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Prostate Cancer Screening Saves Lives

Written by  Suzanne Ramsey

Asked what he misses most about his dad, who died of prostate cancer in 1996, the Rev. Dr. William Lee talks of simple things.

“Saturday morning talks and cleaning fish under the tree and all the stories,” says Lee, pastor of Loudon Avenue Christian Church in Roanoke. “Picking a few crabs, hearing him spin some yarns. All of his brothers gathering, the Lee men under a tree. I miss that. I miss the conversations.”

What is prostate cancer?

Prostate cancer is a cancer that occurs in a man’s prostate — a small, walnut-shaped gland that produces the seminal fluid that nourishes and transports sperm.

Source: WebMD  

Lee’s dad, Leon Lee, lived in Nuttsville in Virginia’s Northern Neck. He worked in the seafood industry, fishing the Chesapeake Bay for menhaden in the warm months and shucking oysters in the winter. On Sundays, he sang in the choir at Beulah Baptist Church in Lively — no particular part, just “somewhere between baritone and bass,” Lee says.

“He was probably one of the most fun-loving people on the planet. He enjoyed life and he enjoyed living. He worked hard all his life and enjoyed family and having a lot of people around. His favorite beverage was Schlitz beer. He was a jokester, life of the party. If you came to the house, he held court.”

With the exception of a little gout, Lee’s dad was in good health until he was diagnosed with prostate cancer at age 63. Lee says he had gone home to Nuttsville for a funeral, and when he arrived saw his dad using a walker. Fearing this was more than a gout attack, Lee made an appointment for him to see his doctor.

At the doctor’s office, Lee’s dad had a prostate specific antigen test and a digital rectal exam, both of which are used to screen for prostate cancer. It was the first time he’d ever been screened.

“He had no health insurance. He never worked a job that had health insurance,” Lee says, adding that his father was too young for Medicare and “too poor for insurance.” 

What is prostate specific antigen testing?

Aprostate specific antigentest measures the amount of PSAin the blood.PSAis released into a man's blood by hisprostategland. Healthy men have low levels ofPSAin the blood; the level normally increases as a man'sprostateenlarges with age.

Source: WebMD 

Finding his PSA level high, a possible indicator of prostate cancer, the doctor ordered an MRI. The news was not good: Lee’s dad had prostate cancer and it had metastasized, meaning it had spread to other parts of his body.

“When he was diagnosed, the doctor’s statement was, ‘It’s a shame for a man to be in perfect health and so far gone with prostate cancer,’” Lee says. “He was a very strong man. It took a while for him to realize how sick he was.”

Lee says his father was devastated by the diagnosis and also by the prognosis, which was given in terms of months. "When I took him home, I remember him going into his room, closing the door and covering his head with the blanket.”

Lee says his mother urged him to go talk to his father, but Lee says he told her, “No, he needs to work things out on his own.” A few hours later, though, he talked with his dad about what he wanted to do about the cancer.

“I said, ‘Tell me what you want. Give up or fight?’” Lee recalls.

In the end, Lee’s dad agreed to undergo hormone therapy, a monthly injection that they hoped would slow the growth of the prostate cancer or kill the cancer cells. He lived for another three and a half years and even returned to work until the cancer returned.  

 “It came on more aggressive the second time, and he died in March of 1996.” Lee says.

What is hormone therapy?

Hormone therapy for prostate cancer is treatment to stop the male hormone testosterone from reaching prostate cancer cells. Hormone therapy for prostate cancer is also called androgen deprivation therapy.

Most prostate cancer cells rely on testosterone to help them grow. Hormone therapy for prostate cancer cuts off the supply of testosterone or stops testosterone from reaching the cancer cells, causing cancer cells to die or to grow more slowly.

Source: Mayo Clinic 

Lee conducted his dad’s funeral service, an occasion he describes as “quite a celebration.” The title of his sermon was “Sanctified Sorrow,” which he explains is “a different kind of sorrow, a holy sorrow,” that is more focused on celebrating a person’s life than mourning their death.

“The sorrow is not one of no hope,” Lee says.

In this celebratory spirit, Lee seriously considered lining his father’s casket with the Schlitz emblem in honor of his favorite libation, something his mom would have no part of.

“It was a huge gathering," says Lee. "My father knew everyone, and everyone knew him. It was a tremendous day. It was not a sorrowful day at all.”

At around the same time, Lee had been thinking about his congregation in northwest Roanoke and the people who lived in the surrounding community and how they needed better access to health care. What he saw in the neighborhood was a dearth of access to medical care — particularly preventive care — and he wanted to do something about it. After his father’s death, he was even more determined.

“It’s what fueled me,” Lee says.

Lee met with representatives from the local hospitals and the city of Roanoke and others in the community to see what could be done. At the time, he says, opening a medical clinic wasn’t on his radar, but that’s what he ended up doing. In 1999, he founded New Horizons Healthcare, a nonprofit, community-based, family health center that serves insured, under-insured and uninsured patients.

“It’s not a free clinic,” Lee says. “Everyone pays according to their ability to pay.”

Another thing New Horizons does, in cooperation with LewisGale Regional Health System, is to host an annual men’s health fair, where men can get free screenings for prostate cancer, among other health issues. Each year as the event approaches, Lee uses his pulpit to spread the word about the importance of being screened for prostate cancer. Notices are put in the church bulletin, email blasts are sent, and the issue is addressed at men’s meetings. And there are men from the community who are willing to talk about their experiences with prostate cancer.

“When those guys stand up and say, ‘Look at me,’ it really takes that issue away,” Lee says, referring to any reluctance the men may have to be screened.

So far, it seems to be working. Lee says that over the past dozen or so years he’s seen a number of men who have been diagnosed with early stage prostate cancer who are “very much alive and productive now.”

Lee says, “This is my passion. The best thing we can do for our children, our wives, our mothers, anybody, is to be tested so we can be around to be fathers to our children and brothers to our sisters — to be family. We can live beyond prostate cancer detection, but we’ve got to get it early — the sooner the better. It’s not a death sentence. It’s a matter of a wakeup call. You can treat it if we get it early.”

Who's at Risk?

According to the American Cancer Society, “other than skin cancer, prostate cancer is the most common cancer in American men.” The organization estimates that in 2015, approximately 220,800 U.S. men will be diagnosed with prostate cancer and about 27,540 men will die from the disease. The ACS says 1 in 7 men will be diagnosed with prostate cancer at some point in his life.

According to the Prostate Cancer Foundation and others, African-American men are even more at risk than their white counterparts.

The foundation reports that “African-American men are more likely to develop prostate cancer compared with Caucasian men and are nearly 2.4 times as likely to die from the disease. Although scientists do not yet understand why prostate cancer incidence and death rates are higher among African-American men, it is widely believed that ... a combination of genetic differences, lifestyle, nutritional habits and medical care may all play a role in the statistics.”

For this reason, Jennifer Vaughn, MD, with Blue Ridge Cancer Care in Roanoke, says some physicians, herself included, “have a lower threshold to encourage PSA screening in their African-American patients. However, we do not have enough objective data to state whether more-intensive screening in the African-American population would improve survival. Therefore, this is always a risk-versus-benefit discussion.”

At what age should men start getting screened for prostate cancer?

"In general, I would consider screening beginning at age 50 in men with an average risk for developing disease — non-African American and no family history. I do not recommend screening for men over the age of 80 or for those who have other diseases that may limit their life span. Among African Americans or those with a strong family history, some experts recommend that screening begin at 40. However, it’s unclear if this approach leads to better survival from the disease."

— Jennifer Vaughn, MD  

As an African-American man, Lee knew he was at greater risk for prostate cancer. He also has a family history of prostate cancer, with both his grandfather and his father dying of the disease.

“My health history suggested I might be at high risk, especially being an African-American male,” Lee says. “I had a biopsy when I was in my 40s and had elevated PSA. It came back negative, but from that day on I have been very cognizant of that. That’s why I was concerned about my dad.”

Research has shown that men with “first-degree” relatives — brothers or fathers — with prostate cancer are at increased risk of getting prostate cancer themselves.

“If you have a first-degree relative with prostate cancer, your own risk of developing prostate cancer may be doubled,” Dr. Vaughn explains. “If you have multiple family members with prostate cancer, your risk may be even greater.”

Research is also beginning to show there are genetic risk factors when it comes to prostate cancer.

“Men who have close family members who carry a BRCA mutation — the mutation most famous for increasing breast cancer risk — should consider being tested for this mutation,” Dr. Vaughn advises. “Men who carry the mutation are not only at increased risk for male breast cancer but also prostate cancer.”

What is the BRCA gene?

BRCA1 and BRCA2 are human genes that produce tumor suppressor proteins. These proteins help repair damaged DNA and, therefore, play a role in ensuring the stability of the cell’s genetic material. When either of these genes is mutated, or altered, such that its protein product either is not made or does not function correctly, DNA damage may not be repaired properly. As a result, cells are more likely to develop additional genetic alterations that can lead to cancer.

Source: National Cancer Institute

When asked about the symptoms of prostate cancer, Mark Currie, MD, of LewisGale Physicians, says there often aren’t any, at least in the early stages. Also, when symptoms do appear, they might be attributed to things like benign prostatic hyperplasia, or prostate gland enlargement, a common condition in older men that causes urinary problems.

What is benign prostatic hyperplasia?

Benign prostatic hyperplasia, also called prostate gland enlargement, is common as men age. BPH can cause bothersome urinary symptoms. Untreated, it can block the flow of urine out of the bladder and cause bladder, urinary tract or kidney problems.

Source: Mayo Clinic  

“Men tend to get some prostate symptoms as they get older, but these are not necessarily or usually indicative of cancer,” Dr. Currie says. “They usually reflect benign growth of the prostate gland. There are not really early symptoms of the cancer itself. That’s why we still think screening is useful, even if the powers that be seem to think it’s not that useful. I think it’s better to have information than not.”

What are symptoms of prostate cancer?

Early prostate cancer usually causes no symptoms, but more advanced prostate cancer can sometimes cause symptoms such as

  • Problems urinating, including a slow or weak urinary stream or the need to urinate more often, especially at night.
  • Blood in the urine.
  • Trouble getting an erection (erectile dysfunction).
  • Pain in the hips, back (spine), chest (ribs) or other areas from cancer spread to bones.
  • Weakness or numbness in the legs or feet, or even loss of bladder or bowel control from cancer pressing on the spinal cord.

Source: American Cancer Society 

Dr. Currie’s reference to "the powers that be" concerns the current controversy over whether prostate cancer screening causes more overall harm than good.

In 2012, for example, the U.S. Preventative Services Task Force, which describes itself as “an independent volunteer panel of national experts in prevention and evidence-based medicine,” concluded that “there is moderate certainty that the benefits of PSA-based screening for prostate cancer do not outweigh the harms.”

Dr. Vaughn explains the controversy this way: “What we learned after PSA screening was implemented into practice is that many men were diagnosed with low-grade or slow-growing prostate cancer that may never have caused them any real harm,” she says.

“These men, however, received treatments that had many side effects, and often experienced a reduction in their quality of life. Prostate cancer screening with PSA testing has therefore become highly controversial, so much so that the USPSTF has recommended against it for men of average risk.”

When Dr. Vaughn's patients don’t want to be screened for prostate cancer, she tells men of average risk that this is a reasonable choice. However, when discussing prostate cancer screening with patients, “I try to make it clear that we cannot predict with certainty which men will develop the more aggressive form of the disease, in other words, who will benefit from screening.”