Editor’s note: This article has been anonymized at the author’s request. “Arthur Avery” is an alias used to protect the identity of the author and their family while still sharing this story with the community.
For three years, I brought it up at every family dinner, every phone call, every birthday. “Dad, have you scheduled your prostate screening yet?” And for three years, I got some version of the same answer: “I feel fine. I don’t need it.”
This is a conversation many families have, especially Black families. Black men face a significantly higher risk of prostate cancer than the general population, which is exactly why prostate cancer screening guidelines recommend Black men start the conversation with their doctor earlier than most.¹ My dad didn’t know that. Honestly, neither did I, until his coworker’s diagnosis changed everything.
He wasn’t being stubborn to be difficult. He genuinely believed that if nothing felt wrong, nothing was wrong. It took a coworker of his getting diagnosed with prostate cancer at a routine PSA test, with no symptoms at all, before my dad finally picked up the phone and made the appointment.
This is what I learned along the way about prostate cancer screening for Black men, and what I wish I had known sooner.
Why My Dad Kept Putting Off His Prostate Cancer Screening
My dad is not a man who avoids doctors out of fear. He goes for his annual physical every year without complaint. But prostate screening felt different to him. He associated it with vulnerability, with a version of “being checked” that felt uncomfortable to even discuss out loud, let alone schedule.
I think a lot of men feel this way. It is not always about denial. Sometimes it is about a screening that feels invasive, or a quiet worry about what might be found, or simply not having anyone explain clearly why it matters when nothing feels wrong.
What Finally Changed His Mind About Getting a Prostate Screening
My dad’s coworker, a man his age with no symptoms and no family history he knew of, was diagnosed with early-stage prostate cancer after a routine PSA test. Because it was caught early, his treatment options were far better than they would have been if he had waited for symptoms to show up.
That story stuck with my dad in a way that my nagging never had. He called his doctor the next week.
Why Prostate Screening Matters, Especially for Black Men
Prostate cancer is one of the most common cancers among men in the United States, and it disproportionately affects Black men.¹ Black men are about 70% more likely to be diagnosed with prostate cancer than white men, and they are more than twice as likely to die from it.¹ Black men are also more likely to be diagnosed at a younger age and with more advanced disease.
The reasons behind this disparity are complex, including differences in access to care, delays in diagnosis, and other systemic factors. But one thing is clear: early detection saves lives, and Black men benefit significantly from starting the screening conversation earlier than the general population.
What a Prostate Screening (PSA Test) Actually Involves
For my dad, most of his anxiety came from not knowing what to expect. Here is what the screening process typically includes:³
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PSA blood test: A simple blood draw that measures prostate-specific antigen, a substance made by the prostate. Elevated levels can be a sign of prostate cancer, though they can also be caused by other, non-cancerous conditions.
- Digital rectal exam (DRE): A brief physical exam where a doctor checks the prostate for any irregularities. It typically takes less than a minute.
Neither test on its own confirms cancer. If results are abnormal, your doctor will talk with you about next steps, which may include further testing.
Prostate Cancer Screening Guidelines: When Should Men Get Screened?
Screening guidelines account for individual risk, and Black men are generally advised to start the conversation earlier than other groups:⁴
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The American Cancer Society recommends that Black men, along with men who have a first-degree relative (father or brother) diagnosed with prostate cancer before age 65, talk with their doctor about screening starting at age 45.⁴
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Men at even higher risk, such as those with more than one close relative diagnosed at an early age, may be advised to start the conversation at age 40.⁴
- Men at average risk are generally advised to have this conversation starting at age 50.⁴
These are starting points for a conversation with your doctor, not automatic testing dates. The decision to screen involves weighing personal risk factors, values, and preferences with your doctor.⁴
How to Talk to a Family Member About Prostate Screening
Looking back, the moment that mattered most wasn’t a pamphlet or a statistic I texted him. It was sitting down and asking him directly what he was afraid of, and then just listening. Once he said it out loud, it seemed to lose some of its weight.
If you are trying to have this conversation with a father, husband, brother, or friend, my biggest piece of advice is this: lead with curiosity, not pressure. Ask what is holding them back before you tell them why they should go.
Self-Advocacy Language For Readers
If you are getting ready to talk with your doctor about prostate screening, try using these words:
- “Based on my age and family history, should I be getting screened for prostate cancer?”
- “Can you walk me through what the PSA test and exam actually involve?”
- “My [father/brother] was diagnosed with prostate cancer. Does that change when I should start screening?”
- “I’m nervous about this test. Can we talk through what to expect?”
How the NOWINCLUDED Community Can Help
My dad’s story is not unusual. So many men, especially Black men, put off this conversation because of fear, discomfort, or simply not knowing where to start.
You don’t have to figure this out alone, and you don’t have to wait for a scare to make the call. Inside the NOWINCLUDED app, you can find trusted, culturally aware health education and real stories from people who have had this same conversation with the people they love.
Frequently Asked Questions
Q: At what age should Black men start prostate cancer screening?
A: The American Cancer Society recommends that Black men talk with their doctor about screening starting at age 45, or age 40 if they have more than one close relative diagnosed with prostate cancer at an early age.
Q: Why are Black men at higher risk for prostate cancer?
A: Black men are about 70% more likely to be diagnosed with prostate cancer and more than twice as likely to die from it compared to white men. The reasons are complex and include disparities in access to care and diagnosis timing, alongside other factors researchers continue to study.
Q: What does a prostate cancer screening involve?
A: Screening typically includes a PSA blood test and sometimes a brief digital rectal exam. Neither test alone confirms cancer; abnormal results lead to a conversation about further testing.
Q: Does an elevated PSA mean I have cancer?
A: Not necessarily. PSA levels can be elevated due to non-cancerous conditions as well. Your doctor can help interpret your results and determine next steps.
Q: How do I talk to a family member who is avoiding this screening?
A: Try leading with curiosity about their hesitation rather than pressure. Understanding what’s holding them back can make the conversation feel less confrontational and more supportive.
References
- American Cancer Society. (2024, January 17). Key Statistics for Prostate Cancer. Retrieved from American Cancer Society: https://www.cancer.org/cancer/types/prostate-cancer/about/key-statistics.html
- American Cancer Society. (2024, January 17). Tests to Diagnose and Stage Prostate Cancer. Retrieved from American Cancer Society: https://www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging/how-diagnosed.html
- American Cancer Society. (2024, January 17). American Cancer Society Recommendations for Prostate Cancer Early Detection. Retrieved from American Cancer Society: https://www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging/acs-recommendations.html
