Prostate cancer: What Black men should know

New Crisis, The, Nov/Dec 2002 by Lee, Kendra

The Color Line

Black men have a 34 percent greater chance of bei diagnosed with prostate cancer and a 123 percent greater chance of dying from it than White men.

When Rev. Thomas Walker was diagnosed with prostate cancer six years ago, he was stunned. A Baptist minister from Rocky Mount, N.C., Walker had gone to the doctor hoping to get rid of an "inconvenient" recurring pain. The last thing he expected to hear was the word "cancer."

"I thought it might be some type of infection," says Walker, 54. "I didn't relate it to prostate problems. I never suspected I had a cancer."

Prostate cancer, the second most common cancer in men (behind skin cancer), starts in the walnut-sized prostate gland, located just below the bladder and in front of the rectum. It is usually found in men 50 years or older, and a man's risk of developing the illness is higher if there is a family history of the disease.

Approximately 1 in 5 men in this country will develop prostate cancer in his lifetime (roughly 198,000 new cases are reported in the United States each year).

In recent years, many high profile Black men have been diagnosed with the disease. Benjamin Carson, M.D., director of pediatric neurosurgery at Johns Hopkins Hospital, and Princeton University professor Cornel West have battled prostate cancer. Black nationalist Stokley Carmichael succumbed to the disease in 1998.

Prostate cancer hits African American men particularly hard. National studies have found that Black men, compared with their White counterparts, have a 34 percent greater chance of being diagnosed with the disease and a 123 percent greater chance of dying from it.

The reasons why these discrepancies exist are not so clear. Theories range from genetics to lifestyle to a high-fat diet. But to William Baker, M.D., assistant professor of urology at the University of California, Davis, and chief of urology at the Sacramento Veterans Affairs Medical Center, the reason Black men die at much higher rates is simple: late detection and a lack of aggressive treatment.

"Many African American men harbor a keen mistrust of the medical profession because of historical bias and mistreatment," explains Dr. Baker, who cites the U.S. Public Health Service's Tuskegee Study of Untreated Syphilis, in which hundreds of low-income Black men with syphilis were denied treatment for 40 years so that researchers could study how the disease progresses.

A study by the Public Health Institute, based in Berkeley, Calif., found that Black males were less likely than White men to have surgery of any type to treat prostate cancer.

"There is a lack of urgency both among Black men, who are not as likely to participate in their treatment choices, and among major [health care] institutions," says Walker.

The Great Debate

Although it is recommended that most men get digital rectal exams annually, beginning at age 50, many African American men are already dying of the disease by that time. As a result, the National Prostate Cancer Institute and the American Urological Association recommend that Black men start getting prostate screenings at age 40. But there has been some debate among national medical organizations, including the National Institutes of Health, about whether annual PSA tests, introduced in the 1980s, are the answer.

PSA stands for prostate-specific antigen, a protein from the prostate gland that can be found in the bloodstream. Normal prostate glands make some PSA, but enlarged glands make more. Although an elevated PSA level doesn't automatically indicate prostate cancer, a high level usually leads doctors to perform a prostate biopsy.

After PSA testing became widespread, the number of men who had surgery or radiation therapy for prostate cancer increased significantly. But because many prostate cancers grow slowly, a number of medical experts believe men may have unnecessarily aggressive treatment of tumors that might never have given them trouble. Some treatments may lead to impotence or incontinence.

Dr. Baker prefers not to get in the middle of the blame game, however, choosing instead to educate Black men about the disease.

Fighting Back

After Ken Lawrence of Dumfries, Va., kept seeing PSA testing ads on television, he decided to get tested.

He was astonished when he was diagnosed with prostate cancer.

"I was a normal guy, going along with no symptoms," says Lawrence, 57.

"Men don't always want to talk about it. We think, `maybe it'll go away or maybe it's not happening to me.' We're not taking advantage of screenings. The emphasis should be on prevention."

That's why Baker of the University of California founded the African American Prostate Cancer Initiative (AAPCI) in Sacramento. As more and more Black men began dying from prostate cancer and the disease became more prevalent, he wanted to raise awareness of the disease in the Black community.

"There is something [about what] we eat, how we are educated, how we act when faced with life-threatening problems and our ability to access quality medical care that sets us apart from Whites and other ethnic groups," Dr. Baker says.