A St. Raphe’s doctor (pictured at right) took to the airwaves to convince men, in particular African-American men, to watch out for a killer.
The killer is prostate cancer. It’s the biggest cancer killer among men (after skin cancer, which is usually less serious), and African American men tend to get prostate cancer at younger ages than men of other races.
Dr. Ralph DeVito, chief of urology at the Hospital of St. Raphael — which currently has a project aimed at screening more black men for the disease — took the pitch to the studios of Citizens’ Television last Thursday night. DeVito (on right in photo above, with some members of the audience) took part in a live, audience-participation show dealing with prostate cancer on the local access TV program “21st Century Conversations.”
The show’s host and producer, N’Zinga Shäni, invited Dr. DeVito and Dr. Joseph Cardinale, an oncologist and medical director of the McGivney Center for Cancer Care at St. Raphael’s, to provide valuable information to viewers. (Shäni is pictured with Dr. Cardinale.)
Men whose cancer is detected early are more likely to be cured. The main way to detect it is through a PSA (prostate-specific antigen) test. The doctors pointed out that although some medical literature indicates there are false positives and false negatives with the test, the PSA is a very reliable test when used in a series. DeVito said the numbers might not tell the whole story because a man’s prostate tends to get enlarged due to age, and that might lead to a higher PSA number: therefore, it is important to look at the PSA numbers over time as well as to the man’s overall health and family history. “What is a high PSA is open to interpretation,” he said. However, several PSA tests over time are quite accurate, which is why an annual PSA test is recommended; it helps to establish a baseline for each man.
Men should start PSA screening at age 40 (for African Americans) and at age 50 for others. All men who have a family history of prostate cancer (particularly if the father had prostate cancer) should start screening 10 years earlier than the age of the father’s diagnosis. To emphasize the importance of regular screening, the doctors also pointed out that a low PSA number in an older male might be a red flag; it might be a sign that the prostate is not making prostate-specific antigen, and this in turn might be due to the presence of prostate cancer.
Another screening tool is the DRE — digital rectal exam.
“But it’s not proven that screening improves survival from prostate cancer,” said DeVito. Some believe it’s possible that screening does more harm than good because a certain proportion of the cancers that are detected may never progress in the person’s lifetime, whereas the treatment could cause significant long-term side effects.
After some probing questions from Shäni, Dr. Cardinale pointed out that this is a controversial point. Early detection significantly improves treatment outcomes. This is another reason why men need to have regular comprehensive checkups. When a doctor knows the patient well, together they can decide on the best approach to effective treatment. The PSA results over time, the DRE, the man’s age, family history and overall health are all important in determining the course of treatment.
Something called the daVinci prostatectomy can greatly reduce the undesirable side effects. It’s a procedure that removes the cancerous prostate using incredibly precise micro-surgery that reduces such possible negative side effects as impotence (from accidentally severed nerves in the groin area) and speeds recovery. Shäni showed an animated video clip of the procedure on her show.
If screening turns up a suspected abnormality, a biopsy is performed to determine if the patient has cancer. “Biopsy” may conjure up visions of incisions, pain, and a certain amount of recovery time, but DeVito and Cardinale emphasized that a biopsy is a 10-minute procedure done in the doctor’s office with a needle and ultrasound, and that no one should decline to have it done out of fear of the procedure, which does not require any incisions.
In response to a question from audience member Norm Forrester about symptoms of prostate cancer, the doctors said, except in late stages, men with prostate cancer often experience no symptoms. As men age, the prostate naturally gets larger and secretes more PSA, and many men experience urgency and frequency of urination. These symptoms could indicate prostate cancer, but most often they do not.
That’s why it’s important to consider all factors in a possible diagnosis, including a man’s own medical history, his family history, his age, race, and others.
Audience member Dottie Green said that since black men have higher rates of prostate cancer, they might be afraid of being used as guinea pigs in prostate cancer studies; therefore, they tend not to be as willing to participate in screenings for prostate cancer as they should be. Does their lack of participation affect the treatment they get? she asked. The docs said no — some black men do participate in clinical trials. All patients who participate in such trials are required to sign consent forms that clearly explain the purpose of the trials, and not everyone is recommended for clinical trials. In fact, even if patients request to be a part of a trial, the doctors will determine if there is any benefit or detriment to such patients participating in those trials.
Still, Shäni delved a little deeper — mentioning the infamous Tuskegee experiment back in the 1930s, in which black men with syphilis were left untreated just so doctors could study the course of the disease. “Although times have changed,” she said, “the history lives on. This is why education is so very important. This historical fear can now be to our detriment.”
To encourage African American men in particular to get screened, St. Raphael’s has initiated Project Brotherhood. With funding from Bayer, the project aims to educate black men in the community about the risks of prostate cancer, the need for screening and follow-up, and actually provides free screenings. The project has conducted two screenings already, reaching about 275 men, and the goal is to do four screenings a year.
OneWorld Progressive Institute, Inc., a volunteer community organization, produces “21st Century Conversations.” Additional information from the program as well as about future Project Brotherhood activities can be found on the OneWorld web site. “21st Century Conversations” can be seen in New Haven, Hamden and West Haven every Tuesday at 9 p.m. and Sunday at 4 p.m. on CTV, Comcast Channel 26.
