Cutting death rates from prostate cancer among African-American men likely requires improving access to medical care -- not just raising awareness of the disease -- a new study of black and white prostate cancer patients in North Carolina suggests.

Prostate cancer disproportionately affects African-American men, who die from the disease at more than twice the rate as their white counterparts.

The new study, published today in the online version of the journal Cancer, found African-Americans are well aware of their increased risk for prostate cancer but still lag behind whites when it comes to getting regular medical checkups and screening tests that aid in early detection.

African-American men also were more likely than whites to report physical symptoms, such as difficulty urinating, as the initial signs of prostate cancer. Such symptoms often are a sign of more advanced disease.

Study authors, who include physicians at UNC-Chapel Hill, Harvard University and elsewhere, concluded the reasons for the gap are largely socioeconomic. African-Americans surveyed had lower incomes than whites, were more likely to be uninsured and less likely to have a regular doctor. Eight percent of African-Americans surveyed reported having no health insurance, compared with 3 percent of white men.

"The African-Americans in the study were hampered by real barriers to accessing care," said Dr. Paul Godley, a medical oncologist at UNC-Chapel Hill and co-author of the Cancer article.

The results are hardly surprising to those familiar with the consequences of doing without health insurance. It is well established that uninsured patients, regardless of race, delay getting needed care. And once they do seek medical attention, uninsured patients often receive less-aggressive treatment than patients with health insurance.

"The biggest health disparity is that 1.4 million people in North Carolina don't have health insurance," said Adam Searing, project director for the N.C. Health Access Coalition, which advocates for the poor and uninsured. He has not seen the prostate cancer study but said the findings highlight the problems faced by the uninsured.

The prostate study also found that African-Americans were less likely than whites to say that they trusted their physician. But researchers did not find the mistrust stemmed from cultural or historical reasons, such as past instances of African-Americans being used as unwitting research subjects.

Instead, the mistrust is another by-product of poor access to care, Godley said. African-Americans were more likely than whites to get care in public clinics and emergency departments, where they tended to see a different provider each time.

"It's harder to develop trust," Godley said.