A memory I will never forget from my medical school training concerned an elderly gentleman who presented to the emergency room with failure to thrive, body pain all over, and 60 pounds of weight loss. His children reported that their father had not been himself for more than a year, so they brought him to the emergency room when he refused to get out of bed.
After an extensive evaluation, including X-rays, the gentleman was found to have abnormal areas throughout most of his bones consistent with cancer. The emergency room team sent off several vials of blood and included a relatively new test called prostate-specific antigen (PSA) to determine if the source of his disease was the prostate gland. A normal value for the PSA is approximately 4ng/ml. My patient’s PSA returned over 1000 ng/ml.
Over the next few years, the PSA blood test would be widely adopted as a means of diagnosing early prostate cancer before it spread to other organs.
African-American men develop prostate cancer 70 percent more frequently and have more than double the mortality of any other racial and ethnic group. Compared to white men, African-American men develop prostate cancer at an earlier age, with more aggressive disease and a higher probability that it will spread to other parts of the body. The PSA blood test, when administered early, has been a remarkable lifesaving discovery.
Before the routine use of PSA, over 50 percent of African-American men with prostate cancer presented to their physician with advanced disease, when treatment is difficult to withstand, and the window for cure has closed. Now, with routine PSA screening, less than 10 percent of men, regardless of race and ethnicity, present with metastatic disease. Because of PSA screening and improved therapies, there has been a dramatic drop in the mortality rate from prostate cancer, unlike what we have seen in any other solid tumor over the last 25 years.
In 2014, Dr. Arnold Bullock, Dr. Bettina Drake, Dr. Angela Brown and myself founded the Prostate Cancer Coalition, an organization composed of health care providers, survivors and health care organizations. The coalition supports the American Cancer Society’s position that there should be a discussion about the risks and benefits of screening, beginning at the age of 45 for African-American men and younger if there is a strong family history of the disease.
Our goals are to educate health care providers about the importance of prostate cancer screening. We are also committed to educating the community through church information sessions, a bus and billboard campaign, a website with educational materials, and partnering with other regional organizations that have already made a substantial difference in men’s health, such as the Empowerment Network and 100 Black Men.
The coalition produced a radio show podcast, Our Healthy Men, that can be accessed at prostatecancerstl.org or on the iHeart Radio app. Topics discussed include: describing the function of the prostate gland and why many men struggle with symptoms of frequency and urgency of urination; outlining the available tests for screening of prostate cancer and strategies to avoid an unnecessary biopsy; reviewing what every man should know when diagnosed with prostate cancer; and providing information on the importance of clinical trials.
Prostate cancer is the second-leading cause of death in our community, and this devastation is largely avoidable with routine screening. Currently only one-third of African-American men report screening routinely. Please talk to your health care provider about this simple blood test and visit our website for free screening information, educational resources and support services. Get screened and save a life.
Founded in 2015, the Prostate Cancer Coalition is a group of health-care providers and survivors in the St. Louis region that came together to advocate smart screening for African-American men and men with strong family histories of prostate cancer. The coalition supports the American Cancer Society’s position that there should be a discussion about the risks and benefits of screening, beginning at the age of 45 for African-American men and younger if a strong family history. The discussion should also emphasize the significant advancements in the detection and staging of prostate cancer and that PSA is just one of many tests available to help make an educated decision. For more information on the coalition, free screenings and community events, visit Prostatecancercoalition@stl.org.
Lannis Hall, MD, MPH is the director of Radiation Oncology at Barnes-Jewish St. Peters Hospital, and Clinical Trials leader for the Program to Eliminate Cancer Disparities at Washington University School of Medicine.
