Examining the Racial Disparities in Prostate Cancer


      Currently, Black men in the United States are greater than 1.5 times as likely to be diagnosed with prostate cancer and more than twice as likely to succumb to the disease. While racial disparities in prostate cancer have been well documented, we must analyze these disparities in the correct context. Discussion of these disparities without correctly describing race as a social construct and acknowledging the impact of structural racism is insufficient. This article reviews the disparities seen in screening, treatment, outcomes, and clinical trial participation. We conclude by outlining future steps to help understand and study disparities, as we strive toward equitable outcomes.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Siegel RL
        • Jemal A
        • Wender RC
        • Gansler T
        • Ma J
        • Brawley OW.
        An assessment of progress in cancer control: an assessment of progress in cancer control.
        CA Cancer J Clin. 2018; 68: 329-339
        • Singh GK
        • Jemal A.
        Socioeconomic and racial/ethnic disparities in cancer mortality, incidence, and survival in the united states, 1950–2014: over six decades of changing patterns and widening inequalities.
        J Environ Public Health. 2017; 2017: 1-19
        • Evans WM.
        Open Wound: The Long View of Race in America.
        University of Illinois Press, Champaign, IL2009
      1. Kendi IX. Stamped from the beginning: the definitive history of racist ideas in America (NY). New York, NY; 2017.

        • Seymour-Smith S
        • Brown D
        • Cosma G
        • Shopland N
        • Battersby S
        • Burton A.
        “Our people has got to come to terms with that”: changing perceptions of the digital rectal examination as a barrier to prostate cancer diagnosis in African-Caribbean men: DRE as a barrier to prostate cancer diagnosis in African-Caribbean Men.
        Psychooncology. 2016; 25: 1183-1190
        • Roberts LR
        • Wilson CM
        • Stiel L
        • Casiano CA
        • Montgomery SB.
        Prostate cancer screening among high-risk black men.
        J Nurse Pract. 2018; 14 (e2): 677-682
        • Sandblom G
        • Varenhorst E
        • Rosell J
        • Löfman O
        • Carlsson P.
        Randomised prostate cancer screening trial: 20 year follow-up.
        BMJ. 2011; 342: d1539
        • Andriole GL
        • Crawford ED
        • Grubb RL
        • et al.
        Prostate cancer screening in the randomized prostate, lung, colorectal, and ovarian cancer screening trial: mortality results after 13 years of follow-up.
        J Natl Cancer Inst. 2012; 104: 125-132
        • Schröder FH
        • Hugosson J
        • Roobol MJ
        • et al.
        Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (Erspc) at 13 years of follow-up.
        Lancet. 2014; 384: 2027-2035
        • Martin RM
        • Donovan JL
        • Turner EL
        • et al.
        Effect of a low-intensity psa-based screening intervention on prostate cancer mortality: the cap randomized clinical trial.
        JAMA. 2018; 319: 883-895
        • Gilligan T
        • Wang PS
        • Levin R
        • Kantoff PW
        • Avorn J.
        Racial differences in screening for prostate cancer in the elderly.
        Arch Intern Med. 2004; 164: 1858
        • Gamble VN.
        Under the shadow of Tuskegee: African Americans and health care.
        Am J Public Health. 1997; 87: 1773-1778
        • Kaplan SH
        • Gandek B
        • Greenfield S
        • Rogers W
        • Ware JE
        Patient and visit characteristics related to physicians’ participatory decision-making style. Results from the medical outcomes study.
        Med Care. 1995; 33: 1176-1187
        • Cooper-Patrick L
        • Gallo JJ
        • Gonzales JJ
        • et al.
        Race, gender, and partnership in the patient-physician relationship.
        JAMA. 1999; 282: 583-589
        • Saha S
        • Komaromy M
        • Koepsell TD
        • Bindman AB.
        Patient-physician racial concordance and the perceived quality and use of health care.
        Arch Intern Med. 1999; 159: 997-1004
        • Doescher MP.
        Racial and ethnic disparities in perceptions of physician style and trust.
        Arch Fam Med. 2000; 9: 1156-1163
        • LaVeist TA
        • Nickerson KJ
        • Bowie JV.
        Attitudes about racism, medical mistrust, and satisfaction with care among African American and white cardiac patients.
        Med Care Res Rev. 2000; 57: 146-161
        • Collins KS
        • Hughes DL
        • Doty MM
        • Ives BL
        • Edwards JN
        • Tenney K.
        Diverse Communities, Common Concerns: Assessing Health Care Quality for Minority Americans. Findings from The Commonwealth Fund 2001 Health Care Quality Survey.
        The Commonwealth Fund, New York2002
        • Mahal BA
        • Chen Y-W
        • Muralidhar V
        • et al.
        National sociodemographic disparities in the treatment of high-risk prostate cancer: do academic cancer centers perform better than community cancer centers?: PC Treatment Disparities by Center Type.
        Cancer. 2016; 122: 3371-3377
        • Moses KA
        • Orom H
        • Brasel A
        • Gaddy J
        • Underwood W.
        Racial/ethnic disparity in treatment for prostate cancer: does cancer severity matter?.
        Urology. 2017; 99: 76-83
        • Tosoian JJ
        • Mamawala M
        • Epstein JI
        • et al.
        Active surveillance of grade group 1 prostate cancer: long-term outcomes from a large prospective cohort.
        Eur Urol. 2020; 77: 675-682
        • Klotz L
        • Zhang L
        • Lam A
        • Nam R
        • Mamedov A
        • Loblaw A.
        Clinical results of long-term follow-up of a large, active surveillance cohort with localized prostate cancer.
        JCO. 2010; 28: 126-131
        • Gökce MI
        • Sundi D
        • Schaeffer E
        • Pettaway C.
        Is active surveillance a suitable option for African American men with prostate cancer? A systemic literature review.
        Prostate Cancer Prostatic Dis. 2017; 20: 127-136
        • Deka R
        • Courtney PT
        • Parsons JK
        • et al.
        Association between African American race and clinical outcomes in men treated for low-risk prostate cancer with active surveillance.
        JAMA. 2020; 324: 1747
      2. NCCN Guidelines: Prostate cancer early detection v.2.2012. National comprehensive cancer network web site. Accessed June 1, 2021.

        • Lowrance WT
        • Breau RH
        • Chou R
        • et al.
        Advanced prostate cancer: AUA/ASTRO/SUO guideline part I.
        J Urol. 2021; 205: 14
        • Lowrance WT
        • Breau RH
        • Chou R
        • et al.
        Advanced prostate cancer: AUA/ASTRO/SUO guideline part II.
        J Urol. 2021; 205: 22
        • Underwood W
        • Jackson J
        • Wei JT
        • et al.
        Racial treatment trends in localized/regional prostate carcinoma: 1992-1999.
        Cancer. 2005; 103: 538-545
        • Moses KA
        • Orom H
        • Brasel A
        • Gaddy J
        • Underwood W.
        Racial/ethnic disparity in treatment for prostate cancer: does cancer severity matter?.
        Urology. 2017; 99: 76-83
        • Hayn MH
        • Orom H
        • Shavers VL
        • et al.
        Racial/ethnic differences in receipt of pelvic lymph node dissection among men with localized/regional prostate cancer: race differences in PLND receipt.
        Cancer. 2011; 117: 4651-4658
        • Koga Y
        • Song H
        • Chalmers ZR
        • et al.
        Genomic profiling of prostate cancers from men with african and european ancestry.
        Clin Cancer Res. 2020; 26: 4651-4660
        • Mahal BA
        • Alshalalfa M
        • Spratt DE
        • et al.
        Prostate cancer genomic-risk differences between African-American and white men across gleason scores.
        Eur Urol. 2019; 75: 1038-1040
        • Tosoian JJ
        • Almutairi F
        • Morais CL
        • et al.
        Prevalence and prognostic significance of pten loss in African-American and European-American men undergoing radical prostatectomy.
        Eur Urol. 2017; 71: 697-700
      3. Howlader N Noone AM Krapcho M SEER Cancer Statistics Review. National Cancer Institute, Bethesda, MD2017: 1975-2014 (, based on November 2016 SEER data submission, posted to the SEER web site, April)
        • Hamdy FC
        • Donovan JL
        • Lane JA
        • et al.
        10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer.
        N Engl J Med. 2016; 375: 1415-1424
        • Dess RT
        • Hartman HE
        • Mahal BA
        • et al.
        Association of black race with prostate cancer– specific and other-cause mortality.
        JAMA Oncol. 2019; 5: 975
        • Halabi S
        • Dutta S
        • Tangen CM
        • et al.
        Overall survival of black and white men with metastatic castration-resistant prostate cancer treated with docetaxel.
        JCO. 2019; 37: 403-410
        • Halabi S
        • Dutta S
        • Tangen CM
        • et al.
        Clinical outcomes in men of diverse ethnic backgrounds with metastatic castration-resistant prostate cancer.
        Ann Oncol. 2020; 31: 930-941
        • Muralidhar V
        • Dee EC
        • Mahal BA
        • et al.
        Association between black race and improved survival following sipuleucel-t immunotherapy in metastatic castrate-resistant prostate cancer: implications for immune biology and integration of radiation therapy with immunotherapy.
        Int J Radiat Oncol Biol Phys. 2020; 108: e901
        • Sartor O
        • Armstrong AJ
        • Ahaghotu C
        • et al.
        Survival of African-American and Caucasian men after sipuleucel-T immunotherapy: outcomes from the PROCEED registry.
        Prostate Cancer Prostatic Dis. 2020; 23: 517-526
        • McNamara MA
        • George DJ
        • Ramaswamy K
        • et al.
        Overall survival by race in chemotherapy-naïve metastatic castration-resistant prostate cancer (Mcrpc) patients treated with abiraterone acetate or enzalutamide.
        JCO. 2019; 37 (212): 212
      4. The effect of patient race and socio-economic status on physicians’ perceptions of patients.
        Soc Sci Med. 2000; 50: 813-828
        • Katz RV
        • Green BL
        • Kressin NR
        • Claudio C
        • Wang MQ
        • Russell SL
        Willingness of minorities to participate in biomedical studies: confirmatory findings from a follow-up study using the Tuskegee Legacy Project Questionnaire.
        J Natl Med Assoc. 2007; 99: 1052-1060
        • Wendler D
        • Kington R
        • Madans J
        • et al.
        Are racial and ethnic minorities less willing to participate in health research?.
        PLoS Med. 2005; 3 (In: Gill P, ed.): e19
        • Rencsok EM
        • Bazzi LA
        • McKay RR
        • et al.
        Diversity of enrollment in prostate cancer clinical trials: current status and future directions.
        Cancer Epidemiol Biomarkers Prev. 2020; 29: 1374-1380
        • Spratt DE
        • Osborne JR.
        Disparities in castration-resistant prostate cancer trials.
        J Clin Oncol. 2015; 33: 1101-1103
        • Murthy VH
        • Krumholz HM
        • Gross CP.
        Participation in cancer clinical trials: race-, sex-, and age-based disparities.
        JAMA. 2004; 291: 2720
        • Brawley OW.
        Prostate cancer and the social construct of race.
        Cancer. 2021; 127: 1374-1376
        • Geronimus AT
        • Pearson JA
        • Linnenbringer E
        • et al.
        Race-ethnicity, poverty, urban stressors, and telomere length in a detroit community-based sample.
        J Health Soc Behav. 2015; 56: 199-224
        • Riviere P
        • Luterstein E
        • Kumar A
        • et al.
        Survival of African American and non-Hispanic white men with prostate cancer in an equal-access health care system.
        Cancer. 2020; 126: 1683-1690
      5. Nine charts about wealth inequality in america(Updated). 2017. Accessed June 18, 2021.

        • 50 years after the Kerner Commission
        African Americans Are Better Off in Many Ways But Are Still Disadvantaged by Racial Inequality.
        Economic Policy Institute, Washington, DC2021