A Doctor’s Perspective on Racism’s effect on Prostate Cancer
I am a black physician recently diagnosed w prostate cancer. Like all other physicians in America, I recite, like dogma, the common phrase, “Most men get prostate cancer, but nobody dies of prostate cancer.” It was considered a minor cancer. Then I got Prostate Cancer, and I learned what an erroneous glossing of that statement’s truth is.
The NCCN, the National Cancer Coalition Network, is the organization that produces best practice guidelines for specific cancers in America. Their prostate cancer guideline has a paragraph near the end of the Prostate Basics section that says, “African American men are more likely to get prostate cancer and at a younger age. Cancer in African American men tends to be more aggressive and advanced.”
But don’t worry, the NCCN says, once detected, AFRICAN AMERICAN men respond just as well to treatment as other men with advanced prostate cancer.
Thrilling.
So, if AFRICAN AMERICAN men are presenting, like me, with advanced disease, that is, when first diagnosed, it is at an aggressive proliferative state, the logical conclusion is that we, the medical profession, are missing the earlier and lifesaving diagnosis of prostate cancer in AFRICAN AMERICAN men. This conclusion has not occurred to most medical practitioners or systems.
AFRICAN AMERICAN men are disregarded. Again.
It’s like a blind spot in American Medicine. It makes me think of that business management instructional video, where a group of basketball players is vigorously passing a ball around, and the viewers are asked to try and count the number of passes made carefully. https://youtu.be/vJG698U2Mvo
I feel invisible to the medical profession.
There are 2 groups of patients at high risk of progression to advanced disease. The first are people who have been diagnosed with stage 1 or 2 levels of prostate cancer. These men have not reached a critical stage of increased growth and activity where treatment— surgery and/or radiation therapy, and/or Androgenic Deprivation Therapy is indicated. They may have a small tumor in only one lobe of the prostate gland and are asymptomatic.
There is distinct value in early diagnosis of prostate cancer. The treatment goal of early, low-grade prostate cancer is curative. The treatment goal of advanced prostate cancer is prolonging life with as few complications and bad side effects as possible.
This first group, those with early low-grade cancer, are placed on “active surveillance,” where they have frequent PSA tests and exams.
The best way to detect the advancement of disease is by having multiple data points that can show a doubling of the PSA within ten months.
The second group of patients at high risk of progressing to advanced disease, where treatment options are significantly reduced, are black men. The idea of screening AFRICAN AMERICAN men at an early age or starting active cancer surveillance is never considered.
Of course, that is if this disparity in treatment is even noticed. The first response from doctors is that active cancer surveillance for black men is not cost-effective or warranted by the overall incidence and outcomes of prostate cancer. The PSA test is a simple blood test. It is not expensive.
So the failure to screen AFRICAN AMERICAN men is not about cost. Why is it that early detection of prostate cancer, a finding that makes a huge difference in the quality of life in a group of people prone to the worst of the disease, is not considered important? This is the best medical course of care. Why is active cancer surveillance denied to African American men?
I feel not just unseen but uncared for. Am I not worthy of care as much as the next man?
This blindness and casual disregard is how systemic racism in America is done. The disparity in medical treatment for African Americans has occurred many times.
If anyone is not sure what systemic racism is or that it even exists in our modern era. Tell them about prostate cancer.
So for you to get the great care you deserve, you need to have your primary care physician on board with your plan of cancer surveillance. Decision-making in cases where the PSA is rising may need a physical examination, careful family history, and imaging, such as a CT scan or MRI. At some point, you will need a biopsy to confirm a cancer diagnosis. At that time, you need a urologist and after staging, a radiation oncologist, all contributing to a treatment plan. A multidisciplinary group that evaluates staged cases is always a sign of good cancer care.
It may come to pass that you will have to insist on the PSA blood testing. In some cases, it will take educating your primary care physician about prostate cancer in African American men. You may have to explain the DOUBLING RULE —If your PSA doubles within ten months, you have prostate cancer till proven otherwise.
I hope this is helpful.
Loren J., MD