Prostate Cancer

Symptoms | Prostate Cancer Info

The mere mention of this mysterious disease stirs fear and confusion. For men, the possibility of being diagnosed with cancer often is enough to dissuade them from seeking proper medical treatment. This reluctance to seek testing has resulted in a higher number of African-American men being diagnosed at a more advanced stage with cancer than of other ethnic

Prostate cancer is the leading cancer diagnosed among men in the United States, and proportionately large numbers of African-American men are diagnosed and dying of this type of cancer. Officials at the National Cancer Institute say African-American men currently have the highest rate of prostate cancer in the world.

From 1988 to 1992, the incidence rates among White men ages 30 to 54 was 12.4 per 100,000. For African-American men, that rate was 19.3.

The numbers jump significantly in older men. From ages 55 to 69, 576.6 out of 100,000 African-American men had incidents of prostate cancer, and 100 of them died. That's compared with 1,594.2 incidents and 625 deaths among men age 70 and older.

By comparison, White men 55 to 69 had an incidence rate of 576.4 with 96 deaths. Those over 70 accounted for 1,264.6 incidents and 298 deaths.

Asian and Native American men have the lowest rates of prostate cancer of all ethnic groups.

Sixty percent of all newly diagnosed prostate cancer cases and almost 80 percent of all deaths occur in men aged 70 or older. Mortality rates for prostate cancer are much lower than the incidence rates. The survival rate for men with prostate cancer is generally high. Yet, the occurrences of prostate cancer have increased in the past few years, mostly due to the use of improved screening methods.

Prostate cancer is often mis-perceived as a fatal, unstoppable disease. In reality, 50 percent of prostate cancer patients have a five-year survival rate, and many are cured.

What prevents men from seek-ingesting is the fear of a diagnosis and the devastating effect it could have on their lives. "Men are not aware that cancer can be cured," says Dr. Isaac Powell, associate professor of urology at Wayne State University in Detroit, Michigan. "They view a diagnosis as a death sentence and have difficulty confronting it."

Dr. Powell says African-American men are most concerned with the inability to control their urine. Because the function of the prostate is to make fluid that feeds sperm and carries the sperm through ejaculation, men are also highly concerned about the loss of sexual performance. While the prostate is important in reproduction, prostate cancer, even the loss of the prostate, does not necessarily mean that sexual performance is diminished.

Despite decades of research, the causes of prostate cancer still are not known. It is believed that carcinogens, or chemicals, alter DNA (deoxyribonucleic acid, the acids that control cell function). Once cells are altered and turn cancerous, they reproduce faster than healthy cells and can spread to other parts of the body as tumors.

In fighting a disease as unpredictable as cancer, early detection is the key to survival. Unfortunately, many African-American men lack equal access to medical care or harbor a distrust for the medical community. To break down these barriers to improve the health of African-American men, there are programs designed to ease their fears and bring about a better understanding of prostate cancer.

Dr. Powell, a member of the Karmanos Cancer Institute, co-authored a paper about the recruitment of African-American men for early detection that was presented at the National Conference on Prostate Cancer. The paper focused on the Detroit Education and Early Detection (DEED) program, a community-based program that involved African- American churches in attracting men to early-detection programs.

DEED has been successful in attracting men who otherwise might have avoided screening for prostate cancer. By the end of June 1994, more than 1,000 men had participated in DEED:

"The screening is beneficial and the rate of complications has been minimal thus far," says Dr. Powell, who is currently working on a follow-up paper that discusses the outcome of the DEED program and focuses on behavior and attitudes. Powell believes the issue of distrust is an important factor that keeps some men away from the program, but he acknowledges that this belief is still an educated guess.

One of the most successful aspects of the DEED involves survivors of prostate cancer who talk to other men about their experiences. "The men listen to them (the survivors) more than they listen to the physicians," Dr. Powell says.

Listening to someone who has lived through the ordeal and seeing prostate cancer from a patient's point of view helps African-American men relate to the process and understand that enduring the discomfort of testing is worth experiencing if the cancer is detected early enough to be treated. Dr. Powell would like to see programs similar to DEED set up around the country and has sent an application to the National Cancer Institute to fund programs in cities that include New York, Chicago, Atlanta and Houston, Texas.

"African-American men do not come to health centers on a routine basis," Dr. Powell says. "Community-based programs will be successful. This is the way to go."

Dr. Powell has seen the program used as a model in other states. "People are attempting to set up programs through their churches."

By the time many African-American men seek medical treatment for cancer, the cancer has spread too much to be treated effectively. "When symptoms appear, it's usually too late for a cure," says Dr. W. Bedford Waters, president of the Urology Section and also a professor at Loyola University. Common symptoms of prostate cancer include pain in the back, pelvis, upper thighs and frequent or even painful urination.

An advocate for early detection, Dr. Waters wants to see programs such as DEED, and those initiated for breast cancer awareness, set in motion to get African-American men more involved in prostate cancer screenings.

Catching prostate cancer in its early stages is crucial. Men with a family history of prostate cancer are at an even greater risk than the rest of the population. They should begin testing at age 40. It is important that all African-American men over 40 have their primary care physician, or a urologist, administer tests once a year.

When men visit their doctor, they should give a blood sample for the prosthetic specific antigen test (PSA). The PSA is a relatively new procedure that measures chemicals secreted by a troubled prostate gland.

"Blood levels are increased when the normal structure of the gland is disrupted by a tumor," Dr. Waters says. "The PSA is useful for diagnosing cancer and monitoring response to treatment."

A doctor should then perform a digital rectal exam (DRE), a procedure in which the doctor inserts his finger in the patient's rectum about two inches and feels the prostate for any changes in size. The DRE exam is a turn-off that prevents many men from going through with the test, but Waters assures that the procedure, while awkward, is not painful.

"It's not as uncomfortable as people think," Dr. Waters says. After the DRE is completed, most patients are relieved that the procedure is much easier than they anticipated. "Many men say, 'Wall, that wasn't so bad after all,'" Dr. Waters adds.

If these tests come back positive, a biopsy is performed. During a biopsy, tissue samples are taken for microscopic exams and definitive proof that cancer is present. A negative biopsy, however, is not a guarantee that cancer is not present.

If a patient is diagnosed with prostate cancer, there are several methods of treatment. Surgery may remove cancerous tumors or the entire prostate to stop the disease from spreading to the rest of the body.

Radiation treatment works to destroy cancerous tissue in one of two ways: external beam and radiation seed implants. With the external beam, x-rays are fired at the cancerous area from outside the body. With implants, tiny radioactive seeds about the size of a grain of rice are injected into the prostate, which prevents the radiation from affecting surrounding organs. The implant procedure is increasing in popularity as an option to the external beam procedure, which can affect other organs and cause nausea and other symptoms in patients. Seed implants are also an outpatient procedure. In contrast, surgical removal can mean a five-day hospital stay, and traditional radiation treatment can take up to six weeks of daily treatment.

What steps can you take in preventing prostate cancer? If you drink, smoke or have a poor diet, a lifestyle overhaul may be in order. Some research suggests that a diet high in fat and red meat increases risk.

High intake of fruits and vegetables may offer some protection. A high-fiber diet can help to limit how long carcinogens stay in your body. There is some interest in the likelihood that the low risk of prostate cancer in certain Asian populations may result from their high intake of soy products. However, nothing has been proven to corroborate this theory.

Cigarette smoke contains more than 40 known carcinogens and has been held accountable in 30 percent of all cancer deaths: Regular exercise is also beneficial.

When it comes to fighting prostate cancer, knowledge is power. Talk to your primary care physician if you think you are experiencing symptoms or have any questions, or seek the advice of a urologist who specializes in care and treatment of the prostate.

Last updated Nov 26/06