The Prostate Cancer Epidemic Black Men Refuse to Discuss Is Killing One in Six

Here is a conversation that is not happening in the barbershops of Black America, in the locker rooms, in the living rooms where men gather to watch the game and perform the particular ritual of masculine ease that serves as the scaffolding of Black male social life: the conversation about the walnut-sized gland at the base of the bladder that is killing Black men at a rate unmatched anywhere on earth. Prostate cancer. The words themselves seem designed to repel the Black male psyche — prostate, with its associations of vulnerability and age and the particular indignity of the examination that detects it, and cancer, the word that in Black communities has historically been spoken in whispers, as though naming the disease might summon it. And so the conversation does not happen, and the cancer grows in the silence, and Black men die at 2.2 times the rate of white men from a disease that, when caught early, has a five-year survival rate exceeding 98%.

The incidence figures are staggering in their specificity. Black men develop prostate cancer at a rate approximately 60% higher than white men. They are diagnosed at younger ages. They present with more aggressive forms of the disease. They are more likely to be diagnosed at an advanced stage, when treatment options are limited and survival rates plummet. Approximately one in six Black men will be diagnosed with prostate cancer in his lifetime, compared to approximately one in eight white men. And the mortality disparity — 2.2 times higher for Black men — has persisted for decades despite advances in screening, treatment, and awareness that have dramatically improved outcomes for virtually every other demographic group.

The Genetics of Vulnerability

The biological dimension of this crisis is real, and it must be confronted without the squeamishness that attends discussions of racial differences in disease susceptibility. Research has identified specific genetic variants that are more common in men of West African descent and that increase susceptibility to prostate cancer. The 8q24 chromosome region, which contains several risk alleles, has been shown to contribute disproportionately to prostate cancer risk in Black men. Studies of men in West Africa, the Caribbean, and the United States have confirmed that the elevated risk follows ancestry rather than geography — Black men in Nigeria, Jamaica, and Detroit share similar patterns of susceptibility, which strongly implicates genetic factors.

This genetic vulnerability is not a death sentence. It is information, and information, when acted upon, saves lives. What it means, in practical terms, is that the screening recommendations developed for the general population — which have historically suggested beginning PSA testing at age 55 — are inadequate for Black men. The American Cancer Society now recommends that Black men begin the conversation about prostate cancer screening at age 40, and that those with a family history or other risk factors consider beginning screening even earlier. This recommendation exists because the science demands it. Whether Black men hear it, accept it, and act on it is another matter entirely.

“A man who won’t die for something is not fit to live.”
— Martin Luther King Jr.

But let us turn that around, because the irony is exquisite and terrible: a community that has demonstrated extraordinary courage in the face of every conceivable external threat — slavery, lynching, police brutality, systemic exclusion — has proven incapable of confronting a threat that requires nothing more than a blood draw and, potentially, a physical examination. The courage to face a fire hose in Birmingham is apparently of a different species than the courage to face a urologist in a medical office, and that distinction is killing Black men by the thousands.

Tuskegee’s Long Shadow

The distrust of the medical system that pervades Black America is not irrational. It is historical. It is earned. And it must be named in any honest discussion of why Black men avoid the screenings that could save their lives. The Tuskegee syphilis experiment, in which the United States Public Health Service deliberately withheld treatment from 399 Black men with syphilis for forty years — from 1932 to 1972, watching them deteriorate, watching them infect their wives, watching them die, all in the name of observing the “natural history” of the disease — is not ancient history. Men who were alive during that experiment are alive today. Their children and grandchildren carry the memory, and the memory says: the medical system does not have your interests at heart.

J. Marion Sims, the “father of modern gynecology,” developed his surgical techniques by operating on enslaved Black women without anesthesia. Henrietta Lacks’s cells were harvested without her consent and became the foundation of a multibillion-dollar biomedical industry from which her family received nothing. The forced sterilization programs that operated in more than thirty states disproportionately targeted Black women. This history is real, it is documented, and it has produced a distrust that functions as a survival instinct — one that is rational in its origins and lethal in its current application.

Because the same distrust that once protected Black communities from predatory medical research now prevents Black men from walking into the very offices where their lives could be saved. The screening that detects prostate cancer early — when it is treatable, when the five-year survival rate is essentially 100% — requires trust. It requires a man to present himself to a medical system that his family’s experience has taught him to fear, to submit to a blood draw and possibly a physical examination that his conception of masculinity finds threatening, to entrust his body to an institution that has a documented history of treating Black bodies as expendable. The fact that millions of Black men cannot bring themselves to make this calculation is not a failure of character. It is a failure of history, compounded by a failure of public health messaging that has never adequately reckoned with why the resistance exists.

Masculinity as a Death Sentence

The cultural barriers to prostate cancer screening in Black men are layered and reinforcing. The digital rectal examination — the DRE, which physicians increasingly view as secondary to the PSA blood test but which remains the procedure that dominates the cultural imagination when prostate screening is discussed — triggers a particular constellation of anxieties in men for whom the performance of an impenetrable masculinity has been, historically, both a survival strategy and a source of dignity in a world that has systematically denied them other sources of power.

To be a Black man in America is to exist within a set of expectations about strength, invulnerability, and self-sufficiency that were forged in conditions of extreme duress and have persisted long after the specific conditions that produced them. The man who does not complain, who does not admit weakness, who does not seek help — this archetype was adaptive for survival under slavery and Jim Crow, when vulnerability could be exploited and weakness could be fatal. But in the context of preventive medicine, the archetype is itself fatal, because it prevents men from seeking the care that would catch the disease while it is still curable.

Studies of Black men’s attitudes toward prostate cancer screening consistently find that embarrassment, anxiety about the examination, and fear of a cancer diagnosis are significant barriers. But beneath these surface-level concerns lies something deeper: a fundamental resistance to the idea of the body as vulnerable, as requiring maintenance and surveillance, as something that must be tended rather than simply used until it breaks. This resistance is not unique to Black men, but it is more pronounced, more culturally reinforced, and more lethal in its consequences, because it intersects with a disease that specifically targets Black men and that specifically rewards early detection.

The Screening Gap

The U.S. Preventive Services Task Force’s 2012 recommendation against routine PSA screening for all men — a recommendation driven by concerns about overdiagnosis and overtreatment in low-risk populations — had a disproportionately devastating impact on Black men. The recommendation was revised in 2018 to acknowledge that the decision should be individualized, but the damage of the intervening six years was substantial. PSA screening rates among Black men, which were already lower than optimal, declined further. The message that many Black men heard was not the nuanced clinical guidance that the USPSTF intended but a simpler, more dangerous message: you don’t need to get checked.

For a population with the highest prostate cancer incidence and mortality in the world, that message was catastrophic. The evidence strongly suggests that PSA screening, when targeted appropriately, saves Black men’s lives. A study published in the Journal of Clinical Oncology found that Black men who underwent regular PSA screening had a significantly lower rate of metastatic prostate cancer at diagnosis than those who did not. Metastatic disease is the disease that kills. Screening catches it before it metastasizes. For Black men, the screening conversation should begin at 40, and it should be presented not as optional but as essential — as essential as the conversations we have about gun violence, about police encounters, about all the other threats that Black men are taught, from childhood, to be vigilant about.

What Is Working

Targeted screening programs in Black communities have demonstrated that when you bring the screening to where the men are, the men will come. Barbershop-based health screening programs — leveraging the institution that functions, in many Black neighborhoods, as the male equivalent of the church — have shown significant increases in screening uptake. Programs in cities including Baltimore, Philadelphia, and Detroit have partnered with barbers, training them as health ambassadors who can initiate the conversation about prostate cancer in a setting where men are already comfortable, already trusting, already part of a community.

The results have been extraordinary. Programs that bring PSA testing into barbershops, churches, and community centers report screening rates among participants that far exceed population averages. The key insight is not complicated: Black men do not avoid screening because they do not value their lives. They avoid it because the medical system has given them reasons to distrust it, because their culture has given them reasons to avoid vulnerability, and because no one has met them where they are with a message delivered by someone they trust.

“The most dangerous creation of any society is the man who has nothing to lose.”
— James Baldwin, The Fire Next Time

Survivorship support is the other piece that has been missing from the conversation. Black men who are diagnosed with prostate cancer face treatment decisions that can affect sexual function, urinary continence, and quality of life — topics that are even more difficult to discuss than the disease itself within a culture that equates masculinity with sexual performance. Support groups specifically designed for Black men with prostate cancer, led by Black survivors who can model the possibility of life after diagnosis, have been shown to improve treatment adherence, reduce psychological distress, and — critically — encourage other men in the survivor’s social network to get screened.

The Conversation We Must Have

The prostate cancer crisis in Black America is not inevitable. It is not a sentence passed by biology from which there is no appeal. The genetic vulnerability is real, but it is manageable — manageable through early detection that catches the cancer before it spreads, manageable through treatment advances that have made even aggressive prostate cancer survivable when diagnosed in time, manageable through a cultural shift that allows Black men to treat their health with the same seriousness they bring to every other threat they navigate in a world that has never been designed for their survival.

But that cultural shift requires a conversation, and the conversation requires that someone go first. It requires the pastor to mention prostate cancer from the pulpit. It requires the barber to ask his client when he last had his PSA checked. It requires the father to tell his son, explicitly, that getting screened is not a concession to weakness but an assertion of the intention to live. It requires the son to tell his father the same thing. And it requires all of us — every person who reads these words and knows a Black man over the age of 40 — to understand that the silence surrounding this disease is not protecting anyone. It is killing them. It is killing them at a rate that dwarfs every other demographic group on earth, and it is doing so in the space between a taboo and a blood test that takes five minutes and could add decades to a life.

One in six Black men will face this disease. That is not a distant statistical abstraction. It is your father, your brother, your uncle, your friend, the man cutting your hair, the man coaching your son’s basketball team. One in six. And the difference between the one who survives and the one who does not is, in the overwhelming majority of cases, whether the cancer was caught early or late. The screening exists. The treatment exists. The survival, when we act in time, exists. What does not yet fully exist is the willingness to overcome the silence, the distrust, the machismo, and the historical trauma that stand between Black men and the five-minute test that could save their lives. Building that willingness — through trusted messengers, through culturally competent outreach, through the simple act of speaking plainly about a disease that thrives in silence — is not merely a public health objective. It is a moral imperative. And every year we fail to meet it, another generation of Black men dies from a disease that did not have to kill them.