PROSTATE CANCER IN BLACK MEN: EXPERT Q&A in BlackDoctor.org

Robert L. Waterhouse, MD
Robert L. Waterhouse, MD

HIFU physician, Dr. Robert Waterhouse was featured as a prostate cancer expert in an article this month in Blackdoctor.org. Click here to read the article or see it pasted below.

Article below from shared from here at Blackdoctor.org.

Black men are more likely to develop and die from prostate cancer than any other ethnic group. Scientists don’t know the exact cause, but it’s believed to be derived from a number of factors. This fatal disease is the most common cancer next to skin cancer amongst men in the United States.  According to the American Cancer Society, 6 out of 10 men ages 65 and older are diagnosed with prostate cancer.

Three of the top specialists on this issue, Dr. Robert L. Waterhouse Jr, Medical Director and Chief Medical Officer of Carolina Urology Partners, PLLC, pathologist, Dr. Crystal Moore and Dr. Jacques Carter of Harvard Medical School shared their expertise with BlackDoctor.org to answer our most pressing questions about the health solutions to combat prostate cancer in the Black community.

BlackDoctor.org: Why does prostate cancer affect Black men at a higher rate?

Dr. Waterhouse: Black men develop prostate cancer at an approximate twofold incidence and die of the disease at about 2.5 fold mortality rated. The adverse health care disparity for prostate cancer behavior in Black men has multifactorial etiology. I believe that biologic factors, environmental factors, socioeconomic factors, and factors related to shared decision making are all contributors.

There is scientific evidence that the oncogenesis of prostate cancer in African American men may have different molecular pathways and involve pathways that have greater virulence and intensity.  Some of molecular differences may be related to an increased incidence of hereditary prostate cancer, while others may be part of a complex array of acquired molecular changes that involve biologic networks for the immune system, inflammation, and other systems.  There are numerous racial differences in expression of genes involved with caner development.  Also, Black men are more likely to be obese and obesity is related to increased incidence and mortality related to prostate cancer as well as potential genetic links between obesity and prostate cancer.

The potential environmental factors may be related to both personal behavior and greater likelihood to live/work in unfriendly ecological settings. It is possible that greater tendency to eat a diet that contains more meat, high fat, fewer plant based antioxidants, and more processed foods with greater amounts of chemical preservatives may increase risk for prostate cancer development.  In addition, Black men are more likely to live in areas that have greater proximity to environmental toxins from industrial waste, sewage processing plants, and areas with poorer air quality.  Black men may have more exposure to occupational chemicals related to pesticides, organic solvents used for cleaning, and industrial fumes in multiple manufacturing and processing plants.

Socioeconomic factors include greater poverty that increases risk for lack of health insurance and lack of resources for medical coverage.  Lack of financial resources directly affects the social environment including insufficient transportation for medical visits, greater risk for homelessness, and inability to purchase medications or access pharmacies.  The resultant impact of these factors leads to increased risk for prostate cancer being diagnosed at a later stage and increased risk for incomplete treatment and follow up. An additional social factor relates to a culture in the Black community for men to resist seeking health care for prostate concerns and having fear about rectal exams or about loss of erectile function from treatment.

These cultural factors link to issues involved with shared decision making about diagnosis and treatment.  African American men may have greater issues with trust in our health care system and therefore are more likely to avoid it or not have the most productive encounters with health care providers.  There are cultural differences in communication that affect the likelihood for Black men to understand the risk of prostate cancer and the benefit for various treatments when it can be diagnosed at its earliest stages.  Data from the Cancer of the Prostate Strategic Urologic Research Endeavor Study found that African American men were less likely to receive radical prostatectomy compared with Caucasian men with similar disease characteristics. Therefore, ineffective shared decision making from suboptimal communication may contribute to late diagnosis, less effective treatment choice, and poorer outcomes.

Dr. Carter: The occurrence of prostate cancer in African-American men and in Caribbean men of African ancestry is more than that seen in men of any other racial or ethnic group. It is estimated that men in the U.S. will develop 181,000 new cases of prostate cancer in 2016.  29,000 of these new cases will occur in black men.  It is also estimated that there will be 26,000 deaths caused by prostate cancer.  Black men will account for 4,500 of these deaths.  Statistically, black men have nearly a 50 percent higher incidence of prostate cancer when compared to white men, and twice the mortality.

We also know that black men develop prostate cancer at an earlier age with higher Prostate Specific Antigen (PSA) levels than white men and that they tend to develop more aggressive disease, based on the Gleason scores.  Black men also tend to have more advanced disease at the time of diagnosis when compared to white men.  According to one major study, this risk for advanced disease persists even after making adjustments for socio-economic, clinical and pathologic variables.  The exact reason for the disparity in the incidence of prostate cancer in black men is not completely clear, but is thought to be a combination of dietary and genetic factors.  The even greater disparity in prostate cancer mortality in these men is probably due, in large part, to lack of routine screening, poor access to health care, and more advanced disease at the time of diagnosis which certainly impacts the treatment outcomes.

BlackDoctor.org: What are the warning signs of developing prostate cancer?

Dr. Waterhouse:There are no signs that warn patients of prostate cancer at its earliest stages, which is why it is of paramount importance that patients seek health care for “well visits (check-ups)” when they have do not have symptoms.  In it late stages of the disease, prostate cancer can cause urinary symptoms including increased urinary frequency, decrease in urinary force, or even blood in the urine.  Once prostate cancer spreads from the prostate, it may involve the bone and cause bone pain or back pain.

Dr Moore: There are several known risk factors for developing prostate cancer.  Advancing age is a factor with approximately 60% of prostate cancer being diagnosed in men older than 65 years of age.  Race and ethnicity is a risk factor since African American men develop prostate cancer at a rate that exceeds other populations. Although the reasons are unclear, geography plays a role. Prostate cancer is more prevalent in North American than it Is in Central and South American or Asia. Family history plays  a role. Men with multiple affected relatives, brothers of men diagnosed with prostate cancer, and men with relatives diagnosed at a young age all have an increased risk of developing prostate cancer in their lifetime. Genetic mutations such as in the BRCA gene (usually associated with breast and ovarian cancer) and HNCPP (often associated with colorectal cancers) also increase the risk of developing prostate cancer.

Dr. Carter: There is a fair amount of data to suggest that diet may play a role in the development of prostate cancer.  Some studies have found that a diet high in animal fats, including dairy, may be a factor in the development of prostate cancer.

Conversely, some studies have concluded that a diet low in vegetables may be a risk factor for developing prostate cancer.  Researchers have not all agreed on this particular point.  More specifically, lycopene, an anti-oxidant found in high concentration in tomatoes, has been associated with a lower incidence of prostate cancer, especially the more lethal tumors.

BlackDoctor.org: Anything to counter this disease before it develops?

Dr. Waterhouse: I do not know definitive interventions that will prevent prostate cancer but eating a more plant based diet rich in multiple antioxidants and with reduced animal fat and fried foods is a reasonable start.  There is controversy over the influence of taking drugs like Dutasteride and Finasteride that are used to treat men who have urinary symptoms related to benign prostate enlargement, although they may influence the risk of developing prostate cancer.  I do not routinely recommend these drugs for prostate cancer prevention.

The early use of PSA as a screening tool for prostate cancer has helped medical providers identify prostate cancer at early stages.  Related to this effort, the Large Urology Group Practice Association (LUGPA) has been and continues to be very active with promoting the availability of this tool for Medicare coverage to enable health care providers to diagnose prostate cancer at its earliest stages for Black men and all men.

Dr. Moore: All of the above factors are beyond our control. There are, however, healthy lifestyle choices which, although not definitely  proven, may contribute to the risk of developing prostate cancer. These include smoking, lack of exercise, poor diet, and chemical exposures (such as agent orange).

BlackDoctor.org: For Black men with prostate cancer what can they do to live a healthier life? 

Dr. Waterhouse: In addition, to the above dietary recommendations, the ability to improve outcome related to prostate cancer and overall health is positively influenced by decreasing obesity and increasing exercise.  Assessment of Vitamin D status and treatment of Vitamin D deficiency may be helpful to achieve good outcomes from prostate cancer.  Although it sounds redundant, optimizing healthy diet and exercise truly are important, along with the use of PSA and digital rectal exam on regular basis beginning as early as age 40 for Black men for early detection.

Dr. Moore: For men diagnosed with prostate cancer, there are several lifestyle choices which can help them, indeed all of us, life a healthier, happier life. Maintaining an optimal weight helps improve virtually every health condition. A diet rich in fruits, vegetables, lean meats, and whole grains can assist with weight loss. Increased physical activity improves both physical and emotional well-being both during and after treatment for prostate cancer. And be sure to check with your physician about any over the counter supplements or herbal treatments to ensure they will not negatively impact your treatments.

Dr. Carter: Increasing the amount of soy in one’s diet may afford some modest protection against the development of prostate cancer, whereas, large amounts of Omega-3 fatty acids and fish oils may be linked to an increase in prostate cancer risk.

Coffee is thought to decrease the risk of developing prostate cancer but alcohol intake has no clear association either way.  The normal intake of multiple vitamins is felt to have no impact on the incidence of prostate cancer.  However, there may be some increased risk with mega-vitamin therapy, especially Vitamin E and zinc.

Looking at lifestyle issues, we have seen that smoking increases the risk of developing prostate cancer and that this has led to a higher incidence in black men than in white men.  Obesity, on the other hand, has a small association with the development of prostate cancer.  Vigorous exercise does decrease the risk of prostate cancer incidence, but only in those men over age 65.

The take-home here in decreasing your risk of developing prostate cancer is to stay a fit as you can by watching you diet, especially the consumption of red meats, don’t smoke, and try to exercise several times a week.  Black men should also get regular medical check-ups that include screening for prostate cancer.

BlackDoctor.org: What’s being done to raise awareness about this issue ?

The 12th annual Prostate Health Education Network Summit will be held September 15-16 in Washington D.C. on Capitol Hill. The summit will bring together survivors of prostate cancer, leaders from the medicine, research and government industry to discuss policy and medical issues about prostate cancer.  Baseball star Ken Griffey Sr.,Congressman Gregory Meeks and the chair of the United States Preventive Task Force will be in attendance. Dr. Carter will be moderating a session “Prostate Cancer Early Detection Testing-The Next Chapter.

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