This article is part of a two-part series by Anissa Durham that explores the lives of Black men battling prostate cancer. Read part one here. This story is copublished with CalMatters.
James Miller Jr.’s dream of being a homeowner had finally come true — which meant a trip to Home Depot for supplies. As he walked the aisles of the home improvement store, his phone rang. It was his doctor with news no one wants to hear: Miller had stage four 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 diagnosis of any racial or ethnic group in America. They’re diagnosed at later stages, often when treatment options narrow. They’re twice as likely to die from the disease compared to white men. These deaths are largely preventable. 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.
What Every Black Man Needs to Know
The prostate is a walnut-sized gland that sits below the bladder, responsible for creating ejaculation fluid, explains Dr. Brent Rose, associate professor of radiation oncology at UC San Diego. One of the biggest problems with prostate cancer is most men don’t have symptoms until it’s advanced.
The most effective screening tool is a prostate-specific antigen (PSA) 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: One in eight Black men will develop prostate cancer, compared to one in 12 white men. Black men are also diagnosed younger. That’s why the American Cancer Society recommends African American men 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 says. “There are two separate hypotheses. One is that it’s genetic. And the other is related to social determinants of health,” — factors such as racism, poverty, and disparities in health care access.
The pain crept into Miller’s lower back and hips first. Then came the frequent trips to the restroom. Just getting older, he thought. When he dropped 20 pounds in a few months, he chalked it up to his diet finally working. But then came chest pain. Finally, he went to the emergency room.
That’s when Miller learned those were the symptoms of late-stage prostate cancer. The once sturdy, get-it-done airport security screener was now riddled with cancer — 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, California, resident says. “How did I get this? Is this karma? Did I deserve this?”
Miller admits he left Home Depot that day and went straight home and got drunk. Devastated, he started Googling, searching for any hope of surviving more than seven years. Depression quickly 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 says. “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. Meaning whether it spread to other lymph nodes or parts of the body, Black men were the most likely to be diagnosed with the disease.
“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 says. “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.”
Secrecy Is Killing Black Men
Melvin Parker watched his wife fight breast cancer. After a lumpectomy on her left breast, twice a day radiation for one week, and four rounds of chemotherapy — in December 2022, she rang the bell.
And then six weeks later, Parker got his own diagnosis: prostate cancer.
The 53-year-old Frisco, Texas, resident had no idea the disease ran in his family. His father had prostate cancer. Parker’s brother had it too, but only revealed his diagnosis after he finished treatment. Both brothers were diagnosed the same year.
“Coming from a family where my dad is very old school, very traditional, very private — we don’t share,” Parker says. “I’m probably the most transparent of the family when it comes to health.”
During a routine Veterans Affairs Department check-up, physicians noticed Parker’s PSA levels were high. Initially, they gave him tips on how to lower them. But a few months later, another test showed the levels were still high.
“I was terrified. I was absolutely floored,” he says. “Is this my slow death? Is this the beginning of the end?”
Parker isn’t sure at what stage his cancer was diagnosed. The American Cancer Society states that prostate cancer stage matters, but doctors now look beyond it to consider risk factors — such as how aggressively it will grow and spread.
According to his doctors, the cancer had been growing in Parker’s body for a couple of years before detection. A month after his diagnosis, he underwent prostate cancer removal surgery. Six months post-op, the results were in.
Today, Parker is cancer-free.
What Are CA Policymakers Doing?
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 a health insurance plan from charging a deductible, copayment, or coinsurance for prostate cancer screening services for high-risk men.
Gov. Gavin Newsom vetoed it. Newsom acknowledged the bill’s “commendable” intentions, but argued it “would result in increased costs to consumers through higher premiums.”
Zero Prostate Cancer, a national advocacy organization, supported the 2023 bill. Ali Manson, vice president of Government Relations and Advocacy at Zero, says they’ve pushed for legislation that eliminates cost-sharing barriers at the state and federal levels. But, policy change must be holistic, she says. There needs to be more investment in prostate cancer education, outreach, and awareness programs.
“Many of the same limitations on access to health care and systemic barriers that stand between Black men and the best possible health generally also impact prostate cancer care,” Manson says, “Like access to high-quality, culturally competent care in their communities, insurance coverage and cost are barriers for many.”
“Please Don’t Be Like Me”
There’s not enough conversation about prostate cancer in the Black community, both Parker and Miller say. Neither realized how common it is until their own diagnoses. Treatment options depend on the stage: radiation, prostate removal surgery, or hormone therapy, Rose says.
Miller takes a daily dose of androgen deprivation therapy. And every three months he gets a Lupron injection. Both hormone treatments have slowed the cancer’s growth and kept it at bay.
Now 64, he’s outlived the seven-year death sentence. But the side effects of these testosterone blockers aren’t a walk in the park: weight gain, loss of muscle, 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 says. “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, particularly Black and Brown men, navigating prostate cancer. The monthly meetings give men an opportunity to release the constant pressure they experience from holding their feelings and fears in. And Miller hopes to raise more awareness about the life-saving importance of education and 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 says. “Learn about it early. Try to get tested early.”
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