In the first two installments of The People’s Tribune’s Prostate Cancer Awareness Series, we looked at the possible warning signs of prostate cancer and explained what a PSA blood test can, and cannot, tell you. The next question is particularly important for our community: Are some men more likely to develop prostate cancer than others?
The answer is yes, and Black men are among those at greatest risk. The American Cancer Society says prostate cancer occurs more often in Black men in the United States and in Caribbean men of African ancestry than in men of other racial and ethnic groups. Its 2026 cancer report goes further, stating that Black men in the United States and Caribbean have the highest documented prostate cancer incidence rates in the world.
The difference is significant
U.S. National Cancer Institute data illustrate just how large the difference can be. The prostate cancer incidence rate among Black men is about 191.5 cases per 100,000 men, compared with 114.5 among White men. Prostate cancer mortality among Black men is also more than twice that of White men, at 37.2 deaths per 100,000 compared with 18.1.
The U.S. Centers for Disease Control and Prevention also reports that Black men tend to develop prostate cancer at younger ages and are more likely to have more advanced disease when it is discovered. These statistics come largely from the United States and should not simply be treated as St. Maarten statistics, but the higher risk documented among men of African ancestry, including in the Caribbean, makes them highly relevant to conversations here.
Why is the risk higher?
Scientists do not have one simple explanation. Researchers believe the difference is likely caused by a combination of factors, including inherited genetic differences, access to healthcare, participation in screening, environmental influences and broader social conditions that affect when cancer is detected and how it is treated.
Genetics may be part of the picture. Researchers have identified inherited genetic variations associated with prostate cancer risk, and some occur more frequently among men with African ancestry. Mutations in genes such as BRCA2 can also raise prostate cancer risk. However, genetics does not explain every case, and most prostate cancers occur in men without a known inherited mutation.
Your family history matters too
A Black man with a family history of prostate cancer may have more than one risk factor working against him. Having a father or brother with prostate cancer more than doubles a man's risk of developing the disease, according to the American Cancer Society. Risk can be even higher when several close relatives have been diagnosed, especially if they developed prostate cancer at a relatively young age.
This means men should know more than their own medical history. Ask questions within the family. Did your father have prostate cancer? What about your brothers, uncles or grandfather? How old were they when they were diagnosed? That information could help a doctor determine how early a conversation about screening should begin.
It is not only about biology
The higher death rate among Black men should also not be interpreted as proof that prostate cancer is automatically more deadly simply because a man is Black. Access to early diagnosis, specialist care and appropriate treatment can make a major difference.
The American Cancer Society notes that disparities in access to and delivery of quality care may contribute substantially to the difference in outcomes. Research has also found that when Black and White men receive similar treatment and care, long-term prostate cancer survival can be comparable.
That makes early conversations, access to testing and proper follow-up especially important.
So when should Black men start asking about screening?
There is no universal rule saying every man should automatically receive a PSA test at the same age. Screening has potential benefits as well as possible harms, including false alarms and the detection of slow-growing cancers that might never cause serious problems.
The American Cancer Society recommends that men at average risk begin discussing prostate cancer screening with a healthcare provider at age 50. For Black men, that conversation should begin at age 45. Men at even higher risk, including those with several close relatives diagnosed with prostate cancer at an early age, should begin the discussion around age 40.
The important word is conversation. Turning 45 does not automatically mean something is wrong, and it does not mean every Black man requires the exact same testing schedule. It means your risk deserves to be discussed.
For Black men in St. Maarten, the message is worth taking seriously: know your family history, know your risk, and do not wait for symptoms before talking to your doctor about prostate health. Prostate cancer can be silent in its early stages, and for men already facing a higher risk, waiting for the body to sound an alarm may mean waiting too long.
