If you’re a Black man, you’re 70 percent more likely than a white man to get prostate cancer. That’s a figure straight from Cancer Statistics 2023, a report by the American Cancer Society (ACS). Also worrisome is that after a two-decade decline, prostate cancer rates are on the rise again.
Prostate cancer is the most commonly diagnosed cancer in Black men and the second leading cause of death in all men after heart disease. Annually, about 12,000 Floridians are diagnosed with prostate cancer and more than 2,000 die each year. With September marking Prostate Cancer Awareness Month, physicians at Baptist Health Miami Cancer Institute would like you to understand more about the risks, screening recommendations and newest treatments for prostate cancer.
Murugesan Manoharan, M.D., chief of urologic oncologic surgery and Abbhi Family Endowed Chair in Urologic Oncology at Miami Cancer Institute
“Managing prostate cancer starts with screening and early diagnosis,” says Murugesan Manoharan, M.D., chief of urologic oncologic surgery and Abbhi Family Endowed Chair in Urologic Oncology at the Institute. “We have many treatment options, and we now have the ability to personalize treatment, but just as with other types of cancer, the earlier it is caught the better.”
The prostate is a small gland located deep in the groin, behind the base of the penis. It helps regulate urine flow and produce seminal fluid. While it tends to enlarge as men age, enlargement isn’t necessarily a sign of cancer.
Risks and screening recommendations
The U.S. Preventive Services Task Force recommends that men speak with their doctors about periodic screening using the prostate-specific antigen (PSA) blood test. In addition to being Black, those at increased risk include men who:
· Are age 55 and above (50 and above for Black men)
· Have a family history of prostate cancer
· Have a BRCA1 or BRCA2 genetic mutation
Additionally, smoking and obesity are believed to be contributing factors.
Early detection ― and the high-tech treatment that can lead to the best survival chance ― is a problem when minority groups do not have access to quality care. The ACS report stated, “Among patients who were most likely to benefit from definitive treatment, Black men were 11 percent less likely than non-Black men to receive it.”
Dr. Manoharan has observed this firsthand, particularly among his Haitian-American patients, many of whom find the cost prohibitive or do not have easy access to care. “Making an informed decision about whether prostate cancer screening is right for them is paramount for men’s health and wellbeing,” he said. “And having access to unbiased information and advice from a medical expert is key.”
Miami Cancer Institute is at the forefront of the movement to address health inequities, recently establishing the Center for Equity in Cancer Care & Research to help identify social determinants of health and improve access to clinical trials.
Common symptoms of prostate problems
Symptoms that should send you to your physician are also those that can be signs of prostate problems that are not cancerous. Talk to your doctor if:
· You are urinating more frequently than usual
· You have pain in your penis or testicles
· It is difficult to begin urinating
· Your urine stream is slow or you experience dribbling
· There is blood in your urine or semen
Treatment is personalized
For those who seek prostate cancer care from an experienced center like the Institute, which offers an array of treatment options, survival rates can reach upwards of 90 percent. Treatments include robotic and nerve-sparing surgery, proton beam therapy, brachytherapy, cryotherapy and high-intensity focused ultrasound (HIFU). Physicians also use laser ablation, hormone and other drug therapy and chemotherapy.
Immunotherapy, using medications to help harness the body’s own immune system to destroy cancer cells, has already made significant inroads in treating a variety of cancer and is continuing to show promise in treating prostate cancer.
Dr. Manoharan adds that patients want minimal side effects and a high quality of life in addition to good outcomes. This includes a quick surgical recovery (minimally invasive techniques mean that many Miami Cancer Institute patients can return home in 24 hours); no incontinence (advances in surgery have decreased the chances of incontinence from 10 to 2 percent in two decades); and a healthy sex life (for those potent before surgery there is now a 75 to 90 percent chance they will remain potent after nerve-sparing surgery).
The Institute has also pioneered the use of hyperfractionated radiotherapy, where higher doses of radiation are spread over fewer days, rather than the traditional radiation course which can require daily visits for up to six weeks.
“We want to provide total care, a combined approach to do what is best for the patient,” Dr. Manoharan says. “This is possible because we have everything under one roof. We can choose whatever is best for the patient.”