Recruitment And Data Collection
African American men were recruited from barbershops, churches, community health centers, radio stations that African Americans listen to, and recreational centers in rural localities. The decision to recruit from these areas was based onthe authors previous research experiences with the African American community, particularly African American men, and on conversations with African American community leaders. It has also been reported elsewhere that when investigators place a high value on the importance of including ethnic/racial minority populations in research, they have more success in recruiting minorities. Several proprietors of barbershops and convenience stores, administrators of free clinic health departments, and church ministers were open to the idea of allowing flyers and announcements and recruiting individuals for the research. Participants met the following criteria: 40 years old, self-reported as an African American male, never been diagnosed with prostate cancer, and able to provide informed consent. Interested men contacted the first author, and a time and location convenient for the participant were established to check eligibility and conduct the interview. The University of Virginias Institutional Review Board for Social and Behavioral Sciences approved the study.
Types Of Prostate Cancer
There are different types of prostate cancer. These are defined by how developed the cancer is, whether it is only the prostate gland thats affected, or if the cancer has spread to other parts of the body.
Early prostate cancer Early prostate cancer sometimes called localised prostate cancer is when only the gland is affected, and the cancer hasnt spread to any surrounding tissues or other parts of the body.
Locally advanced prostate cancer Locally advanced prostate cancer is where the cancer has spread to tissues around the gland.
Advanced prostate cancerAdvanced or metastatic cancer of the prostate is when the cancer has spread beyond the gland to other parts of the body. These secondary deposits are called metastases.
Living With Prostate Cancer
As prostate cancer usually progresses very slowly, you can live for decades without symptoms or needing treatment.
Nevertheless, it can affect your life. As well as the possible side effects of treatment, a diagnosis of prostate cancer can understandably make you feel anxious or depressed.
You may find it beneficial to talk about the condition with your family, friends, a family doctor and other men with prostate cancer.
Financial support is also available if prostate cancer reduces your ability to work.
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Pros And Cons Of The Psa Test
Pros:
- it may reassure you if the test result is normal
- it can find early signs of cancer, meaning you can get treated early
- PSA testing may reduce your risk of dying if you do have cancer
Cons:
- it can miss cancer and provide false reassurance
- it may lead to unnecessary worry and medical tests when there’s no cancer
- it cannot tell the difference between slow-growing and fast-growing cancers
- it may make you worry by finding a slow-growing cancer that may never cause any problems
Why Does Prostate Cancer Happen
The causes of prostate cancer are largely unknown. But certain things can increase your risk of developing the condition.
The chances of developing prostate cancer increase as you get older. Most cases develop in men aged 50 or older.
For reasons not yet understood, prostate cancer is more common in men of African-Caribbean or African descent, and less common in Asian men.
Men whose father or brother were affected by prostate cancer are at slightly increased risk themselves.
Recent research also suggests that obesity increases the risk of prostate cancer.
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What Are The Advantages And Disadvantages Of Having A Biopsy
Your doctor should talk to you about the advantages and disadvantages of having a biopsy. If you have any concerns, discuss them with your doctor or specialist nurse before you decide whether to have a biopsy.
Advantages
- Its the only way to find out for certain if you have cancer inside your prostate.
- It can help find out how aggressive any cancer might be in other words, how likely it is to spread.
- It can pick up a faster growing cancer at an early stage, when treatment may prevent the cancer from spreading to other parts of the body.
- If you have prostate cancer, it can help your doctor or nurse decide which treatment options may be suitable for you.
- If you have prostate cancer, youll usually need to have had a biopsy if you want to join a clinical trial in the future. This is because the researchers may need to know what your cancer was like when it was first diagnosed.
Disadvantages
What Does A Prostate Biopsy Involve
If you decide to have a biopsy, youll either be given an appointment to come back to the hospital at a later date or offered the biopsy straight away.
Before the biopsy you should tell your doctor or nurse if youre taking any medicines, particularly antibiotics or medicines that thin the blood.
You may be given some antibiotics to take before your biopsy, either as tablets or an injection, to help prevent infection. You might also be given some antibiotic tablets to take at home after your biopsy. Its important to take them all so that they work properly.
A doctor, nurse or radiologist will do the biopsy. There are two main types of biopsy:
- a trans-rectal ultrasound guided biopsy, where the needle goes through the wall of the back passage
- a transperineal biopsy, where the needle goes through the skin between the testicles and the back passage .
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Diagnosis Of Prostate Cancer
If you have symptoms, you usually begin by seeing your GP. The first tests used to diagnose prostate cancer is a rectal examination. You may also have a PSA test.
The PSA test is a blood test to measure your PSA level. Prostate-specific antigen is a protein made in the prostate. Some of this PSA leaks into the blood and can be measured by a blood test.
If your PSA level is higher than normal but your rectal examination is normal, your GP usually checks your PSA level again before referring you to a specialist.
Your GP may refer you for other tests at the hospital:
Positron Emission Tomography Scan
A PET scan is similar to a bone scan, in that a slightly radioactive substance is injected into the blood, which can then be detected with a special camera. But PET scans use different tracers that collect mainly in cancer cells. The most common tracer for standard PET scans is FDG, which is a type of sugar. Unfortunately, this type of PET scan isnt very useful in finding prostate cancer cells in the body.
However, newer tracers, such as fluciclovine F18, sodium fluoride F18, and choline C11, have been found to be better at detecting prostate cancer cells.
Other newer tracers, such as Ga 68 PSMA-11 and 18F-DCFPyl , attach to prostate-specific membrane antigen , a protein that is often found in large amounts on prostate cancer cells. Tests using these types of tracers are sometimes referred to as PSMA PET scans.
These newer types of PET scans are most often used if its not clear if prostate cancer has spread. For example, one of these tests might be done if the results of a bone scan arent clear, or if a man has a rising PSA level after initial treatment but its not clear where the cancer is in the body.
The pictures from a PET scan arent as detailed as MRI or CT scan images, but they can often show areas of cancer anywhere in the body. Some machines can do a PET scan and either an MRI or a CT scan at the same time, which can give more detail about areas that show up on the PET scan.
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Prostate Cancer Symptoms And Diagnosis
Prostate cancer tends to develop slowly, so its symptoms may not show for many years, and might never cause any problems in your lifetime.
But some men have cancer that is more aggressive. This will need treatment to stop the disease or at least delay the cancer spreading outside the prostate gland.
Prostate cancer can cause a range of symptoms, none of which are specific only to prostate cancer.
The signs of prostate cancer only become noticeable when the prostate is enlarged enough to affect the urethra the tube carrying urine from the bladder to the penis. This means you might notice things like a greater need or effort to urinate, and then a feeling your bladder hasnt properly emptied.
But these signs dont mean you have prostate cancer. They could be caused by something else, like benign prostatic hyperplasia where your prostate is enlarged but not affected by cancer.
For some men the first symptoms of prostate cancer are when it has spread beyond the prostate gland to the bones. This may cause symptoms such as back, hip or pelvic pain but again could be caused by benign conditions such as arthritis.
Whatever pain, discomfort or symptoms you feel, it is always best to discuss these with your GP.
GP tests Based on your symptoms, your GP can use one of the following tests to help reach the right diagnosis.
Prostate specific antigen testA PSA test is a blood test that measures the total amount of protein produced by the prostate.
Staging And Grading Of Prostate Cancer
The stage of a cancer describes its size and how far it has spread, based on your test results. A doctor decides the grade by how the cancer cells look under the microscope. Gleason score is the most commonly used grading system for prostate cancer. This gives an idea of how quickly the cancer might grow or spread.
You and your doctors can then talk about the best treatment choices for you.
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Family History And Genetics
Your family history is information about any health problems that have affected your family. Families have many common factors, such as their genes, environment and lifestyle. Together, these factors can help suggest if you are more likely to get some health conditions.
Inside every cell in our body is a set of instructions called genes. These are passed down from our parents. Genes control how the body grows, works and what it looks like. If something goes wrong with one or more genes , it can sometimes cause cancer.
Is prostate cancer hereditary?
If people in your family have prostate cancer or breast cancer, it might increase your own risk of getting prostate cancer. This is because you may have inherited the same faulty genes.
My father had prostate cancer. What are my risks?
- You are two and a half times more likely to get prostate cancer if your father or brother has had it, compared to a man who has no relatives with prostate cancer.
- Your chance of getting prostate cancer may be even greater if your father or brother was under 60 when he was diagnosed, or if you have more than one close relative with prostate cancer.
- Your risk of getting prostate cancer may also be higher if your mother or sister has had breast cancer.
Do you have a family history of prostate cancer?
If you’re over 45 and your father or brother has had prostate cancer, you may want to talk to your GP. Our Specialist Nurses can also help you understand your hereditary risk of prostate cancer.
What’s A Raised Psa Level
The amount of PSA in your blood is measured in nanograms of PSA per millilitre of blood .
If you’re aged 50 to 69, raised PSA is 3ng/ml or higher.
A raised PSA level in your blood may be a sign of prostate cancer, but it can also be a sign of another condition that’s not cancer, such as:
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Causes Of Prostate Cancer
It is not known exactly what causes prostate cancer, although a number of things can increase your risk of developing the condition.
These include:
- age risk rises as you get older and most cases are diagnosed in men over 50 years of age.
- ethnic group prostate cancer is more common among men of African-Caribbean and African descent than in men of Asian descent.
- family history having a brother or father who developed prostate cancer under the age of 60 seems to increase the risk of you developing it. Research also shows that having a close female relative who developed breast cancer may also increase your risk of developing prostate cancer.
- obesity recent research suggests that there may be a link between obesity and prostate cancer.
- exercise men who regularly exercise have also been found to be at lower risk of developing prostate cancer.
- diet research is ongoing into the links between diet and prostate cancer. There is evidence that a diet high in calcium is linked to an increased risk of developing prostate cancer.
In addition, some research has shown that prostate cancer rates appear to be lower in men who eat foods containing certain nutrients including lycopene, found in cooked tomatoes and other red fruit, and selenium, found in brazil nuts. However, more research is needed.
Want to know more?
Prostate Specific Antigen Test
PSA is made by the prostate and some of it leaks into the blood. A small sample of blood is taken from a vein in the arm and sent to a laboratory to measure the level of PSA. You may be advised to avoid strenuous exercise and sexual activity for 48 hours before taking a PSA test as it could affect the results. It is also important to tell your doctor about any other medication or procedures you have had as these could also affect your PSA.
For those aged between 50 and 69, a PSA level of above 3 nanograms per millilitre is considered raised. However, only one in four men with a PSA level between 4 and 10 micrograms per litre has prostate cancer. There are various reasons for a raised PSA level. A high PSA does not necessarily mean you have cancer, nor does a lower level mean you do not.
As it is generally felt that the PSA test is an insufficiently accurate indicator of prostate cancer, you may find it helpful to undergo regular PSA tests to detect any changes early. Any man over the age of 50 is entitled to a free PSA test under the NHS informed choice programme, called Prostate Cancer Risk Management.
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Getting The Results Of The Biopsy
Your biopsy samples will be sent to a lab, where they will be looked at with a microscope to see if they contain cancer cells. Getting the results usually takes at least 1 to 3 days, but it can sometimes take longer. The results might be reported as:
- Positive for cancer: Cancer cells were seen in the biopsy samples.
- Negative for cancer: No cancer cells were seen in the biopsy samples.
- Suspicious: Something abnormal was seen, but it might not be cancer.
If the biopsy is negative
If the prostate biopsy results are negative , and the chance that you have prostate cancer isnt very high based on your PSA level and other tests, you might not need any more tests, other than repeat PSA tests sometime later.
But even if many samples are taken, biopsies can still sometimes miss a cancer if none of the biopsy needles pass through it. This is known as a false-negative result. If your doctor still strongly suspects you have prostate cancer , your doctor might suggest:
- Getting other lab tests to help get a better idea of whether or not you might have prostate cancer. Examples of such tests include the Prostate Health Index , 4Kscore test, PCA3 tests , and ConfirmMDx. These tests are discussed in Whats New in Prostate Cancer Research?
- Getting a repeat prostate biopsy. This might include getting additional samples of parts of the prostate not biopsied the first time, or using imaging tests such as MRI to look more closely for abnormal areas to target.
Prostate cancer grade
Gleason score
Discussion And Study Limitations
A number of the participants, particularly the seven married men, reported that family involvement played an important part in their decision making process. Other studies , have also found that spouses played a major part in gathering information and advising on healthcare, and family members were key individuals in the decision-making process in the African American community. The men in this study took in to consideration their familys and friends advice when deciding whether to have or not to have prostate cancer screening.
Yet the majority of these men had limited information about prostate cancer. Many believed that they were not well informed about the disease by healthcare providers and thought that more education about prostate cancer was needed for the public, and particularly for individuals at high risk. However, participants also thought that their physicians played an important role through information and recommendations on whether to have prostate cancer screening. Further, participants decision to have prostate cancer screening was based in part on their trust in healthcare providers.
The limited amount of information the participants had about prostate cancer is consistent with others. These men were not aware that African Americans are at higher risk for prostate cancer and mortality than other races. Lack of knowledge about the disease may have led in the individuals to believe that they were not susceptible to this potentially serious disease.
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More Support And Resources
True North
True North is a global prostate cancer program developed by Movember to help improve outcomes and quality of life for men diagnosed with prostate cancer. With the help of clinicians, researchers, health organisations and user feedback, True North aims to provide information, resources and support to help men navigate the prostate cancer journey.