Prostate cancer has the widest racial disparity in cancer-related death nationwide.¹ Black men experience higher incidence rates, more aggressive disease progression, and a mortality rate two to three times higher than for men from other racial and ethnic groups.² That’s why early detection through screening is vital‒particularly for high-risk populations—and health care providers play a crucial role in facilitating this process.

Screening options

The primary tools for prostate cancer screening are the prostate-specific antigen (PSA) test and the digital rectal examination (DRE).³ While the PSA test is essential, recent studies indicate that DRE is not an effective screening method, nor does it improve detection when used in conjunction with PSA testing. Instead, multiparametric magnetic resonance imaging (mpMRI) has emerged as a more precise diagnostic option, helping many men avoid unnecessary biopsies.⁴

That said, DRE may still be useful in certain clinical situations—such as for patients exhibiting lower urinary symptoms or when PSA levels are normal but clinical suspicion remains high. It can be beneficial in identifying benign conditions like benign prostatic enlargement or prostatitis, and in rare cases, it may detect aggressive cancers in men who do not produce PSA. However, the routine use of DRE may discourage men – especially Black men – from seeking care due to the stigma surrounding the exam.⁴

Screening guidelines

The U.S. Preventive Services Task Force recommends shared decision-making for men aged 55 to 69. However, emerging research suggests that Black men should begin discussing screening with their provider as early as age 40.^5,6 Studies show that initiating PSA screening in their 40s could reduce prostate cancer mortality by up to 30 percent among Black men.⁷

Tips for providers: Making shared decision-making work

While shared decision-making is widely recommended for prostate cancer screening, implementing it effectively can be challenging. The U.S. Centers for Disease Control and Prevention (CDC) offers an interactive tool to help providers navigate conversations about prostate cancer screening using a structured framework. It encourages providers to:

• Discuss individual risk factors, such as age, race, and family history.
• Explain the benefits and potential risks of PSA screening in clear, everyday language.
• Invite patients to share their personal values and preferences regarding screening.
• Use simulated scenarios to build confidence and enhance communication skills.⁸

Black men often view primary care providers as gatekeepers to essential screenings, yet many feel dismissed or unheard during these discussions. By initiating conversations and aligning recommendations with each patient’s risk profile, providers can build trust and reduce disparities in prostate cancer outcomes.¹

Cigna Healthcare coverage

The PSA test and DRE are typically covered at no cost when administered at in-network locations, which your patients can find by logging in to myCigna.com.

You can learn more information about our coverage policies related to preventive care services in the Preventive Care Services Coverage Policy (A004).

1 Patient and Physician Perceptions of Prostate-Specific Antigen Testing Among Black Individuals.

2 Cancer Facts & Figures 2025.

3 Screening for Prostate Cancer.

4 Is the digital rectal exam any good as a prostate cancer screening test?

5 Should I Get Screened for Prostate Cancer?

6 Why Black Men Should Consider Earlier Screening for Prostate Cancer.

7 The Impact of Intensifying Prostate Cancer Screening in Black Men: A Model-Based Analysis.

8 Talk to Nathan.