Research shows that African American men have a 60% higher incidence of prostate cancer and the highest prostate cancer death rate of any other group across the country. Regionally, some ZIP codes in St. Louis, particularly north St. Louis County, have some of the highest prostate cancer rates.
“We know a lot of this is not because people could not be diagnosed at an early stage. They just aren't participating in screening, either because of lack of availability or lack of knowledge,” said Dr. Arnold Bullock, a Washington University urologist and surgeon.
As a medical professional and specifically as a Black man, Bullock said it is his duty to encourage people — not only during Prostate Cancer Awareness month — but to get screened. He swears by early detection screenings because he said they saved his life.
“If you're picked up early and you pick a really, really good surgeon or a good radiation oncologist … you can get a treatment and not miss a beat,” said Bullock, who is a prostate cancer survivor.
Cancer treatments and surgery are helping lower prostate cancer mortality rates in African Americans, but Bullock said the most effective way to start reducing the prostate cancer disparity rates among Black men is to simply start talking about the disease.
St. Louis Public Radio’s Andrea Henderson spoke to Bullock about prostate cancer, the importance of prostate level screenings and why African Americans have higher incidence and mortality rates.
This conversation has been edited for clarity and length.
Andrea Henderson: Why are there higher incidence and mortality rates of prostate cancer in African Americans in north St. Louis County than there are in any other areas in the St. Louis region?
Arnold Bullock: If you look at a map that was generated by the St. Louis County health commissioner, it clearly demonstrates higher rates of prostate cancer in north St. Louis County compared to around the Barnes-Jewish Hospital area in the Central West End. And believe it or not, even though there are only five to eight miles separating Christian Hospital from Barnes-Jewish Hospital, the rate of prostate cancer death is five times higher. It's a similar rate for breast cancer between this area, which is kind of a well-to-do area with very high screening rates, compared to an area where the screening rates are relatively low. So, we know a lot of this is not because people could not be diagnosed at an early stage, it is that they just aren't participating in screening. It is either because of the lack of availability or the lack of knowledge.
Henderson: Why is it important for African Americans to get screened for prostate cancer?
Bullock: The most common cancer men can get in America is prostate cancer. The second most common is lung cancer. The third is colon cancer. Lung cancer has the highest death rate, but of course, you have a higher chance of dying of prostate cancer than any other cancer, even if you've never had a history of tobacco exposure, you weren't smoking and your spouse wasn't smoking. You have men who have a higher rate of prostate cancer and a high rate of dying from prostate cancer that merely requires a blood test called a prostate-specific antigen.
Henderson: What is prostate cancer?
Bullock: First of all, you can get cancer in any organ, so the prostate is an organ. It's an organ that sits right below your urinary bladder. You can't feel it yourself. Your urine travels from your bladder right through your prostate and then out through your penis. The prostate mixes the liquid that you see when you climax. That ejaculate primarily comes from your prostate, and the prostate secretes all of these nutrients to keep the sperm healthy until they catch up to an egg to fertilize. So, that's the purpose of the prostate.
Most people who have prostate cancer have no idea that they have prostate cancer. You would think that you would have a slow strain. No, that's usually because you just have an enlarged prostate. You would think you would have blood in your urine. No, that means you have bladder cancer. So, the only way you typically know you have prostate cancer is you're starting to lose weight, or you are having pain in your bones. Those are bad signs.
Henderson: Why are Black people at a higher risk of having prostate cancer, and what are some ways that people can lower their risk?
Bullock: We believe that African Americans have a higher rate of prostate cancer, genetically, because we carry some genes or have gene sequence repetitions that put us at higher risk. Just like some African American women are at a higher risk of breast cancer because they carry certain genes related to breast cancer. Sometimes it’s where you live, maybe you live close to high-frequency radio towers. You have been exposed to toxic environmental agents like Cadmium, all of these factors. We really don't know, but a lot of it is diet. So, if there's one thing you could do, it's to limit the amount of animal proteins that you consume.
Henderson: If you are looking to get your PSA levels checked, how do you start the conversation?
Bullock: Like Dr. Jones, I've been informed about the need to be screened. So, let me ask you something. “I'm worried about my next life insurance screen, so in order to be able to get a $2 million life insurance package, what test would you give me?” No insurance company will give you a $2 million package if they don't know what your colon shows, if they don't know what your PSA is, if they don't know what your EKG shows or what your cholesterol level is. I bet you won't get a $2 million life insurance package if you're walking around with a PSA of 12. It’s so simple.
Henderson: What are some misconceptions about prostate cancer or the prostate in general that Black men have?
Bullock: African American men and African American women in cancer overall have a 20% to 25% higher rate of cancer. The biggest myth is, I know my body and I could feel it. No, you can't. The second myth is that you can't cure cancer, so why would you even want to know about something you don't cure? With PSA screenings, the chances of finding a Black man with cancer spread to other parts of his body is well under 5% now, at the time of diagnosis. It all depends on at what point he got screened, and so that of whites is even lower. The death rate from prostate cancer plummeted after the PSA came out. When there was a suggestion that people didn't need to get screened in 2012, in north St. Louis County, we cut back on screening from the high 40% down to low 20%. We saw the rate of advanced cancer go right back up. So, in 2018, when they reversed that and we started doing more screening through Barnes-Jewish and Christian Hospital centers, you can see the rate of advanced disease start to go back down. So, we know that we can detect prostate cancer early with a PSA screening.
Henderson: Many African Americans do not really go to the doctor regularly because they don't trust the doctors or the hospital settings. How do we move past that lack of trust, especially knowing that we have some of these higher rates?
Bullock: Some of this is based on fact. There were these major medical studies where they were using Black and German prisoners, exposing them to things to see how they became symptomatic over the years. Now, you're talking about these studies that happened in the 1940s and 1950s. As a consequence, though, you have very low African American participation in some of our research projects, especially cancer research. You have a lot of Black people who will say, “Well, I only want to see a Black doctor,” which is OK, but sometimes, based on your particular medical problem, there are some people who are super specialized and they happen to be white. In that case, you want to see the best doctor, Black or white.
I found out I had prostate cancer because my PSA kept going up. I had one of my junior partners, who is Asian, do my surgery. I came back … five to six weeks later, and I started going back to the gym. So, I think that if you're picked up early and you pick a really, really good surgeon or a good radiation oncologist … you can get a treatment and not miss a beat. Of course, the later you're detected, the more likely you have a problem.
It is not the color of the person who is treating you, it's the time and patience they take when you're being seen, and that's not necessarily race-related.
Henderson: What can family members or friends do to support people, especially Black men, who have prostate cancer?
Bullock: The No. 1 thing family members can do is to tell people that they've heard of prostate cancer. You can't support treatment, and there's very little need to support treatment if the cancer is detected early. The No. 1 thing is it starts by early detection, and that means, if you've heard of PSA and you know someone in your family or friends who are over 40, you should ask the question, “I had my PSA done or my mammogram done and we're in the same age group, so have you ever had a PSA test?”
Available PSA screenings:
People can get screened from 10 a.m. to 2 p.m. Oct. 4 during the Manchester Community Event at 200 Highlands Blvd., Manchester, MO.
Men 40 and older can request a free PSA screening voucher at 314-286-2587. Screenings are held at the Washington University Medical Campus or at Christian Hospital in north St. Louis County.
