KWENU: Our Culture, Our Future

Prostate Cancer and Black Men: A call to action

 

 Chidi Achebe

Bobofine6@hotmail.com

&

Victoria Howard-Robinson

Boston, MA

 

 

Monday, January 17, 2004

 

“A Disgraceful Tragedy”

African-American men are at a greater risk for developing prostate cancer than men of other racial or ethnic backgrounds. The head of the American Cancer Society (ACS), Charles J. McDonald, MD, informs us that “black men in America are 1.5 times more likely to develop prostate cancer and are 2 to 3 times more likely to die of the disease than white men.” [i] Indeed, African American men have the highest rate of prostate cancer in the world and the lowest rate of survival. [ii]

 

John R. Kelly, a board director of the American Cancer Society, believes that “Prostate cancer, particularly among African Americans, is a disgraceful tragedy that needs immediate and drastic action.” [iii] To that end, the American Cancer Society “urges more education about prostate cancer and stronger grassroots organizations, particularly in the African-American community, to engage in advocacy and in education and patient support initiatives. The ACS believes that increased funding of clinical research on Prostate Cancer involving African American men will be particularly salient. The umbrella organization of cancer specialists also calls for more community support for African American prostate cancer patients and their families.” [iv]

 

It is clear that the replication of this novel and multi-pronged public health improvement strategy, in black populations across the globe will be critical in any successful campaign against this malignancy. [v]

 

The threat of Prostate Cancer to Nigerian (African) Men

Not surprisingly, most (and often the best) data about Prostate Cancer amongst black men exists for African American men. This fact, however, has turned out to be of particular relevance for other black men susceptible to this disease around the world.

 

The findings among African American men are intriguing because they raise questions about the genetic underpinnings of prostate cancer – genetic predisposition, susceptibility. In other words, given the findings among African American men and the fact that African Americans share a significant amount of genetic information with Africans (Nigerians), would one therefore expect to find concomitantly high prostate cancer rates amongst, for instance, Nigerian men? 

 

Already, several Nigerian scientists have explored this conundrum. In what has been hailed as a landmark study, JO Ogunbiyi and OB Shittu of the Department of Pathology, University College Hospital, Ibadan, Nigeria, reviewed male cancer patients recorded in a Nigerian cancer registry to assess the current trends in prostate cancer in Nigeria. 

 

According to these scientists, who published their findings in the Journal of the National Medical Association, “Results show that prostate cancer has become the number one cancer in Nigerian men and constitutes 11% of all male cancers. The median age of patients was 67.5 years (variance 5.6), and the mean age was 71.4 years (variance 14.3). These results indicate that despite the absence of screening programs in Nigeria, the number of prostate cancer cases has increased. The known risk factors probably contribute to a varying degree among Nigerians, who are generally of average build or in the low-normal range for body mass index. Moreover, the role of genetics cannot be underplayed. Given its biological characteristics, more cases of prostate cancer probably would be recorded among this population if screening were undertaken.” [vi]

Others such as D. N. Osegbe of the Department of Surgery, College of Medicine and Lagos University Teaching Hospital, Nigeria, agree and believe that “
Prostate cancer incidence and the magnitude of the risk in our population may have been grossly underestimated. The clinical prostate cancer rate in Nigerians may be as great as that noted in black men in the United States, which may suggest a common enhancing genetic predisposition.” [vii]

Prostate Cancer Underpinnings

“No one understands the precise reasons why African-American men have the highest rate of prostate cancer in the world…..though theories abound. It's probably a combination of biological and environmental factors” [viii] according to Johns Hopkins Urologist Alan W. Partin, M.D., Ph.D.

 

For the first time, however, scientists believe that they may have made a breakthrough in cracking this mystery. Jim Shaw shares the news:

 

“Doctor Jim Mohler of Roswell Park Cancer Institute in Buffalo has discovered a crucial difference in the prostates of African American men.

 

All men have what are known as androgen receptor proteins - they are the receptors for the hormones that regulate male traits like facial hair and baldness. But Doctor Mohler has found that the levels of those proteins are 22 percent higher in the prostates of African Americans than in whites. And even more striking, they are 81 percent higher in the prostate cancers of African Americans! So what this suggests is that the prostate of an African American can be thought of to be in a 'revved-up' state where it's being stimulated to grow and perhaps develop cancer because of greater stimulation.”

 

Other researchers such as Dr Michael Wong suggest that the over-expression of androgen receptor proteins on prostates of black men could pave the way for the development of new treatments and therapies. The challenge for scientists he posits is “being able to pin point when the protein becomes active and why.” This crucial information will then enable doctors make earlier and more accurate diagnoses and initiate effective treatments. [ix]

 

Diet and Prostate Health

P.G. Dagnelie and other scientists recently performed a systematic review of the scientific literature on links between diet and prostate cancer. They analyzed several prospective studies examining diet or anthropomorphic variables against risk of prostate cancer incidence or mortality; and found that higher intake of selenium, pulses, and tomatoes or lycopene seem to be protective against prostate cancer; while very high calcium intake above 2000 mg/day seems to increase risk.[x]

In addition, a low-fat, high-fiber diet and regular exercise can slow prostate cancer cell growth by up to 30 percent, according to a new study by researchers at UCLA's Jonsson Cancer Center and UCLA's Department of Physiological Science. A low-fat diet may also help men with aggressive prostate cancer better fight their disease and live longer, according to the same researchers. Their findings indicate that a diet low in polyunsaturated fats slowed cancer growth and increased survival times in lab models. [xi]

 

The Importance of Prostate Screening

“Prostate cancer is the most commonly diagnosed form of cancer among men [in the United States] and the chances of being diagnosed with it increase with age,” says Dr. Richard Babaian, professor of Urology and director of University of Texas M. D. Anderson Cancer Center’s Prostate Cancer Detection Clinic. “It's important for more men to get screened regularly for prostate cancer so we can diagnose it in earlier stages when treatment is most effective.” [xii]

 

What does “Screening” mean? [xiii]

Screening means looking for signs of disease in people who have no symptoms. So screening for prostate cancer is looking for early-stage disease when treatment may be more effective. The main screening tools for prostate cancer are the Digital Rectal Exam (DRE) and the Prostate Specific Antigen (PSA) test. These tests may suggest the need for further tests.

 

What is the PSA? [xiv]

PSA stands for “Prostate Specific Antigen.” PSA is a substance produced by cells from the prostate gland and released into the blood. The PSA test measures the PSA level in the blood. A small amount of blood is drawn from the arm. The doctor has the blood analyzed in a lab to see if the PSA level is normal. The doctor may also use this test to check for any increase in your PSA level compared to your last PSA test. As a rule, the higher the PSA level in the blood, the more likely a prostate problem is present. But many factors, such as age and race, can affect PSA levels. Some prostate glands produce more PSA than others. Because many factors can affect PSA levels, you should discuss whether getting the PSA is right for you. If you do your doctor is the best person to interpret your PSA test results.

 

What is DRE? [xv]

The DRE or Digital (finger) Rectal Exam is a quick exam for checking the health of the prostate. For this test the doctor inserts a gloved and lubricated finger into the rectum for several seconds. This allows the doctor to feel the back portion of the prostate for size and any irregular or abnormally firm areas.

 

WHAT MEN (AND WOMEN) SHOULD KNOW ABOUT PROSTATE SCREENING [xvi] *

An individual should not wait for the appearance of symptoms before getting screened for prostate cancer. Some signs and symptoms that may indicate prostate disease include: a weak urinary stream; difficulty starting urination; frequent urination; urgency (difficulty postponing urination); awakening frequently at night to urinate; interruption of the stream (stopping and starting); blood in urine; pain or burning on urination. It is important to note that Prostate cancer causes no symptoms in the early stages when treatment is most likely to result in a cure. [xvii]

Prostate enlargement, also known as Benign Prostatic Hypertrophy (BPH), becomes more common as men age; symptoms may include difficulty with urination or a frequent need to urinate. A simple blood test, known as the Prostate Specific Antigen (PSA) test, may be used to screen for prostate disease. A doctor may also use a Digital Rectal Exam (DRE) to check for an enlarged prostate. [xviii]

 

Many cases of Prostate Cancer are detectable prior to the onset of any symptoms and one would hope to be diagnosed at that stage of the disease. Routine screening (PSA and DRE) for prostate cancer should begin at age 50. But for Black men - African-American and Nigerian men, many experts recommend commencing screening earlier, during the annual Physical Examination at age 40 and no later than 45.[xix]

 

As with many health care issues, “Early Detection is Your Best Protection.” If you are having trouble or discomfort while urinating, or find yourself making several trips to the bathroom throughout the night, speak to a doctor. A variety of treatments, including medication, can ease symptoms and make for better quality of life. [xx]

 

Looking Forward

Black men and women, indeed individuals of both genders of all races, creeds, religions and social classes who care about this issue, can play an important role in disseminating information about prostate cancer and educating those at risk. This can be achieved by encouraging direct and open discussion of an issue that is often difficult to contend with. Building stronger grassroots organizations, particularly in at risk populations across the globe, will also be salient. Governments, NGOs, women’s groups and foundations can also more actively engage in advocacy and in education and patient support initiatives.

 

The fight against this malignancy will require increased funding as well as clinical research on Prostate Cancer involving subjects at risk for the disease particularly outside America.

 

For Nigeria, and other developing countries, there is a clear need for public health policy that encourages at risk men (those over the age of 40) to obtain annual Digital Rectal Exams during physical exams. Investment in laboratories that can perform the important serum screening test PSA – Prostate Specific Antigen – for early and appropriate diagnosis will be particularly important if we are to tame this “malignant menace.”

 

 

Chidi Achebe MD, MPH  is the Medical Director of Whittier Street Health Center, Boston, MA

 

Victoria Howard Robinson is the Vice President for Community Relations and Development at Whittier


[i] Information from discussion with Mimi Okam-Achebe MD, Attending Physician in Oncology/Hematology at Yale University Hospital, New Haven, CT.

Also American Cancer Society Action Proposal on Prostate Cancer in African Americans (press release Jan 13, 1998)
Annals of Internal Medicine (1997; 127:813-816).

Also: http://psa-rising.com/medicalpike/africanamer.htm

 

[ii] Ibid

[iii] Ibid

[iv] Ibid

[v] Ibid

[vi] Journal of the National Medical Association 1999 Mar; 91(3):159-64

[vii] Journal of Urology, 1998 Jul; 160(1):135                       

[viii] http://healthlink.mcw.edu/article/954386073.html

Also Information from discussion with Mimi Okam-Achebe MD, Attending Physician in Oncology/Hematology at Yale University Hospital, New Haven, CT.

 

[ix] Ibid

[x] P.G. Dagnelie et al. Diet, anthropomorphic measures and prostate cancer risk: a review of prospective cohort and intervention studies. BJU International 2004 93: 1139-1150.

 

xii  http://www3.mdanderson.org/news/20000804.html

Also Alex Zacharias, M.D., Urologist, Advanced Healthcare

http://www.medicalmoment.org/_content/facts/sep04/254373.asp

 

[xiii] This information was developed by the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC).

 

[xiv] Ibid

[xv] Ibid

[xvi] This information should also be known by all individuals of every race, religion, creed and social class who care about this issue.

[xvii] American Foundation for Urological disease.

 http://www.afud.org/conditions/prostatedisease.asp

 

[xviii] This information was developed by the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC).

[xix] Ibid.

[xx] Ibid.

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