How to cite: Murphy, AB. “Prostate Cancer Risk Assessment in Black Men.” September 15, 2025. Accessed Feb 2026. https://grandroundsinurology.com/prostate-cancer-in-black-men/
Summary
Adam B. Murphy, MD, MBA, MSCI, Distinguished Professor of Population Health Research in Urology, Associate Professor, Urology, Preventive Medicine, Northwestern University, Chicago, Illinois, addresses disparities in prostate cancer detection and outcomes for Black men, highlighting the limitations of current biomarkers and imaging tools, as well as the need for validation across diverse populations.
Dr. Murphy explains that Black men continue to face the highest incidence and mortality rates of prostate cancer in the United States, with a 70 percent higher incidence compared to their white counterparts. Puerto Rican men also now rank among the groups with the highest prostate cancer mortality. He notes that new Prostate Cancer Foundation guidelines recommend earlier baseline prostate-specific antigen screening for Black men, starting at age 40 to 45, rather than 50 to 55, with continued screening until age 70.
Dr. Murphy describes that as prostate cancer prevalence increases in high-risk populations, the positive predictive value of screening tools rises, but the negative predictive value declines. This means that Black men may be more likely to have clinically significant disease missed if existing tools are not recalibrated for this population. He highlights the Stockholm-3 assay, the 4Kscore, and other biomarker platforms, noting that while sensitivity and specificity are promising, calibration and race-stratified validation remain incomplete. He stresses that MRI-informed risk assessment tools also underperform in Black men, with published data showing lower sensitivity and negative predictive value compared to non-Black men.
Dr. Murphy emphasizes that molecular differences in prostate tumors across racial groups may underlie these disparities. He adds that MRI visibility of prostate tumors is significantly lower in Black men, which suggests current scoring thresholds may not be sufficient. He concludes that recalibration of biomarkers and imaging tools, coupled with broader validation studies across diverse populations, is essential to reduce disparities and improve risk assessment in Black men.
The Global Summit on Precision Diagnosis and Treatment of Prostate Cancer is a unique multi-disciplinary forum organized to inform the key health care stakeholders about the emerging advances in clinical cases and research and create a consensus-based vision for the future of precision care and educational and research strategy for its realization. The mission of the Summit is to fill the currently existing gap between the key experts of in vivo imaging, the world authorities in the in vitro fluid- and tissue-based molecular diagnostics, including genomics, and thought leaders in the development of novel observation strategies (e.g., active surveillance, or AS) and therapeutic interventions.
ABOUT THE AUTHOR
Adam B. Murphy, MD, MBA, MSCI, is a Distinguished Professor of Health Equity Research in Urology and an Associate Professor of Urology and Preventive Medicine (Cancer Epidemiology and Prevention) at Northwestern University’s Feinberg School of Medicine in Chicago, Illinois. He is also an attending urologist at Northwestern Memorial Hospital and Jesse Brown Veterans Administration Medical Center, also in Chicago.
