CLINICAL REVIEW / PEER REVIEWED

Screening for Prostate Cancer in Black Men

Clinician Reviews. 2018 October;28(10):24-28

Author(s):

Walter Jermaine Thompson, DHSc, MPH, CHES

While the incidence of prostate cancer has declined in general over the years, the incidence and mortality rate among black men is disproportionately high. Screening recommendations differ among medical organizations, perpetuating the divide; this article aims to raise awareness and deliver clear direction for screening.

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References

1. Murphy SL, Kochanek KD, Xu J, Heron M. Deaths: final data for 2012. Nat Vital Stat Rep. 2015;63(9):37-80.
2. Nevada Division of Public and Behavioral Health. Comprehensive report: prostate cancer. September 2015. http://dpbh.nv.gov/Programs/Office_of_Public_Healh_Informatics_and_Epidemiology_(OPHIE)/. Accessed September 19, 2018.
3. Odedina FT, Dagne G, Pressey S, et al. Prostate cancer health and cultural beliefs of black men: the Florida prostate cancer disparity project. Infect Agent Cancer. 2011;6(2):1-7.
4. Winterich JA, Grzywacz JG, Quandt SA, et al. Men’s knowledge and beliefs about prostate cancer: education, race, and screening status. Ethn Dis. 2009;19(2):199-203.
5. Bhavsar A, Verma S. Anatomic imaging of the prostate. Biomed Res Int. 2014,1-9.
6. National Institutes of Health. Zones of the prostate. www.training.seer.cancer.gov/prostate/anatomy/zones.html. Accessed September 7, 2018.
7. CDC. Prostate cancer statistics. June 12, 2017. www.cdc.gov/cancer/prostate/statistics/. Accessed September 7, 2018.
8. American Cancer Society. Prostate cancer risk factors. www.cancer.org/cancer/prostate-cancer/causes-risks-prevention/what-causes.html.
9. Mkanta W, Ndjakani Y, Bandiera F, et al. Prostate cancer screening and mortality in blacks and whites: a hospital-based case-control study. J Nat Med Assoc. 2015;107(2):32-38.
10. Hoffman R. Screening for prostate cancer. N Engl J Med. 2011;365(21):2013-2019.
11. CDC. Who is at risk for prostate cancer? June 7, 2018. www.cdc.gov/cancer/prostate/basic_info/risk_factors.htm. Accessed September 7, 2018.
12. American Cancer Society. Cancer facts and figures 2017. www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2017/cancer-facts-and-figures-2017.pdf. Accessed September 7, 2018.
13. Woods VD, Montgomery SB, Belliard JC, et al. Culture, black men, and prostate cancer: what is reality? Cancer Control. 2004;11(6):388-396.
14. Braithwaite RL. Health Issues in the Black Community. 2nd ed. San Francisco, Calif: Jossey-Bass Publishers; 2001.
15. Ogunsanya ME, Brown CM, Odedina FT, et al. Beliefs regarding prostate cancer screening among black males aged 18 to 40 years. Am J Mens Health. 2017;11(1):41-53.
16. American Cancer Society. American Cancer Society Recommendations for Prostate Cancer Early Detection. April 14, 2016. www.cancer.org/cancer/prostate-cancer/early-detection/acs-recommendations.html. Accessed September 7, 2018.
17. American Urological Association. Early detection of prostate cancer. 2013. www.auanet.org/guidelines/prostate-cancer-early-detection-(2013-reviewed-for-currency-2018). Accessed September 7, 2018.
18. United States Preventative Services Task Force. Final recommendation statement. Prostate cancer: screening. 2018. www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/prostate-cancer-screening1. Accessed September 7, 2018.
19. Shenoy D, Packianathan S, Chen AM, Vijayakumar S. Do African-American men need separate prostate cancer screening guidelines? BMC Urol. 2016;16(19):1-6.
20. Odedina FT, Campbell E, LaRose-Pierre M, et al. Personal factors affecting African-American men’s prostate cancer screening behavior. J Natl Med Assoc. 2008;100(6):724-733.

IN THIS ARTICLE

Prostate cancer screening tools
Ethic disparities
Screening guidance

Prostate cancer, the second most common cancer to affect American men, is a slow-growing cancer that is curable when detected early. While the overall incidence has declined in the past 20 years (see Figure 1), prostate cancer remains a major concern among black men due to disproportionate incidence and mortality rates.^1-3 A general understanding of the prostate and of prostate cancer lays the groundwork to acknowledge and address this divide.

ANATOMY OF THE PROSTATE

Although most men know where the prostate gland is located, many do not understand how it functions.⁴ The largest accessory gland of the male reproductive system, the prostate is located below the bladder and in front of the rectum (see Figure 2).⁵ The urethra passes through this gland; therefore, enlargement of the prostate can cause constriction of the urethra, which can affect the ability to eliminate urine from the body.⁵

The prostate is broken down into four distinct regions (see Figure 3). Certain types of inflammation may occur more often in some regions of the prostate than others; as such, 75% of prostate cancer occurs in the peripheral zone (the region located closest to the rectal wall).^5,6

DIAGNOSING PROSTATE CANCER

Signs and symptoms

According to the CDC, the signs and symptoms of prostate cancer include

Difficulty starting urination
Weak or interrupted flow of urine
Frequent urination (especially at night)
Difficulty emptying the bladder
Pain or burning during urination
Blood in the urine or semen
Pain in the back, hips, or pelvis
Painful ejaculation.

However, none of these signs and symptoms are unique to prostate cancer.⁷ For instance, difficulty starting urination, weak or interrupted flow of urine, and frequent urination can also be attributed to benign prostatic hyperplasia. Further, in its early stages, prostate cancer may not exhibit any signs or symptoms, making accurate screening essential for detection and treatment.⁷

Screening tools

There are two primary tools for detection of prostate cancer: the prostate-specific antigen (PSA) test and the digital rectal exam (DRE).⁸ The blood test for PSA is routinely used as a screening tool and is therefore considered a standard test for prostate cancer.⁹ A PSA level above 4.0 ng/mL is considered abnormal.¹⁰ Although measuring the PSA level can improve the odds of early prostate cancer detection, there is considerable debate over its dependability in this regard, as PSA can be elevated for benign reasons.

Sociocultural and genetic risk factors

While both black and white men are at an increased risk for prostate cancer if a first-degree relative (ie, father, brother, son) had the disease, one in five black men will develop prostate cancer in their lifetimes, compared with one in seven white men.³ And despite a five-year survival rate of nearly 100% for regional prostate cancer, black men are more than two times as likely as white men to die of the disease (1 in 23 and 1 in 38, respectively).^8,11 From 2011 to 2015, the age-adjusted mortality rate of prostate cancer among black men was 40.8, versus 18.2 for non-Hispanic white men (per 100,000 population).¹²

Continue to: The disparity in prostate cancer mortality...