PROSTATE CANCER remains one of the most striking examples of racial disparity in health outcomes in the United States. Black men face a twofold higher risk of dying from the disease compared with the general population. This gap has persisted for more than five decades, despite overall reductions in mortality since the introduction of prostate-specific antigen (PSA) testing. Higher incidence rates, younger age at onset, more aggressive disease at diagnosis, and worse survival outcomes all contribute to this disparity. These differences reflect the combined effects of structural, social, biological, and health care factors.
PSA testing has been shown to reduce prostate cancer deaths by 20% to 30% over long-term follow-up. However, Black men remain underrepresented in large screening trials, and screening rates declined across all groups after the 2012 US Preventive Services Task Force recommendations. To understand why Black men may face particular barriers, researchers conducted a mixed-methods study examining both patient and practitioner perspectives on PSA testing.
The study found that both groups often lacked sufficient knowledge about the risks and benefits of screening, as well as the stark disparities in prostate cancer outcomes affecting Black men. Information available to patients was frequently inaccessible or of poor quality. Primary care practitioners (PCPs) reported low confidence in the value of PSA screening and tended to rely on broad national guidelines rather than those recommending earlier screening for high-risk groups. Compared with urologists, PCPs were also less likely to discuss PSA testing with Black patients or with those with a family history of the disease.
Trust and communication emerged as crucial facilitators. Black patients reported more positive experiences when receiving care from racially or culturally concordant physicians, highlighting the importance of diversity in the medical workforce.
These findings underscore the need for better education of both patients and practitioners, clearer guidance on high-risk populations, and efforts to build trust through culturally informed care. By addressing these barriers, there is an opportunity to reduce longstanding disparities in prostate cancer outcomes and improve early detection for Black men.
Reference
Lee JR et al. Patient and physician perceptions of prostate-specific antigen testing among black individuals. JAMA Netw Open. 2025;8(9):e2530946.
