Men of African ancestry are nearly twice as likely to have prostate cancer than men of European ancestry. They are also more likely to develop prostate cancer at an earlier age and have more aggressive forms of the cancer, leading to a higher mortality rate than other groups.

The risk is even higher for men with a family history of prostate cancer. How do you respond if you are at higher risk? We’ll explain what researchers know about the heritability of prostate cancer and how to approach the screening process with a doctor.

Many risk factors are associated with a prostate cancer diagnosis. Some of these factors include:

  • Age. Risk of prostate cancer increases rapidly after age 50, and 60 percent of cases are diagnosed in men over 65.
  • Ethnicity. African American men and Caribbean men of African descent are more likely to get prostate cancer than white, Hispanic, or Asian men.
  • Family History. Having a father or brother with prostate cancer more than doubles your risk. It’s even higher if you have multiple family members with prostate cancer.

Though we know men who fall into any or all of the above categories are more likely to be diagnosed, there’s no definitive answer to what causes prostate cancer. Scientists estimate about 10 percent of prostate cancers are related to inherited gene mutations. Those mutations cause changes in genes that suppress tumors, help cells grow, or repair DNA.

Researchers theorize that the discrepancy between prostate cancer rates for men of African ancestry versus white men could be due to a combination of factors, such as:

  • genetics
  • diet
  • environment
  • lifestyle
  • socioeconomic conditions

In a 2013 study of more than 1,200 Black men in Barbados, West Indies, researchers found that men with a family history of prostate cancer were three times as likely to develop the disease.

In another study reported in 2021, researchers looked at 1,225 men undergoing prostate biopsy. Results showed that a family history of prostate cancer was associated with the risk of high-grade (more aggressive) prostate cancer in Black men.

In 2018, the National Institutes of Health and the Prostate Cancer Foundation launched a study called RESPOND, or Research on Prostate Cancer in Men of African Ancestry: Defining the Roles of Genetics, Tumor Markers, and Social Stress.

Researchers hope to recruit 10,000 African American men with prostate cancer for the investigative study, which will look at environmental and genetic factors. The goal is to better understand why disparities in the disease exist.

Since a man’s primary risk factors — age, family history, and ethnicity — cannot be altered, screening for prostate cancer is often touted to manage the disease before it reaches advanced stages.

Screening for prostate cancer is not standard practice, though. The decision to be screened is made individually by a man and his doctor, based on risk factors.

There are a few methods for screening for prostate cancer:

  • Digital rectal exam. A doctor physically examines the prostate for changes or lumps.
  • Prostate-specific antigen (PSA) blood test. PSA levels could be elevated due to prostate cancer, but an enlarged or inflamed prostate may also lead to high PSA levels even when no cancer is present.
  • 4Kscore test. New blood test that accurately identifies the risk of aggressive prostate cancer. It plays an essential clinical role as a reflex test before proceeding with initial prostate biopsy in men with an elevated PSA level or abnormal digital rectal examination results.

If either of these tests shows cause for concern, further tests are necessary to diagnose prostate cancer, such as an ultrasound, an MRI, or a biopsy.

A 4Kscore test is a new blood test that determines the risk of high-grade prostate cancer. It is often employed following an abnormal digital rectal examination and before a biopsy. Similarly, your doctor may order a Prostate Health Index (phi), a Food and Drug Administration-approved blood test that’s a recommended approach to reducing biopsies.

Screening for prostate cancer is not always seamless. Tests can give false results, but the next step is usually a biopsy because doctors don’t know whether it’s a false positive. In older men especially, a biopsy may result in complications or unwanted side effects such as an infection or blood in the semen.

The decision to be screened is individual. Talk with your doctor about whether screening is a good idea, especially if you have risk factors such as a family history of prostate cancer.

Another screening option is genetic testing. While some genes have been identified and associated with a higher risk of prostate cancer, genetic testing also has its drawbacks.

Testing can be costly and may not be fully covered by insurance. Also, results, such as the presence of a mutation with unknown effects on your risk of cancer, may cause stress or anxiety.

While genetic test results may identify genetic mutations that increase cancer risk, it’s unsurprisingly often an emotional time as family members learn of their own potential risk.

As difficult as the information may be — including survivor’s guilt if you learn you don’t have the variant that a family member has — scientists gain an increased understanding of the relationship between cancer and human genes, doctors and patients stand to benefit.

Men of African descent are more likely to develop prostate cancer, have more aggressive forms of prostate cancer, are more likely to be diagnosed at a younger age, and are less likely to survive the cancer.

Risks are even higher for men who have one or more relatives with prostate cancer. Though prostate cancer screening is not standard practice, Black men with a family history may benefit from screening. Talk with your doctor about the risks and benefits of screening for prostate cancer.