Have The Conversation

By Victor Ukwu, MD, Chief Medical Officer, Saint James Health. Creator, The ManKave®

How many of us know our father’s favorite team, the car he always wanted, or the music he played on Saturday mornings — but have no idea whether he ever had prostate cancer? Or any cancer, for that matter.

I ask men about family history all the time in clinic: “Any prostate cancer in your family?”

Sometimes the answer comes quickly. Other times, there is a pause.

“I don’t know, Doc.”

That pause bothers me. Not because every man should know every detail of his family’s medical history. Most of us don’t. It bothers me because Black men carry one of the highest burdens of prostate cancer in the country, and too many of us enter the conversation later than we should.

September is Prostate Cancer Awareness Month. But awareness isn’t the problem anymore. Most men have heard of prostate cancer. Many know they should ask about screening.

The question is what we do with what we know. And that question hits differently for Black men.

A risk Black men cannot ignore

Prostate cancer is the second-leading cause of cancer death among American men. A Black man in the United States has roughly a 1-in-6 lifetime chance of developing prostate cancer, compared with about 1 in 8 men overall. Black men develop prostate cancer at a rate 67% higher than white men and are about twice as likely to die from it.

The difference begins earlier, too. Between ages 50 and 59, approximately 1 in 28 Black men will be diagnosed with prostate cancer, compared with about 1 in 57 white men.

Those numbers deserve our attention. But I do not believe the answer is as simple as saying, “Black men need to get screened.”

Our outcomes are complicated, but complexity cannot excuse inaction. Black men should be having informed conversations about prostate cancer earlier — not after something goes wrong.

“But Doc, I feel fine”

Good. Let’s keep it that way.

One pattern I see in men — not just Black men — is our tendency to use symptoms as permission to seek care.

Something hurts. We make an appointment.

Something stops working. Now we are concerned.

The warning light comes on. Eventually, we take the car to the shop.

Prostate cancer does not always give us that courtesy. Early-stage prostate cancer often causes no symptoms.

Waiting until you feel something is not a screening strategy. By the time certain symptoms appear, the disease may already be more advanced.

We started finding less cancer. Then something troubling happened.

For years, prostate cancer screening became less common. There were legitimate reasons: PSA testing could identify cancers that might never become dangerous, while unnecessary biopsies and treatment could cause real harm, including urinary incontinence and sexual dysfunction.

Medicine was right to confront those harms.

But more recent data show prostate cancer trends reversing — and, more importantly, advanced disease increasing. According to a 2025 American Cancer Society analysis, distant-stage prostate cancer increased by 2.6% annually among men younger than 55, by 6% annually among men ages 55 to 69, and by 6.2% annually among men 70 and older during the most recent decade studied.

That does not prove reduced screening caused the increase. Many factors influence cancer trends. Still, the direction is difficult to dismiss.

The issue is not simply how many prostate cancers we find. It is when we find them — and that distinction matters enormously.

Screening today is not screening 20 years ago

A PSA result is not a cancer diagnosis. It is information.

An elevated result does not automatically mean cancer or an immediate biopsy. Today, clinicians can consider repeat testing, prior PSA values, family history, medications, additional biomarkers, and prostate MRI. If cancer is found, active surveillance may be appropriate for lower-risk disease.

The goal is not to find every prostate cancer. The goal is to find cancers that can hurt you early enough to treat them while avoiding unnecessary harm from cancers that may never become dangerous.

That is a very different proposition.

So when should you start the conversation?

No single birthday marks the moment every man suddenly needs a PSA test. Professional organizations make somewhat different recommendations, and the right time depends on your individual risk.

Remember this: If you are a Black man between 40 and 45—or already past that age—start the conversation.

Not necessarily the test. The conversation.

Ask your clinician:

• What is my risk?
• Should I have a PSA test?
• If we check it, what will the result mean for me?
• If it is abnormal, what happens next?

That is shared decision-making in language that means something.

Know your number, but do not worship it.

PSA stands for prostate-specific antigen. It is measured with a simple blood test, but it is imperfect.

Age, prostate enlargement, inflammation, and medications can affect the result. Drugs such as finasteride can lower PSA levels and change how the result should be interpreted. Do not simply chase a so-called normal number. Know whether you have had a PSA test, understand the result in the context of your risk, and know what happens next.

Then call your father.

One prostate cancer screening tool does not require insurance, an appointment, or a laboratory: a conversation.

Ask your father whether prostate cancer runs in the family. Ask your brothers. Ask your uncles. Ask about your grandfather. And do not stop at prostate cancer. Certain patterns of prostate, breast, ovarian, and pancreatic cancers can provide important clues about inherited cancer risk.

Some of these conversations will be awkward, but you must have them anyway. We inherit more than last names. We inherit recipes. Traditions. Habits. Stories. And sometimes, risks nobody thought to tell us about.

Family health history is part of our inheritance. Knowing it is part of our responsibility.

Have the conversation before you need it.

So, here is where I land: I am not arguing that every Black man should run out tomorrow and demand a PSA test. I believe in something more deliberate.

Black men carry too much prostate cancer risk for silence, symptoms, or chance to determine when this conversation begins.

We have learned important lessons about overdiagnosis and overtreatment. We should not forget them. But yesterday’s concerns about doing too much should not become today’s excuse for doing too little — especially while advanced prostate cancer is increasing.

Start earlier. Know your family history. Ask about PSA testing. Understand your result. Know what happens next. Most importantly, follow through.

Then do one more thing: Bring another man with you.

Before September ends, call your father, brother, uncle, fraternity brother, co-worker, or friend and ask him one question:

“Do you know your prostate cancer risk?”

Do not send him a statistic. Start a conversation, because sometimes the conversation we have before something hurts is the one that changes everything.

Stronger conversations. Healthier men.

This article is for general educational purposes and is not a substitute for medical advice. Talk with a qualified health care professional about your individual risks and screening options.

Sources

Kratzer TB, et al. “Prostate Cancer Statistics, 2025.” CA: A Cancer Journal for Clinicians.

American Urological Association/Society of Urologic Oncology. Early Detection of Prostate Cancer Guideline.

American Cancer Society. Recommendations for Prostate Cancer Early Detection.

National Cancer Institute. Prostate-Specific Antigen Test Fact Sheet.

American Cancer Society. Cancer Facts & Figures for African American/Black People 2025-2027.

Inside The ManKave® is an initiative of Maven Community Health Inc.