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Because prostate cancer tends to grow slowly and not all men
experience symptoms, physicians recommend screenings start at age 55. But MetroHealth urologist
Charles Modlin, MD, emphasizes the need for screenings in Black men to start much earlier.

Contributed by Charles Modlin, MD, MBA | Director of Health Equity & Medical Director of the Office of Equity, Inclusion & Diversity.

Prostate cancer is the most common cancer diagnosed among men in the United States, after skin cancer. This year, the American Cancer Society estimates 288,300 new cases will be diagnosed.

Because prostate cancer tends to grow slowly over many years, and not all men experience symptoms, physicians recommend that screenings for most men start at age 55. But MetroHealth urologist Charles Modlin, MD, emphasizes the need for screenings in Black men to start much earlier, at age 40.

Q:  When should men start seeing a Urologist?
A:  If someone is having symptoms (difficulty urinating, getting up frequently at night to urinate, pelvic discomfort, etc.), they should make an appointment to see a urologist. A urologist is a surgical subspecialist who treats men and women. They have clinical expertise in treating and diagnosing conditions of the urinary tract. And in men, that extends into the male reproductive system.

One of the most common conditions that we see is the benign enlargement of the prostate, which usually starts happening as we get older, around age 40. So, in addition to a primary care provider, all men need to have a urologist.

Q:  When should black men start getting screened for prostate cancer?
A:  The American Urological Association recommends white men with no family history of prostate cancer wait until age 55 to start screening. But for Black men and men with African ancestry, and all men with a family history, they should begin screening at age 40. Most men diagnosed with prostate cancer have no symptoms.
Q:  Why do black men need to get screened at a younger age?
A:  Black men have almost twice the incidence of developing prostate cancer than white men. And they have twice the death rate from prostate cancer than white men. One reason for that is that they are often diagnosed at a later stage, which points to a disparity in access to health care.

Statistics show that 1 in 8 or 9 American men will develop prostate cancer. For Black men, it’s 1 in 6. And for Black men with a family history of prostate cancer – a father, brother, uncle, first cousin or grandfather who had it – it’s 1 in 5. So, we need to be more aggressive in screening these individuals.

Q:  What does the screening consist of?
A:  A digital rectal examination (DRE) and the prostate specific antigen (PSA) blood test are done in one visit. If men don’t want the DRE, we can do the blood test alone.
Q:  What happens next?
A:  As urologists, we consider additional risk factors (age, race, family history) to determine what PSA score is considered “normal,” how frequently to screen, and whether a prostate biopsy – the only way to definitively diagnose prostate cancer – is needed.

The pathology results of a malignant tumor are graded using a system called the Gleason score, which goes from 6 to 10. The higher the number, the higher the grade, meaning the cancer is more likely to spread. Not every man diagnosed with prostate cancer needs to be treated right away, if at all. If the prostate cancer is a low grade, it may never affect them during their lifetime, if they’re in their 60s, 70s, 80s. But for younger men, it is likely that that cancer will enlarge enough over time to eventually require treatment.

Q:  What is active surveillance?
A:  Active surveillance, or watchful waiting, consists of getting PSA blood tests every three to four months to monitor the score. It also includes repeat prostate biopsies every 18 months to two years, to see if the pathology grade goes up. Black men with a grade of 7 have a higher incidence of progression than their white counterparts with the same score, so MRI imaging also may be used to track the size of the prostate. We need to follow them very closely.

Active surveillance has only been really part of the practice in the last 10 years or so. Before that, we probably were overtreating some men because every man who was diagnosed was recommended to undergo treatment.

One reason we’ve adopted active surveillance is to avoid some of the complications and side effects that can accompany treatment.

Q:  What are the treatment options?
A:  Prostate cancer is treated with radiation therapy, hormonal therapy or radical prostatectomy, the surgical removal of the prostate. Prostatectomy is almost exclusively performed using robotic surgery now. It’s less invasive and allows for a speedier recovery.

Some men with these low grades prefer to undergo treatment because they don’t like the thought of having cancer in their body and not having it addressed.

Q:  What one thing should black men do today?
A:  Whenever possible, all men should try to gain knowledge about their family medical history and if prostate cancer (or any other cancer) runs in the family.  Also, tell your relatives that when they turn 40, they need to get screened for prostate cancer.

Talk to your primary care provider about prostate cancer screenings.
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Charles S. Modlin Jr., MD, MBA

Director of Health Equity & Medical Director of the Office of Equity, Inclusion & Diversity.