Get Well Wednesday: Prostate Cancer In The African American Community

Dr. Stacy Loeb is an assistant professor of urology and population health at New York university (NYU) specializing in prostate cancer and is one of the prostate cancer foundation’s funded young investigators.

Dr. Loeb is an internationally recognized expert in prostate cancer with more than 285 peer-reviewed published articles and 11 book chapters.

Dr. Loeb also frequently gives international lectures on prostate cancer, social media and men’s health. Dr. Loeb also hosts the men’s health show on Sirius XM 110 satellite radio.

What Is Prostate Cancer?

A: The prostate is a gland found only in males that makes some of the fluid that is part of the semen. . The prostate is located below the bladder and in front of the rectum.it is the size of a walnut in younger men, but commonly gets larger as men get older. This condition is known as enlarged prostate, and may cause bothersome urinary symptoms but is not associated with cancer. Prostate cancer occurs when cells in the prostate gland start to grow uncontrollably.

Q: How does prostate cancer affect the African-American community? Why does it seem like prostate cancer is more aggressive in African-American men than other races?
A: African-American men are significantly more likely to develop prostate cancer, and have more than twice the risk of dying from prostate cancer. The reason for this disparity is a major topic of scientific investigation and a priority area of research for the prostate cancer foundation. There are many possible contributors to this issue ranging from genetic factors to differences in access to quality medical care. Data shows that African-American men are less likely to be advised about cancer screenings and less likely to undergo surgery.

Q: What are the risks associated with prostate cancer?
A: Age is the biggest risk for prostate cancer, but is not the only risk factor. Other important factors include: family history, genetic factors, race, and lifestyle habits. Genes for disease can run in families. Therefore, men who have a relative with prostate cancer are twice as likely to develop the disease, while those with two or more relatives are nearly four times as likely to be diagnosed. The risk is even higher if affected family members were diagnosed before the age of 65.

Q: How often should you get tested for prostate cancer?
A: It is very important for African-American men to talk to their doctor about prostate cancer screening. I recommend a baseline screening in the early 40’s. This value gives a lot of information about a man’s risk of ever developing life-threating prostate cancer. The baseline screening results and other risk factors can be used to determine how often testing is needed after that.

Q: What are some of the cutting edge developments for prostate cancer?
A: We are in the midst of a very exciting time in prostate cancer research, with new advances and discoveries being made every day. For example, research funded by the prostate cancer foundation showed that the brca gene (a mutation known to be associated with breast cancer) is also associated with an increased risk of prostate cancer. These cancers respond to different types of treatment than what is traditionally used for prostate cancer. In the future, we will see more and more “precision medicine” where treatment will be tailored to the specific genetic alterations in the individual patient.

Q: What is the “know your numbers” campaign?
A: The “know your numbers” campaign kicked-off in April. It is a national men’s health initiative geared to shed light about the significant disparities that exist between men of African descent and other ethnicities, and to raise awareness about the risk factors associated with prostate cancer. For more information, you can visit: www.pcf.org/knowthenumbers.

Q: What type of effect does the diet have on the prostate?
A: Many different factors influence prostate cancer risk. It does have a large genetic component, but lifestyle factors also play a significant role. Parsing out these factors is complicated and is a major area of research. Generally speaking, a Mediterranean diet is thought to be potentially beneficial for the prostate, including ly copene (found in tomato products). By contrast, charred meat and excess dairy are thought to be potentially harmful. Overall, what is heart-healthy is prostate healthy.

Dr. Stacy Loeb now answers questions from the Text Tom club.

Q: Is there such a thing as a prostate massage?

A: Prostate massage is sometimes used for the diagnosis of prostatitis. Urine is collected before and after prostate massage to check for signs of inflammation or infection.

Q: My friend was just diagnosed with prostate cancer. Is there a holistic treatment he can try?

A: The treatment options for prostate cancer depend upon the tumor features (such as stage and grade) as well as the age, general health and preferences of the patient. Low-risk cancers may not require upfront treatment and may be managed with active surveillance, whereas treatment is typically recommended for intermediate or high-risk cancers. Unfortunately there is no holistic cure for prostate cancer. However, a healthy diet and exercise is a very important adjunct to go along with any type of prostate cancer treatment.

Q: Please ask the doctor if the level of sexual activity has a bearing on prostate health?

A: A recent study suggested that men who had a greater number of ejaculations per month were less likely to develop prostate cancer. Follow-up studies are underway to examine the effect of ejaculation on prostate cancer tissue and whether it has a direct effect, or whether men in the previous study with more ejaculation were healthier in some other way that was beneficial to the prostate.

Q: I’ve had the surgery, in fact tomorrow makes a year. What are the chances of it returning?

A: The risk of recurrence depends on the stage and grade of the cancer. It is important to continue checking the PSA blood test to make sure there is no recurrence.

Q: How come the USPTF gives PSA screening a D and tells physicians not to test? Also, Medicare will make the patients sign an ABN and will not cover the test.

A: The United States Preventive Services Task Force (USPSTF) actually issued a new draft recommendation in 2017 in which they changed from a D grade to a C grade. The current version recommends shared decision-making about PSA, which means that patients and physicians should have a discussion about the pros and cons of screening.

Q: I take two tamlosin capsules for my prostrate issue. However, I’m still getting up 3 to 4 times each night to urinate. Does that mean my meds are not working?

A: Tamsulosin is a medication used for treatment of lower urinary tract symptoms associated with prostate enlargement. Night-time urination may be due to prostate enlargement, but may also be due to other health conditions and lifestyle factors. It is best to see a doctor for evaluation into the cause of your persistent symptoms and determine the appropriate management.

Q: Any special concerns regarding or changes in sexual practices with your partner suggested after prostate cancer diagnosis or during treatment (i.e., condom wear, oral sex, etc.)?

A: There are no specific recommendations for a change in sexual behavior after prostate cancer diagnosis. Some forms of prostate cancer treatment have a risk of erectile dysfunction. If that occurs, there are many different management options that you can discuss with your doctor.

Q: Does a plant-based diet help with all of these diseases?

A: A plant-based diet is generally thought to be beneficial for health. There is some evidence that cruciferous vegetables are good for the prostate. Overall, a balanced diet and exercise that is heart-healthy is also prostate-healthy.

Q: Ask Dr. Loeb if there is scientific proof that eating a plant-based diet mitigates cancer?

A: There is no definitive evidence that a plant-based diet will affect the course of prostate cancer. However, maintaining a healthy diet and exercise are certainly beneficial to overall longevity and may reduce some side effects of cancer treatment.

For more information head over to PCF.org/KnowtheNumbers.com And follow them on Faceboog @PCF.org or Twitter @PCFnews.