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Why Are Black Men 30% More Likely to Die from Prostate Cancer?

Photo credit: Marina Petti/Getty Image
Photo credit: Marina Petti/Getty Image

“Have you had your prostate checked recently?” That isn’t the first question we imagined asking Steve McQueen, director of the multi award-winning 12 Years a Slave, but we’re here to talk about his recent short video Embarrassed, which addresses the disproportionately high rate of prostate cancer in Black men.

“Yes, absolutely,” he says.

Fifteen years ago, McQueen’s father died from the disease, so when he was approached to make a film on the subject, he knew he had to get involved. “The film has saved lives,” he says simply. “We know that with early detection there’s a 98% survival rate.”

Photo credit: Marina Petti/Getty Image
Photo credit: Marina Petti/Getty Image

“The fact that my father didn’t have to die of this disease, that really pissed me off. Why didn’t he know? Why didn’t I know?”

It’s a good question. The prostate is a small gland at the base of the bladder that helps produce semen and is about the size and shape of a walnut. Black men are twice as likely to get prostate cancer than other men – one in four will receive the diagnosis compared to one in eight men generally, while they're also 30% more likely to die from the disease than their men of other races.

Much is unknown about the biological reasons behind these shocking statistics, but there are some key cultural and socio-economic theories that feed into the problem. McQueen’s film touches on one of them – shame.

Embarrassed features four high-profile Black actors, Morgan Freeman, Idris Elba, Micheal Ward and Chiwetel Ejiofor, who challenge the idea that discussing the illness with family and friends is something to be ashamed of. “Don’t let embarrassment stop you from having this important conversation,” Freeman says in the film. “You may save someone’s life,” adds Ejiofor.

Photo credit: Marina Petti
Photo credit: Marina Petti

Based on Men's Health's conversations, it appears that one source of embarrassment comes from the common assumption that a prostate cancer test involves a doctor performing an anal examination. In reality, the first check is a simple blood test which looks at the level of your PSA (prostate specific antigen). A raised level of this protein may indicate cancer, which can be confirmed or ruled out by further tests.

This is something Joe Appiah, a 51-year-old civil servant and Masters athlete, wants more people to understand. He's currently recovering from an operation to remove his prostate in October 2021, and when we spoke in January 2022, he had just participated in his first athletics competition since his surgery. "We have to let people know it’s a simple blood test, and then it’s survivable when you catch it early,” he says.

Photo credit: Marina Petti/Joe Appiah
Photo credit: Marina Petti/Joe Appiah

Speaking to other Black men who have recovered from prostate cancer there also appears a reluctance within the Black community to talk about anything “below the belt”. That’s certainly the experience of Luke Williams, a teacher originally from Jamaica, whose father died of the disease, but didn't tell anyone that he had it. He believes he kept it hidden “not only because it’s a private part of the body, but also because it’s indicating that he might be losing his manhood,” he says.

“For some men," says Michael Ward, actor and star of Top Boy and Blue Story, "and Black men in particular, going to the hospital [makes] you feel like less of a man because you’re seeking help. But that barrier needs to be broken.”

“This is not about weakness," adds McQueen. "This is about strength. This is about taking control of a situation and being healthy.”

When Was the Last Time You Got Your Prostate Checked?

Like many of the men we spoke to, Errol McKellar's father also had prostate cancer. This is quite common – people are at greater risk if it runs in their family. “When I was diagnosed, I had the conversation with my dad and he said, ‘I had that five-years ago.’ I was so upset. I said to him, ‘could you not have said something to us?’ But when I went out and started doing talks around the country [about prostate cancer], I realised it's very normal, particularly in the African-Caribbean community. It's not a conversation they want to have.”

Photo credit: Marina Petti/Errol McKellar
Photo credit: Marina Petti/Errol McKellar

In the UK, this seems to be a widely held cultural attitude. As a first-generation migrant, McKellar recognises that he was brought up to avoid making a fuss about anything. “We all had that fear of being disrespectful and not toeing the line. You never spoke unless you were asked, you never did things out of place, because it brings disgrace to the family.”

Paul Parker, a former professional footballer who was part of England's 1990 World Cup squad and now fundraises for Prostate Cancer UK following his father’s recovery from the disease, also grew up with this idea. A few years ago, his father was diagnosed with prostate cancer. “He didn’t want to bother anybody, and that was the attitude of people who came come over from the West Indies in the late 50s. They didn’t want to be in people's faces or be a burden on anybody.”

McKellar found out he had prostate cancer aged 53. His diagnosis came completely by chance. After visiting the doctor for a snoring problem, he picked up a leaflet that encouraged getting a PSA blood test and booked in for the same day. By the time his cancer was discovered, it had spread, leaving him needing an operation to remove his prostate followed by a month of radiotherapy treatment. “That was a difficult period for me,’ he recalls.

McKellar knew that his close shave with the disease would change his life; he just wasn’t quite sure how. When he returned to work running a car garage in East London, it came to him. One of his regular customers walked in, and somewhere in the conversation he remembers asking him, “When was the last time you got your prostate checked?” The customer was thrown, but McKellar persisted. He promised to give him a 20% discount if by the time he came back to pick up his car he’d been to the GP.

When the customer came back two weeks later, he showed McKellar a letter that said he had cancer on a quarter of his prostate. He had caught it just in time. He requested that the discount money be donated to charity, and urged McKellar to continue raising awareness.

And that’s exactly what he did. McKellar began encouraging all his male customers to get checked. “[That customer] was the first of 48 guys that walked into my garage who were diagnosed with prostate cancer; twenty-eight of those guys were African-Caribbean men, of which unfortunately two are no longer here.” One of the men who passed away was 42, while the other was just 36.

Photo credit: Marina Petti
Photo credit: Marina Petti

McQueen’s film is particularly striking for the age range of the featured actors. As Appiah encountered when his GP questioned why he was asking for a PSA test aged only 50, even some medical professionals consider prostate cancer an ‘old-person’s disease’. In truth, and as McKellar sadly knows all too well, it can affect men, non-binary and intersex people of any age.

It was for this reason that McQueen was particularly keen to work with actors spanning different generations. For Ward, the youngest of the actors, prostate cancer wasn’t something he’d given much thought to before. "Being involved in the film made me think super differently about health in general and definitely about prostate cancer," he says. "It made me want to speak to people in my family to ask them to get checked. When the film dropped, it allowed other people to want to check, so for me that was a special feeling."

Photo credit: Marina Petti/Getty Image
Photo credit: Marina Petti/Getty Image

Bafta award-winning actor, Chiwetel Ejiofor adds that he believes the film has encouraged positive conversation. “I've had a lot of messages from people saying, it reminded me I've got to get myself checked out," he says. "And even though that the campaign is targeted at Black men, it opens up the conversation, and everybody wants to make sure that they're okay and get checked out.”

The success of McKellar's discount scheme led to him working with other garages in the area to set up similar initiatives. He eventually also founded his own charity, the Errol McKellar Foundation, to expand his awareness-raising work. “I set up the Foundation to make a difference, by openly explaining to guys look, this is what it is and this is what’s going to happen if you leave it," he says. "I always go back to what I'm qualified to do: would you drive your car down the road with no brakes? No. So why not treat your body the same way?”

Finding the Problem Is the First Step Towards Finding the Solution.

Luke Williams has lived in the UK for 20 years. Aged 47, he was diagnosed with prostate cancer and, like so many others, it was the same disease that had killed his father some years previously. As he recalls this, Williams becomes visibly emotional. It wasn’t until after his father died that he knew what had caused it. At the time, his mum urged him to return to the family home in Jamaica to visit but didn’t mention why. Shortly after returning to Kingston, Williams found out that his father had passed away.

Photo credit: Marina Petti/Luke Williams
Photo credit: Marina Petti/Luke Williams

There was a bittersweet contradiction in his loss. His uncle and two cousins had also been diagnosed, so he understood that there was likely something hereditary about this cancer. Thinking of his father he says, “It was like saying, you’ve given this to us, but you’ve also given us life at the same time, because we know that you had it, and that then told us that we need to get checked. You’ve given us the warning.”

Williams began to get checked every year. One year, his doctor noticed his PSA was a little high, but dismissed it as he thought he was too young. The following year, the same thing happened. Williams’ doctor asked about his lifestyle, and concluded that his prostate was slightly larger than normal due to the fact that he did spin classes regularly. “Fortunately, that doctor then retired,” he laughs. The new doctor took things a bit more seriously and referred Williams for an MRI scan. A further biopsy confirmed that he had stage three prostate cancer. Stage four is terminal.

Williams says he hasn’t struggled too severely with the side effects of his operation. In fact, he’s been able to put a positive spin on his near-death experience: “I’ve been one of the lucky ones. Before having the surgery, I took lots of things for granted, but it really changes your perspective.”

Photo credit: Marina Petti
Photo credit: Marina Petti

Stigma and shame aren’t the only reason Black men are at such high risk. Experts point to genetics as well: “We know the secret may lie in changes in the DNA passed on through generations and inherited by the men from their parents,” says professor Ros Eeles, professor of Oncogenetics at the Institute of Cancer Research.

Photo credit: Marina Petti/Getty Image
Photo credit: Marina Petti/Getty Image

It’s not uncommon for certain illnesses and health issues to affect some ethnicities and races more than others. Yet there has not been a significant study into precisely why Black men are so greatly affected by prostate cancer – until now. The PROFILE study, taking place at the Royal Marsden NHS Trust, is looking at Black men’s DNA and whether any genetic results could serve as a helpful screening tool.

Parker is already signed up to the study. He explains how, despite continuing to fundraise for prostate cancer research, he was determined to do more. “I felt I still had to give. I think it would have just been irresponsible of me to say no with [everything that happened] with my dad. I'm glad that I've done it because I can now talk about doing it with other people.”

Ejiofor stresses the importance of the study to overcome racial biases within medical research. “There's a lot of research out there that is specifically directed in one direction, which is white male, and everybody else fits in around that research.”

Photo credit: Marina Petti/Prostate Cancer UK
Photo credit: Marina Petti/Prostate Cancer UK

“I think there are cultural ideas about masculinity that affect Black men, but I think those things can be overcome with a sustained effort from the medical profession to include all of these different voices and dynamics,” Ejiofor adds.

Williams hopes that people will take part in the study “without reservation". "If we can identify why we are twice as likely to have it, then finding the problem is the first step towards finding the solution,” he says.

And, having already saved the lives of 46 men already, McKellar is hoping that the study can save many times more. “The thing about prostate cancer is,” he says, “if you ignore it, it will kill you. What they’re doing at the Royal Marsden is fantastic, but it can only work if people go and get involved in it.”

The PROFILE study is currently recruiting men aged 40-69 years old who are at greater risk of prostate cancer, including men of African or African-Caribbean ancestry. You can find out more about the study here.

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