Black people with prostate cancer face a complex interplay of structural barriers such as inadequate health education, underrepresentation in clinical trials and reduced access to treatment -all of which contribute to poor health outcomes.• Current screening guidelines do not provide specific guidance to clinicians treating Black patients, which likely contributes to their increased risk of developing and dying of prostate cancer.• Implementing targeted screening programs in Canada for Black people could result in earlier detection and treatment, and lower risk of death.• Any attempt to alleviate racial disparities in health requires not just isolated changes such as screening and treatment guidelines, but also a wider understanding of systemic racism and its impacts on patient outcomes.