Wellness: The Silent Killer

Prostate cancer is the second most common cancer among American men, behind skin cancer. One in six will be diagnosed with the disease during their lifetimes, according to the American Cancer Society, and one in 36 American men will die of the disease, making it the second deadliest cancer for men, after lung cancer.

And the figures are even higher for African-American men: one in five will develop prostate cancer in their lives, and one in 22 will die from it, according to the ACS.

Scientists have not settled on a definitive explanation for that race-based disparity, suggesting it could be rooted in genetics, environmental factors or lifestyle differences. In 2009, researchers working on a project called the African-American Hereditary Prostate Cancer Study announced that they’d identified a genetic mutation which, when found in black men, could make them three times more likely to develop the disease.

While scientists work to sort out the why behind the high rates of prostate cancer among black men, a local group is working to make sure that population is informed about the risks they face and the steps they can take to reduce them. Those efforts include a prostate cancer symposium, organized by Men of Color Health Awareness, or MOCHA, and called “Eliminate Health Disparities: Body, Mind, Spirit and Community Strategies,” scheduled for Friday, June 15. The free public event will run from 8:30 a.m. to noon at Springfield’s Mass Mutual Center; Christopher Lathan, a doctor from the Dana-Farber Cancer Institute, will give the keynote address. Simultaneous Spanish translation will be provided. (See sidebar for more information.)

The goal of the symposium, said MOCHA’s Lamont Scott, is “to make men, most of all, more knowledgeable [about] this silent killer for Afro-American men.”

Scott is a volunteer mentor with MOCHA, working to spread the word among other men about the importance of getting screened for prostate cancer, especially as they get older, when their prostates naturally enlarge. But that’s not always easy, Scott noted. “Men do not like to go to the doctor,” he said. “We have to be pushed by our wives and girlfriends and mothers and fathers.”

Why the reluctance? Some African-Americans don’t feel trusting of the medical establishment, suggested Hank Douglas, a fellow MOCHA mentor. And because they’re less likely to have access to quality healthcare, often they don’t go to the doctor until it’s absolutely necessary. “And we really don’t want to go then,” Douglas added with a chuckle. “I think it’s just a man thing.”

And let’s be blunt: there’s also a good deal of discomfort around the standard physical prostate examination, which involves some rather intimate probing by a doctor’s gloved finger. “Men sometimes feels a little violated or uncomfortable about that,” Scott acknowledged. But, he added, it’s a crucial exam that shouldn’t be avoided because of fear or shame.

As Douglas put it: “It’s not the finger that kills you—it’s the cancer.”

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There’s another kind of screening for prostate cancer, one that may be less invasive but that’s become extremely controversial: the prostate-specific antigen, or PSA, test. That blood test checks the levels of an antigen produced by the prostate that may be present in higher levels in men who have prostate cancer. (Elevated PSA levels can also be connected to other causes, such as infections.)

Last month, the U.S. Preventive Services Task Force—an independent body made up of experts from various medical fields and convened by the federal government—came out with a recommendation against using the PSA test to screen for prostate cancer, saying it offers “a small potential benefit” but “significant potential harms.” Those harms, according to the task force, include the high rate of false-positive results that can “cause worry and anxiety and can result in follow-up tests and procedures, such as biopsies, that aren’t needed” and that carry their own risks, such as infections and urinary problems.

The group also warned of the risk of “overtreatment,” noting that 90 percent of men found to have prostate cancer through a PSA go on to have treatment such as surgery, radiation or hormone therapy, even when their cases might not warrant such interventions. Those treatments, the USPSTF said, can result in complications including impotence, incontinence and bowel control problems, and complications related to surgery.

“Prostate cancer is a serious health problem that affects thousands of men and their families,” Michael LeFevre, the USPSTF’s co-chair, said at the time of the announcement. “But before getting a PSA test, all men deserve to know what the science tells us about PSA screening: there is a very small potential benefit and significant potential harms. We encourage clinicians to consider this evidence and not screen their patients with a PSA test unless the individual being screened understands what is known about PSA screening and makes the personal decision that even a small possibility of benefit outweighs the known risk of harms.”

The USPSTF’s recommendation has resulted in not a little disagreement and distress among medical professionals and their patients who have become accustomed to regular PSA testing. The American Cancer Society, rather than come out against routine PSA testing, responded to the recommendation by saying that men should consult with their doctors at age 50 to “make an informed decision about whether to be tested after learning about the potential risks and benefits of testing.” Men at higher risk for prostate cancer—including African-Americans and men whose fathers or brothers have had the disease—should have that conversation earlier, at 45, the ACS urges.

Douglas, the MOCHA mentor, is dubious of the task force’s recommendation, which he worries could undermine the work his group is doing. While mentors can’t offer individual medical advice, he and Smith both urge other men to be informed about their risks and what they can do to reduce them.

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While the fresh debate over screening is dominating the conversation about prostate cancer right now, it’s far from MOCHA’s only concern. The group also urges men to make life choices that will keep them healthy in the first place. “Just a simple change in lifestyle and diet and exercise will help reduce the risk of prostate cancer,” Douglas noted.

That holistic approach colors all of MOCHA’s work. A project of the YMCA of Greater Springfield, funded by the Mass. Department of Public Health, the group was formed two years ago to improve overall wellness among men of color through public education and social supports, as well as to address race-based health disparities.

Those disparities aren’t limited to prostate cancer; according to the Centers for Disease Control and Prevention, African-American men have a life expectancy of 69.7 years, six years shorter than white men. Black men (and women) are more likely than whites to have coronary heart disease and hypertension and to suffer stroke; they’re also more likely to die from those problems. (Just one example of the differences: 61.5 percent of black men with heart disease will die from it before the age of 75, compared to 41.5 percent of white men, the CDC says.) And the 2008 National Healthcare Quality and Disparities Reports showed that Hispanic and black men were 10 percent less likely than white men to have a primary healthcare provider.

MOCHA’s signature effort is a free, six-week program on men’s health, covering topics ranging from exercise and nutrition to mental health and violence prevention. The class, which is held at the Springfield YMCA on Chestnut Street, also includes a 12-week membership to the Y.

Smith and Douglas both became MOCHA mentors after completing the course. (It’s a testament to the program, says Y spokesperson Kris Allard, that many alumni go on to become mentors.) Smith, a seven-year survivor of cancer, said his own good fortune made him eager to find a way to help other men overcome health disparities. “There’s always something we can do about it,” he said.

“I’ve made a major lifestyle change in my diet and exercise program and in trying to improve my community spirit,” said Douglas, who learned about the MOCHA program through Smith. As a mentor, he said, he can serve as “a role model for health manhood” and help develop positive relationships with other men of color.

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Prostate Awareness Events