Prostate cancer is not an equal opportunity disease. In fact, black men are at higher risk for prostate cancer than are white men, Asian men, and Hispanic men. To make matters worse, prostate cancer is more aggressive in black men as well as more deadly. Why is the picture of prostate cancer so gloomy for black men, and more important, what can they do about it?
Prostate cancer rates among black men
For starters, the incidence of prostate cancer among black men , according to a report from the National Cancer Institute, is 60 percent higher than it is among white men. A more recent report from the Centers for Disease Control and Prevention broke down the incidence of prostate cancer among different ethnic groups, noting that prostate cancer occurred in about 240 per 100,000 black men, compared with about 130 per 100,000 white men, 120 per 100,000 Hispanic men, and 75 per 100,000 Asian men (latest figures are from 2008).
Researchers have wondered why black men fare so poorly when it comes to prostate cancer, so a study published in the Journal of Urology tackled that question. Investigators examined the prostate glands of 1,056 men, black and white, between the ages of 20 and 80, who had died of causes other than prostate cancer. A control group consisted of an evaluation of the prostate glands of 2,874 men who had who undergone prostate removal (radical prostatectomy).
When the researchers examined the prostate glands of the men who had died, they found the prevalence of prostate cancer and the volume of the prostate gland were similar between the men regardless of race and between the ages of 20 and 60. The Gleason grade of cancer (grade assigned to prostate cancer based on its appearance microscopically) also was similar for both black and white men through age 70.
However, there was a difference when the researchers evaluated the men who had had a prostatectomy. Specifically, the volume of prostate cancer was greater for black men ages 39 to 70 when compared with white men, and black men also have four times the chance of having advanced prostate cancer or prostate cancer that had spread (metastasized) than did white men.
Prostate cancer risk factors in black men
Experts have come up with a few risk factors that may at least partly explain why black men are at higher risk of prostate cancer and more aggressive and deadly prostate cancer than are men of other populations.
- Environmental influence: The fact that black men who live in Africa have a lower rate of prostate cancer and death associated with prostate cancer than do black men living in the United States suggests that environmental factors, such as diet, exposure to environmental toxins, and similar factors may increase the risk of prostate cancer among black men (African-Americans) when compared with white men.
- Skepticism: Black men tend to be less trustful of their physicians than are white men. They also tend to be less likely to see the same doctor on return visits for care and less likely to be screened for prostate cancer.
- Quality of health care: Black men are less likely to have health insurance and/or access to health care, which means they are less likely to have prostate cancer detected at an early stage.
- Genetics: A Harvard School of Public Health study indicated that genetic differences may be important in determining prostate cancer among black men. Researchers noted that the average number of androgen (hormone) receptor gene CAG configurations was lower among black men than among white and Asians.
- Vitamin D: Vitamin D helps protect against prostate cancer, but generally individuals do not get enough of this important nutrient. Black men are especially prone to having low or deficient levels of vitamin D because they have dark skin, which is less effective at producing vitamin D than is lighter skin. Therefore, they need to either spend more time in the sun or be sure to take vitamin D supplements.
- Calcium absorption: You may think the ability to effectively absorb calcium is a positive characteristic, but for some black men, it is not. In fact, researchers at Wake Forest Baptist Medical Center discovered that calcium increases prostate cancer risk in African-American men who have a certain alternative form of a gene (called a genetic allele). This allele enhances the calcium-absorbing abilities in men when compared with individuals who don’t have the allele. Overall, investigators found that black men who were genetically predisposed to absorb calcium poorly were 59 percent less likely to develop advanced prostate cancer than were men who had the genes that allowed them to absorb calcium well. Therefore, calcium increases prostate cancer risk in African-American men
How black men can protect themselves from prostate cancer
Admittedly, the news concerning black men and prostate cancer is not reassuring, but that doesn’t mean they can’t take steps to reduce their risk of developing prostate cancer or dying of the disease. The following steps are suggestions for all black men.
- Get screened for prostate cancer beginning at age 40. Although the typical age to begin screening for prostate cancer is 50 for men of other races, black men should begin at least five years but preferably a full decade sooner and get a prostate-specific antigen (PSA) test and a digital rectal examination (DRE). Remember: prostate cancer is more aggressive in black men, so the sooner the disease is detected and treated, the better.
- Supplement with vitamin D. Black men should first have their vitamin D levels checked by their physician, then take the necessary steps to restore their vitamin D levels by taking supplements if their vitamin D level is low. It is also recommended that vitamin D levels be rechecked after six months of supplementation.
- Be careful of calcium intake. Until researchers can establish that possessing a certain genetic allele increases a black man’s ability to absorb more calcium (and there are effective ways to test for this trait), it may be wise for black men–as it is for all men–to limit their calcium intake to no more than 1,000 mg daily, which is the recommended daily allowance, and to get calcium from food (preferably non-dairy foods such as leafy greens, sardines, almonds, and calcium-fortified orange juice) rather than supplements.
Read more in our Prostate Cancer Health Center.
Platz EA et al. Racial variation in prostate cancer incidence and in hormonal system markers among male health professionals. Journal of the National Cancer Institute 2000 Dec 20; 92(24): 2009-17
Powell IJ et al. Evidence supports a faster growth rate and/or earlier transformation to clinically significant prostate cancer in black than in white American men, and influences radical progression and mortality disparity. Journal of Urology 2010 May; 183(5): 1792-96
Schwartz GG et al. Prostate cancer in African-American men and polymorphism in the calcium-sensing receptor. Cancer Biology & Therapy 2010 Jun 15; 9(12): 994-99