Why Black men—and the people who love them—must put prostate cancer screening back into the community conversation.
A generation ago, Chicago public-health leaders understood something medicine sometimes forgets: health information is most powerful when it reaches people where they live, gather, and trust one another.
In 1999, Chicago urologist Dr. Terry Mason and public-health leader Joseph “Joe” Harrington helped establish the Thapelo Institute, bringing education, prevention strategies and health screenings directly to African American men. Harrington later helped carry prostate-health conversations into barbershops—turning the barber’s chair into a place where men could hear facts, question myths and be urged to see a doctor.
Joseph Harrington tells us, “In its earliest, most treatable state, prostate cancer doesn’t produce any symptoms. So, out of an abundance of care and concern, Dr. Mason and I came together with a group of like-minded Black male health professionals to create, the Thapelo Institute. Our focus was to do our best to improve the health status of Black men. Knowing that Black men are 1.7 times more likely to get prostate cancer and twice as likely to die, it was imperative for us to include prostate cancer education and screening in all of our events and activities.”
That work matters just as much today. The programs may be less visible, but the danger has not faded. Prostate cancer often grows without early symptoms, and a man can feel perfectly healthy while the disease develops. Waiting for pain or urinary trouble can mean waiting too long.
Real Men Charities has been hosting events and collaborating with other organizations to bring awareness to prostate disease for twenty-seven years. Rael Jackson, President of Real Men Charities, states, “The fact that Black men are more than twice as likely to die from prostate cancer as men in other racial or ethnic groups, according to the CDC, is reason for alarm, and reason for every Black man to get tested.”
Prostate cancer is the most commonly diagnosed cancer among U.S. men other than skin cancer and the second-leading cause of male cancer death after lung cancer. The American Cancer Society estimates that in 2026 about 333,830 people will be diagnosed and 36,320 will die from the disease. About one man in eight will receive a prostate cancer diagnosis during his lifetime.
The burden is not shared equally. Black men are about 67% to 70% more likely than White men to be diagnosed, and their prostate cancer death rate is approximately twice as high. In the latest detailed American Cancer Society report, the mortality rate was 36.9 deaths per 100,000 Black men, compared with 18.4 per 100,000 white men.
There is no single explanation. Researchers are studying inherited risk, tumor biology and environmental influences. But access also matters: insurance and out-of-pocket costs, delayed diagnosis, uneven access to specialists and high-quality treatment, mistrust rooted in medical racism, and too few clear conversations about screening are all factors resulting in a preventable gap in who gets diagnosed early and who survives.
For much of the 20th century, prostate cancer was often found only after symptoms appeared or the disease had spread. The PSA blood test entered widespread medical use in the late 1980s and early 1990s, making it possible to detect many cancers earlier. Death rates later fell sharply as screening and treatment improved. But PSA screening also revealed slow-growing cancers that might never have harmed a man, leading some patients to undergo biopsies or treatments with side effects they might not have needed.
That history explains why today’s guidance emphasizes informed, shared decision- making—not fear and not a one-size-fits-all rule. Screening should be a conversation about a man’s age, Black ancestry, family history, overall health, and personal preferences.
PSA stands for prostate-specific antigen, a substance made by the prostate. The test measures PSA in a blood sample. A higher number can be a warning sign, but it does not automatically mean cancer. An enlarged prostate, infection, recent medical procedures and some medicines can affect the result. An abnormal PSA may lead to a repeat test, imaging, other biomarker tests or a biopsy.
A PSA test is not automatically included in the usual complete blood count or metabolic panel. Ask whether PSA was ordered, and ask for the actual result so it can be compared over time.
A digital rectal examination (DRE) may sometimes be used as part of an evaluation, although the CDC notes that the U.S. Preventive Services Task Force does not recommend DRE alone as a screening test because evidence of benefit is lacking.
Major organizations do not use identical age cutoffs, which is one reason men should talk with a clinician rather than rely on a slogan. The American Cancer Society advises men of African ancestry to discuss screening at age 45. The American Urological Association recommends offering screening to people at increased risk—including those with Black ancestry—between ages 40 and 45. Men with more than one close relative diagnosed early, or certain inherited mutations such as BRCA1 or BRCA2, may need an even earlier and more individualized plan.
Early prostate cancer usually causes no symptoms. When symptoms do occur, they may include trouble starting or stopping urination, a weak or interrupted urine stream, urinating often—especially at night—blood in the urine or semen, pain with ejaculation, or persistent pain in the back, hips or pelvis. These symptoms can have noncancerous causes, but they deserve medical attention. New leg weakness or numbness, loss of bladder or bowel control, or severe bone pain requires urgent evaluation.
There is no guaranteed way to prevent prostate cancer, and age, ancestry and inherited genes cannot be changed. No vitamin, herb or supplement has been proved to prevent the disease. A healthy lifestyle, however, supports overall cancer and heart health and may reduce the risk of aggressive disease:
Maintain a healthy weight. Obesity has been linked in some studies to a greater risk of aggressive prostate cancer.
Move regularly. Aim for activity you can sustain—walking, cycling, swimming, strength work or active household tasks.
Build meals around vegetables, fruit, beans and whole grains, while limiting highly processed foods and large amounts of red or processed meat.
Do not smoke, and limit or avoid alcohol.
Know your family history. Ask whether a father, brother or son had prostate, breast, ovarian or pancreatic cancer, which can signal an inherited cancer risk.
Keep appointments and follow up on abnormal results. Screening saves no one if the result is never discussed.
The lesson of Chicago’s barbershop initiatives was not merely that men needed a blood test. It was that trusted people could make lifesaving conversations ordinary. Wives, partners, sisters, daughters, friends, pastors, barbers and fraternity brothers can all ask one respectful question: “Have you talked with your doctor about a PSA test?”
No man should be shamed or frightened into screening. He should be given the facts, allowed to weigh benefits and risks, and supported in getting follow-up care. Early-stage prostate cancer has a five-year relative survival rate approaching 100%; once it has spread to distant parts of the body, survival is far lower. The best time to begin the conversation is before symptoms appear.
Ranoule Tatum, a prostate cancer survivor, has dedicated over twenty years to informing and saving lives in addition to being a representative for Real Men Charities. His mantra is: “Early detection is a man’s best protection.”
