The disparity in prostate cancer mortality among black men has been attributed to multiple variables. Cultural differences can play a role in whether patients choose to undergo prostate cancer screening. Black men are, for example, less likely than other men to participate in preventive health care practices.13 Although an in-depth discussion is outside the scope of this article, researchers have identified some plausible factors for this, including economic limitations, lack of access to health care, distrust of the health care system, and an indifference to pain or discomfort.13,14 Decisions surrounding prostate screening can also be affected by a patient’s perceived risk for prostate cancer, the impact of a cancer diagnosis, and the availability of treatment.
Other factors that contribute to the higher incidence and mortality rate among black men include genetic predisposition, health beliefs, and knowledge about the prostate and cancer screenings.15 While most researchers have focused on men ages 40 and older, Ogunsanya et al suggested that educating black men about screening for prostate cancer at an earlier age may help them to make informed decisions later in life.15
PRACTICE POINTS
- Prostate cancer remains a major concern among black men due to disproportionate incidence and mortality.
- Developing prostate cancer screening recommendations for black men would help reduce mortality and morbidity in this population.
- Educating black men about screening for prostate cancer at an earlier age may help them to make informed decisions later in life.
IMPLICATIONS FOR PRACTICE
The age at which men should begin screening for prostate cancer has been a source of controversy due to the lack of consensus between the American Cancer Society, the American Urological Association, and the United States Preventive Services Task Force (USPSTF) guidelines (see Table).16-18 The current USPSTF recommendations for prostate cancer screening do not take into account ethnic differences, despite the identified racial disparity.19 Ambiguity in public health policy creates a quandary in the decision-making process regarding testing and treatment.9,19,20
Early screening and intervention is necessary to help mitigate prostate cancer morbidity and mortality.21The authors support the use of the American Cancer Society guidelines, which are comprehensive and clearly define who is considered to be at risk. The guidelines suggest screening black men and men with known family histories (considered to be at high risk) at age 45, and screening men with a strong family history (multiple first-degree relatives who developed prostate cancer at a young age) beginning at age 40.
In addition, these guidelines recommend the use of both the DRE and PSA screening tests. Screening should be performed every two years for men who have a PSA level < 2.5 ng/mL, and every year for men who have a level > 2.5 ng/mL.
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