2002-03 Broadcast Season
Broadcast Program Transcripts
Episode #1809
Prostate Cancer

Lewis: Mitchell Lewis, moderator
Darkes: Dr. Leroy Darkes, Rex Senior Health Center
Walker: Rev. Thomas L. Walker, Ebenezer Baptist Church
Augustine: Robert Augustine
Dyer: Winston Dyer, prostate cancer survivor
M: Male speaker

Voiceover: Coming up, prostate cancer and its fatal impact on the African-American community. Why are African-American males for susceptible to this disease than their Caucasian counterparts? What preventative measures can be taken? We'll discuss this topic next, on Black Issues Forum.

Voiceover: This program was made possible by contributions to UNC-TV from viewers like you. Thank you.

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Lewis: Good evening and welcome to Black Issues Forum. I'm Mitchell Lewis. Tonight we will discuss prostate cancer and how this disease has been fatal, especially among African-American men. Statistics indicate that African-American men may have the highest rate of prostate cancer incidence in the world. The prostate cancer mortality rate among African-American men is twice as high as that for Caucasian males. In a few minutes, we will talk with a prostate cancer survivor and a physician who is conducting his own campaign in prostate cancer awareness to get their insights. But first, let's take a look at an excerpt from the PBS Special, Prostate Cancer: A Journey of Hope, that features prostate cancer patients who are now overcomers of the deadly disease.

Voice-over: For reasons no one yet understands, prostate cancer attacks and kills black Americans at a higher rate than almost any ethnic group in the world. At age 59, Robert Augustine is facing prostate cancer after the deadly disease took his brother, who was only 50.

Augustine: He didn't tell no one about it until it started giving him problems. And when they took him to the hospital, whatever, to have it done, it was too late, it had spread.

Voice-over: The American Cancer Society recommends that all PSA blood tests and digital rectal exams should be offered annually, beginning at age 50, to men with a life expectancy of at least 10 years, as well as to younger men who are in high-risk groups, particularly those who have a family history of the disease, and African-American men who have a higher incidence and likelihood of prostate cancer.

M: "We know that black Americans have one of the highest incidences of prostate cancer in the world, and in this country, the incidence is about 35% higher than for American Caucasian men, but the mortality is two-fold higher and has remained so over many years."

M: The researchers don't know exactly why. It is suggested maybe our diet, maybe our stress level. Some maybe even suggested that our testosterone runs higher. We really don't know

M: It's not always because we're not screened. The reason is because we just plain all cannot afford it, and if you're not feeling any pain, we tend to not go to the doctor's.

M: Those are the individuals where the message really needs to be gotten out there. And interestingly enough, there are a number of free screening programs, I would bet, in every city, but we need to get the message out to the populations that are really underserved, because they have the highest mortality.

Dyer: My introduction to prostate cancer started with the death of my 46 year old brother, from cancer. And then my dad four months later. And then I was told by doctors that I should be checked. But being ignorant to prostate cancer, and not knowing what it was, that was my first, first, first ever screening at age 50, the same month that my dad passed away, and came up positive.

M: For the African-American community, it's really an epidemic. And the thing that destroys our people is the lack of knowledge.

Lewis: And joining me now is Rev. Thomas L. Walker, pastor of the Ebenezer Missionary Baptist Church in Rocky Mount, North Carolina, and a prostate cancer survivor. Rev. Walker is also an accomplished gospel singer and producer, and has written a book, Brother to Brother: You Don't Have to Die With Prostate Cancer. Dr. Leroy Darkes is a medical doctor at Rex Senior Health Center in Raleigh, and is a strong advocate of promoting early detection and screening of prostate Cancer. Gentlemen, welcome to Black Issues Forum.

M: Happy to be here.

M: Good morning.

Lewis: Dr. Darkes, we will begin with you. Explain to us, what is prostate cancer and the functions of the prostate.

Darkes: Okay. To understand that I think it is important to understand what the prostate is and where it is and what it does. Prostate is a gland composed of muscular and glandular tissue about the size of a walnut. It sits at the base of the bladder and surrounds the tube that drains the urine from the bladder to the outside. The prostate's primary function is to secrete the bulk of the volume of let's say, the ejaculate, and it produces a milky alkaline-like substance that helps neutralize the environment in the birth canal so that fertilization can occur. Now, cancer is an abnormal growth of cells, so prostate cancer is when there's a collection of abnormally growing cells within that prostate gland.

Lewis: Rev. Walker, how did you find out that you had prostate cancer?

Walker: Basically through a test, a general visit to the doctor. And it wasn't a regular visit, it was one that I had had some symptoms and I wanted to go get them checked out. And as a result of the PSA and later biopsy, I discovered I had cancer.

Lewis: What was your initial reaction when you found out?

Walker: Horror, shock. You know, it was really hard to believe, really.

Lewis: Now Rev. Walker alluded to this a little bit, but Dr. Darkes, how is it determined that one has prostate cancer?

Darkes: Generally we will screen men with the PSA blood test and the digital rectal exam, which is the physical examination of the prostate. That leads to a level of suspicion that then can go on to further diagnostic studies, such as a biopsy, where a piece of the tissue is actually taken, placed on a microscope slide and examined in the laboratory.

Lewis: Now are there any known symptoms that could lead to this?

Darkes: Well I always like to preface that by saying that the most common symptom of prostate cancer is no symptom at all. So don't take comfort if you do not have any of these symptoms, but understanding the anatomy and the function of the prostate, you can have symptoms primarily involving the urinary tract, frequent urination, getting up at night, trouble starting or stopping, a dribble, a decrease in the force of the stream, blood, pain: all could be indication that that there is a problem with the prostate that needs to be evaluated.

Lewis: So screening is also very important in this matter?

Darkes: Absolutely. I would say that most men who develop prostate cancer probably do not have symptoms.

Lewis: Now of course the statistics have actually increased as far as African-American me being diagnosed with prostate cancer. At one time it was 1 in every 8 men; now it's 1 in every 5. Why the change?

Darkes: Well I think a lot of that has to do with the ability to be more effective in our screening. If we can make the diagnosis more efficiently and more effectively, then we're going to find the disease more often, and I think that's actually what's being reflected when they talk about the increase. It's really an increase in the rate at which we're discovering something that was probably already there.

Lewis: Rev. Walker, once you discovered or found out that you had prostate cancer, what did you do, how did you initially go about trying to cure yourself of the cancer?

Walker: Well my doctor and I have a good relationship, he suggested I do a lot of research and I did it. But like some men, I also tried to do some kind of home remedy type things; not understanding prostate cancer I tried to do it through diet, weight loss, tried to get some things to just sort of knock it out of me. But I have a chapter in the book called I'll Fix It, but it didn't work.

Lewis: What were some of the emotional frustrations you had to deal with once you found out?

Walker: Whenever you're told you have cancer, your hold world changes. You begin to think of death, leaving your family; prior to that, the burden of being on your family. So these were the directions of my thoughts that I had. So I began to double-check wills and just that whole piece, talking about who would be the pastor of my church when I'm gone, and all that kind of thing.

Lewis: But you then decided to seek medical attention. What was that like; it seems like there's a lot of information out there; how did you deal with it?

Walker: Well, in my research I discovered that prostate cancer is the most treatable and curable cancer there is, if you catch it in time. And so the hope began to build up in me. I saw the biggest problem with prostate cancer is ignorance. It's like most cancers. And so in my research I discovered that if I would move with haste and make treatment selection, that I would probably be alright. And so then I started moving in that direction.

Lewis: And of course this is a personal question to bring up, but as far as performance, what were some of the things that you had to deal with as far as, did you have problems as far as sexual performance or did you have concerns about that in general?

Walker: Well like most men, that becomes your concern. You know, my doctor suggested surgery and then he told me the possible side effects of surgery: impotence, incontinence. He said it didn't have to happen but there was a large percentage. My research showed me there was a large percentage. Therefore I did not want to choose, I wanted to choose some other option, if they were effective options. And of course he mentioned what I did, because men are concerned about the side effects of impotence. Of course when you're told you have cancer, I came to the point that I'd rather have been alive and impotent than to have been dead and potent, you know? So it became less and less of an issue.

Lewis: Dr. Darkes, in your dealing with men who have prostate cancer, what were some of the emotional ranges that you noticed?

Darkes: Well you kind of heard a pretty good cross section there. Everything from running and hiding to just sheer determination to overcome it, just as I kind of heard Rev. Walker say, that when men hear that word, the first thing they do equate the word cancer with, is death. And depending on how they choose to deal with that, some say well this is the battle I'm in and I'm going to win it; others say, well, you know I feel fine, I'm not hurting, I'm not going to deal with it. And that's terribly unfortunate, because ignoring this cancer does not ignore the consequences of it. And it's deadly.

Lewis: We talked about this earlier, but what are the side effects involved with prostate cancer?

Darkes: The cancer itself. What can happen with prostate cancer is that as that gland continues to grow, there's going to be increasingly more problems with the urinary system. All the things that I mentioned as possible symptoms can become real symptoms, to the point of totally shutting down the urinary tract as the cancer grows and then spreads beyond the confines of the glands, typically it goes into the bones, and that can cause excruciating pain, it can cause anemia, which is a drop in your total blood count, which is the source of all your nutrient energy supply to all the tissues in your body. So it takes a toll on the entire physical well being, to the point that it can lead one to being so vulnerable to other diseases and other things, that it kills them.

Lewis: Ultimately death. Rev. Walker, you opted for the TheraSeed procedure. Explain to us, what is that procedure and was it difficult for you?

Walker: No, in fact, it was good news. Let me just lead up to that just by saying, I did not want the surgery and then I looked at external radiation and I ended up going to a New Port Richey, Florida to take the seeding, which is brachytherapy. And the process was I went for a straining and then the fitting and then the actual seeding, which they put you in sort of a stock as a woman having a baby, and they have something like a wheezy board type where they literally place those seeds that's approximately the size of a mustard seed, and they are radiated, and they strategically place them into your prostate around the cancer. And for six weeks those seeds are active. And you're limited from being around babies, pregnant women, because you are literally active. But the side effects are minimum, no lasting; I have had no lasting side effects. And the good news is that I'm cured.

Lewis: Now Dr. Darkes, is there any new type of procedures besides the theraseed procedure that folks could look at, or what are the procedures that are available now?

Darkes: Well the two broad categories include radiation and surgery, I mean, that's the general choice that a man has to make. Within those there are different types of procedures. The surgical procedures are getting better and better, they have what they call the ability to spare the nerves which can preserve the functioning, let's say, and within the radiation, they do the seeding and some are actually combining the seeding of the prostate with external radiation which actually improves the outcome. And as they get more and more experience with these procedures, both of these procedures, they have been able to minimize or reduce the likelihood of the complications and the side effects. Side effects from surgery you've heard some mentioned with impotence and incontinence. And with radiation initially, there were side effects of, because of the position of the prostate to other structures: the bladder, the bowel, etc. There were problems with bleeding from the bowel; there were problems where the bowel could actually be destroyed, and the problems with the bladder. These have all been minimized as they've gotten more experienced and better expertise, just targeting that prostate. And the outcomes now give me a number of options. And that's what's so important about being diagnosed or detected early, to have all the options available so that you can participate in your care and treatment and take an active role in the outcome.

Lewis: Now what are other types of detection?

Darkes: Besides doing the digital rectal exam and the PSA blood test, those are primarily, that's the way we do it at this point. On the horizon there's word of a "super" PSA test that may allow us to determine if there's actually cancer present, but I don't think that that's available even on a research level. It's just kind of talk that's out there right now. Right now, the best way to detect this cancer is to be screened every year, starting at age 40, with both the digital rectal exam and the PSA blood test.

Walker: Might I just say too, and the doctor and I have done some workshops together with men, and I don't know if it was at that particular, the one we did that a man raised a question, their concern about the digital exam, and it's been around for a long time, it's been the only one they had. And some men want to know, can they have a blood test and not do the digital? But Doc, I'm not trying to take away the show, but that's a key!

Darkes: Oh no.

Lewis: You're the expert, we need to know this, we need to know this.

Darkes: That's right, absolutely. The digital rectal exam is the physical examination of the prostate. It's the only way we can examine that prostate physically. Because of the anatomy again, the only way to feel the prostate is through the wall of the rectum. And I always like to say that the only portion of the prostate that we can manage to feel by doing that happens to be the area where most of the cancers begin. So we can examine the part of the prostate that we need to examine. Not getting the digital rectal exam is getting half of a screening. You can have a fairly normal PSA and still have an abnormal prostate. You can certainly have an abnormal prostate and have a normal PSA. And so putting the two together gives us the best tools we have to calibrate our level of concern or suspicion, because those are not diagnostic tests; it's just to screen.

Lewis: Rev. Walker, how did your family react, as far as you going through the processes of trying to control this prostate cancer? How was their support while you were going through this?

Walker: Well, family support is paramount. It is very important, because prostate cancer is a family disease, as is most cancers. And my family support played a tremendous role. My wife was there when I was told I had prostate cancer, and even though she has some physical challenges herself, she seemed to put them on hold and zero in on me. I have a son who's a minister, daughter, she's an attorney, but they put their careers sort of on hold and everybody focused: "How can we help you do the research? How can we help keep your mind focused? Because you are the one that we've been leaning on, let us help you during this crisis." So I think that family support would probably run second, run the same as that of the doctor, the physician and all. It's very important.

Lewis: Dr. Darkes, anything to add on that?

Darkes: I would also add that having the support of your peers and your colleagues and your friends and your relations, one of the problems I think, particularly with African-American men, is we tend to be private and hold things close. Prostate cancer is something we don't want to talk to each other about. I think it's absolutely essential that we deal with that, because adding that level of support helps the process along just as much as knowing your family cares about you, is going to be there to support you, and also it allows you to have a dialogue that may help educate you in terms of how you actually participate in your care. If we don't know what questions to ask our doctors, we don't ask them. If we don't know and share our experiences with each other, we limit ourselves to just receiving what's given, as opposed to knowing how to understand how to question and ask about what are the options, what else is available, how do I know this is the best place and you are the best person to be treating me

Lewis: Mitchell, I just thought, when the doctor-talk, in my mind-but he covers another point, I thought of too, and it's very important, and I may have heard him say this in the workshop: when you go to a doctor, it's always important to carry a family member or a friend with you, on this issue especially because sometimes you're so overwhelmed you don't hear what is being said. If you have a family member or a friend that can take notes, this is critical.

Lewis: Now you were talking about support; where do you find that support?

Darkes: Well I'm glad you asked that, because that support has been very difficult to come by, but in the next coming months, there's going to be a process by which men who are newly diagnosed with prostate cancer will be able to be connected with another man who has been there and has been through the process and can serve in whatever capacity is necessary to provide that support, whether it be an explanation of what the prostate is, to pointing to a web site, to helping to make suggestions about urologists. Whatever that void is, we want to try to provide a process by which it can be filled, and allow men to access that in a way that's comfortable for them.

Lewis: And of course Rev. Walker, you have written a book, Brother to Brother: You Don't Have to Die With Prostate Cancer.

Walker: Yes.

Lewis: Tell us a little bit about the book.

Walker: Well, the book was born out of, as I said, my research, and realizing the fact that when a person has prostate cancer, the statistics have shown that family members are more susceptible to having it if you had it, like if your father had it, your son, and so forth. So those kind of concerns caused me to do the research, but then eventually it evolved into a book. The book was written primarily to show when you have the disease, what some of the emotional traumas are, the importance of the family involvement and just procedures, a step by step process.

Lewis: And you also have a CD out. Tell us about that.

Walker: Well the CD, I've done gospel music since the late '70s, and I thought well, if I could give a few moments to prostate cancer and bring it public, that maybe it would make more men aware of it. So I took one of the cuts on my CD to talk about the hope for those who have prostate cancer.

Lewis: Dr. Darkes, briefly, what advice do you have for men in general, as far as getting checked for prostate cancer?

Darkes: Okay, what I always like to say is that you don't necessarily have to like being screened; in fact, you may not even have to want to be screened, other than the fact that knowing that it's the right thing to do. Not getting screened or avoiding that screening does not avoid the cancer. It avoids the opportunity to take full advantage of all of the options once you are diagnosed. And then you really are victimized, because after the fact, you learn more and more and then you regret not being as aggressive as you could on the front end. Prostate cancer is our disease right now; we have the highest incidence, the worst outcomes, the highest mortality rate. We need to do something about it. We have a responsibility to do something about it.

Lewis: But can it be prevented?

Darkes: Well, that's a very good question. Right now there is a very large study going on to see if indeed there are effective ways to prevent it. There's a number of, a lot of speculation of things we can do: vitamin E, selenium. These are antioxidants, have been looked at in other cancers with the incidental observation that there's been fewer new cases of prostate cancer in men who've taken these things. So there's a lot of promise in that. Diet, needless to say, a healthy diet, a generically healthy diet may very well reduce one's risk; a healthy lifestyle, not being obese; exercising; not smoking cigarettes; all can reduce the risk of developing cancers as well as prostate cancer.

Lewis: Well gentlemen, I thank you so very much for your comments. The Rev. Thomas L. Walker and Dr. Leroy Darkes, thank you for being part of our program. And we thank you for watching Black Issues Forum this evening. If you would like to learn more about tonight's guests, visit our web site at www.unctv.org/bif, or you can call us at 919-549-7167. We appreciate your calls and your feedback. For Black Issues Forum, I'm Mitchell Lewis. Good night.

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