Proton therapy, education can help remedy racial disparities in prostate cancer care

African American men diagnosed with very low-risk prostate cancers are much more likely than white men to actually have aggressive disease that goes undetected with current diagnostic methods, a John Hopkins study recently suggested.

According to the American Cancer Society, prostate cancer occurs more often in African American men than in men of other races. African American men are also more likely to be diagnosed at an advanced stage and are more than twice as likely to die of the disease as white men.

And despite the fact that African American men are more likely to be diagnosed with more advanced prostate cancer than white men, they are not receiving optimal treatment, such as proton therapy.

One way to lessen these disparities is through education, said Keith Gregory, executive director, Hampton University Proton Therapy Institute (HUPTI) in Hampton, Virginia. “At HUPTI, we partner with organizations such as the Hampton Roads Prostate Health Forum on various events,” said Gregory. “At these events, we provide information about the importance of early detection of prostate cancer as well as the use of proton therapy as a treatment option.”

One reason proton therapy has a role to play in helping reduce racial disparities in prostate cancer care is because it does not have the side effects of traditional photon radiotherapy. “The patients we treat at HUPTI, particularly the patients we treat for prostate cancer, have told us that they’ve had a better quality of life after protons,” said Gregory. “And a better quality of life translates into fewer trips to the physician to deal with side effects. That’s the role that proton therapy can play in prostate cancer.”

Past research has indicated that lack of health insurance, unequal access to health care services and absence of ties to a primary care physician are among the barriers to prostate cancer screening for African Americans.

“I think the issue is that a disproportionately small percentage of African American men are being screened for prostate cancer in the first place,” said Robert Marckini, author of the book “You Can Beat Prostate Cancer” and founder of Brotherhood of the Balloon, a 6,500-member group of men who chose proton therapy to treat their prostate cancer.

“I’d estimate that less than 2 percent of the members of our group are African Americans,” Marckini said. “That tells you that the number of African Americans who find the best treatment in the world for prostate cancer, proton therapy, is disproportionately low.”

“In the African American community, there are issues with access to health care,” said Gregory. “There is also a lack of education about the value of early cancer detection and the role early detection can play in a patient’s long-term survival.”

These factors, in addition to the seeming propensity of black men to develop more aggressive prostate cancer than white men, make community outreach and early detection especially important to African American families.

PSA testing is an important early-detection tool for prostate cancer

In 2012, the U.S. Preventive Services Task Force (USPSTF) advised the elimination of a routine prostate-specific antigen (PSA) screening test for prostate cancer in healthy men. Champions for early detection of the disease were not pleased.

 

“They are doing the male population in this country a huge disservice,” said Robert Marckini, author of the book, “You Can Beat Prostate Cancer” and founder of Brotherhood of the Balloon, a 6,500-member group of men who chose proton therapy to treat their prostate cancer.

The USPSTF said science indicates “there is a very small potential benefit and significant potential harms” in PSA screening, and that routine PSA screening could lead to false positives, which in turn could result in overdiagnosis and overtreatment.

“The problem is not that too many men are being diagnosed with prostate cancer,” said Marckini. “The problem is that men are being overtreated for prostate cancer. So do you throw the baby out with the bathwater? Stop diagnosing the disease because some urologists are being too aggressive and doing surgery on men who could do watchful waiting? No — you educate patients and get doctors to act more responsibly.”

With watchful waiting, patients are not treated, but monitored closely to detect any progression of the disease. If the disease progresses, an appropriate treatment can be prescribed.

The earlier aggressive prostate cancer is detected, the greater the chances of it being contained in the prostate without migrating to surrounding tissues, and the better the chances of considering proton therapy as a treatment.

Prostate cancer is often treated by performing a radical prostatectomy, an operation that involves removing the prostate and any nearby tissue that may contain cancer. However, removing the prostate can often cause impotence and incontinence.

With proton therapy, prostate cancer is treated with very precise, targeted proton beams that target only the tumor volume with minimal impact on surrounding healthy tissues. There is usually no negative impact on the ability to have an erection or to retain bladder control.

“When men find out they have prostate cancer, and the urologist starts talking about morbidity and potential surgical side effects such as impotence, incontinence, strictures, infection and other things, it frightens men,” said Marckini, himself a prostate cancer survivor who underwent proton therapy 12 years ago. “But men should not fear getting diagnosed or worry about side effects. Because there is a treatment that can almost guarantee they will not lose bladder control and give them the absolute best chances of maintaining sexual function. And that’s proton therapy.”