Black men in California face higher risks and higher bills for prostate cancer

James Miller Jr.’s dream of being a homeowner had finally come true, so he went to Home Depot for supplies. As he walked the aisles his phone rang. His doctor had news no one wants 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 rate of prostate cancer of any racial or ethnic group in America. They’re diagnosed at more advanced stages, often when treatment options narrow. They’re twice as likely to die from it compared to white men. Yet in California, where Miller lives, no legislation specifically addresses prostate cancer screening or prevention.

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

Most men don’t have 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, far more accurate than a digital rectal exam. Rose says many men avoid screening because they dread the rectal exam, but that 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 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. And the other is related to social determinants of health,” such as racism, poverty and disparities in health care access.

Pain crept into Miller’s lower back and hips first. Then came frequent trips to the restroom. Just getting older, he thought. When he dropped 20 pounds in a few months he thought his diet was finally working. But then came chest pain. 

Finally he went to the emergency room. Miller learned those were symptoms of late-stage prostate cancer. The once sturdy, get-it-done airport security screener was now riddled with cancer in his hips, lymph nodes, thigh bones, ribs and even on his skull.

“It was like a recording in my head. Oh my God, I’m gonna 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, searching for any hope of surviving more than seven years. Depression set in. After decades of neglecting his health and grinding through stressful jobs, Miller wondered if there was more he could’ve done.

“Most Black men, you figure, ‘I’m still breathing, I’m still walking around, I’m fine.’ We’re taught from when you’re a little boy, you grind it out, suck it up,” Miller said. “But we have the highest rates of prostate cancer.”

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

“Black men are more likely to die from prostate cancer if they get it, on average, but not because the cancer itself is all that different,” Rose said. “It’s more likely that Black men tend to have more barriers to care. So getting diagnosed a little bit later or maybe not getting the optimal treatment.”

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

In 2023, Assemblymember Mike Gipson authored Assembly Bill 632, which would have prohibited health insurance plans from charging deductibles, copays or coinsurance for prostate cancer screening for high-risk men. 

Gov. Gavin Newsom vetoed it, saying  it “would result in increased costs to consumers through higher premiums.”

There’s not enough conversation about prostate cancer in the Black community, Miller said; he didn’t realize how common it was until his diagnosis. 

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

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

“I hope there’s someone out there that I can be with, who will accept me for what I am now,” he said. “But it does play into your sense of manhood. What kind of man you are now versus what you were.”

In 2023, Miller started The Walnut Tribe Support group, a safe space for men navigating prostate cancer. Monthly meetings give men an opportunity to release the pressure to hold their feelings and fears in. And Miller hopes to raise more awareness about early screening. 

“You don’t want to be like me and learn about it at the last stages. Please don’t be like me,” Miller said. “Learn about it early. Try to get tested early.”

This commentary was adapted from an article produced for Word in Black. It accompanies an article about a journalist’s fight with prostate cancer.