Former President Joe Biden’s recent update about his stage 4 prostate cancer has brought renewed attention to a disease that is both common and highly treatable when detected early. During Prostate Cancer Awareness Month, Biden has urged men not to put off conversations with their doctors about screening, drawing particular attention to the importance of early detection for Black men and those with a family history of the disease.

The timing comes as researchers and public health organizations continue to examine why Black men in the United States experience a substantially higher burden of prostate cancer and how to make early detection more accessible. Prostate cancer is the most common non-skin cancer among American men, and the American Cancer Society estimates that about 1 in 8 men will be diagnosed during their lifetime. The disease is also the second-leading cause of cancer death among American men, behind lung cancer.

The disparity is particularly pronounced among Black men. According to the National Cancer Institute, Black men have a higher incidence of prostate cancer than White men, with age-adjusted incidence rates from 2017 to 2021 of 188.7 cases per 100,000 Black men compared with 114.9 per 100,000 White men. Black men also have higher mortality from the disease, even after researchers account for differences in access to care.

Those differences make the question of when and how men begin talking about prostate cancer screening especially important.

A screening conversation can be an early step

Prostate cancer can develop without noticeable symptoms, particularly in its early stages. The National Cancer Institute notes that early-stage prostate cancer does not usually cause symptoms, which means waiting for warning signs may allow the disease to progress before it is identified.

Screening commonly involves a blood test that measures prostate-specific antigen, or PSA. Elevated PSA levels can be associated with prostate cancer, but they can also result from noncancerous conditions, including an enlarged prostate or inflammation. Because PSA screening can lead to false-positive results, additional testing and treatment that may not ultimately be necessary, major medical organizations recommend that men discuss the potential benefits and harms with a healthcare professional before deciding whether screening is right for them. The American Cancer Society recommends that men at average risk begin a screening discussion with a healthcare provider at age 50 if they are expected to live at least another 10 years. For men at higher risk, including Black men and men with a father or brother who was diagnosed with prostate cancer before age 65, that conversation is recommended beginning at age 45. Men with more than one close relative diagnosed at an early age are considered at even higher risk and should begin the conversation at age 40.

The recommendations illustrate why prostate cancer screening cannot be reduced to a single age or test for every man. The U.S. Preventive Services Task Force recommends individualized decision-making about PSA screening for men ages 55 to 69 and does not recommend PSA-based screening for men age 70 and older. The task force has also acknowledged the significantly higher prostate cancer burden among Black men while noting that evidence remains insufficient to determine exactly how the benefits and harms of screening differ for this population. For Black men, however, the challenge is not simply determining whether screening should occur. It is also ensuring that men have the information, access and opportunity to make that decision.

A new study announced this month at the University of Oklahoma illustrates one approach researchers are taking. With a five-year, $2.9 million National Institutes of Health grant, researchers are testing an interactive app called Connect2Care that is designed to increase PSA screening among Black men in Oklahoma. The study will enroll 684 Black men ages 55 to 69 who are not up to date with PSA screening. Participants will receive either the Connect2Care intervention, a U.S. Preventive Services Task Force informational app or usual care. Connect2Care combines prostate cancer education with an option for completing an at-home PSA blood test that is analyzed by a certified laboratory. The researchers say the approach is intended to address barriers that can make clinic-based screening difficult, including transportation, work and family responsibilities, cost and limited access to healthcare. The app also allows participants to request a confidential conversation with a prostate cancer survivor, an effort researchers say could help address stigma surrounding prostate health.

The need for better information is also reflected in recent survey findings from the Prostate Health Education Network. A preliminary survey of 168 Black men found that 91% said they would be willing to receive a PSA test, while 93% said the information they received increased their interest in being tested. At the same time, 48% of respondents between ages 40 and 80 reported that they had never received a PSA test, and another 25% said they had not had one in four to six years. PHEN cautioned that the survey was not nationally representative, but the findings point to a gap between interest in prostate health and actual screening. That gap matters because early detection can change the course of prostate cancer. The American Cancer Society reports that the U.S. prostate cancer death rate fell by about half between 1993 and 2022, a decline likely influenced by earlier detection and advances in treatment. At the same time, the organization notes that the decline has slowed in recent years as more cancers are being diagnosed at an advanced stage.

For Black men, closing that gap requires more than encouraging people to get screened. It means making risk information understandable, ensuring screening discussions happen early enough, addressing barriers to care and making follow-up available when a test raises concerns. Family history is particularly important because having a father, brother or son with prostate cancer increases a man’s risk. Certain inherited genetic changes, including BRCA1 and BRCA2 variants, can also increase risk.

Biden’s experience has put a highly visible face on the consequences of discovering prostate cancer after it has already spread. But the larger public health story extends far beyond one person. For communities facing a disproportionate burden of prostate cancer, early detection must be paired with access to high-quality diagnosis, treatment and follow-up care.

As Prostate Cancer Awareness Month continues, the message for men is not that every person should automatically undergo a PSA test. It is that men should know their risk and have an informed conversation with a healthcare provider about whether screening makes sense for them. For Black men, that conversation may need to begin earlier. Making sure they have the information and access to have it could be an important part of closing a long-standing gap in prostate cancer outcomes.