No AccessJournal of UrologyAdult Urology1 Mar 2022

Representation in Online Prostate Cancer Content Lacks Racial and Ethnic Diversity: Implications for Black and Latinx Men

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    Black men have the highest incidence and mortality from prostate cancer (PCa) and lower quality of life compared to other U.S. racial groups. Additionally, more Latinx men are diagnosed with advanced disease and fewer receive guideline-concordant care. As many men seek medical information online, high-quality information targeting diverse populations may mitigate disparities. We examined racial/ethnic representation and information quality in online PCa content.

    Materials and Methods:

    We retrieved 150 websites and 150 videos about “prostate cancer” using the most widely used search engine (Google) and social network (YouTube). We assessed quality of health information, reading level, perceived race/ethnicity of people featured in the content and discussion of racial/ethnic disparities.


    Among 81 websites and 127 videos featuring people, 37% and 24% had perceived Black representation, and racial/ethnic disparities were discussed in 27% and 17%, respectively. Among 1,526 people featured, 9% and 1% were perceived as Black and Latinx, respectively. No content with Black or Latinx representation was high quality, understandable, actionable and at the recommended reading level.


    Black and Latinx adults are underrepresented in online PCa content. Online media have significant potential for public education and combating health disparities. However, most PCa content lacks diversity and is not readily understandable.


    • 1. Pew Research Center: Social media fact sheet. Pew Research Center 2021. Available at Accessed December 6, 2021. Google Scholar
    • 2. National Cancer Institute: Surveillance, Epidemiology, and End Results Program. 2021. Available at Accessed December 10, 2020. Google Scholar
    • 3. : Longitudinal regret after treatment for low- and intermediate-risk prostate cancer. Cancer 2017; 123: 4252. Google Scholar
    • 4. : Quality of life among black prostate cancer survivors: an integrative review. Am J Mens Health 2018; 12: 1648. Google Scholar
    • 5. : African Americans and their distrust of the health care system: healthcare for diverse populations. J Cult Divers 2007; 14: 56. Google Scholar
    • 6. : The influence of eHealth literacy on perceived trust in online health communication channels and sources. J Health Commun 2017; 22: 53. Google Scholar
    • 7. : Undertreatment of high-risk localized prostate cancer in the California Latino population. J Natl Compr Canc Netw 2018; 16: 1353. Google Scholar
    • 8. : Racial/ethnic differences in physician distrust in the United States. Am J Public Health 2007; 97: 1283. Google Scholar
    • 9. : Impact of the primary information source used for decision making on treatment perceptions and regret in prostate cancer. Am J Clin Oncol 2018; 41: 898. Google Scholar
    • 10. : Dissemination of misinformative and biased information about prostate cancer on youtube. Eur Urol 2019; 75: 564. Google Scholar
    • 11. : Consumer evaluation of the quality of online health information: systematic literature review of relevant criteria and indicators. J Med Internet Res 2019; 21. Google Scholar
    • 12. Python Package Index: googlesearch-python 1.0.1. PyPI 2021. Available at Accessed August 10, 2021. Google Scholar
    • 13. Python Package Index: beautifulsoup4 4.10.0. PyPI 2021. Available at Accessed August 10, 2021. Google Scholar
    • 14. DISCERN Quality Criteria for Consumer Health Information: The DISCERN Instrument. DISCERN 2020. Available at Accessed June 28, 2020. Google Scholar
    • 15. Agency for Healthcare Research and Quality: The Patient Education Materials Assessment Tool (PEMAT) and User's Guide. AHRQ 2017. Available at Accessed May 29, 2017. Google Scholar
    • 16. U.S Department of Health and Human Services, National Institutes of Health and National Cancer Institute: Making Health Communication Programs Work. 2020. Available at Accessed January 11, 2020. Google Scholar
    • 17. : Racial disparities and online health information: YouTube and prostate cancer clinical trials. BJU Int 2020; 126: 11. Google Scholar
    • 18. : Race as biology is fiction, racism as a social problem is real: anthropological and historical perspectives on the social construction of race. Am Psychol 2005; 60: 16. Google Scholar
    • 19. : Comparison of knowledge and information-seeking behavior after general COVID-19 public health messages and messages tailored for Black and Latinx communities: a randomized controlled trial. Ann Intern Med 2021; 174: 484. Google Scholar

    Funding Acknowledgement: This study was supported by a Department of Defense Health Disparity Research Award and the Prostate Cancer Foundation, and the Edward Blank and Sharon Cosloy-Blank Family Foundation. The funders did not participate in study design, conduct or submission.

    CRediT Statement: Conceptualization: SL, HB, SG, JR, ATL; Methodology: SL, HB, SG, JR, ATL; Analysis: DW, KS; Data curation: All authors; Writing–Original Draft: SL; Writing–Review & Editing: all authors; Project Administration: TSN, NB; Funding Acquisition: SL, HB, SG, JR, NB, ATL.

    This study was deemed exempt from institutional review board approval.

    See Editorial on page 496.