Black Men and Prostate Cancer Screening

Zachary Klaassen:

Hi. My name is Dr. Zach Klaassen. I'm a urologic oncologist at the Georgia Cancer Center in Augusta, Georgia. I'm delighted to be joined by Dr. Sam Washington, who is a urologic oncologist at UC San Francisco. We're joining together today on Prostate Cancer Patient Voices to discuss health equity, specifically Black men and screening for prostate cancer. So Sam, thanks for joining us today for this conversation.

Samuel Washington:

Yeah, thanks for having me.

Zachary Klaassen:

So just to set the background, we know that generally, one in eight men will get prostate cancer, but we know that among Black or African American men, this may be as low as one in six. And we know that there may be some biological, maybe some systemic reasons why this may be the case. Maybe outline both of those for our listeners.

Samuel Washington:

I think there's always been, especially in medicine and in science, our assumption is that biology is driving these differences. And thankfully, there's been more data to show in settings where access to screening, appropriate follow-up is the same, we're seeing that those differences are decreased significantly. I think also, other population studies tell us that there are areas of the country and populations such as Black men where they are at higher risk because of these non-biologic factors, but how they interact with that environment and the medical institutions in which they would receive care.

Zachary Klaassen:

I see. And we were talking offscreen about Alameda County and some of the work you've done there. What are some of the gaps and some of the barriers for Black men specifically to get prostate cancer screening?

Samuel Washington:

Yeah. Well, I'm excited about this new partnership with Alameda County Public Health Department. Their focus has really been on prostate cancer screening because it responds to the needs within their area, and broadly, I think it's the same issue. We need to respond to the needs of the populations that we treat. 

Understanding what those barriers are is important, and I think a lot of that, you can only get by talking to those populations in those areas. What we've seen is that based on where you live, those differences do matter, and it comes down to how you go from a blood test, that true first point of screening, through all the other steps that we know as providers to get to that diagnosis.

Zachary Klaassen:

And maybe just mention, what is screening for our patients? Why do we do screening for prostate cancer?

Samuel Washington:

So the whole idea behind screening is testing with a PSA on men who have no symptoms. So the overarching goal is for us to define cancer, to find cancer that would impact their lifespan well before it's grown outside the prostate, so when we have that opportunity to cure it.

Zachary Klaassen:

And I think one thing that's important for our patients and their caregivers to understand is that we think all men should get screened, but it's particularly important for Black men. This is one of the health inequities that we see is that they're getting screened less than the rest of the population. So why is it important specifically for Black men to get screened for prostate cancer?

Samuel Washington:

Well, I always say I'm a numbers nerd, and just the numbers are there. National statistics tell us which groups are at higher risk. They tell us that the rate of aggressive disease may start sooner for multiple different reasons. And I would argue that being a Black man myself, I always ask, am I at higher risk? And the fact that we don't have a clear answer to that tells us that we need to ask questions sooner and be certain that we get answers faster.

Zachary Klaassen:

And so somebody who's listening to our conversation, they're at risk of prostate cancer, maybe they're not. They're just listening and they're curious, maybe their dad had prostate cancer. When should men in general and when should Black men specifically get tested for prostate cancer with PSA screening?

Samuel Washington:

Well, we've traditionally always talked about the general population being around the age of 50 for screening. Pushing that back sooner, particularly for men with a positive family history. A known inherited risk, meaning some factor passed on from parents to children that increased the risk of cancer. So Black men being at higher risk of worse outcomes, pushing that earlier to 45 is a good starting point to start having that discussion and testing.

Zachary Klaassen:

Yeah, it's a good number. So I think the take home from that is average risk Black men probably should get tested at 45, and even younger, depending on whether their father, their brother, maybe an uncle had prostate cancer. Is that a fair statement?

Samuel Washington:

Yeah, and that's where we're seeing that people are acknowledging this risk. Some groups say 45 to 50, some say 40 to 45. The key is really knowing that number early so you have that baseline understanding of your risk, and you start to continually test and measure over time to see if that's changing.

Zachary Klaassen:

That's great. I think one of the barriers, at least in my practice, and I practice in an area of Georgia where there's a lot of underserved men as well, is just figuring out what to do. So they hear this conversation. Should they go to their primary care physician? Should they go to their ... If they have a urologist, how should they approach this? How should they have that conversation?

Samuel Washington:

I tell everyone it can be tough to navigate that medical system in healthcare and testing. The first step is getting that blood test. No matter what it shows, that gives you more information, more data, and helps people like us understand what to do next. Sometimes, that means even if your primary care doctor is not interested in testing, letting them know, "I know I'm higher risk. I should know what that number is to start out with." Once you have that number, that can inform the next steps.

Zachary Klaassen:

Yeah. I think for anybody listening to our conversation, one of our take homes is be an advocate for your health. Be an advocate for your screening, be an advocate for not just prostate cancer, but blood pressure, diabetes, heart disease, all these things. We'll try to make it as easy to get it done, but we have to get the message out there. I think being an advocate for your health is important. I think as we wrap things up, is there anything with regards to health equity or health inequity with prostate cancer screening that we haven't mentioned yet?

Samuel Washington:

I think the key is for us to understand what it truly looks like, and I think for us in the medical field, we understand that healthcare is a process. It's not a single point in time connected to another distant point in time. For me to go from a PSA to a diagnosis of prostate cancer is multiple visits, so understanding what health equity looks like in the delivery and process of healthcare is a very different question than what we've asked before in many settings. So really teasing that out will help us better support our patients.

Zachary Klaassen:

Absolutely. Final take home point, what's your message to a Black man or underserved patient listening to our conversation about getting in with testing, understanding what your number is?

Samuel Washington:

I tell everyone, ask questions and get that number. That's consistently what we tell all our community partners and everyone that we screen in the community currently.

Zachary Klaassen:

Wonderful. Sam, thanks for joining us on Prostate Cancer Patient Voices.

Samuel Washington:

Thanks again. Always happy to be a part.