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Focus on Disparities Research in Prostate Cancer

During Black History Month, we honor and celebrate the contributions of Black people in art, science, politics, and many other areas. As the theme of Black History Month this year is Black Health & Wellness, it is an opportunity to raise awareness of efforts to combat systemic racism and reduce the excess burden of cancer, COVID-19, and other conditions among Black individuals. We remain mindful that this focus must be continued throughout the year; it cannot stop after February 28th.

Why are Black men more likely to get prostate cancer?

In prostate cancer, the death rate has dropped by over 50% in the past 30 years, yet persistent disparities remain. Black men are about 75% more likely to be diagnosed with prostate cancer than non-Hispanic White men and are over 2 times more likely to die from the disease. Many people ask: is this due to genetics, biology, or environment?

The answer is, all of these.

  • Genetics: PCF-funded researcher Dr. Chris Haiman (USC) has found that men of African ancestry inherit about twice the prostate cancer risk on average compared to men of European ancestry.
  • Biology: At the time of diagnosis, Black men tend to have more advanced and aggressive disease. This may be linked to genetics (risk of more aggressive disease) or socioeconomic factors (less access to appropriate PSA screening) or, most likely, a combination.
  • Environmental factors are complex, but one thing we do know is that some part of increased risk is linked to systemic racism: access to care (related to lack of insurance, interactions with providers, and mistrust of the healthcare system), opportunities for healthy lifestyle, and stress. 

New findings

The hopeful news is that researchers are addressing these problems with increased urgency. Recent findings shed light on how prostate cancer treatments affect Black men, and how this may help doctors and patients make more informed decisions about care.

Previous research has suggested that one of the newer hormone therapy medicines, abiraterone, works better for Black vs white patients with metastatic castration-resistant prostate cancer (mCRPC). A study by Dr. Ravi Parikh of the University of Pennsylvania and team was the first to show that African-American men given abiraterone given as a first treatment for mCRPC lived longer than non-Hispanic white men (23 vs. 17 months). Dr. Parikh’s work was funded by a PCF Young Investigator Award.

A new oral form of hormone therapy called relugolix was FDA-approved in late 2020. It is important to understand how safe and effective this medication is in Black men. Dr. Daniel George of Duke University presented results at a national meeting this month focusing on Black participants in a large clinical trial comparing relugolix to the commonly used medication leuprolide (trade name Eligard or Lupron). The team found that relugolix and leuprolide were equally effective at keeping testosterone low over the long term. For several other measures, relugolix worked better in Black patients, and there were fewer significant side effects with relugolix. The team concluded that relugolix is effective and well-tolerated among Black men in this study.

More work remains

Important work remains to accelerate advances against cancer among Black people. PCF has been funding research into disparities for more than 25 years, totaling over $19 million. Just a few examples include:

  • Collaboration: PCF helped to secure $27 million in investment for the PCF-NCI RESPOND initiative to study why African American men are more likely to be diagnosed with and die from prostate cancer, related to genetic, social, and other factors.
  • Genetic risk: Thanks to the generosity of philanthropist Robert F. Smith, we are funding expansion of Dr. Haiman’s research into an early risk stratification tool (called a “polygenic risk score”), with the aim of increasing participation by Black men to 100,000.
  • Optimizing treatment: Understanding how signals in the blood can be used to predict and monitor response to the immunotherapy sipuleucel-T in African American men.
  • Access to care: We need to ensure that more patients have access to these treatments. PCF is funding the development of a digital tool to expand access to clinical trials to diverse populations.

What can men do

  • Talk to your family about risk. These should be open conversations, not deep family secrets. Because of these genetic risks, that’s how you keep your kids safe.
  • Get screened. If you are Black or have a family history of prostate or other cancers, start talking to your doctor about PSA screening at age 40.
  • Take charge. We can’t fix all of these problems overnight, but you can still take actions that have effects right now: Get our wellness guide, exercise, and eat a plant-centric diet.
  • Be an advocate for yourself in discussions of prostate cancer screening or treatment. Get the PCF Prostate Cancer Patient Guide to empower yourself with knowledge. If you are a patient with aggressive prostate cancer, consider getting two types of advanced testing: biomarker testing of your tumor to potentially identify precision treatment, and genetic testing for inherited mutations.
  • Consider enrolling in a clinical trial or research registry. Trials help doctors understand how new and existing treatments work in diverse populations, benefiting future patients. The “placebo” group generally gets at least the best standard of care, not “no treatment.” There are also many studies that simply observe you and collect data over time. Researchers take many precautions to keep your information secure. Talk to your doctor about participating in a study.