Latino Men and Prostate Cancer: A Complicated Relationship

During Hispanic Heritage Month, which takes place from September 15 to October 15 each year, the nation celebrates Latino Americans’ achievements and contributions to US history and culture. It is also an opportunity to reflect on the opportunities to understand and improve health outcomes for all Latino Americans so we can continue to make the lives of millions of people stronger.

According to the Prostate Cancer Foundation, “Prostate cancer is the most commonly diagnosed cancer among Hispanic/Latino men in the U.S., comprising more than 1 in 5 of all new cancer diagnoses.” A portion of the population is of lower socioeconomic status and more likely to have public health insurance, and “Hispanic/Latino men diagnosed with prostate cancer also appear to be more likely to be diagnosed at a younger age, and with higher risk disease.”

Of the approximately 13,000 cases diagnosed in Latino men every year in the United States, 1,800 die of prostate cancer, making it the fourth leading cause of cancer death among Latinos.

These are compelling statistics, but they don’t provide a complete picture of how prostate cancer affects the Latino American population. Prostate cancer risk and screening vary significantly within the Latino population, due to several factors:

• Latinos’ access to and utilization of healthcare resources
• Cultural and socioeconomic determinants
• The heterogeneity of the Latino population
• The underrepresentation of Latinos in clinical studies and biobanks

Healthcare access and utilization among Latinos

In general, access to healthcare resources for the Hispanic population is limited, and not all of those who have access will use these resources. Fewer Latino Americans have access to health insurance than the general U.S. population and are less likely than non-Hispanic whites (NHW) to be employed at companies that provide health insurance. And when they do have access to care, there’s a clear language barrier for new or first-generation immigrants–they do not yet have a level of fluency that allows for serious discussions about health, and there are not enough Spanish-speaking healthcare providers or translators to meet the needs of this growing population. For a portion of the population, their undocumented status prevents them from seeking care, for fear of deportation, or makes public healthcare difficult to secure in the first place.

For the reasons listed above, many Latino Americans do not have a regular primary care physician and go to emergency rooms or urgent care clinics for their healthcare needs. Without an individual relationship with a primary care doctor, discussions about screenings are less likely to take place, and the importance of preventive measures not emphasized.

Cultural and socioeconomic determinants, and the Hispanic Paradox

A study on cancer risks and outcomes in Latino Americans notes, “Despite having higher poverty rates, lower education, and less access to health care than non-Hispanic Whites (NHW), Latinos tend to have overall better health indicators than those of other racial/ethnic groups with whom they share socio-economic (SES) characteristics.” Epidemiologists have named the phenomenon the “Hispanic Paradox”; the same study lists various possible explanations for it, including “cultural and lifestyle practices brought by Latino immigrants from their countries of origin, reproductive behavior, extended family support, and a distinct genetic heritage.”

Focused on the science of cancer in the Latino population, another study also points out “the lower incidence, lower mortality, and relatively comparable survival among Hispanics in relation to non-Hispanic whites (NHWs)” when it comes to cancer. But the study goes on to state that “cancer patterns among US-born Hispanics in relation to NHWs are not nearly as favorable as their foreign-born counterparts in the United States.” This implies that the survival advantage does not “stem from being Hispanic per se,” but from being foreign-born, which is “an advantage not exclusive to Hispanics, but also present among foreign-born Asians and Blacks.” The more assimilated Latino men become, the more their prostate cancer incidence resembles that of NHWs.

The American Cancer Society offers another explanation: “the ‘Hispanic Paradox’ may reflect incomplete or biased data instead of a true survival advantage.” Because a lower percentage of the Latino American population accesses healthcare, there are fewer disease statistics about this population, which risks painting a false picture of the Latino American population as healthier than it perhaps truly is.

A final possible SES determinant in prostate cancer risk applies specifically to the chemicals Mexican-American farm workers are regularly exposed to. Some research has addressed this possibility: One study, of Mexican Latinos in Texas, associated a higher risk of prostate cancer with “exposure to agrichemicals, being US-born, lack of physical activity, and [prostate cancer] family history.” Another observed that California farm workers, who are predominantly Mexican, showed disproportionately more prostate cancer cases than NHWs in California.

The heterogeneity of the Latino population

Latino Americans is a sociopolitical designation that includes people of varying genetic, racial, and national origins.

When the Latino American population is broken down by nationality, there is noticeable variation among subgroups in cancer risk and incidence. Research on Latino American men has found the incidence of prostate cancer is about 9% lower than NLW men, but “higher than the incidence among men in most Latin American countries, which show wide differences in incidence and mortality across countries.”

A 2022 study in Nature “found marked heterogeneity” when risk groups and treatments “were disaggregated by racial subgroup and country of origin. These findings “support further collection of disaggregated data in Hispanic communities and study of potential mechanisms underlying the observed differences.”

Underrepresentation of Latinos in clinical studies and biobanks

As of 2019, fewer than 2,000 Latinos have been included in epidemiological studies of prostate cancer in the United States. Such low participant numbers mean the knowledge gap for prostate cancer etiology in Latinos is larger than for other racial or ethnic groups. Compounding this problem is the fact that often, Hispanic/Latino ethnicity is not volunteered by patients or study subjects, so it is difficult to determine the actual number of Latino study participants. Sometimes, researchers are left to extrapolate a study participant’s ethnicity from his last name. Research on this problem acknowledges that “across the continuum”–from causes of prostate cancer to prostate cancer survival– “there are several other challenges and knowledge gaps, which overall are larger for Latino men, who are greatly understudied.”

An urgent need for more research and education

In addition to the knowledge gaps researchers face in studying prostate cancer in Latino men, the men themselves may be inadequately informed about the importance of screening. Research on advancing the study of cancer in Latinos states, “Most PCa diagnoses are triggered by screening with elevated prostate-specific antigen (PSA), and Latinos show lower rates of PSA cancer screening.” A lower incidence of screening could also result in an underestimation of prostate cancer rates among Latino men.

When Latino men do receive initial screening, they often are then less likely to receive follow-up for active surveillance. Research states, “Alarmingly, Latinos under active surveillance seem to be less likely to receive medical monitoring,” and “Latinos under active surveillance were more likely to be lost to follow-up” than their non-Latino white counterparts.

Regardless of national origin, Latinos would benefit from regular discussions about prostate cancer risk and screening options with a healthcare provider. In addition, a greater awareness in the Latino American community of prostate cancer risks and preventive measures might compel more Latino men to participate in important clinical and epidemiological studies. All men deserve equal education and access to screenings and follow-up care for this treatable cancer.