The men most at risk for aggressive prostate cancer - black men with a family history - are the least likely to get screening even during peak ages of risk, researchers say.

Only 25 percent of black men during peak ages of 60-69 are screened using the common blood test that measures prostate specific antigen levels and 36 percent get annual digital rectal exams, according to a study published in the Feb. 15 issue of Cancer.

Black males are diagnosed with prostate cancer at an average age of 65.

Just under 50 percent of all high-risk black males get blood tests and 38 percent get physical exams. Sixty-five percent of black males without a family history get the blood test and 45 percent get physical exams. By comparison, 81 percent of white males age 60-69 get blood tests and 68 percent get physical exams.

“Healthy black men who have several first-degree relatives with prostate cancer are much less likely to have ever gotten a prostate screening than black men without a family history and white men in the general population,” says Dr. Sally Weinrich, a nursing professor and Georgia Cancer Coalition Distinguished Cancer Scholar. “However, these are the men who have a higher-than-average risk because of their positive family histories. Hereditary forms of prostate cancer are usually diagnosed at an earlier age than non-hereditary prostate cancer.”

Dr. Weinrich and her husband, Dr. Martin Weinrich, an MCG biostatistician, identified black males with positive family histories through the national African American Hereditary Prostate Cancer Study, funded by the National Institutes of Health and concluded in 2004. Comparable black males and white males were identified through the Centers for Disease Control and Prevention’s 1998 and 2000 National Health Interview Surveys.

Prior research has shown that black men have a 50 percent higher incidence of prostate cancer and more than double the mortality rate of white men. This research further suggests a glaring health disparity with access to health care and economics as key factors, Dr. Weinrich says.

“Black men have the right to be informed about prostate cancer screening options,” she says. “We need additional research to study the reasons why black men with a positive family history have lower screening rates than black men in general.”

Physicians should ask men specific questions about their family history. Men should also ask their families questions about who has had cancer and at what age they were diagnosed, experts say.

“While doctors cannot conclusively diagnose hereditary prostate cancer because no prostate cancer gene has been identified, answers to those questions are critical to our genetic revolution,” says Dr. Weinrich.

Scientists are discovering more each day about the disease, she says. “People should also pay attention to the research. Thanks to genetic and scientific knowledge, we know more today about prostate cancer than we did five years ago and we will learn even more in the next five years.”

Other co-authors on the study include Dr. Georgia Dunston, Howard University; Dr. Francis Collins, National Human Genome Research Institute; Dr. James Bennett, an Atlanta urologist; and other participants of the African American Hereditary Prostate Cancer Study.

“We at the School of Nursing are pleased that the Weinrichs have such depth in this area of much-needed research,” says Dr. Lucy Marion, dean of the MCG School of Nursing. “They have a long history of research for detection of cancer among older African-American men.”

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