Prostate cancer is the most commonly diagnosed cancer in Black men and one of the deadliest. A 2025 report from the American Cancer Society (ACS) found that Black men are 67% more likely than white men to develop the disease and more than twice as likely to die from it.
Obesity adds another layer of risk, intensifying the likelihood of aggressive tumors and late-stage diagnoses.
How Obesity Alters Cancer Behavior
Obesity affects how the body functions, including how it responds to cancer. Fat tissue can stir up inflammation and shift hormone levels, which may help prostate cancer grow or spread. These changes can make the disease harder to treat, especially when it’s caught late.
A recent study published in BMC Cancer found that men who gained weight after a prostate cancer diagnosis had a 64 percent higher risk of dying from the disease. Researchers believe this may reflect underlying illness, treatment side effects, or disease progression.
Another study, published in the Journal of the National Cancer Institute, found that men with obesity were more likely to die from prostate cancer, even when they received regular screenings. Researchers did not identify a single cause, but they pointed to challenges in detection.
PSA, or prostate-specific antigen, is a protein measured in the blood to help spot prostate cancer early. In people with obesity, PSA levels can be diluted by a larger blood volume, which may make results appear lower than they actually are. That can delay follow-up testing.
Additionally, rectal exams may be harder to perform accurately in men with obesity, which can affect how well the prostate is assessed during screening. These screening limitations can allow the cancer to grow before it is caught, making treatment more difficult and survival less likely.
Diagnoses Are Rising, Especially in Late Stages
Data from ACS shows that prostate cancer rates, which had been declining for years, began increasing around 2014. Between then and 2021, new cases rose by about 3 percent annually. The most concerning trend is in advanced-stage diagnoses, which are growing fastest in men over 55. These late-stage cases are harder to treat and carry a much lower chance of survival.
The same report estimates that men diagnosed early have a five-year survival rate close to 100 percent. For those whose cancer has already spread, that number drops to just 38 percent. Researchers point to reduced screening and delayed detection as key factors behind the shift, especially in communities with limited access to care.
Screening Isn’t Reaching Those Who Need It Most
In 2012, federal guidelines advised against routine PSA testing, which led to fewer screenings and more late-stage diagnoses, especially among Black men. Providers became less likely to offer the test, and insurance coverage grew more limited. Even after the guidelines were updates in 2018, screening rates haven’t fully recovered. The effects of that rollback are still felt today, especially within our community.
The Prostate Cancer Foundation now urges Black men to begin screening discussions between ages 40 and 45. The American Cancer Society recommends starting at 45 for those at higher risk, including men with a family history. Despite these guidelines, many Black men still face barriers to screening, including cost and limited provider access.
The Policy Pivot
In 2023, lawmakers introduced the PSA Screening for HIM Act. The bill aimed to require insurance plans to cover prostate cancer screenings for high-risk men without out-of-pocket costs. It named Black men and those with a family history as priority groups and called for screening to begin at age 40. Although it didn’t pass, it marked a shift. For the first time, federal policy acknowledged the survival gap and the need to screen earlier.
In 2025, the bill returned as H.R.1300 in the 119th Congress. Sponsored by Rep. Neal Dunn and co-sponsored by Rep. Yvette Clarke and others, it calls for mandatory coverage of PSA screenings starting at age 40 for men at high risk. That includes Black men, men with a family history, and those whose providers identify elevated risk due to obesity.
The bill removes cost-sharing, which means no co-pays or deductibles for eligible screenings. It also highlights the contrast in outcomes. Nearly 100 percent survive when caught early; just 37 percent when caught late.
The bill is still in committee, but its message matters. It shows that these concerns are being heard and could be acted on in the future. Policy is beginning to reflect what Black men, and their families have long known. Early screening saves lives, and equity starts with access.
Resources:
Press Releases
Weight gain or loss after diagnosis and survival outcomes in prostate cancer: a meta-analysis | BMC Cancer | Full Text
Growing implications of obesity for prostate cancer risk and mortality: where do we go from here? | JNCI: Journal of the National Cancer Institute | Oxford Academic
Archived: Prostate Cancer: Screening | United States Preventive Services Taskforce
Prostate Cancer Foundation Highlights Evidence-Based Prostate Cancer Screening Guidelines for Black Men | Prostate Cancer Foundation
American Cancer Society Recommendations for Prostate Cancer Early Detection | American Cancer Society
Text – H.R.1826 – 118th Congress (2023-2024): PSA Screening for HIM Act | Congress.gov | Library of Congress
Text – H.R.1300 – 119th Congress (2025-2026): PSA Screening for HIM Act | Congress.gov | Library of Congress
