Jay Holloway:
Did you know that African Americans have higher overall cancer incidence rates than any other racial or ethnic group in the U.S. And in North Carolina we have the highest mortality rate in the U.S. and the world for African American males with prostate cancer. I'm Jay Holloway. Coming up next we'll talk about this silent killer on Black Issues Forum. [Music] Good evening and welcome to Black Issues Forum, I'm Jay Holloway. On tonight's program we continue a two-part discussion on a North Carolina health crisis: AIDS and prostate cancer. Tonight is part two with a discussion prostate cancer. A subject that also has become an epidemic in North Carolina and specifically among African American males. Prostate cancer is the second leading cause of cancer death among men with only lung cancer causing more deaths. North Carolina's death rate has lead the nati n for several years with about 25% white males and more than 60% for minorities. One in eight African American men will develop prostate cancer. Tonight we have a studio audience composed of health care professionals, community workers, church members, and just plain interested citizens. And our goal is tonight is to talk about prostate cancer. On our panel we have Dr. Leroy Darx who specializes in internal medicine with Kaiser Permanente and also Dr. John Holt, who is with the American Cancer Society's prostate cancer awareness action team and also is a gastroenterologist. Thank you both for being with us tonight on the program. And of course we want to move right into the discussion and explain right off what prostate cancer is for our audience. Either one of you.

Dr. Leroy Darx:
Prostate cancer just like any other type of cancer is an abnormal growth of cells occurring in a specific organ. In this case the prostate being located right at the junction of the bladder and the urethra.

Jay Holloway:
Now I think we have some diagrams. Let's show that slide about what prostate cancer, as you talk about this and we'll walk right on through that. Now explain to me again now prostate cancer --

Dr. Leroy Darx:
Well prostate cancer is an abnormal disorganized growth of the prostate tissue itself.

Jay Holloway:
And then you were about to explain where that is.

Dr. Leroy Darx:
Right. The prostate is located at the juncture of the bladder and the urethra. The urethra being the tube that drains the urine from the bladder to the outside.

Jay Holloway:
Okay, we have a second slide of that as well. And so the slide that we're showing now. It's right in the middle of this label prostate there in the middle.

Dr. Leroy Darx:
Yeah, the yellow structure of the bladder and you can see the prostate circles the urethra as it exits the bladder.

Jay Holloway:
Dr. Holt, tell us who are at risk for this prostate cancer. That's in our next slide.

Dr. John Holt:
In general men over the age of 50 but in the African American population it tends to occur at a younger age. But it is strictly a disease of males.

Jay Holloway:
So you're saying at 40 or younger than 50 it occurs more often in African Americans.

Dr. John Holt:
Correct.

Jay Holloway:
Right. Here in North Carolina I know that the statistics are, as we stated in our opening, we've got an epidemic here and what are the statistics and why is it such a problem in North Carolina. And we can show that slide.

Dr. John Holt:
The major problem is that people aren't getting screened and then when they are and the disease is detected it's at a higher stage and therefore not curable.

Jay Holloway:
So we're seeing here now that one of 11 white men have it and in African American communities one of eight African American males.

Dr. John Holt:
Correct.

Jay Holloway:
And in terms of our next slide here we can walk right through these slides here. The stages of diagnosis here. Can you walk us through that? We're comparing African Americans with whites there and I see that in terms of the advanced stages 25% are African Americans whereas 12% are whites and in between those stages 19% African Americans and 22% whites. And in the early stages 56% African Americans and 60% whites. Can one of you all translate that to why there is such a disp arity between African Americans and whites? What is it that is causing this? Do we know?

Dr. Leroy Darx:
There could be several factors. I think that recently has come to light is that one of the tests that is used to screen in our population is the PSA, which we'll talk about. The PSA was developed to measure a substance that is created by normal prostate tissue. As the tissue becomes abnormal, more PSA will be excreted and can be detected in the blood. The problem is that the normal values for that test were developed on a white male population. And therefore it didn't take into account that black males tend to be more vulnerable to the prostate cancer and, therefore, by the time the threshold that was developed for white males is reached in a black male they may have already passed the earlier stages of the disease, therefore, presenting at a much further along stage.

Jay Holloway:
So this PSA is a screening mechanism? I know Dr. Holt you're involved with the American Cancer Society awareness team and you all are proposing a strong effort for screenings in North Carolina.

Dr. John Holt:
Correct. The test is actually a blood test. It's a non-invasive means of screening and as Dr. Darx has pointed out there has been a problem with the ranges but then also the recommendations from the American Cancer Society have been that screenings take place after the age of 50 and the particular group that I'm working with we feel that the screening needs to take place at a younger age.

Jay Holloway:
For African Americans?

Dr. John Holt:
For African Americans.

Jay Holloway:
The American Cancer Society has also worked closely with the American Association of Retired Persons and produced a video to kind of talk about these pros and cons of screening and what it's all about and we might take an opportunity now to take a look at that and come back and talk more about this subject. [VIDEO NARRATOR]: There's a lot we don't know about prostate cancer, primarily because research is in the infant stages. So while we wait for answers, we must learn what we do and don't know about prostate cancer. The prostate gland is a male sex gland that produces a thick fluid for the semen. Located just below the bladder at the base of the penis, the prostate surrounds the urethra, the tube that carries urine. As men age, the prostate grows larger and squeezes the urethra, causing complications in urination. More than half the men in the United States between the ages of sixty and seventy have symptoms from an enlarged prostate gland. Although uncomfortable, this enlarged prostate is not necessarily life-threatening. However, if you urinate frequently, feel pain when urinating, have difficulty in beginning or maintaining a urine stream, or if you see blood in your urine, your body might be warning you of cancer. The two most common methods of screening for prostate cancer are: the digital rectal exam, the DRE, and the blood test called PSA, which monitors the level of a protein in the prostate gland. A third method, which some researchers believe is quite as accurate as the rectal exam, is called diagnostic ultrasound. Doctor Kathleen Heard is a radiologist at the Washington Adventist Hospital in Maryland.

Dr. Kathleen Heard:
The best thing that I can equate it to is radar. Sound waves are used to literally paint a picture of internal anatomy that we can't see in many other ways. We can tell much more clearly which areas are cancers, and which ones are not. [VIDEO NARRATOR] As we'll see, prostate cancer is unusual, because it isn't always deadly. So the use of the PSA and ultrasound as routine screening tests is controversial. While both can detect cancer, they cannot tell if it's life-threatening and needs to be treated. Jim Williams, who works for an international prostate cancer support group, is convinced that early detection saved his life.

Jim Williams:
Prostate cancer is a silent killer. The best time to be treated for this disease is when there are absolutely no symptoms. I was fortunate in my case in that the doctor included a blood test called a PSA in a normal physical examination. I had no problems with my prostate, and the disease was caught at that early stage. If, however, I had waited until I started to have blood in my urine, or to have problems with incontinence, then probably the disease would have gone outsid e of the prostate. [VIDEO NARRATOR] Dr. Otis Brawley, an oncologist at the National Cancer Institute, recommends screening only for men with symptoms.

Dr. Otis Brawley:
The most important thing that I can say to an African-American man is: If one has difficulties in urination, if one has pain, if one thinks one might have a prostate problem, one definitely should go talk to a physician and get those diagnostic tests. If one has no symptoms, and is concerned about prostate cancer, one really needs to learn all about the controversies, the possible benefits, as well as the possible harms, of prostate cancer screening.

Jay Holloway:
Well, that video certainly brings us up to date about prostate cancer and certainly affecting men over fifty, but in our community, you say over forty they should start getting the test. You want to add something about that video, Dr. Darx?

Dr. Leroy Darx:
Yes. As a practicing internist, my recommendation is that every African-American male over the age of forty get at least a digital rectal exam, and if there is a family history of prostate cancer, that that includes a PSA screening. The risk of prostate cancer increases by a factor of two if you have one family member with prostate cancer, and by a factor of ten if you have two. So I think that every male over the age of forty should have at least a digital rectal exam done annually.

Jay Holloway:
Now in our previous program we talked about the hesitancy of African-Americans, and we didn't say, but I guess particularly males going to the doctor and being concerned about tests and these type of things. What do you have to say, other than what we said earlier, to these men based on their perceived hesitancy about coming to the doctor, and wanting to take a look at this?

Dr. Leroy Darx:
I would say that coming in to be screened, there might be some discomfort, but it could save your life.

Jay Holloway:
Save your life. We have in the studio audience one of the co-chairs of the minority prostate cancer awareness team with the American Cancer Society, Joe Sanders, and anybody in North Carolina that's involved with this issue has probably seen this gentleman. Tell us what this effort is really all about and what you've been doing in your observations around the state.

Joe Sanders:
Well, what the effort is about, basically, is education. Getting the information out, as we've heard over and over again, one of the main problems with the high rate of disease in the black community is one of lack of information and lack of accessibility. We want to get information out to the community about this disease, what it is. There are men who have symptoms, don't realize what those symptoms are, and continue on. So by the time they go for a checkup, they're at the a dvanced stages. So we're saying that, find out about this disease, what this thing is, what are the symptoms here. And when you start experiencing backaches and frequent urination, or difficulty with urination, get in and get a check up. That's the big key. We want to get men to get that check up.

Jay Holloway:
Now what about the women in their lives here? We have ladies in the audience and while this is a disease and a cancer that affects men only, what do you have to say because I think we have a video that kind of -

Joe Sanders:
I've got news for you. This disease affects everybody. It affects the family. When the male is affected with that disease, just like Mr. Williams said, he went and got his PSA. But it was his wife that encouraged him to go forth and get the operation.

Jay Holloway:
Let's take another look at a brief video, produced also by the AARP, that talks about this subject. [VIDEO NARRATOR] Albert Bailey underwent surgery and now suffers from incontinence and impotence. But his wife gives him support. F I knew it was going to be a hard decision, but I felt this way. I had to be the strong one, because if I didn't, and didn't show help for him, and he was the one with the problem, he would go down. So I knew what I had to do and I'm still doing that. [VIDEO NARRATOR] Incontinence and impotency are the most common side effects of treatment. And yet some men would rather die of cancer than give up sex.

Dr. Otis Brawley:
There's a lot more to life than sex. When you are in the box, you are in the box and there is nothing else that you can do. So if one looks at it in that manner, as opposed to wanting to continue to have sex because one does not want to have that operation, that may cause some sort of impotency, as opposed to death? Look at those options. [VIDEO NARRATOR] The Lewises are a very close family. The love they have for one another has guided them through tough times. So while the side effects of surgery have been inconveniences, they have not been a hindrance to their relationship. Although Lee will always have difficulty controlling the discharge of urine, he can still consummate his love for Alvina by taking penile injections which stimulate an erection. But with or without injections, implants, or other treatments for impotency, a man and a woman can demonstrate their love an affection in many ways.

Alvina Lewis:
Love is a lot more than sex life. And I was concerned about his overall health. And if he decided that surgery was what he felt was best for his particular situation, then that was what I would go along with. LL: And so that really-I don't think I hesitated one bit at all because of what surgery might do to my sex life.

Jay Holloway:
Well of course this is a real touchy subject, and probably that video said it much easier than we could say it here in the audience, but it is a touchy subject, and I think a member of our audience has a question for one of the panelists or possibly someone here. [AUDIENCE MEMBER] My main question is cost. As you know, in the African-American community, a lot of our communities, there is an economic drought. We have men that they are the only breadwinner in the family in some cases, and they make too much to receive any type SSI or any type social services help, but yet they don't make enough to pay the bills. So now what do they do and where do they go for treatment? There, is there free treatment out here for those men?

Jay Holloway:
Doctors, we've got an economic question here: Health care affordability. Where do they go? Joe has the answer to that. All right, please, Joe.

Joe Sanders:
Well, right now, you're right. There is a cost factor there. And one of the things that we're looking at is to get the government to put more funding into research and education for prostate cancer, and also to provide, to get insurance companies to cover the screening for prostate cancer. Because, with any other types of disease, when you go to the doctor-this is something I was sharing with Dr. Darx before, actually, he shared with me-the fact that, if a guy comes in with lu ng cancer, there's not much he can do for him. Person comes in with any other type of things like that, diabetes, for instance, there's nothing he can do except to make him well, make him comfortable, okay? But, with prostate cancer, if it's detected early, the person can live a pretty good life from that point on because the doctor can do something by removing the prostate, or doing some radiation treatment, or doing something to help that person along.

Jay Holloway:
Let's talk about that, doctors. What are the options when someone is treated with this, to be treated?

Dr. Leroy Darx:
Well, just to take one step back, I would stress that, when you are talking about the economics of this disease, it certainly is a lot less expensive to detect cancer and cure the patient than it is to have someone come in with advanced disease, who eventually is going to die, and all we can do is prolong the inevitable. So I would stress again that males between forty and fifty who are asymptomatic, have no symptoms of this disease, come in. It's a simple digital rectal exa m, really, no expense except for the office visit.

Jay Holloway:
Dr. Holt?

Dr. John Holt:
To get back to your question, what we're trying to do in Raleigh and actually throughout North Carolina is to get organized and try to get some of the lab companies to provide the exams free, to get physicians to volunteer time to have screening campaigns where we do the exams for free. And that's part of what we're trying to do here in North Carolina.

Jay Holloway:
We've got another question or comment. Sir? [AUDIENCE MEMBER] How does the fact, diet factor into prostate cancer? Could you address that? I think that's a real issue, especially with the African-American community.

Dr. Leroy Darx:
I'm not aware specifically of any dietary factors with prostate, as opposed to colon or other type cancers. I'm not sure if you are?

Dr. John Holt:
Well, I know it' controversial, but there is believed to some association with high-fat diet with prostate cancer. Once again, it's controversial, depends on what you read, who you read, whether or not you believe it or not.

Joe Sanders:
And he's right. On that issue, there are no definite studies that have been done, but there's a lot of suspicion in that direction. Also there are other factors that are factoring in that are related to that, also. And my thing is that if someone tells me that there's a suspicion that if you go down that street, you're going to have a problem, I'm not going to go down that street. So if you tell me that there's a suspicion of a high-fat diet or anything like that, then we're going to cut it.

Jay Holloway:
We did a program with black churches on eating fruits and healthy diets and so, you'd think some common sense things-just watch your high fat, exercise, and these kinds of things certainly will help you maintain your health, but could impact prostate cancer as well. You had a comment, sir? [AUDIENCE MEMBER] Yes, I'm Willard Tanner from Winston Salem. And I've had two grandparents to pass as a result of prostate cancer. And my concern was, is it generational, and if so, does it skip every other generation?

Jay Holloway:
Good question.

Dr. Leroy Darx:
Well, I don't believe it's, uh, the link, the family link is not clear. What we know is that if you do have a relative who has had prostate cancer, you have a twofold increase in your risk. If you have two, tenfold. So my recommendation would be very close surveillance. Annual exams, probably do a PSA.

Jay Holloway:
Okay, all right. We have another question here. Yes. [AUDIENCE MEMBER] It seems that it's imperative that the screenings be done, so that there will be data collected on exactly how prostate cancer affects the African-American man. It seems as though there is not data, because we have not been a part of none of the experiments. And so, we need to, and I think that it's imperative that we start doing this. And so that there is maybe something that can be done to curb this _____.

Dr. John Holt:
That's an excellent point, and the studies that have been done were in older black men and what we do need to do is to start doing prospective studies, starting with young men and following them over time to get the data.

Jay Holloway:
Another question. [AUDIENCE MEMBER] Yes, I'm sitting here learning and I recognize that I have one of the symptoms up there. But I'm only thirty-six years old. And during my annual exams at my doctor, I've never been, nobody's ever talked to me about a prostate screening. And I remember when I was younger, I used to get asked about it, but since I've gotten older I haven't been asked about that. And my concern is, you know, my getting older, and I talked to a friend and they said, well, when you get older, you have a mo re difficult time starting urination and stopping. What, what can be done with the physicians? Because right now I'm thinking I need to get to my doctor. But what can be done with the physicians to make sure that they are talking to their patients about this?

Jay Holloway:
Quick answer. We've only got about thirty seconds left here.

Dr. John Holt:
Part of the problem is just what the current recommendations are from the American Cancer Society. And that's what we're trying to change now, and it's just once again education and even education among the medical community.

Dr. Leroy Darx:
And I would just add, I just hope that there's not anyone who sees this program or who's in this audience who, if they have any of the symptoms, they're empowered to talk to their physicians about this. You bring this up, and I guarantee your physician will pay attention to you and take care of the problem.

Jay Holloway:
Well, this is certainly a subject that we could talk about all night, but time really runs out. Any final concluding comments you have, either? Joe, you've got fifteen seconds.

Joe Sanders:
Well, I just want to give out the 800 number, because the video is available. Just call 1-800-227-2345, and you'll get the information. And we got a petition that we'd like you to sign, also.

Jay Holloway:
All right. Well, we'll get that information on our website, and I would certainly like to thank our studio audience, thank our panelists, and thank you for watching our program tonight, and we invite you to watch Black Issues Forum of course every Friday night at eleven o'clock on UNC-TV. Most likely, prostate cancer will or has affected someone you know, you father, your grandfather, brother, uncle, friend, or it might affect you. While we don't know everything about prostate cancer, we hope that you are now more informed about the epidemic here in our state and across the country about the screenings, and about what you and your organization can do. Please contact us with your comments and if you would like to use this program or this series as a discussion guide in your community, ci vic group, classroom, or church, our telephone number is 919-549-7167, or you may e-mail us at bif@unctv.org, or visit us on the worldwide web at www.unctv.org/bif. You'll find information on past episodes and additional information on issues of concern to African-Americans. Thank you again for watching Black Issues Forum. I'm Jay Hollowly, and you have a blessed evening and a good night.

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