Dr. Rick Kittles cuts through much of the rhetoric surrounding the efficacy of the PSA test for African-American men. Not enough perspective has been given to the genetic differentials of the test and the underlying issues of the test versus treatment.
Black men bear a much greater prostate cancer burden than white men. Between 1997 and 2001, age-adjusted incidence and mortality rates among Black men are, respectively, 62% and 144% higher than among white men. Higher crude incidence rates among Black men between ages 40 and 60 accounts for some of this difference. There is concern that early screening and treatment for Black men may be warranted; but there is disagreement on appropriate screening, especially for Blacks. Thus, prospective assessment of the efficacy of screening to reduce mortality remains necessary.
The issue of the PSA test has been best addressed in suggesting that those men at high risk from prostate cancer will derive the most benefit from the PSA test. A video discussion by Dr. Ian Thompson will highlight the risk factors and how to use the new Prostate Cancer Risk Calculator
Much evidence exists indicating that Blacks face greater barriers to health care than whites. These obstacles can be at least partially surmounted by educating Black men, having successful outreach programs available to them and, establishing a network they will trust and use. Supporting the factor of understanding the PSA test is a presentation made by Dr. Brian Stone within the context of our Minority Men's Health Webinar and also our Patient Education Symposium. Dr. Stone's PowerPoint presentation can be viewed here. Additionally you can access the audience comments and questions from the Symposium via our Symposium Portal.
Further addressing the issue of the disparity of incidence and mortality related to prostate cancer, is the impact of genetics presented in African-Americans versus Caucasians. Most recently, Dr. Isaac Powell presented evidence from his research to our Symposium audiences. The thrust of his work derives from the actuation of certain parts of AA gene pathways stimulated by conditions of hereditary/familial incidence and other environmental and/or lifestyle factors of co-morbidity. Dr. Powell's presentation can be viewed here, and you can access the audience comments and questions from the Symposium via our Symposium Portal.
Because many Black men delay in getting the tests that can provide an indication of early stage prostate cancer, they will often not be diagnosed until symptoms (urinary problems, blood in urine, pain, etc.) have begun to appear. Even if these symptoms or others are not present, the cancer may have progressed to a somewhat advanced stage - Gleason 7 or higher - which
requires an entirely different management approach. Dr. Ronald Morton, in an interview, provides key information on how best to address an advanced stage tumor at first diagnosis.
It has been shown that African-Americans don't engage themselves in the process of becoming educated about the risk they face from prostate cancer and are not as diligent in getting the necessary tests that can aid in early detection of the disease. Apart from these facts, which have been discussed above, there remains a significant situation in the course of disease management that Blacks find themselves even more disadvantaged - pain management and palliative care associated with side effects from treatment and/or the progression of the disease. Dr. Biren Saraiya has contributed significantly to our Educational Programs based on his clinical practice and research. A most recent PowerPoint presentation can be seen here as well as audience comments and questions from the Symposium via our Symposium Portal. Our research has shown in too many cases that patients fear questioning their doctors on treatment protocols or in asking for relief from pain because there is a perception that, in doing so, they will not get the best possible treatment for their conditions. A detailed guideline for how best to obtain the best possible palliative care can be found in an interview with Dr. Saraiya in our May 2010 In The Know™ Newsletter.
Being able to utilize the Internet and other informational resources is key to early disease detection and treatment as well as management of the disease to achieve best possible survival and quality-of-life objectives. Dr. Arnon Krongrad has spoken at our Webinars and Symposiums on the issue of effective doctor/patient dialogues. His presentation from our last session can be viewed here as well as audience comments and questions from the Symposium via our Symposium Portal. More importantly, Dr. Krongrad has created an online patient community where questions and concerns can be shared with others who can provide information from their personal experiences that may be helpful in charting your own path. The "New" Prostate Cancer Infolink provides the basics on creating the necessary dialogue between you and your health care providers to insure the best standard of care for you.
The issue of racial health disparity has many roots in genetic incidence, access to information and/or resources, etc.; however, there may be other elements based on cultural factors, socio-economic status, personal responsibility that could be driving the lack of African-American
participation in the change necessary to reverse this clinical imbalance. A recent Symposium presentation by Dr. Jean Bonhomme speaks in depth to some of these other barrier issues.
In many cases you will want to reach out for a personal contact to aid in your information search. The Prostate Net® provides a team of survivor counselors who can provide help in your decision-making; you can request their assistance by:
Black Doctor.Org A comprehensive discussion of conditions relating to the prostate important for all men, but with particular emphasis for African-American men who have the highest rates for prostate cancer incidence and mortality.