“Overall, African American men are 1.8 times more likely to be diagnosed with—and 2.2 times more likely to die from—prostate cancer than white men.” (From ZERO The End of Prostate Cancer) This point blank statement is the result of statistics that have remained fairly consistent over recent decades. This data has been the basis for a long-held belief that prostate cancer kills more Black men than White men.

Now, a December 2021 article by Stern, et al. contradicts this belief. Their paper is the most recent in a long string of studies showing that when certain factors are corrected for, PCa-specific death rates are equal between Blacks and Whites. For instance, in 2000 a paper by Merrill & Lyon found that

…black men do not have a statistically greater chance of prostate cancer mortality than white men after adjusting for differences in stage and grade, age, number of primary cancers, and treatment. Later stage at diagnosis is the primary reason for the higher likelihood of prostate cancer mortality among black men compared to white men.^[i]

To return to the Stern article, the authors used national Canadian data on 51,530 men who were diagnosed with PCa from 1992-2010. Their health data was cross referenced with Canadian census information in order to determine each patient’s ethnicity, divided into the following groups: Black; East Asian; South Asian; Southeast Asian/Filipino; West Asian or Arab; White; White and Latin American, Arab or West Indian; Latin American, Arab or West Asian with a write-in response indicating European ancestry; or Native American. (Interestingly, only the South Asian and East Asian groups had a lower risk of PCa-specific death. The main point is, “No increased risk of prostate cancer-specific mortality was observed among Black men.”

So, the answer to the title question is no, PCa does not kill more Black than White men. Yet the riddle remains as to why more Blacks than Whites are diagnosed with PCa. It doesn’t appear to be due to different biological disease lines. Dr. Daniel Spratt, co-chair of Genitourinary Clinical Research at University of Michigan, states, “The data show that black men don’t appear to intrinsically and biologically harbor more aggressive disease.”^[ii]

However, socioeconomic factors can account for racial disparities. The organization ZERO notes:

Because of historical context, race in the United States is correlated with socioeconomic status, and lower socioeconomic status is correlated with increased cancer risk and poorer outcomes. African American men may also be harmed by racial bias in preventive care, as they are less likely than white men to be offered the option of having a PSA test, and are more likely than white men to be told that the benefits of the PSA test are uncertain.^[iii]

Dr. Spratt supports this view. Black men “…generally get fewer PSA screenings, are more likely to be diagnosed with later stage cancer, are less likely to have health insurance, have less access to high-quality care and other disparities that can be linked to a lower overall socioeconomic status.”^[iv] Low socioeconomic status is also demographically associated with higher rates of cardiovascular disease and diabetes, two conditions that contribute to worse health outcomes in general, especially when they coexist with cancer. Finally, a 2016 study found that compare to Whites, both Black and Hispanic men were less likely to receive most conventional treatments except for radiation, which they were more likely to receive.

While it’s good news that when all things are equal, Whites and Blacks have the same odds of PCa specific death. On the other hand, it’s bad news that healthcare access inequity exists in the U.S.—a sad, consistent statistical reality that no one can adequately explain.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Merrill RM, Lyon JL. Explaining the difference in prostate cancer mortality rates between white and black men in the United States. Urology. 2000 May;55(5):730-5.
[ii] Imhoff, Jordan. “Study Explores Why Prostate Cancer Mortality is Higher in Black Men.” University of Michigan Lab Report. May 23, 2019. https://labblog.uofmhealth.org/lab-report/study-explores-why-prostate-cancer-mortality-higher-black-men.
[iii] https://zerocancer.org/learn/about-prostate-cancer/risks/african-americans-prostate-cancer/
[iv] https://zerocancer.org/learn/about-prostate-cancer/risks/african-americans-prostate-cancer/