East of the River | Prostate Cancer: A Helpful Guide

By Matthew McClure August 7, 2024

What is prostate cancer? In men, the prostate is a gland located underneath the bladder and in front of the seminal vesicles. The urethra passes through the prostate, which adds fluid to ejaculate and helps move it out of the body. Adenocarcinoma (a type of cancer in cells that produce mucus) is the most common form of prostate cancer. It targets the glands that produce seminal fluid in the prostate and affects a staggering 70% of Black men. Abnormalities in your prostate cells don’t necessarily mean you have prostate cancer. Further tests should be done.

Why is there a stigma associated with prostate cancer?
As a resident of Ward 8, Chair of the Anacostia Coordinating Council (ACC) and a survivor of prostate cancer, Lamont Mitchell is intimately familiar with the unique conditions east of river that threaten the health of African American men and their families in his community. He knows more than anyone why prostate cancer isn’t something people like to talk about. “The treatment for prostate cancer can involve lower libido for a prolonged period, or even forever. That’s the stigma that nobody wants to deal with. We want to encourage Black and Brown men to get together and have open, honest communication.” Mitchell founded Know Your Numbers DC, a partnership between the ACC and Martha’s Table that creates safe spaces for conversations about prostate cancer, makes testing more accessible and less intimidating, and offers support to those afflicted by the disease. “We’re encouraging churches and fraternity organizations to start men’s health groups, where men can talk about the stigmas around prostate cancer. We want to bring in medical professionals to do blood testing. We want to encourage and incentivize men to get tested. If you catch this early, it can make a huge difference. Prostate cancer is a family disease. It affects the whole family.”

Why should you be worried?
Mitchell says that Black men residing in Wards 7 and 8 have an average of 17 years shaved off their life expectancy compared to their counterparts in Ward 3. “That’s because of a lack of healthcare options, lack of education and a lack of encouragement. It’s totally unacceptable and nobody should be happy about that.” As with many other forms of cancer, genetics can play a role in prostate cancer. “If your brother, your father or your grandfather had prostate cancer, or even if your mother had breast cancer, you might have the gene that predisposes you to prostate cancer,” says Mitchell, whose mother died of breast cancer and whose grandfather had prostate cancer. “90% of African American men on autopsy have an elevated PSA (Prostate Specific Antigen), so they could have had low level prostate cancer.”

Dr. Michael Whalen, Associate Professor of Urology and Director of Urologic Oncology at the George Washington University School of Medicine & Health, confirms that African American men are disproportionately affected by prostate cancer. “The incidences of prostate cancer are about 1.5 times higher in Black men compared to Caucasian men. There’s a twice as high death rate from prostate cancer in that population.” Dr Whalen says research is ongoing to find out why. “There’s work being done as to whether there’s a genetic basis, whether it’s lack of access to care, resistance to screening or nutritional influences. Black men that are treated are also found to have more aggressive and advanced disease at the time of surgery.”

What are the specific risk factors associated with DC’s African American communities?
Fresh, healthy, nutritious food can be hard to find in Wards 7 and 8. While there’s currently no direct link between prostate cancer and diet, eating plenty of fruits, veggies, whole grains and avoiding red meat can lessen your chances of prostate cancer even if you’re already genetically predisposed. Getting regular exercise and avoiding smoking and tobacco products can also aid your body’s natural defenses against prostate cancer. Regular medical checkups are also critical. “One of the main reasons why Black men have more aggressive types of prostate cancer is that we don’t catch it early enough.” Mitchell says. “As Black men, we don’t see the doctor often enough.” Dr. Whalen suggests that perhaps trust in doctors is an issue. “In the healthcare industry there have been some notable violations of trust. The Tuskegee trials, the ovarian cancer cells from Henrietta Lax who never consented. These precedents may make this population suspicious of healthcare. African American men are notoriously under-represented in clinical trials despite making up 13-15% of the population.”

Signs and Symptoms?
Prostate cancer is sometimes referred to as a silent killer because often there are no symptoms, says Dr. Whalen. “The disease is largely asymptomatic. The only sign might be an abnormal blood test. A patient may feel healthy and then not go to the doctor because nothing is wrong.” He suggests watching out for blood in urine, frequent and urgent urination, incontinence, or an inability to urinate.

Medical services and treatment options East of the Anacostia River?
Patients seeking screening, diagnosis and treatment for prostate cancer must travel over the river – to Georgetown’s Lombardi Comprehensive Cancer Center, for example – or to surrounding states to access urology and oncology facilities. The New Cedar Hill Regional Medical Center, GW Health is slated to open at St. Elizabeths East next year and will have both oncology and radiology units available. The Potomac Urology and Surgery Center in Maryland’s National Harbor is a 17-20 minute drive from Historic Anacostia.

Does insurance cover diagnosis and treatment?
This is dependent on your unique medical care plan or insurance. Dr. Whalen acknowledges that affordable care plans can sometimes mean there’s a delay in treatment once prostate cancer is diagnosed. “Medicaid does pose certain bureaucratic hurdles. Sometimes the authorization process is onerous.” Institutions like George Washington University School of Medicine & Health have an active team of engaged social workers who consult with patients on the best treatment approaches given their financial and economic context.

Medical terminology:
What are PSAs?
Prostate Specific Antigens (PSAs) are proteins produced specifically by prostate cells. An elevated PSA level might indicate the presence of prostate cancer, but it’s critical that further tests are done to confirm this.

What is a DRE?
A Digital Rectal Exam (DRE) is a manual diagnostic method that your Primary Care Physician will use to check for abnormalities on the prostate gland, in the anus and rectum. Often done in conjunction with a PSA test, a DRE is painless and takes only a few minutes.

What is a PSMA PET CT?
A PSMA (Prostate Specific Membrane Antigen) PET (Positron Emission Tomography) scan is a new imaging technology that involves injecting patients with a small amount of radioactive tracer which bonds to prostate antigens. A scan picks up these tracers and can show possibly cancerous cells both in the pelvic area and in other parts of the body where it might have spread. Recent research indicates that a PSMA PET CT is more successful at imaging possible metastatic (spreading) cancer tumors than a regular CT or bone scan.

What is your Gleason score?
When prostate tissue samples are studied under a microscope, an overall Gleason grade is given to the size and structure of the cells being studied to determine the level of or need for prostate cancer treatment. A low grade (1-3) indicates well-formed cells, while a higher grade (4-5) indicates potentially problematic cells. A Gleason score should be used in conjunction with other tests to determine treatment options, should they be required.

What is Androgen Deprivation Therapy (ADT)
Androgens are hormones (testosterone and dihydrotestosterone) that are found in people assigned male at birth (AMAB). They are produced by the testes, adrenal glands and the prostate gland. Androgens help cancerous prostate cells grow and spread, so ADT is used to lessen the production and amount of androgens in the body to help treat prostate cancer. Various types of ADT treatments are available and all have different side effects.

What is Brachytherapy?
A localized form of cancer treatment, brachytherapy involves the placement of a radioactive source inside your body at or within the site or organ affected by cancer. This treatment can be either low dose (the source remains inside your body for a few days), high dose (the source is removed after a few minutes of treatment) or permanent (the source is never removed but the radiation eventually wears off).

What is Stereotactic Body Radiotherapy (SBRT)
Charged proton beams – along with imaging technology- target very specific, smaller areas affected by cancer and destroy the DNA of abnormal cells to prevent them duplicating. SBRT is most often used after other radiotherapy has been attempted.

Read the full article here. Learn more about prostate cancer and get support by visiting Know Your Numbers DC at www.kyndc.com or call KYNDC at (202) 390-2517. The GW Medical Faculty Associates Prostate Cancer Clinic can be reached on 202 677 6962.