Oncology) of more than 1,800 men ages 52 to 62, African-American men who are diagnosed with very-low-risk prostate cancers are actually much more likely than white men to actually have aggressive disease.

For some reason, current diagnostic approaches do not recognize the severity of prostate cancer in African-American men. Although past studies have found it safe to delay getting treatment and monitor some presumably slow-growing or low-risk prostate cancers through “active surveillance” (AS), this approach is not a good idea for black men.

African-American prostate cancer risks

African-American men fall into a higher-risk category for aggressive prostate cancer, possibly due to genetic or lifestyle factors such as diet, environmental chemicals, or other factors. African-American men have a higher rate of prostate cancer than black men who live in Africa. Compared with white men, African-American have twice the risk of prostate cancer in their early 50s and are twice as likely to die from prostate cancer.

African-American prostate cancer is harder to classify

Urologist urologist Edward M. Schaeffer, M.D., Ph.D., who is a co-author of the study, shed some light on why African-American men may have these aggressive cancers that are more difficult to detect. He feels that this information is critical because following a cancer thought to be low-risk or slower growing is not a good idea when in a black patient.

“We think we are following a small, nonaggressive cancer, but in reality, this study highlights that in black men, these tumors are sometimes more aggressive than previously thought. It turns out that black men have a much higher chance of having a more aggressive tumor developing in a location that is not easily sampled by a standard prostate biopsy.”

Future of African-American prostate cancer detection and treatment

Future studies will help determine race-specific criteria for diagnosing and monitoring prostate cancer. In the laboratory, they are working to develop new strategies to more accurately identify the risks of African-Americans with newly diagnosed prostate cancer. Hopefully this will help determine whether a patient can undergo active surveillance or needs immediate treatment. Researchers are also trying to figure out why prostate cancers have a tendency to hide out in the anterior prostate, specifically in African-Americans.

Read more in our Prostate Cancer Health Center.


Sundi D et al. African American men with very low-risk prostate cancer exhibit adverse oncologic outcomes after radical prostatectomy: should active surveillance still be an option for them? Journal of Clinical Oncology 2013 Aug 20; 31(24): 2991-97

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