Cancer prostate radiation

Two years ago, the Rev. Charles R. Williams was full of life, leading the Indiana Black Expo to a level of growth that has made it one of the biggest annual gatherings of African-Americans in the country. But in early summer, the 55-year-old sat in his Midwest home, desperately clinging to life. Struck down by prostate cancer in the prime of his life, Williams needed around-the-clock assistance. He labored to talk, and was recently told that the disease had spread to his brain.

As Williams' condition worsened, he was given only two weeks to live. But even in that weakened state, he continued his nonstop campaign and issued a last will and testament to Black men: "Get an annual prostate cancer examination!"

"I didn't find out that I had prostate cancer until more than two years after I had it," he says. "By that time, it had spread. If they had caught it earlier, there might have been hope. I have had every treatment there is. There's nothing else they can do. I just have to keep prayerful."

Striking African-American men of all socioeconomic levels and educational backgrounds at the highest rate in the world, prostate cancer is so insidious among Black males that, according to the National Cancer Institute, it is almost at "epidemic" levels.

In recent years, a who's who among Black men have been struck by the disease. Nelson Mandela. Harry Belafonte. Louis Farrakhan. Sidney Poitier. Dr. Louis Sullivan. Dr. Benjamin Carson. Ambassador Andrew Young. That's just to name a few. And earlier this year, Black Enterprise Founder and Publisher Earl G. Graves Sr. revealed he had the disease.

Prostate cancer accounts for 40 percent of all cancers diagnosed among Black men, and is more likely to kill them than any other cancer. It is estimated that about 1 in 5 Black men will develop prostate cancer sometime during his life. One in 22 Black men will die of prostate cancer, with the mortality rates among Blacks being twice as high as that for Whites, and this rate is increasing almost 2 percent each year. Despite many advances in treatment and understanding of the disease, scientists still do not know why prostate cancer seems to target Black men in the United States. It is unlikely that the increased risk is due only to genetics, since men in Africa have lower prostate cancer rates than men in the United States.

Experts like Dr. Willie Underwood, an assistant professor of urology surgery in the University of Maryland Medical School, believe the lack of appropriate and timely treatment could be the main reason for the disparity. "We know African-American men are more likely to die from prostate cancer. However, when they are diagnosed with the most aggressive cancers, they are less likely to receive definitive treatment," he says. "This could possibly impact the reported racial disparity in prostate cancer mortality. While research has focused on a genetic cause for increased mortality in African-Americans, treatment disparities is something that could be addressed in the context of health policy. Equal treatment for equal disease is something that should be achievable."

Graves agrees that early detection and appropriate treatments are keys in combating the disease. He has said that the first warning sign that something was wrong came in the form of an irregular PSA (Prostate Specific Antigen) test given at his doctor's office and later confirmed by a biopsy. "Prostate cancer can be treated successfully if caught early," says Graves, who chose to come forward with his personal health situation after his doctor told him that African-American men are most likely to develop the disease. "Each and every person at risk needs to learn about the disease; commit to be tested; and make the lifestyle, health, and dietary choices that can help prevent the disease."

Prostate cancer may have no symptoms, so routine testing is important for men over 40. But when symptoms are present, they include: a weak or interrupted flow of urine, difficulty urinating or urinating frequently (especially at night), pain or burning when you urinate, blood in the urine, nagging pain in the back, hips, or pelvis.

The chance of having prostate cancer increases rapidly after age 50, with more than 70 percent of all cases being diagnosed in men over 65. The American Cancer Society recommends that regular prostate exams should be done by a doctor for men older than 40. During the examination, a doctor will usually insert a gloved finger into the rectum (a digital rectal examination) to feel for lumps as well as size and firmness of the prostate. For men over 45, the Prostate Specific Antigen (PSA) blood test is usually performed, followed by a biopsy for men whose PSA result raises concern.

But recent studies have brought into question the necessity of a traditional PSA test or biopsy. A University of Texas study earlier this year found that 15 percent of older men with supposedly normal PSA readings indeed had prostate cancer--and some even had aggressive tumors. And a review of data by Johns Hopkins University from a recent nationwide trial of the relatively new "free" PSA test--which measures the ratio of free-floating enzymes to the enzyme total, which includes those bound to proteins in the blood--shows the new test is just as accurate in revealing cancer risk as a PSA and subsequent prostate biopsy, which in and of itself is an expensive and often painful procedure.

While this year alone, prostate cancer will be diagnosed in nearly 300,000 men in the United States, and kill about 45,000, the good news is that it is one of the easiest cancers to treat if detected early. Alarmed by the large number of Blacks' deaths as a result of prostate cancer, a national mobilization effort is underway to teach African-American men how to survive the potentially deadly disease.

When famed pediatric neurosurgeon Dr. Benjamin Carson was diagnosed with prostate cancer two years ago, the cancer was dangerously close to spreading beyond his prostate. "As a survivor of this disease, I feel very strongly that we must emphasize in the most vigorous way possible how important early detection and treatment is," says Carson, who continues to be cancer-free after surgery to remove the malignancy. In fact, Dr. Carson says prostate cancer doesn't have to kill anyone. "The diseases of the prostate gland are eminently treatable if detected early and treated aggressively and appropriately," says Carson who won his battle with the disease. "There is no reason that a person diagnosed with these diseases cannot live a long productive and highly enjoyable life."

For those diagnosed with prostate cancer, there are a number of treatments. Oftentimes an approach called "watchful waiting" is appropriate when the cancer hasn't spread outside the prostate. This approach consists of regular exams to monitor the cancer's progress without any actual treatment. Although the cancer continues to grow, it may grow so slowly that it doesn't cause problems in a man's lifetime. Especially for elderly patients, this approach may be appropriate if the cancer is small and of low grade.

When watchful waiting is not an option (and studies show that prostate cancer may become a significant threat within 10 years if not treated), four kinds of treatments are commonly used: surgery to remove the cancer; radiation therapy to kill the cancer cells with high-dose x-rays or other high-energy rays; hormone therapy to stop the cancer cells from growing with the use of hormones; and biological therapy to fight the cancer by using your body's immune system.

Most times, surgery is the preferred treatment for prostate cancer. But other, more high-tech, treatments are showing promise. Surgeons at Howard University Hospital in Washington, D.C., have successfully implanted high-dose radioactive seeds into the prostate of such high-profile patients as Minister Louis Farrakhan. A procedure pioneered by Dr. Alfred Goldson, professor and chairman of the Radiation Oncology department at Howard University Hospital, seed implantation is now universally used as a treatment option.