Exploring the Vision of an Equitable Prostate Cancer Care Delivery System: Perspectives of Black Men in Charleston,South Carolina

Abstract

Prostate cancer presents a pressing public health challenge in the United States and disproportionately affects Black men. Despite efforts to address these disparities, equitable access to timely diagnosis and optimal treatment remains elusive for many Black men. Using focus group discussions, the researchers aimed to understand what constitutes equitable cancer care and identify tools needed by Black men for equitable navigation of prostate cancer care. Through a community-engaged qualitative design, 29 Black males aged 40 to 75 participated in virtual and in-person focus groups in August 2023. Data analysis employed NVivo qualitative software and an inductive thematic approach. Three overarching themes emerged: general prostate knowledge, barriers and experiences, and preferred communication channels. Participants discussed their understanding of prostate cancer, barriers to screening, experiences with healthcare delivery, and trusted information sources. Findings revealed nuanced differences between groups but emphasized the importance of clear communication, respect, and community support in cancer care. The researchers’ future recommendations include developing educational programs, addressing systemic barriers, providing early education on prostate cancer risk, implementing training for providers, creating support groups, and revisiting national guidelines for Black men. The study provides valuable insights into the experiences and needs of Black men when accessing equitable prostate cancer care that are essential for addressing disparities in cancer outcomes.

Introduction

Prostate cancer remains a significant public health concern in the United States, with approximately 299,010 new cases and 35,250 deaths projected for 2024 (American Cancer Society, 2024). Within this landscape, Black men are disproportionately affected and face greater incidence rates than White men (Rebbeck, 2018; Siegel et al., 2021). Black men are diagnosed with prostate cancer at a younger age, usually 2 years younger than other ethnicities, and often when in advanced and aggressive stages of the disease, leading to diminished treatment options and increased morbidity and mortality rates (Das & Rodriguez, 2020; Rawla, 2019).

Despite these alarming statistics, equitable access to timely diagnosis and optimal treatment eludes many Black men, contributing to persisting disparities across the prostate cancer continuum (Smith et al., 2017). Notably, data indicate that fewer Black men undergo intensive therapies or definitive surgeries, such as radical prostatectomy, compared to White men, thus exacerbating inequities in care (Naik & Akinyemiju, 2017). Recognizing the urgency of addressing these disparities, the American Cancer Society (2019) recommended initiating discussions about prostate-specific antigen testing at the age of 45 years for Black men to promote early detection and intervention.

However, systemic barriers compounded by historical and contemporary experiences of racism impede Black men’s engagement with the healthcare delivery system and perpetuate disparities in prostate cancer outcomes (Rogers et al., 2018). A history of discrimination and inequity in treatment has created a mistrust in the health delivery system that hinders efforts to provide Black men with prompt diagnosis and equitable care (Rogers et al., 2018). Moreover, limited health literacy and masculinity-related stigmas further deter Black men from seeking healthcare, thereby increasing delays in diagnosis and treatment initiation (Smith et al., 2017).

Within the American landscape, the southern region, exemplified by states such as South Carolina, grapples with stark prostate cancer disparities, with mortality rates among Black men reaching 2.5 times those of White men (DeSantis et al., 2019). This geographic variation underscores the intersectionality of race and place/region in shaping health outcomes and demonstrates the necessity of targeted interventions tailored to local contexts (DeSantis et al., 2019).

To dismantle the structural barriers perpetuating prostate cancer disparities, comprehensive efforts are imperative. Although in recent years researchers have demonstrated a growing interest in Black men’s health research, few studies have explicitly examined their experiences with navigating the healthcare delivery system, particularly within the context of cancer care. Therefore, a nuanced understanding of the factors contributing to inequitable prostate cancer care experienced by Black men is essential to inform targeted interventions and policy initiatives aimed at fostering health equity.

Against this backdrop, the researchers sought to illuminate the perspectives of Black men affected by prostate cancer by focusing on letting their voices elucidate the elements of equitable cancer care delivery. Investigating the barriers and facilitators shaping Black men’s engagement with the healthcare delivery system allowed researchers to address critical gaps in our understanding of prostate cancer disparities and inform evidence-based strategies to promote health equity. Specifically, we answered two crucial questions: (a) What would an equitable cancer care delivery system look like? and (b) What tools would be essential for Black men to enable them to receive equity when they are navigating prostate cancer care?

Methods

Study Design

This study utilized a community-engaged, qualitative design approach (semi-structured focus groups) to explore Black men’s prostate cancer knowledge, experiences, perceptions, and beliefs in Charleston, South Carolina.

Study Setting

The study was conducted in Charleston within the service area of the Medical University of South Carolina (MUSC) Hollings Cancer Center, which serves patients from all South Carolina counties. Notably, 75% of these counties are rural, posing challenges such as transportation issues and limited access to specialty care and clinical trials. South Carolina has a significantly higher Black population percentage (27%) than the national average (14.2%), and over 15% of residents live below the poverty line, exceeding the national average (11.6%) (MUSC Hollings Cancer Center, 2024). Importantly, poverty is associated with worse cancer outcomes and a higher risk of death.

Sampling and Eligibility

The study employed purposeful sampling, a standard qualitative research method for identifying and recruiting information-rich participants relevant to the community and experiences of interest (Palinkas et al., 2015). Participants were recruited from Charleston, South Carolina, through networks associated with the MUSC Hollings Cancer Center, community partners, and prostate cancer advocate Lee Moultrie’s connections. Culturally targeted flyers were designed by the study team and were utilized with recruitment email communication.

Eligibility criteria included Black men aged 40 to 69 years residing in Charleston who were not diagnosed with prostate cancer, as well as Black men aged 40 to 75 residing in Charleston who were prostate cancer survivors. Ineligibility criteria included insufficient proficiency in English and not belonging to one of the purposefully sampled groups: Black men without prostate cancer who were over the age of 69, or Black men diagnosed with prostate cancer who were under the age of 40 or over the age of 75 years, residing in South Carolina.

A total of 29 Black men participated in four focus groups, as shown in Table 1.

Table 1.

Number of Black Men Who Participated in the Study.

Date of participation	Kind focus group	Time of participation	Number of participants
Friday, August 11, 2023	Non-prostate cancer virtual group	5:00–6:00 p.m.	9
	Prostate cancer survivors’ virtual group	7:00–8:00 p.m.	8
Saturday, August 12, 2023	Prostate cancer survivors’ in-person group	10:00–11:00 a.m.	6
	Non-prostate cancer in-person group	12:00–1:00 p.m.	6

Data Collection

Two virtual focus groups (Zoom-recorded) and two in-person focus groups (audio-recorded) were conducted. Data collection was guided by IRB-approved focus group and semi-structured individual interview protocols. All data were collected in August 2023, and each focus group lasted approximately 60 min. All focus group participants received a $75 gift card incentive for their participation in the study.

A semi-structured focus group interview guide was developed to facilitate discussions and allow for flexibility in exploring various topics related to prostate cancer knowledge, attitudes, barriers, and facilitators (Creswell & Poth, 2018). This approach ensured that facilitators could delve into general themes while also having predefined topics to maintain consistency across groups. The guide underwent rigorous vetting for cultural, linguistic, and health literacy appropriateness by the study team and community partner, Lee Moultrie, with feedback utilized to refine the guide and enhance its effectiveness in capturing participants’ perspectives.

Data Analysis

An a priori coding scheme—“prefigured codes or categories (often from a theoretical model or the literature)” (Creswell & Poth, 2018, pp. 641–642)—to guide the coding process was developed based on the focus group instrument and the previous literature (Odedina et al., 2022; Toms et al., 2016). NVivo 12, a qualitative and computerized informatics tool (Jackson & Bazeley, 2019), was used to import transcribed data into the NVivo database. It has features that allow one to drill down into the data by explicating chunks of text and uncovering subtle connections in ways that are simply not manually possible. This informatics tool helps link emerging themes back to the original text that supports them, thereby rigorously justifying findings with evidence. During the analysis phase, data were coded from the focus groups’ transcripts using a process of open, axial, and selective coding using NVivo 12 software (Creswell & Poth, 2018; Jackson & Bazeley, 2019). Coding schemes were developed by identifying, classifying, and labeling the primary patterns in the transcripts. During open coding, the constant comparative approach (Glaser, 1965), in which each category is considered a unit of analysis, was used to group the codes into categories. Using this approach, themes were identified. Axial coding was then applied to explore the interrelationship of categories. The frequency and consistency with which participants indicated categories in the transcripts were used to provide credibility for these categories.

Theme Tree

Figure 1 presents the theme tree that visually represents the major themes and subthemes that emerged from the data analysis. The theme tree illustrates how the overarching themes of general prostate knowledge, barriers and experiences, and preferred communication channels are interconnected, with each theme branching into secondary themes and further into specific subthemes. This structure provides a clear explication of the thematic landscape, setting the stage for the detailed presentation of the study results.

Figure 1.

Theme Tree. Major themes and sub-themes that emerged from data analysis.

Results

Across both focus groups—survivors of prostate cancer and men who were not diagnosed with prostate cancer—three major overarching themes emerged: general prostate knowledge, barriers and experiences, and preferred communication channels. Although the knowledge, preferences, and perspectives were similar across both groups, experience-related nuanced differences also existed between the groups. This section presents specific findings from both focus groups.

Cancer Survivor Participants

Among men who had been diagnosed with prostate cancer, within the general prostate knowledge theme, there were six secondary themes and several subthemes within each secondary theme. The first secondary theme was that of understanding prostate cancer. The men in this focus group talked about the individualization of both the cancer experience and treatment choices: “Everyone is different. There’s no ‘one size fits all’ treatment.” They discussed the impact of misinformation on choices and perceptions: “I did a lot of research, and some of it is myth—about the love of barbecue food for Black men, that we love charcoal food [as a reason for disparities], all kinds of myths and stuff.” They also talked about the importance of preventive care related to prostate cancer: “So getting checked at the proper age, whether you want to get checked or not, you better do it if you want to stay on this side.” One participant celebrated the success of early detection, stating, “It can be treated if caught in an early stage.” Participants also acknowledged that prostate cancer is often asymptomatic in its early stages, describing it as a “silent cancer,” and emphasized the importance of regular screening. They recognized the heightened risk faced by African American men, with one participant noting, “I know it grabs a hold of a lot of us Black men,” while another participant highlighted the universality of risk: “I know that prostate cancer can strike just about anyone.”

When asked to discuss prostate cancer symptoms, some of the men in the survivors’ group talked about the surprise of not having experienced symptoms. “I was in my 50s when I was first diagnosed with prostate cancer, no symptoms,” one participant said. Other participants highlighted persistent pain and urinary changes as crucial indicators of prostate health. One described frequent headaches: “You’re getting headaches every day, you’re taking aspirin, but every day you’re suffering with headaches,” while others noted increased nighttime urination: “Well, just the frequent urination, and asymptomatic is one of the thing because my cancer was diagnosed based upon a urinary problem,” and “I started having problems urinating. It’s probably one of the biggest signs that I remember the reason why I went and got checked.” These symptoms urged them to seek medical advice, leading to early cancer detection.

The group explored awareness of screening guidelines, and the participants discussed both the age at which they started getting checked and age-related screening guidelines. “I think the Black men need to be 40 years old, maybe, or something like that, because it’s really prevalent. At least 40 years old, then he can start getting screening.” For some participants, their family history influenced their decision to start screenings. “I started getting screened when my dad was diagnosed with prostate cancer.” They also talked about the importance of monitoring PSA levels for early prostate cancer detection: “I started getting checked and that’s why I was able to watch my scores continue to creep up over time. It got above five. And then that’s when we did the biopsy and found the cancer cells. And then we took action.” Regular screening enabled timely diagnosis and intervention.

The group also explored perceptions, discussions, and screening behaviors within their social circles. They talked about taking on the role of starting conversations about prostate cancer screening and diagnosis as well as providing support to others undergoing prostate cancer treatment. “I pastored a church … I had a couple other pastors that ended up with prostate cancer, so we started making sure that we had the conversation with our congregations about it.” Another participant shared, “My son’s 27 and he’s well aware of the history, and I’ve encouraged him to start getting checked at age 30.” Participants discussed a lack of awareness in their social circles and the impact of their choosing to openly share their experiences on the choices of others: “I don’t think [they were aware] until I mentioned to them that I’d had prostate cancer and suggested they go get checked. Then a lot of them went and got checked then after that.” Participants discussed finding a different reception to the conversation by generation. “I’ll bring it up, then I’ll find out how many people other than myself have actually gone through it. And I find that refreshing, but the younger generation does not want to talk about it,” one participant stated.

They also described the benefits of sharing being therapeutic, being comforted by sharing their experiences with others, and feeling that they are helping others. They also found resistance to their encouragement of screening: “I remember stopping at a restaurant at the club also, and one guy was insistent that he wasn’t going to get screened based upon whatever his age was.” They also discussed the healthcare facilities available in Charleston for prostate cancer screening, including stationary institutions (e.g., MUSC and the Veterans’ Affairs facility), as well as mobile units: “You can, they [mobile units] do the urgent care centers. There’s blood work, there’s LabNow, which is a mobile unit.” The men in this group also discussed community health programs that include cancer screenings in their programming.

Within the overarching theme of barriers and experiences, prostate cancer survivors discussed several obstacles to screening, emphasizing fear, stigma, and mistrust. The digital rectal exam (DRE) was identified as a major deterrent, with one participant stating, “The digital exam is our biggest hindrance of getting that yearly checkup of staying on top of it.” Societal stigma and concerns about side effects, such as impotence and incontinence, further deterred men from seeking early detection, with another noting, “that’s the stigma and the finger are the things that prevent people.” Participants also highlighted information gaps and the need for better education about screening guidelines and locations. One remarked on the scarcity of information, saying, “lack of information. Education. And distorted information.” There was also a call in this group for more accessible education, including public awareness campaigns through billboards and radio.

Socioeconomic challenges were also significant, with concerns about the affordability of healthcare and limited access to insurance. One participant expressed, “A lot of people can’t afford health[care].” In addition, mistrust in healthcare providers was a recurrent theme, underscoring the need to build trust between the healthcare delivery system and patients, “Trust. Trust factors of doctors. Healthcare,” to encourage men to seek early screening and care. Additional concerns included financial/insurance concerns with healthcare centers prioritizing profit, as well as language barriers and the presence of bias in the healthcare delivery system: “So they look at your insurance to see how good your insurance is, then they go from there.” Language barriers and bias in healthcare were acknowledged, with participants noting challenges in communication and the presence of bias: “There’s bias within healthcare.”

Some participants also reported positive healthcare experiences, emphasizing empathy, respect, and supportive care: “The whole process was great. I was well taken care of, well respected.” They valued open communication and developed strong relationships with their doctors, praising early diagnosis and expertise.

The participants talked about the importance of and appreciation for clear and honest communication and compassion, both in terms of experiencing these things and in sharing the importance of them in provider-patient communications. One participant advised, “Explain more or give me a better understanding in layman’s terms because a lot of times doctors try to throw a lot of big words around and you be trying to, ‘What is he talking about?’” Another participant said, “Don’t treat me like a piece of meat. Put yourself in my shoes and have some compassion for what I’m going through or what I’m dealing with.” They valued being presented with a range of treatment options and being educated about them to empower them to make informed decisions: “Sharing with the patients as many treatment options as possible.” Professionalism, respect, and trustworthiness were also highlighted as fundamental qualities, reinforcing their trust in the healthcare team: “Be respectful. Be respectful.”

For the final overarching theme, preferred communication channels, participants in the prostate cancer survivors’ group listed four information sources that they trust and rely on: healthcare professionals (especially emphasizing the importance of Black doctors); medical institutions; medical Literature; online information searches, including their process for assessing the information they get there (“I Google it, ask the question. Now once I ask the question, four or five different sites might come up with that same question, and I go to all of them to see what’s the difference”); and family and friends, particularly people they trust who are in healthcare: “I’ve got a great resource in my son-in-law. He’s an oncologist.”

Participants Without Prostate Cancer

For the focus group of men who were not diagnosed with prostate cancer, the first overarching theme of general prostate knowledge had six secondary themes, each with several subthemes. Within the first secondary theme, understanding prostate cancer, participants explored factors that elevated their risk (“I know that it affected [the] African American community a great deal”), the impact of family history (“my uncles, almost every one of them … passed away … from prostate cancer, my mother and my father’s side”), and the variability of severity (“In some men it is what you refer to as ‘slow growing,’ and some men, it’s aggressive, but each man’s case is individual”). They discussed the importance of preventive care, noting that “I feel screening regularly is certainly important,” and described prostate cancer as a silent threat and a universal risk: “My supervisor had it, and he was a type of guy that got checked every year, and he got checked and everything was good.” The participants also shared areas where they did not feel informed: “I’m not sure how it originates or what the cause of it is.”

In addition to asymptomatic prostate cancer, participants also discussed prostate cancer symptoms about which they had heard, including bleeding when urinating (“I heard that once you see bleeding or anything when you have to use the urinal, it’s probably problematic”), enlarged prostate, erectile dysfunction, and urinary changes—“difficulty urinating or frequency urinating, especially at night.” The participants also discussed screening guidelines, including (a) whether screening should begin at 40 or earlier: “If there is no history of it in your family, you probably want to start somewhere between the age of 28 and 35”; (b) the need to screen if experiencing symptoms: “I would think that if you’re having some symptoms and you believe it’s related to your prostate, regardless of your age, I think a male should get a check even if he is in the early 30s”; and (c) the role that family history plays in deciding when to get screened: “Some suggested starting as early as age 22 for individuals with a family history of prostate cancer.”

The participants discussed the perceptions of screening for prostate cancer in their social circles. They shared both the lack of awareness of prostate health, particularly with younger men in their communities—“I hang around and deal with younger men, they may speak about it every now and then, but not that much, definitely the people who are younger, they certainly don’t”—and their efforts to encourage talk about and prioritize prostate health: “I’ve encouraged everybody I know.” They shared challenges talking about prostate health, such as denial—“Then on the other side of my family, younger cousins, ‘It can’t happen to me’ that’s the attitude”—and openness to the conversations: “It’s easy to talk about because in my circle it’s people 55 and in the 60s. So certainly, it’s of a concern to us, and we don’t have a problem talking about it.” The conversations revealed a generational divide in attitudes toward prostate cancer screening. Some participants noted progress, but others observed resistance among men who feel too young or invincible: “Most of my friends are 42 to 46. They probably felt they’re not at that age [where they] need to worry about it yet.” Participants noted a higher willingness to undergo screening in families with a history of prostate cancer, which drives proactive health measures. One participant shared, “I know there is a history of it in my family, so we’ve always been kind of taught to be, that there’s a possibility it could happen, so to be aware.” When asked, participants listed MUSC, Trident, East Cooper, and Roper St. Francis in South Carolina as facilities for prostate cancer screening.

Within the overarching theme of barriers and experiences, participants in the group without a prostate cancer diagnosis explored three secondary themes with several subthemes. The first secondary theme was barriers to screening. Participants talked about a need for greater sensitivity and respectfulness in the way the exam is administered, as well as shifting their social circles’ approach to the exam: “The portrayal of the testing, that we—guys get together and they joke about it. They get their finger poking your butt. ‘You like that, you like that kind of thing.’ And we make a game of it, a joke of it, as opposed to expressing it in a way that it’s essential to our health.” They also talked about the fear of diagnosis—“I think it’s mindset, ‘If I don’t get checked and I’m not diagnosed, then I don’t have it’”—a lack of information (“Circle of ignorance”), economic barriers (“We have so many families that are not adequately covered, medically”), and conflicts with work as a priority (“Mindset, I don’t want to take the time off from work”).

Participants also discussed their experiences with the healthcare delivery system, including both positive (“I’ve had good experiences with doctors and healthcare”) and negative, from scheduling (“I’ve been trying to make an appointment to go see the rheumatologist, and it took me two months to get in there”), to the need for interpersonal relationships with providers (“If he’s not interpersonal, find me another one”), to the importance of respect and empathy from providers (“I had a situation where I felt disrespected. I went to a doctor’s office, and I had to wait for a long time. He didn’t even see me because after a while I just walked out”). Participants also had more suggestions on how providers can provide support and encouragement. They expressed the importance of treating all patients equally: “Regardless of race, sex, age, whether they look prosperous, financially prosperous or like they’re almost homeless, treat everybody the same.” They also suggested active follow-up from the provider, maintaining ongoing contact with patients, and effective information dissemination, that is, making the effort to ensure that the information is more comprehensive and reaches a broader audience: “I think they could be providing more detailed information. That’s the one thing I can think of, to provide more detailed and complete information.”

In exploring preferred communication channels, participants without a prostate cancer diagnosis highlighted their trusted sources for information. They frequently turn to family and friends, particularly those in healthcare professions: “My daughter, she’s a nurse, and my two sons-in-law are both nurses, and they give a lot of information.” Healthcare professionals are also valued sources, with participants noting the importance of guidance from primary care physicians and proactive communication, including text messages: “My doctor, my primary care physician, he is one super individual. He informs me of a lot of stuff.” Medical institutions, such as MUSC and the Veteran’s Hospital, are trusted for reliable information. Participants also turn to medical literature and personal research: “I study … I did a lot of stuff in college because I wanted to be a doctor.” In addition, online search engines, especially Google, are commonly used to explore various perspectives and information on prostate cancer.

Discussion

The findings from our study provide valuable insights into the elements that could lead to more equitable prostate cancer care from the perspective of Black men in a southern United States city. For example, increased general knowledge about prostate cancer (screening, treatment, and navigation/care coordination) through trustworthy sources, elimination of barriers to screening and treatment, active listening and empathetic, compassionate interactions between patient and provider, and timely access to care would facilitate a more equitable prostate cancer care experience for Black men. Through the lens of the socioecological model (Bronfenbrenner, 1977; McLeroy et al., 1988) and the framework of community-based participatory research (Israel et al., 2010), we can discern various layers of influence on individual health behavior and decision-making among Black men facing prostate cancer disparities.

First, the discussion on general prostate knowledge revealed both common understanding and gaps in awareness among participants. Both groups acknowledged the importance of preventive care and regular screenings and emphasized the necessity of early detection for successful treatment outcomes. However, disparities in knowledge regarding risk factors, symptoms, and screening guidelines were evident. Participants without prostate cancer often expressed uncertainty about the disease’s development, with some admitting they were unsure how prostate cancer occurs. In contrast, survivors demonstrated a more concrete understanding, recognizing it as a significant health issue that targets a specific gland in men, is often overlooked. This difference in awareness highlights a gap that may contribute to delays in seeking screening among those without the disease. Regarding risk factors, both groups recognized the impact of family history, but survivors were more aware of Black men’s higher risk and often cited personal and family experiences as reasons for routine screening. Conversely, some participants without prostate cancer were less aware of specific risk factors, suggesting a need for targeted education in this area. Both groups agreed on the importance of early detection, with survivors advocating strongly for regular screenings, often citing their experiences as proof of its life-saving potential. They emphasized that without regular check-ups, the disease could progress unnoticed until it becomes more difficult to treat. Participants without prostate cancer shared this sentiment but often discussed it in more general terms, lacking the urgency conveyed by survivors. This finding aligns with existing literature indicating a lack of awareness and knowledge about prostate cancer among Black men (Ogunsanya et al., 2017; Oliver et al., 2018). The findings underscore the urgent need for targeted educational interventions aimed at improving prostate cancer literacy within the Black community, which is crucial for early detection and improved outcomes.

Moreover, the discussion surrounding barriers and experiences underscored the multifaceted challenges faced by Black men in accessing prostate cancer screening and treatment. For men without prostate cancer, apprehension about the screening process, particularly the DRE, and misconceptions about screening methods contribute to avoidance. Fear, stigma, and concerns about potential side effects, such as impotence and incontinence, are also significant deterrents. These barriers are compounded by socioeconomic challenges, including inadequate insurance coverage and financial hardships, which limit access to screening and timely medical care. In contrast, prostate cancer survivors, while still grappling with fear and discomfort associated with the DRE, often experience more personalized and compassionate care from healthcare providers. Survivors also emphasize the importance of clear communication and respect from their healthcare teams, which fosters trust and encourages adherence to follow-up care. However, the fear of impotence and incontinence remains a prevalent concern even after diagnosis, highlighting the ongoing psychological and emotional challenges these men face. The findings are consistent with existing literature, which underscores the impact of cultural mistrust, healthcare system biases, and socioeconomic disparities on Black men’s healthcare-seeking behaviors (Chowdhury-Paulino et al., 2022; Woods et al., 2004). Addressing these barriers requires targeted interventions to improve communication, cultural competence, and access to affordable screening services. The study has important ramifications for Black men’s prostate cancer outcomes since it highlights the need for specific support and education to help overcome these obstacles.

Furthermore, the preferred communication channels identified by participants highlighted the importance of diverse sources of information in shaping Black men’s health-related decisions. Men without prostate cancer predominantly engage with established health institutions such as MUSC and the Veteran’s Hospital. They value these institutions for general health information, relying on their established credibility. This is consistent with findings from Lillard et al. (2022), which highlight the reliance on traditional health sources among non-diagnosed individuals. In contrast, men with prostate cancer actively seek information from specialized cancer support organizations such as Harvard Medical School, the CDC, and the Prostate Health Education Network. This group demonstrates a more targeted approach, utilizing research-oriented resources and attending educational seminars, reflecting a proactive attitude toward managing their condition. This behavior aligns with previous studies indicating that cancer patients often engage more deeply with specialized resources (Mestdagh et al., 2023).

Healthcare providers play a crucial role for both groups, but their interactions differ. Men without prostate cancer maintain engagement with primary care physicians through modern communication methods, such as text messages, which aligns with the use of contemporary digital tools noted by Lillard et al. (2022). Conversely, men with prostate cancer emphasize interactions with specialized doctors, including those of similar racial backgrounds, highlighting the importance of trust and cultural competence in their healthcare experiences. Both groups utilize medical literature and online resources extensively. Men without prostate cancer engage with general health literature, while those with prostate cancer integrate professional literature with other resources for a more specialized approach. The prevalence of online search engines and websites among both groups underscores the growing importance of digital platforms in health information dissemination. These findings suggest that health communication strategies should be multifaceted, integrating traditional institutions, specialized resources, and digital platforms while fostering strong patient-provider relationships. Tailoring communication strategies to these preferences can enhance the effectiveness of health interventions and support improved health outcomes among Black men.

However, certain nuances in the findings of this study warrant further exploration. For instance, the differential perspectives on prostate cancer within social circles, particularly across generational lines, underscore the need for targeted interventions that address varying levels of awareness and attitudes toward screening across different age groups. In addition, the reliance on family and friends as trusted sources of information underscores the importance of community-based approaches in promoting health equity and disseminating culturally competent care.

Conclusion

This study contributes to our understanding of the perspectives of Black men on prostate cancer care delivery; it emphasizes the importance of addressing knowledge gaps, overcoming barriers to screening and treatment, and leveraging trusted communication channels to promote health equity. By integrating these findings into evidence-based strategies and policies, stakeholders can work toward eliminating disparities in prostate cancer outcomes and ensuring that all men have access to timely, high-quality care. Based on the findings from this focus group research, several recommendations can be made to improve prostate cancer care delivery for Black men. First, there is a need to develop educational programs targeting both men without prostate cancer and those newly diagnosed with early stage prostate cancer that are aimed at enhancing their understanding of scientific data and treatment outcomes to facilitate informed decision-making regarding treatment options. In addition, efforts should focus on initiating prostate cancer education at a younger age, particularly targeting Black youth, to increase awareness of their risk and promote early detection. Establishing support groups and interventions tailored to Black men and their families can empower them to actively engage in their treatment decisions, thus promoting equity in prostate cancer care. Furthermore, it is essential to investigate system-level factors that either facilitate or hinder early diagnosis and treatment initiation for prostate cancer among Black men. Educating healthcare providers about the unique challenges faced by Black men in accessing timely diagnosis and treatment is imperative, as is improving the dissemination of information on prostate cancer within the Black community. Finally, there is a need to assess whether adjustments to patient characteristics and national prostate cancer guidelines are necessary to better address the specific needs of Black males in prostate cancer care.

The results highlight the need for community-based prostate cancer education for Black men in South Carolina. To address this need, the MUSC Hollings Cancer Center established the South Carolina Prostate Cancer Education and Navigation to Screening Program for Black Men (SC AMEN Program) in September of 2021. The goals of the program are to provide a 1-hr prostate cancer educational module to Black men in communities across South Carolina, followed by 3 months of navigation to prostate cancer screening. To date, the SC AMEN program has enrolled 494 Black men in 16 counties of South Carolina, 88% of whom were behind in their prostate cancer screening at enrollment. Nearly 70% of the participants have been navigated to prostate cancer screening with shared decision-making.