African Americans & Prostate Cancer
• Family History: Men with a family history of prostate cancer are more likely to be diagnosed with the disease than men without a family history.
• Diet: A high-fat diet increases a man’s risk for advanced prostate cancer, including a high intake of red meat or high-fat dairy, as well as a limited intake of fruits and vegetables.
• Smoking: Middle-aged men who smoke face twice the risk of developing more aggressive forms of prostate cancer than men who have never smoked.
• Exercise: Less physically active men may be at a higher risk of prostate cancer.
To help identify individual risks, check out the American Urological Association’s Prostate Golf (http://www.auafoundation.org/prostate), an online tool assessing a man’s risk for developing prostate cancer.
Prostate Cancer in African Americans
African American men have the highest incidence rates for developing prostate cancer, though the exact reasons for this link is unclear. In 2007, it was estimated that 31,870 African American men would be diagnosed with prostate cancer, accounting for 37 percent of all cancers diagnosed in this population. Currently, death rates from prostate cancer are 2.4 times higher in African Americans than in white men. Moreover, African American men tend to present with more advanced disease and have poorer overall prognoses than Caucasian or Asian men.
Reasons for the racial differences are not well understood and researchers are trying to determine why the African American community suffers more from prostate cancer. Some possibilities include:
• Genetic, environmental and social influences can affect the development and progression of prostate cancer in African American men.
• Limited access to health care, including lack of insurance, may mean that African American men do not always receive the preventive care and screening they need.
• Distrust or negative attitudes toward screening tests and regular check-ups may mean that prostate cancer is diagnosed at a more advanced stage in African American men.
Common Signs and Symptoms
In its early stages, prostate cancer usually does not cause noticeable symptoms. However, some men will experience symptoms that might indicate the presence of prostate cancer, including:
• A need to urinate frequently, especially at night
• Difficulty starting urination or holding back urine
• Weak or interrupted flow of urine
• Blood in urine or semen
• Frequent pain or stiffness in the lower back, hips or upper thighs
Because these symptoms can also indicate the presence of other diseases or disorders, men who experience any of these symptoms should undergo a thorough check-up to determine the underlying cause of the symptoms.
Diagnosing Prostate Cancer
While most experts agree that healthy men over the age of 50 should consider screening for prostate cancer, the age at which a man should start screening is still in debate. Those who are at a higher risk of prostate cancer, such as African American men or those with a family history of prostate cancer, should consider starting annual screening at age 40.
Physicians commonly use two examinations to screen men for prostate cancer: a digital rectal examination (DRE), in which a doctor inserts a gloved finger into the rectum to feel for lumps in the prostate, and a prostate-specific antigen (PSA) blood test, a simple test that measures a patient’s level of PSA in the blood. PSA is a protein produced by the prostate and is a good indicator of activity (such as cell division) in the gland. A prostate that feels abnormal, along with an elevated PSA level, are possible indicators of the disease; however neither test alone nor in combination can provide a definitive diagnosis. If either test is abnormal, your physician may suggest a biopsy, which can provide much more information and is required before a diagnosis can be made.
Treating Prostate Cancer
Approaches for managing prostate cancer range from active surveillance (“watchful waiting”) to treatment, including surgery, radiation, hormone therapy and chemotherapy. Surgery and radiation are considered equally effective therapies for early-stage prostate cancer, while hormonal therapy and chemotherapy are often used in advanced or late-stage prostate cancer that may have spread outside the prostate. Targeted therapies are specifically designed to interfere with the way prostate cancer cells grow, interact with each other and/or with the immune system. A number of targeted therapies are being investigated for prostate cancer, but none have been approved by the FDA.
Talking to Your Treatment Team
Consultation with three types of prostate cancer specialists — a urologist, a radiation oncologist and a medical oncologist — will offer the most comprehensive assessment of the available treatments and expected outcomes. It is important to be prepared with questions when you meet these specialists. For more information about prostate cancer, including a list of questions to ask your doctor and an on-line risk assessment tool, visit http://www.auafoundation.org/prostate. Additional information is available at www.UrologyHealth.org.