For Black men, a prostate cancer diagnosis can bring urgent questions about more than the disease itself. It can raise concerns about whether the cancer was found early, whether every treatment option has been explained, how side effects may affect daily life, and whether cost, transportation, insurance, or access to specialists could delay care. As Black men face higher prostate cancer rates and worse outcomes, knowing what questions to ask and understanding available treatments can be an important part of staying involved in care.
This guide focuses on one of the six classes of medications -- Androgen Receptor Pathway Inhibitors (ARPIs), a standard treatment class for advanced prostate cancer. This class includes Xtandi, Nubeqa, Erleada, and Zytiga, which work in different ways to slow or stop cancer growth and may not be right for every patient. Learning who may take them, how they work, how they are given, what research shows, and which side effects to watch for can help Black men have clearer, more informed conversations about prostate cancer treatment with their healthcare teams.
Prostate cancer affects Black men at unequal and alarming rates. Recent information from the National Cancer Institute and the Centers for Disease Control and Prevention shows that Black men are about 67% more likely to be diagnosed with prostate cancer and about twice as likely to die from it as white men.
Black men are often diagnosed at younger ages, which can mean facing treatment, side effects, and long-term health concerns earlier in life. Some Black men are diagnosed after the cancer has spread, which can limit treatment choices and make the disease harder to control. There is no single reason for these high rates, and race alone does not determine outcomes. These findings make it especially important for Black men to discuss screening, treatment choices, medicine side effects, and available support with their healthcare providers.
Although researchers continue to develop advanced prostate cancer treatments, social and healthcare factors can be just as important, and sometimes even more important, in affecting a man’s health and chances of doing well with prostate cancer. These factors include insurance coverage, treatment costs, where a person lives, access to specialists, treatment delays, communication, and low participation in clinical trials.
Treatment is not the same for every man. The healthcare team considers whether the cancer has spread, whether it still responds to testosterone-lowering treatment, previous medicines or chemotherapy, test results, overall health, daily function, and personal goals. Health conditions such as high blood pressure, diabetes, heart disease, kidney problems, and weak bones may also affect treatment safety and monitoring. Medicines, vitamins, and supplements may interact with cancer treatment.
Tell your healthcare team about every health condition, medicine, and supplement you take. Also share your health beliefs, personal concerns, and any problems involving cost, transportation, or access to specialized treatment. This information helps your healthcare team create a safer treatment plan made to fit your health needs and personal situation. Studies show that Black men can have outcomes similar to, and sometimes better than, white men when care is timely, culturally responsive, and supported by specialist access, financial help, transportation, and close follow-up.
Getting the right prostate cancer treatment depends on more than a doctor’s recommendation. Your health, test results, insurance coverage, location, and access to specialists can affect which treatments work best and are available to you. Clear communication can help you take a more active role in treatment decisions. Do not assume every option will automatically be discussed with you.
Ask what type and stage of prostate cancer you have, why a treatment is being recommended, and whether you need special testing. You can also ask about other medicines, clinical trials, insurance coverage, and help with treatment or travel costs. Research involving Black men shows that patients value shared decision-making but may not always receive complete information about treatment choices and side effects. Some men also report that they were never invited to consider a clinical trial. When few Black men join clinical trials, doctors have less information about how well prostate cancer treatments work, or what side effects may occur in the men most affected by the disease.
The treatment options commonly used for advanced prostate cancer can be divided into six classes. These classes include:
Androgen Receptor Pathway Inhibitors (ARPIs)
ARPIs are commonly used to treat certain types of advanced prostate cancer, and medicines in this class are discussed in detail under the medications in this guide. ARPIs are given along with testosterone-lowering treatment unless both testicles have been surgically removed. Although each medicine works differently, ARPIs block testosterone and other male hormones to help slow or stop prostate cancer growth.
Androgen Deprivation Therapy (ADT)
ADT blocks pituitary gland signals that tell the testicles to make testosterone, which may slow or stop prostate cancer growth in certain advanced prostate cancer types.
Medicines in the ADT class may cause hot flashes, sexual problems, tiredness, muscle or joint pain, weight gain, high blood sugar, or heart changes. The healthcare team closely monitors blood pressure, blood sugar, cholesterol, heart, kidney, liver, bladder, and bone health, especially in patients with diabetes or existing heart or liver problems.
Radioactive Medicines and Radioligand Therapy
Targeted prostate-specific membrane antigen (PSMA) radioactive therapy may be used to treat certain advanced prostate cancers. It finds prostate cancer cells with enough PSMA, attaches to them, and delivers radiation directly to destroy them. A PSMA PET scan is required before treatment to confirm that the cancer has enough PSMA for the therapy to target.
Bone-targeted radioactive therapy travels through the bloodstream to areas where prostate cancer is damaging the bones. Once there, it releases radiation that destroys nearby cancer cells.
Poly -ADP-ribose polymerase (PARP) inhibitor
PARP inhibitors are targeted medicines that stop prostate cancer cells from repairing damaged DNA. Changes in BRCA1, BRCA2, or other DNA-repair genes can make the cancer more likely to respond. As DNA damage builds up, the cancer cells may stop growing or die. A blood or tumor test is needed before treatment to check for these gene changes in certain advanced prostate cancers.
Rubraca is taken twice daily, with or without food. It may be used for advanced prostate cancer types with harmful BRCA1 or BRCA2 gene changes, when the cancer continues to grow after Xtandi or Zytiga treatment. Talzenna is taken once daily, with or without food, and is always given with Xtandi for certain prostate cancers with specific DNA-repair gene changes.
These medicines can lower blood cell counts, so regular blood tests are needed. Kidney and liver function may also be monitored, and other medicines are reviewed for possible interactions with treatment.
Chemotherapy
Chemotherapy is a class of strong medicines used to damage cancer cells or stop them from growing in certain advanced prostate cancer types. Because it can also damage healthy, fast-growing cells, other medicines and frequent monitoring are usually needed to manage side effects. Chemotherapy is given through a vein by trained healthcare professionals, with safety precautions followed before, during, and after each infusion.
Immunotherapy
Immunotherapy helps the immune system recognize cancer cells or block the signals they use to hide and multiply. Provenge (sipuleucel-T) and Keytruda (pembrolizumab) are immunotherapies used to treat certain advanced prostate cancers. Both are given through a vein by trained healthcare professionals, but work differently to slow or stop cancer growth.
Keytruda (pembrolizumab) blocks a signal cancer cells use to hide from the immune system. It may be used alone for certain advanced prostate cancers with specific DNA-repair problems or many gene changes, often after other treatments stop working. Keytruda is given through a vein over about 30 minutes every three or six weeks, while Keytruda Qlex is given under the skin on a similar schedule. Both are administered by trained healthcare professionals.
Treatment may cause the immune system to attack healthy organs, as a result blood tests may be needed to check thyroid, liver, and kidney function and blood sugar. Report a new cough, trouble breathing, diarrhea, severe stomach pain, yellowing of the skin or eyes, rash, extreme tiredness, headaches, dizziness, or major changes in urination right away.
Learning about treatment choices can help patients take a more active role in prostate cancer care. The medications featured represent ways to treat different forms or stages of advanced prostate cancer, and each has its own benefits, risks, testing needs, and side effects. Your healthcare providers should share why a medicine is being recommended, what other options might work, and what support is available. All men should seek clear information, timely care, and a treatment plan that fits their needs. This is especially important for Black men, who face higher prostate cancer rates, a greater chance of serious illness or death, and social and healthcare factors that may affect their care.
This guide is not intended to provide a comprehensive list of all available treatments for advanced prostate cancer. The medications featured represent a selection of established and emerging treatment approaches that may be considered at different stages of the advanced prostate cancer journey. Treatment decisions are individualized and depend on a number of factors. Patients should talk with their healthcare team about the full range of treatment options that may be appropriate for them.
This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking any drug or commencing or discontinuing any course of treatment.
Black men are more likely to develop prostate cancer and die from the disease than white men. They may also be diagnosed at younger ages or after the cancer has spread. Understanding the diagnosis, available treatments, possible side effects, and support resources can help Black men take an active role in their care and make informed decisions with their healthcare teams.
Treatment depends on the type and stage of cancer, whether it has spread, whether it still responds to testosterone-lowering therapy, and which treatments you have already received. Your healthcare team will also consider your test results, overall health, other medical conditions, daily activities, and personal treatment goals. Medicines such as Xtandi, Nubeqa, Erleada, Pluvicto, and Zytiga are used for different forms of advanced prostate cancer and are not appropriate for every patient.
Tell your healthcare team about every health condition you have, especially high blood pressure, diabetes, heart disease, kidney problems, or weak bones. Provide a complete list of your prescription medicines, over-the-counter products, vitamins, herbs, and supplements because some may interact with prostate cancer treatments. You should also discuss concerns about side effects, costs, insurance, transportation, or getting to a specialist.
Yes. Certain blood, tumor, imaging, or genetic tests may help determine which treatments are appropriate for you. Clinical trials may also provide access to newer treatment approaches, but research shows that Black men are not always invited to participate. Ask your healthcare team whether testing or a clinical trial should be considered based on your diagnosis and treatment history.
Tell your healthcare team as soon as possible. A social worker, patient navigator, financial counselor, or treatment-support program may help with insurance questions, medication costs, transportation, or referrals to specialists. You can also ask whether the medicine’s manufacturer offers savings or patient-assistance programs. These barriers are part of your care and should not be faced alone.
Medicines, vitamins, and supplements may interact with cancer treatment.
These medicines work in different ways and are not right for every man.
Some medicines may harm an unborn baby. Men with female partners who can become pregnant should use effective birth control during treatment and for three months after the last dose.
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