Black men in California are at higher risk of prostate cancer

By Anissa Durham, especially for CalMatters

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James Miller Jr.’s dream of being a homeowner finally came true, so he went to Home Depot for supplies. As he walked down the aisles, his phone rang. His doctor had news no one wanted to hear: Miller had stage 4 metastatic prostate cancer.

His first question: “How much time do I have?”

Maybe seven years, the doctor said. He was 57.

Miller’s story isn’t unique—it’s an epidemic hiding in plain sight. Black men face the highest rates of prostate cancer of any racial or ethnic group in America. They are diagnosed in more advanced stages, often when treatment options are limited. They are twice as likely to die from it as white men. Yet in California, where Miller lives, no legislation specifically addresses prostate cancer screening or prevention.

Advocates say it’s unacceptable — and it’s costing black men their lives.

Most men have no symptoms until prostate cancer is advanced, said Dr. Brent Rose, associate professor of radiation oncology at UC San Diego.

The most effective screening tool is a prostate-specific antigen test – a simple blood draw, much more accurate than a digital rectal exam. Rose says many men avoid screening because they fear the rectal exam, but this test is no longer the standard recommendation.

The statistics are sobering: 1 in 8 black men develop prostate cancer, compared to 1 in 12 white men. Black men are diagnosed younger, so the American Cancer Society recommends they start screening at age 45 — five years earlier than everyone else.

“Why is it more common in black men? The answer is we don’t know,” Rose said. “There are two separate hypotheses. One is that it’s genetic. The other is related to social determinants of health,” such as racism, poverty and disparities in access to health care.

The pain first crept into Miller’s lower back and thighs. Then came frequent trips to the bathroom. I’m just getting oldhe thought. When he lost 20 pounds in a few months, he thought his diet was finally working. But then there was chest pain.

He ended up going to the emergency room. Miller learned that these were symptoms of late-stage prostate cancer. The once fit and dexterous airport security screener was now riddled with cancer in his thighs, lymph nodes, femurs, ribs and even his skull.

“It was like a record in my head. Oh my God, I’m going to die,” the Riverside resident said. “How did I get this? Is this karma? Did I deserve this?”

Miller admitted he left Home Depot that day, went home and got drunk. He started Googling, looking for any hope of surviving more than seven years. Depression set in. After decades of neglecting his health and working a stressful job, Miller wondered if there was more he could do.

“Most black men think I’m still breathing, I’m still walking, I’m fine.” We’re taught from the time you’re a little boy, you grind it, you suck it,” Miller said. “But we have the highest rate of prostate cancer.”

According to the Centers for Disease Control and Prevention, between 2003 and 2022, black men had the highest rates of localized, regional, and distant prostate cancer in the lymph nodes or other parts of the body.

“On average, black men are more likely to die from prostate cancer if they get it, but not because the cancer itself is that different,” Rose said. “Black men are more likely to have more barriers to care. So they get diagnosed a little later or maybe don’t get the optimal treatment.”

Only a few states have legislation that eliminates out-of-pocket costs for prostate cancer screening. California is not among them. But according to California Reparations ReportAfrican-American men in the Golden State are five times more likely to die from prostate cancer than their white peers.

In 2023 MP Mike Gipson author’s Assembly Bill 632which would prohibit health insurance plans from charging deductibles, copayments or coinsurance for prostate cancer screening in high-risk men.

Gov. Gavin Newsom vetoed it, saying it would “increase costs for consumers through higher premiums.”

There isn’t enough talk about prostate cancer in the black community, Miller said; he didn’t realize how often was it until his diagnosis.

Miller takes daily doses of androgen deprivation therapy and receives a Lupron injection every three months. Both hormone treatments slowed the growth of the cancer.

Now 64, he has outlived a seven-year death sentence. But the side effects of these testosterone blockers include weight gain, muscle loss, fatigue, and decreased libido.

“I hope there’s someone I can be with who will accept me for who I am now,” he said. “But it plays a role in your sense of masculinity. What kind of man you are now versus what you used to be.”

In 2023, Miller started the support group The Walnut Tribe, a safe place for men suffering from prostate cancer. Monthly dates give men an opportunity to release the pressure to hold back their feelings and fears. And Miller hopes to raise awareness about early screening.

“You don’t want to be like me and find out about this in the final stages. Please don’t be like me,” Miller said. “Learn about it early. Try to get tested early.”

This comment was adapted from an article created for Word in black. It accompanies an article on a the journalist’s fight with prostate cancerr.

This article was originally published on CalMatters and is republished under Creative Commons Attribution-NonCommercial-No Derivatives license.