Imagine leaving your yearly physical confident that your doctor checked everything that matters, only to learn later that a simple blood test for prostate cancer was never part of the routine. For many Black men, this is a real experience. In a new study, published in the Journal of Racial and Ethnic Health Disparities, many of the men interviewed assumed prostate cancer screening was automatically included in their regular blood work. Often, it wasn’t.
These missed opportunities can carry serious consequences, because Black men in the United States are diagnosed with prostate cancer about 67% more often than White men and die from the disease at more than twice the rate. That gap has held steady even as overall prostate cancer deaths have declined in recent decades. The prostate specific antigen (PSA) is a protein that is released by prostate cancer cells but not by normal prostate. A simple blood test that measures the amount of PSA in blood can help detect prostate cancer early, when it is most treatable. A positive PSA test is the most often identified sign of prostate cancer. Even so, advice about who should be tested and when varies widely, with few screening guidelines adequately addressing the higher risk that Black men face. Some organizations, including the Prostate Cancer Foundation and the American Cancer Society, suggest starting screening conversations as early as age 40, while the U.S. Preventive Services Task Force recommends shared decision making about screening between ages 55 and 69 without explicit guidance for higher risk groups.
While the toll of prostate cancer on Black men is well documented, “far less is known about the specific, lived barriers that Black men face in accessing PSA testing,” said Dante’ Morehead, the study’s first author and a community outreach and education specialist at the University of Washington.
To better understand those barriers, Morehead worked with senior author Dr. Yaw Nyame, a urologic oncologist and health services researcher at the University of Washington and a member of the Public Health Sciences Division at Fred Hutch Cancer Center. The team partnered with the Black and African Descent Collaborative for Prostate Cancer Action (BACPAC), a community-led network of Black prostate cancer patients, advocates, physicians and researchers working toward prostate cancer equity. The researchers set out to understand how the health care system, social conditions and personal experiences together shape whether Black men get tested, working closely with BACPAC advisors who helped design the study and shape the interview questions.
Between fall 2021 and winter 2022, Morehead, who brings deep experience in cancer education within Black communities, interviewed 29 Black men living in Washington State who ranged in age from 34 to 72. Some of the men had never been screened, while about half had been diagnosed with prostate cancer. After carefully coding each conversation to identify shared patterns, the researchers presented their early results to Black men with prostate cancer and community advocates to make sure the findings reflected their experiences.
The first of five themes that emerged from the interviews centered on trust. Men said that a good relationship with their doctor made it easier to talk about PSA testing, with several explaining that having a Black provider brought a sense of comfort rooted in history. “I think as black folks, we one, don’t trust anybody with medicine,” one participant said, adding, “And of course, historically we know why.” Others described raising questions about prostate cancer only to feel that their concerns were brushed aside or downplayed.
The second theme reflected the men’s belief that PSA testing should be a standard part of preventive care for Black men, even though many felt the test might never be offered unless they brought it up themselves. The third theme focused on information, which men described as scarce, confusing or rarely tailored to Black men. Several participants were surprised to learn that prostate cancer can affect younger men, while others knew only about the digital rectal exam without realizing that a simple blood test existed. “Our community is not highlighted as necessarily a community that needs to get this information to improve survival rates,” one man said.
The fourth theme highlighted the powerful role of family, friends and churches, since hearing about a neighbor’s or fellow churchgoer’s diagnosis often prompted men to get checked, while families that rarely discussed health created additional barriers. “Black men need to look out for each other,” one participant said. The final theme showed how ideas about masculinity, along with worries about sexual function and incontinence after treatment, made some men reluctant to talk about prostate health with their doctors or their peers.
According to the authors, these findings point to several opportunities for change, including educational materials developed with community input, training for providers in active listening and cultural humility, efforts to recruit and support more Black physicians, and community partnerships that help make conversations about prostate health feel normal rather than embarrassing.
The study also raises new questions that the team hopes to pursue. “We want to know, what does effective cultural humility training or culturally relevant information look like in practice, and can it measurably shift Black men’s screening and care experiences?” Morehead said. Their next steps include exploring patient-centered interventions and taking a closer look at conversations between patients and providers in clinical settings.
The research grew out of collaboration across the Cancer Consortium, including the Pacific Northwest Prostate Cancer SPORE, which works to reduce inequities in prostate cancer, and Fred Hutch’s Office of Community Outreach and Engagement, which helped the team connect with patients, advocates and community organizations.
“This study is moving beyond individual-level explanations of inequities in PSA testing and looking at structural, equity-related barriers within the larger framework of the healthcare system,” Morehead said.
This work was supported by the Andy Hill Cancer Research Endowment (CARE) Fund and the National Cancer Institute through the Pacific Northwest Prostate Cancer SPORE.
Fred Hutch/University of Washington/Seattle Children’s Cancer Consortium Member Dr. Yaw Nyame contributed to this research.
Morehead, D., Lee, J. R., Young, B., Tolbert, V., Masembe, J., Kim, S. M., Mecham, S. H., Sage, L., Austin, E. J., Wolff, E. M., Gore, J. L., Nyame, Y. A., & BACPAC Collaborative (2026). A Qualitative Evaluation of Structural and Social Determinants of Health, Black Race, and Perspectives of Prostate Cancer Risk and Early Detection. Journal of racial and ethnic health disparities, 10.1007/s40615-026-03122-8. Advance online publication.
Science Spotlight writer Darya Moosavi is a postdoctoral research fellow within Johanna Lampe's research group at Fred Hutch. Darya studies the nuanced connections between diet, gut epithelium, and gut microbiome in relation to colorectal cancer using high-dimensional approaches.