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Black Men Can Beat Prostate Cancer
Dr. Durado Brooks is one of the leaders in the fight against prostate cancer and he breaks down the confusion over the benefits and potential ‘harm’ of the well known PSA test. In short, he advises to become better informed about the screening and treatment options best for you!
Less than two years ago, the United States Preventive Services Task Force (USPSTF) issued new recommendations against prostate cancer screening. The USPSTF recommended that regardless of age, men without symptoms should not routinely have the prostate-specific antigen (PSA) blood test to screen for prostate cancer.
The task force is an independent panel of experts authorized by Congress to make recommendations about specific preventive services for patients with no signs or symptoms. It released a draft of these recommendations in October, 2011.
Given the level of disparity of prostate cancer among Black males, I spoke with Dr. Brooks about this controversial recommendation and what men should be doing to protect themselves.
“I would point to the American Cancer Society guidelines. They were last updated in 2010 but we looked at the same data. In our review of the evidence there is potential evidence of benefits for prostate screening.”
Dr. Brooks went on to say, ‘black men are at higher risk of being diagnosed and dying from prostate cancer.’
Apparently, one of the challenges of prostate cancer screening (e.g. a PSA test) is that it’s also tied to treatment in the USA and many men who have prostate cancer are actually better off not having it treated because treating a slow growing tumor may result in treatment complications versus complications from the tumor itself. But convincing a patient to not have any cancer treatment is challenging. And to many people, it’s just counterintuitive.
The harm of screening for prostate cancer is really the harm of prostate cancer treatment, but we have to think of them in concert according to Dr. Brooks. Telling a man his PSA level is elevated or telling someone they have cancer and scaring them to death impacts them emotionally and psychologically.
The PSA is a much more common screening test but Dr. Brooks says, ‘it is much better to get a prostate biopsy over a PSA but even that is a bronze, not gold standard. Think of the biopsy as poking a needle in an orange trying to hit a seed and you don’t know if you will hit it.’
Another potential harm is a false-positive screening result. When PSA levels are high for non-cancerous reasons, it also has implications for life insurance coverage, emotional stress, etc. Two out of three men who have an elevated psa and have additional test will learn they actually don’t have cancer.
All men should be informed about the harms and benefits and talk to their clinician. It’s important for each patient to make a personal decision for themselves about prostate cancer screening and treatment.
Dr. Brooks says, “men need to learn about their family history and make informed decisions. We don’t have a lot of good evidence of things that lower risk of prostate cancer. But following a diet that’s low in fat, low in red meat, is just a good idea overall. Obesity has been associated with worse outcomes for men with prostate cancer.”
Durado Brooks, M.D., M.P.H., director of prostate and colorectal cancers for the American Cancer Society, has spent much of his career working to enhance the role of prevention in primary care and to improve care for medically underserved populations.
Dr. Brooks is also actively engaged in ACS initiatives designed to eliminate disparities in cancer prevention, detection and outcomes.
He subsequently served as fellow in General Internal Medicine at the University of Texas Southwestern Medical Center in Dallas, and earned a master’s degree in Public Health from the Harvard School of Public Health.