The silent killer of men, and why they won’t find out
The numbers are there for all to see. One in six men will have prostate cancer in their lifetime.
Prostate cancer occurs in African-American men 60 percent more often than Caucasian men, and when they are diagnosed, it’s more likely to be in advance stages.
African-Americans get screened and tested at the same rate as White Americans — 52 percent — however more black men get the disease. But what about the other 48 percent of African-American males in the prime age group? Why are they avoiding getting screened?
Men avoid seeing the doctor
“Men don’t get tested if we think we don’t think anything is wrong,” says Larry Green, facilitator of the African-American Prostate Cancer Support Group at Lincoln Community Center in Durham, North Carolina.
This poses a challenge, because prostate cancer warning signs are subtle.
“Prostate cancer typically doesn’t have any symptoms which is why screening and testing are so important. It is often considered as a silent killer,” says Stanley Frencher Jr. MD, MPH, who is chief resident in urology at Yale University.
For some men, there is a reluctance to be screened due to how they view themselves.
“Some of the treatment for prostate cancer will impact sexual function, so men avoid treatment,” explains Thomas Farrington, founder and president of the Prostate Health Education Network (PHEN), who is also a prostate cancer survivor.
As a result, some men have decided to live with the results.
“Men make a trade off of dealing with the disease versus not feeling like a man,” adds Green.
And it doesn’t help that, going through it or survived it, men are very reluctant to talk about prostate cancer.
“There is a personal factor involved where men don’t want to hear bad news,” says Frencher.
Not expected to care
In May 2012, the United States Preventive Services Task Force has recommended against Prostate Specific Antigen (PSA) based screening for Prostate Cancer. This was done to reduce misdiagnosis and overtreatment. However, according to some, it has decreased the public’s awareness of this deadly disease.
“The controversy surrounding the accuracy of PSA screenings and Digital Rectal Exams combined with the reluctance of men going to the doctor in the first place has put a lot of men off from seeing the doctor,” says Frencher.
Two of the initial screenings done for prostate cancer are PSA and rectal exams. A number of men have felt that a rectal examination — using a doctor’s finger — is too invasive and often avoid it.
“A lot of men will get the PSA screen, but they will object to getting the [rectal exam] despite the consequences,” says Green.
The cost is too high
Some men are still unwilling to go through with the surgery. Two of the major side effects are impotence, and incontinence, both of which can be permanent.
“[Men] think if they get a diagnosis and have surgery they won’t be a man anymore because they can’t get it up. It doesn’t take many stories to get that fear [of getting screened] out there” explains Green.
Furthermore, due to the socioeconomic status, lack of medical insurance plays a role in why they more men aren’t being screened.
“African-American and Latino men are less likely to have insurance which means they are less likely to have primary care and less likely to have any type of screening,” says Frencher.
Public perception is reality
Some African-American men still harbor resentment over how African-Americans were treated in the past.
“There is still a mistrust of the healthcare system that has resulted from the Tuskegee Studies with syphilis and the feeling of being a guinea pig,” says Frencher.
Adding the present statistics with the historical past have made some African-American males think twice about getting screened and treated.
“Since African-American get it at a 60 percent higher rate than other ethnic groups and twice the death rate, being diagnosed at younger age, you put all of that together and a lot of African-Americans feel as if they are being experimented on,” explains Frencher.
What can be done to increase the numbers of men who are screened?
Education and awareness are two places to target.
“Quite frankly, there is a lot of confusion about prostate cancer so education and awareness are the biggest things.”
The PHEN network has worked with churches to increase awareness of prostate cancer in the community by sending out information, podcasts and having their members share their own stories about living with prostate cancer.
In addition, PHEN is having their 5th annual Father’s Day Rally Against Prostate Cancer. Over 300 churches nationwide are taking part in this event. Frencher still feels more should be done.
“Churches are a great place to start but what about the men who don’t attend church? You have to reach them in other areas such as barbershops, elk clubs, lodges, fraternity meetings.”
Frencher also feels that prostate cancer is often overshadowed by other, more publicized, cancers.
“Breast cancer has very similar numbers to prostate cancer but you hear a lot more about it and people consider that to be much more of a disease than prostate cancer in spite of the numbers,” explains Frencher.
Change public policy
A study from the National Cancer Institute has shown, that in spite of the criticism of PSA screening, over 1.3 million men were found to have prostate cancer by doing PSA screenings who would have otherwise been caught unaware.
“PSA screenings should intensively screen men at increased risk which [include] African-American men and all men with relatively high PSA levels in their 40s,” says Dr. Gerald Andriole, chief of urologic surgery at Washington University School of Medicine in St. Louis.
In response to the new recommendations by USPSTF, a government task force, the National Comprehensive Cancer Network released a statement stating that PSA screening had “advantages and disadvantages” and that there are no right answers. Suggesting that each man should make an informed and knowledgeable decision about whether the test is best for them.
“Knowledge is the best defense against prostate cancer,” says Farrington.
It’s not just patients that need to become more aware and educated, Frencher says, but doctors as well.
“[Health care] providers need to be more consistent in their message when educating patients. Sending mixed messages will only confuse the patients,” explains Frencher.
More research, technology and advancements may ultimately help with the tough decisions.
“The better the tools to diagnose [prostate cancer], the better we can identify which men should take that risk [of incontinence and impotence] in order to extend their life and have a higher quality of life,” says Frencher.
Dr. Terrance McGill is an aspiring family physician with a passion for writing and increasing health awareness in the community. He recently completed his master’s in public health at the University of North Carolina at Chapel Hill.