"As Black Men, We Keep Things Close to the Hip": 5 Questions for a Urologist About Prostate Cancer
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Most men don't regularly talk about their prostate—the walnut-size gland just below the bladder that produces seminal fluid.
But considering the statistics surrounding prostate cancer, they should. It's the second most common cancer in males in the United States and one of the leading causes of cancer death among all men.
And like many other types of cancer, it has a significant impact on Black communities. The numbers shine a harsh light on racial disparities: Prostate cancer makes up roughly 37% of all newly diagnosed cancer cases in Black men. Black men get prostate cancer at a younger age than men from other groups, and they are more likely to have advanced disease when they are diagnosed.
Ultimately, Black men are twice as likely to die from prostate cancer than most other men.
However, when prostate cancer is detected earlier—either at a localized stage before the cancer has spread outside the prostate or a regional stage when spread is limited to nearby body structures—the odds of survival are high. “Prostate cancer is the only cancer that has a five-year survival rate of 96 to 100% when found early,” says Vincent M. Bivins, M.D., FACS, president of Urology Centers of Alabama.
The American Cancer Society recommends that men at average risk for prostate cancer discuss screening with their healthcare provider at age 50. Men at high risk (which includes Black men in general and any man with a first-degree relative who had prostate cancer) should have the conversation at age 45. Black men with a family history of breast, ovarian, or prostate cancer should discuss getting screened at age 40.
Unfortunately, research shows that Black men are less likely to receive prostate cancer screening than white men. While factors like social barriers, distrust of the healthcare system and stigma surrounding prostate cancer play a role, a general lack of awareness and understanding of the disease is also a huge issue, says Dr. Bivins.
That’s why, as part of its Our Race to Health Equity initiative that aims to eliminate racial health disparities, Johnson & Johnson has launched Talk That TalkTM. This educational campaign and movement focuses on inspiring Black men to take action, normalizing prostate health discussions and encouraging early detection. Through the campaign's website, monologue videos, social media channels and consumer-friendly resources—such as a screening checklist, guide to talking to your doctor and PSA tracker tool—Talk That Talk is designed to empower Black men to make prostate health and regular screening a priority.
We spoke with Dr. Bivins to learn more about the importance of early detection, the reasons for prostate cancer disparities and why removing stigma is vital to saving lives.
What's driving the racial disparities surrounding prostate cancer diagnoses and survival rates?
Studies suggest there's probably a genetic factor that results in Black men having higher diagnosis rates than men of other backgrounds. We're still trying to understand this.
But the fact that Black men are also more likely to be diagnosed with more advanced stage prostate cancer is probably due to a delay in screening. The possible reasons for this delay are multifactorial. You're looking at education: Are they aware of the screening guidelines? You're looking at access: Do people have good access to doctors in these communities? Are screening processes set up so we can catch the cancer at an early stage?
The social determinants of health—such as a person’s financial stability and access to quality medical care—also play an important part. Early on, prostate cancer has no symptoms. So if I only have $100, do I spend $50 to go across town to a doctor if I’m not having any symptoms? For some people, it's probably not going to happen.
How aware are your patients of the facts surrounding prostate cancer and race?
I have a suburban, an urban and a rural population in three different offices. I think each one has a different level of how connected they are with their health. Some are more educated about their health and more educated about prostate cancer. I have some people who know the data just as well as I do, if not better.
But I also get men who come in and don’t know my name. They just know they have an appointment. They don't know what medication they're taking; they just know they take a white or blue pill.
When I try to educate them about prostate cancer, they say, "Whoa, Doc! I feel okay. I feel normal." Then I have to explain that prostate cancer may not cause any signs or symptoms in the early stages.
Trying to get them to do a prostate-specific antigen (PSA) blood test (a widely used screening test that can detect prostate cancer) is usually easy. But getting them to agree to a digital rectal exam (which can confirm if the prostate is enlarged—a possible sign of cancer) is very challenging, especially if they have no symptoms.
Do you think prostate cancer has a taboo preventing people from talking about it?
Absolutely. As Black men, we keep things close to the hip. I’ve diagnosed patients with prostate cancer, and they say they’re not going to tell their wife or kids. One guy has been cured of prostate cancer for seven years, and he never told his wife. It's just that stigma.
Also, with the history of mistreatment of African Americans in general and within the medical world, such as the Tuskegee experiment, there’s distrust in the healthcare system.
Some men don’t want to get a PSA because they might be diagnosed with cancer—and they think back to the experiences of their fathers or uncles with prostate cancer, when treatment was more likely to lead to complications like incontinence and impotence. That sort of became the brand, even though the technology has greatly improved, and complications are not as bad compared to 30 years ago.
As we educate men, we explain that technology has greatly improved and treatment options have fewer risks, while highlighting that men diagnosed with prostate cancer are living a normal lifestyle. With this information, the conversation will change.
What about reducing the stigma associated with the digital rectal exam, which is part of screening?
We’ve got to take that “invading” stigma away. First, we have to help men understand the importance of the exam. That means explaining that 18% of people with prostate cancer have a normal PSA, and the only way you're going to find cancer in those patients is through a digital rectal exam. It’s also incumbent upon the provider to help men relax and not rush through the exam.
What's the best way to educate men and help end the disparities in prostate cancer rates?
We need to focus on education. Let's get into the barbershops, churches, social clubs, fraternities and community organizations. Get men involved, and let's make them deputies of prostate cancer care.
We must educate people to understand that preventive measures are important because they allow us to detect and address possible problems early on.
Let's empower healthcare providers to get screenings going. Let's put money toward screenings and prevention. Let's meet Black men where they are and get them screened and treated appropriately. Fortunately, prostate cancer is one disease that, with early detection, you really can impact and potentially save lives.
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