Story URL: http://news.medill.northwestern.edu/chicago/news.aspx?id=222996
Story Retrieval Date: 12/11/2013 5:23:45 PM CST
Chicago entrepreneur Al Brown accepted the worst when doctors diagnosed him with prostate cancer in 2008.
“In the black community, often times, the word cancer is linked to death,” Brown said. “It wasn’t until I was diagnosed that I did my research … that’s why my organization encourages men to seek treatment early, ” he added.
After discovering his illness, Brown founded Time 4 the 99, an organization dedicated to raising prostate cancer awareness among black men.
This year alone, 240,000 men will be diagnosed and 30,000 will die from the illness, a toll that has pushed awareness and preventative action for the disease at the forefront of many medical circles.
“At the end of the day, patients need to be told their odds of benefitting and of being harmed by each of the treatment options,” said Gerald Chodak, a urologist and prostate cancer specialist.
Prostate cancer treatment has evolved from a “wait and see” approach to proactive prevention and early treatment.
Although early treatment can be beneficial for the one in six men that get diagnosed every year, it’s not always the route that leads to an increased survival rate.
Treatment options for this complex disease are not one-size-fits-all. Prognosis depends on the stage of the cancer, and even a man’s race.
Brown, who has a history of prostate cancer in his family, said the disease strikes African-American men more aggressively, especially since they tend to shun doctors and screening. According to the Center for Disease Control, more black men die of the disease than any other race, but that is often related to lack of insurance and treatment. Research shows that with proper treatment plan and prevention techniques, the odds for survival are the same for all races.
Then the question becomes: What variables make black men more prone to the illness?
Although medical researchers agree that black men are more susceptible to the disease than any other race, they are still unable to establish scientific causes.
By contrast, the socioeconomic factors faced by African American men are undeniable.
“More African American men are with out insurance, don’t see a doctor on a regular basis…and if they do need treatment they may not have access to the best treatments,” said William Catalona, medical director of the urological research foundation.
Cultural stereotypes also impede treatment among black men.
“We don’t want to associate with anything that may take away our virility. We don’t want to wear anything that may have the ability to take away our erections…that’s not a conversation that most black men want to have,” said Brown.
The prostate, a walnut-sized gland located between a male’s bladder and rectum, protects and enriches sperm while also regulating urine flow. When the prostate becomes cancerous, men may experience trouble urinating or functioning sexually.
“Most men probably don’t want to deal with that. But I can speak very definitively about black men,” said Brown. “A friend of mine thought that if he ignored his symptoms, he could avoid facing it all together.”
The digital rectal exam, or DRE, is a screening test, which many black men are reluctant to undergo. During the test, a physician puts a gloved, lubricated finger into the rectum to feel for any bumps or hard areas on the prostate.
The DRE is a turn off for many people.
“They need to be informed of the other ways to get checked. Before my diagnosis I thought a PSA stood for Public Service Announcement. A lot of men don’t realize there are many alternatives to the DRE,” Brown said.
PSA, or prostate specific antigen, is a substance found in men’s blood and semen. The PSA test is used to detect prostate cancer early. A healthy PSA level ranges between four and 10 nanograms and as a man’s PSA level increases, so does his chance of having prostate cancer.
Treatment options range from “active surveillance,” such as monitoring PSA levels and conducting biopsies to surgical procedures that remove the prostate. These options have many different side effects, and the results are dependent on a man’s age, race and other various factors specific to each man.
Men of all races confront this illness and treatment options, of course.
Chicago businessman Steve Gross, 50, was recently diagnosed with low risk prostate cancer after his annual physical in March. His doctor performed a biopsy after detecting a PSA level just above 4 that was gradually rising.
Gross is considering surgery to remove his prostate.
“They just don’t know how long it’s been there. The option to do nothing is viable, but has what I have been there for three months or ten years? You don’t know,” Gross said.
Because the odds have shown that when a man is diagnosed with prostate cancer, his odds of dying from it are relatively low in some cases, early may raise unnecessary red flags.
Statistics show that all men with prostate cancer have a 98 percent 15-year survival rate according to cancer.org. Another U.S. study published in the New England Journal of Medicine reported that surgery failed to increase the survival rate.
Chodak does not always agree with the message to promote early screening. “The bottom line is to focus on the science and not on an emotional reaction that ignores the results from well done studies.”
A key barrier hindering better prostate cancer outcomes is lack of education. Many men do not want to talk about it, or are unaware of the facts related to the disease, treatment and prognosis.
While early screening could extend the life of a 48-year-old African-American man with early stage prostate cancer, it could potentially trigger needless worry for a Caucasian man of the same age with low odds of dying from the cancer.
The recent exposure to the BRCA 1 gene and its association with an increased risk for breast cancer translates into a new proactive approach for prostate cancer. Now called the “Angelina Jolie Effect” after the actress famously underwent a preventative mastectomy because she carried the gene, doctors are predicting men may follow suit with preventative prostatectomies.
This type of proactive treatment could have more dire side effects for men than mastectomies have for women. Men may lose control of excretory functions and/or become impotent for the rest of their lives.
“If someone approached me about doing a radical prostatectomy because their gene test was positive, I would not do that,” Chodak said. “I don’t think there’s enough evidence to know if it’s the right action to take.”
One preventative measure that is being considered as highly affective is a healthy diet. Asian men have the lowest incidence of prostate cancer than any other race, and doctors attribute that to a diet low in red meat, fried meals and processed foods..
“Diet may be playing an important role here in your risk of developing prostate cancer and maybe even your risk of dying from it,” Chodak said.