Prostate Cancer > A Decision Guide for African Americans
A Decision Guide for African Americans
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Is screening right for you?
The decision is yours.
Some medical experts believe all men should be offered regular screening tests
for prostate cancer. Other medical experts do not. To help you understand both
sides of the issue, let's begin with the basics.
This information was developed by
the U.S. Department of Health and Human Services, Centers for
Disease Control and Prevention (CDC).
The Prostate and Prostate Cancer
What is the prostate?
The prostate is a walnut-sized gland that only men have. It is part of the reproductive
system that makes the fluid that carries sperm. As you can see in the picture
below, the prostate is located in front of the rectum and just below the bladder.
The urethra (the tube that carries urine from the bladder to outside the body)
runs through the center of the prostate. As men age, the prostate tends to increase
in size. This can cause the urethra to narrow and decrease urine flow.
What is prostate cancer?
Prostate cancer is made up of cells that do not grow normally. The cells divide
and create new cells that the body does not need, forming a mass of tissue called
a tumor. These abnormal cells sometimes spread to other parts of the body, multiply,
and cause death.
What causes prostate cancer?
As with many types of cancers, medical experts do not know what causes prostate
cancer. They are studying several possible causes.
Can prostate cancer be prevented?
Medical experts do not know how to prevent prostate cancer. But they are studying
many factors. They do know that not smoking, eating a healthy diet, staying
physically active, and seeing your doctor regularly contribute to overall good
health.
Are African American men at increased risk for prostate cancer?
Yes. Though all men are at risk, African American men have
higher rates of getting and dying from prostate cancer than men of other racial
or ethnic groups in the United States. Scientists do not know why it is more
common in African American men than in others. They are studying possible reasons,
including culture, environment, and differences in the biology of the disease
in African American men.
Prostate Cancer Death Rates by Race/Ethnicity in
Men Aged 45 and Above
Tabular description of this graph
What is the lifetime risk of prostate cancer in African American men?
An African American man in his lifetime has about a:
- 19 percent chance (1 in 5) of being diagnosed with prostate
cancer.
- 5 percent chance (1 in 20) of dying from prostate cancer.
What else can increase the risk for prostate cancer?
Besides race and ethnicity, other factors that can increase risk are:
- Family history. Men with a father, brother, or son who
has had prostate cancer are at greater risk for developing it themselves.
- Age. The older a man is, the greater his risk for getting
prostate cancer. See the chart below.
Risk of Being Diagnosed with Prostate Cancer by Age:
African American Men
Tabular description of this
chart
Is prostate cancer serious?
Some prostate cancers become a serious threat to health by growing quickly,
spreading beyond the prostate gland to other parts of the body, and causing
death. Yet other prostate cancers grow slowly and never become a serious health
threat or affect how long a man lives. Doctors can't always be sure what type
of cancer is present in your particular case.
How serious is prostate cancer in African American men?
Among the 10 leading causes of cancer death in African American men, prostate
cancer is second, behind lung cancer. When compared to all causes of death,
prostate cancer is the fourth leading cause of death among African American
men over age 45.
Top Ten Causes of Death among African American Men over
Age 45
Tabular description of this graph
What are the symptoms of prostate cancer?
Many men with prostate cancer have no symptoms. If symptoms appear, they can
include:
- blood in the urine;
- the need to urinate frequently, especially at night;
- weak or interrupted urine flow;
- pain or burning feeling while urinating;
- the inability to urinate;
- constant pain in lower back, pelvis, or upper thighs.
If you have any of these symptoms, see your doctor as soon as possible. Keep
in mind that these symptoms may also be caused by other problems common to older
men that are not cancer, such as an infection or an enlarged prostate.
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Prostate Cancer Screening
What does "screening" mean?
Screening means looking for signs of disease in people who have no symptoms.
So screening for prostate cancer is looking for early-stage disease when treatment
may be more effective. The main screening tools for prostate cancer are the
digital rectal examination (DRE) and the prostate specific antigen (PSA) test.
The DRE and the PSA test cannot tell if you have cancer; they can only suggest
the need for further tests.
"I like getting more information so I can ask my
doctor questions."
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What is the DRE?
The DRE or digital (finger) rectal examination is a quick exam for checking
the health of the prostate. For this test, the doctor inserts a gloved and lubricated
finger into the rectum. This allows the doctor to feel the back portion of the
prostate for size and any irregular or abnormally firm areas.
What is the PSA test?
PSA stands for "prostate specific antigen." PSA is a substance produced
only by cells from the prostate gland and released into the blood. The PSA test
measures the PSA level in the blood. A small amount of blood is drawn from the
arm. The doctor checks the blood to see if the PSA level is normal. The doctor
may also use this test to check for any change in your PSA level compared to
your last PSA test.
As a rule, the higher the PSA level in the blood, the more likely a prostate
problem is present. But many factors can affect PSA levels. Some prostate glands
produce more PSA than others. PSA levels tend to increase with age. In addition,
PSA levels tend to be higher in African American men than in others. PSA levels
can also be affected by:
- certain medical tests or procedures;
- an enlarged prostate; and/or
- a prostate infection.
Since many factors can affect PSA levels, your doctor is the best person to
interpret your test result.
How accurate are the screening tests?
No test is right all the time and that is true of the PSA test and DRE. The
PSA test is better at suggesting that small cancers are present, especially
those toward the front or sides of the prostate gland, or deep within it. But
the DRE can sometimes suggest cancers in men with normal PSA levels. That is
why both the PSA test and the DRE are usually performed.
In a large study, it was found that if 100 African American
men over age 50 take the PSA test:
- 87 will have a normal PSA level (though
a small number of these men will have cancer that was missed by the test).
- 13 will have a higher than normal PSA level
and require further tests. After further testing, results will show:
- 8 do not have prostate cancer.
- 5 do have prostate cancer.
"We like to discuss health matters together."
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What do medical experts say about screening?
Medical experts agree that every man needs balanced information on the pros
and cons of prostate cancer screening to help him make an informed decision.
Balanced information is important because medical experts disagree whether men
should be screened regularly for prostate cancer.
Medical experts who encourage regular screening believe current scientific
evidence shows that finding and treating prostate cancer early, when treatment
might be more effective, may save lives. They recommend that African American
men, and men who have a father, brother, or son with prostate cancer, should
discuss with their doctor the need for an annual DRE and PSA test starting in
their 40s. For all others, they recommend informing men of the benefits and
limitations of prostate cancer screening, and offering the screening tests annually
beginning at age 50. All of these recommendations apply to men with a life expectancy
of at least 10 years.
Medical experts who do not recommend regular screening want convincing evidence
that finding early-stage prostate cancer through screening, and treating it,
saves lives. They believe some of these cancers may never affect a man's
health and treating them could cause temporary or long-lasting side effects
like impotence (inability to keep an erection) and incontinence (inability to
control the urine flow, resulting in leakage or dribbling). Since they believe
it is unclear if the potential benefits of screening outweigh the known side
effects of treatment, they recommend that all men be given information on the
pros and cons of screening before making their own decision.
When will medical experts know more?
Medical experts are working together on major research studies to get answers.
These studies are called clinical trials. They will help determine whether a
man who gets screened regularly is less likely to die of prostate cancer than
a man who does not get screened. Clinical trials involve thousands of male volunteers
and take a long time. Extra efforts are being made to recruit African American
men into these studies. These clinical trials will also help experts understand
how prostate cancer may be different for African American men. Results are expected
in five to 10 years. They should help experts know if screening saves lives.
In addition, experts are conducting studies to find the gene or genes that
may cause hereditary (inherited) prostate cancer, which is believed to be responsible
for 5-10% of prostate cancers in all men. These studies may one day lead to
simple genetic tests that can identify men at higher risk for the disease. Medical
experts are also conducting the first large national study of hereditary prostate
cancer in African American families.
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Page
Follow-Up Testing
"Screening means more than just getting tested."
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What if the results of your screening tests indicate that you might
need further testing?
Do not panic. Most men who go for further testing do not have cancer.
If your PSA test or DRE suggests a problem, your doctor most likely will refer
you to a urologist (a doctor who has special training in prostate-related problems).
Additional testing is necessary to determine if the problem is cancer or something
else.
The urologist may perform a transrectal ultrasound — a small probe inserted
into the rectum that bounces sound waves off the prostate, producing a video
image. Transrectal ultrasound does not provide enough specific information to
make it a good screening tool by itself, but some doctors find it useful as
a follow up to a suspicious PSA test or DRE.
If the urologist suspects cancer, tiny samples of the prostate may be removed
with a needle. This is called a biopsy. A biopsy is usually performed in the
urologist's office. The samples are examined under a microscope to determine
if cancer cells are present.
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Treating Prostate Cancer
What happens if prostate cancer is found?
No two men with prostate cancer are the same. Many factors affect the decision
whether or not to treat the disease: the patient's age, whether the cancer
has spread, the presence of other medical conditions, and the patient's
overall health.
When prostate cancer has been found in its early stages and
has not spread beyond the prostate, a doctor and his patient may decide upon:
- watchful waiting — monitoring the patient's
prostate cancer by performing the PSA test and DRE regularly, and treating
it only if and when the prostate cancer causes symptoms or shows signs of
growing;
- surgery (radical prostatectomy) — removing the prostate;
- external radiation therapy — destroying cancer cells
by directing radiation at the prostate;
- internal radiation therapy (brachytherapy) — surgically
placing small radioactive pellets inside or near the cancer to destroy cancer
cells;
- hormone therapy — giving certain hormones to keep
prostate cancer cells from growing;
- cryotherapy — placing a special probe inside or near
the prostate cancer to freeze and destroy the cancer cells.
More advanced prostate cancers that have spread beyond the prostate can be
complex to treat and may be incurable. Patients should discuss with their doctor
the best course of action.
"There is more to screening than I realized."
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Do these treatments have side effects?
Side effects from prostate cancer treatment depend mainly on the type of treatment,
the patient's age, and his overall health. Men can experience pain, discomfort,
and other mild to severe side effects that may be temporary or may last a long
time. Two important side effects from treatment are impotence and incontinence.
When a doctor explains the treatment options, he or she can discuss how mild
or severe side effects might be, and how long they might last. Also, a doctor
may be able to perform surgery or prescribe drugs to relieve some side effects.
Should I be screened for prostate cancer?
The decision is up to you and your doctor. Know your risk factors for prostate
cancer and the pros and cons of screening:
Pros
I'm taking the screening tests because they will give me peace of mind.
As an African American man, I am at higher risk for getting and dying from prostate
cancer. I understand that taking the screening tests could mean finding a problem,
taking further tests, and treating a potentially serious prostate cancer. And
since there's no way to tell if the prostate cancer will cause problems
in the future, I want it found early when treatments might be more effective.
Cons
Although I'm an African American man, I will hold off and not take the screening
tests until medical experts agree that finding prostate cancer through screening,
and treating it in its early stages, reduces the chance of dying from it. Screening
tests could lead to further tests and treatment of a prostate cancer that may
never cause problems. And treatment can have serious side effects.
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Conclusion and Resources
"The right decision is the one that is right for
me."
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Thank you for reading this booklet. We hope it helped you understand the prostate,
prostate cancer, and the different opinions on screening. To decide whether
screening is right for you, discuss the pros and cons of screening with your
doctor and the people important in your life. For more information on prostate
cancer testing, treatments, and studies, talk with a cancer information specialist
at 1-800-4-CANCER (1-800-422-6237), or visit the Web site: www.healthfinder.gov
and type in the words "prostate cancer."
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