Black Men and Prostate Cancer: 2 RCCA Oncologists Discuss ‘the Number You Need to Know


Glen Gejerman, MD, says that when it comes to risk for developing prostate cancer and for having poor outcomes with the disease, Black men face several significant disadvantages relative to men from other racial and ethnic backgrounds.

The board-certified radiation oncologist explains that Black men are:

• more likely to develop prostate cancer, facing a 1-in-6 lifetime risk as compared to a 1-in-8 risk for men overall;¹
• diagnosed at a median age of 65 years, two to four years earlier than the median age of diagnosis for other men;¹
• more likely than other men to have cancer that has spread beyond the prostate prior to diagnosis;²
• roughly twice as likely as other men to die from the disease.¹
  

“Those numbers are discouraging, but there also is one very important number that can facilitate detection of prostate cancer in its earliest stages, giving patients the best chance for successful outcomes,” says Dr. Gejerman, a genitourinary cancer specialist at the John Theurer Cancer Center of Hackensack University Medical Center in Hackensack, NJ.

The physician, who practices with Regional Cancer Care Associates (RCCA), one of the nation’s largest networks of oncology specialists, continues, “I’m referring to a patient’s prostate-specific antigen, or PSA, number, which can be measured from a small sample of blood obtained during a simple blood draw. A large proportion of cases of prostate cancer are identified by investigating an elevated PSA value in a man not experiencing any symptoms. This is one reason why it is so important for men to have regular physical examinations and for those exams to include PSA screening starting at the age appropriate for a man’s degree of risk for prostate cancer.”

Dr. Gejerman adds, “While I want to emphasize the potentially life-saving value of PSA screening, I also want to note that an elevated PSA does not – in itself – confirm the presence of prostate cancer. Several factors, including infection, recent sexual activity, or an enlarged prostate, can cause PSA to rise. So having an elevated prostate-specific antigen value is not cause to panic, but it is cause for further investigation. When warranted based on a man’s history, physical examination, and other assessments, a urologist may perform a prostate biopsy, which is key to making a definitive diagnosis of prostate cancer.”

The Importance of Starting Prostate Cancer Screening Early

Because Black men have an elevated risk for prostate cancer and a younger median age of diagnosis compared to others, several medical organizations recommend that they begin PSA screening earlier than men of other racial and ethnic backgrounds.

Manmeet Singh Ahluwalia, DO, explains, “The American Cancer Society recommends that men at average risk for prostate cancer begin screening at age 50. However, the society says that men who are at high risk should start screening at age 45. The organization includes African Americans and men whose father or brother was diagnosed with prostate cancer before age 65 in this high-risk group. Further, if men are at even higher risk due to having two or more risk factors, such as being African American and having a first-degree relative diagnosed at an early age, the American Cancer Society recommends starting screening at age 40.”³

The board-certified medical oncologist and hematologist adds that the American Urological Association recommends that clinicians offer prostate cancer screening starting at age 40 to 45 years for men at increased risk due to factors including African ancestry, germline mutations, and a strong family history of the disease.⁴ He continues that the National Comprehensive Cancer Network^® (NCCN) recommends obtaining a baseline PSA level at age 40 in Black men, people with genetic mutations that increase risk for the disease, and those with a concerning family or personal history, as opposed to starting screening at age 45 in other men.⁵

Dr. Ahluwalia, who practices at RCCA’s Howell, NJ, and Tom’s River, NJ, offices, notes that one of the key goals of PSA screening is to detect prostate cancer before it has spread. “The 5-year relative survival rate for localized or regional prostate cancer is more than 99%, but that rate drops to 38% for distant cancer.⁶ While we want to detect prostate cancer as early as possible in all patients, prompt identification is particularly important in Black men given their younger median age at diagnosis and the fact that they are more likely than other men to already have metastases when diagnosed. The hope is that starting screening at a younger age will enable us to find and treat more cases while the disease is still contained to the prostate.”