My Black is NOT Cracking.

A post on prostate health by John Washington

In a period of about two weeks in January, I learned that not one, not two, but three men I knew had either recently been diagnosed or had recently had surgery as a result of a prostate cancer diagnosis.  Over the past few years, I had already learned of several friends that had battled and survived prostate cancer.  Until that time, I had only known a few older men that had lost their lives to the disease, but they were much older.  Old enough to be my parents.  One actually was a stepparent.

This was different.  These were my friends and folks my age and younger!  Two were just on the other side of 50!  All these brothers being diagnosed with the same thing!  I mean, what the hell is going on?  I didn’t go all conspiracy theory or anything?  You know, suggesting that alien forces, or friends of Trump, were out there trying to wipe out the race by killing off all the brothers.  But I found it to be alarming, nonetheless.

No, I’m afraid that ignorance, fear, lack of information, access to medical treatment and prevention, and misinformation is what’s putting my brothers at risk.  Rather than do my usual research, I asked my contributor John “Jay” Washington, who from personal experience alone, is far better equipped to speak on the subject than I could ever be no matter how many articles and papers I read!  As Jay states in his post, brothers are almost twice as likely to be diagnosed with prostate cancer and more than twice as likely to die from prostate cancer compared to non-Hispanic white men. But on a positive note, prostate cancer with early detection is both treatable and curable.  Key words.  EARLY DETECTION.

So, this post is not only for my brothers out there, but for the women, (or whomever) that love them! 

Sikhona (I am here to be seen)! Sawubona (I see you!)

Every so often parts of my body yell out for attention. I think the African greeting Sikhona (Hello, see ME!) is an integral part of my relationship to parts of my body. It is a dialogue that happens often as I get older. Whether it’s a tight hip flexor or a muscle spasm in my back, my body speaks out to me. Sometimes I’m thinking, “where in the hell did that pain come from?” Then I need to remind myself that what’s causing it is partly due to my aging body. I resolve to take better care of myself, but I’m finally beginning to accept the fact that “my Black is cracking a little!”

What concerns me most is when my organs scream out at me. I imagine them saying, “See me, please see, me. I am here!” In the words of the traditional African American spiritual, my organs go on to say, “I’ve been ‘buked and scorned” and I can’t go on like this without your help. Then I imagine them deciding after ignoring them “Okay, time for me to act up and throw you off a bit. No love and no attention, then I’m going to disrupt your life maybe for the day, week, or perhaps even months! It all depends on how I’m being treated.”

I’ve learned to at once reply by saying the current popular cultural phrase with African origins, Sawubona (Hello, I see YOU!) More than being polite, these greetings carry the importance of recognizing the worth and sanctity of each part of my body. Although these greetings are meant to symbolize the importance of another person and integrating ourselves into our communities, it also helps me to be aware of my body’s needs and give importance to it. 

---

I could go on about other intermittent medical conditions and as I look back, I’m glad I can chuckle about some of them. Others not so much. This brings me to the topic of my essay that I want to share: our prostates and reasons for us to foster discussions about ways to keep our bodies healthy and alive.  We Black men appear to have gotten a bad rap here or so the statistics make it look that way.

According to my electronic medical records, I’ve been getting a Prostate-specific Antigen (PSA) blood test since August of 2013. This test measures a protein in my prostate that if elevated might indicate cancer. It also can show an infection as well. I’m not quite sure if 2013 was the first time that I took a blood test for it, but I do remember getting checked at prior annual physical examinations. And yes, the checkup involved the doctor sticking a finger up my butt to feel if it’s ok. All I ‘gotta say about that is that it’s all in a day’s work – both the doctors and mine in keeping healthy!

When I got my PSA test results in September of 2018 after my annual routine physical examination, I was alarmed. At the time of my visit, my doctor hadn’t mention anything unusual when he felt my prostate and since the test results had always been within a normal PSA range of 0-4.5 nanogram (ng) per milliliters (ml), a very sensitive test I might add, I figured all was cool. On that day my prostate decided to scream out, “Hello? See ME?” My PSA test was 9.9 ng/ml! Oh God please don’t let it be cancer. I’ll tell you more about my high-test results later but first I must share a related story.

---

You remember my dad, Johnny, from my last post, right? My hero who modeled a bunch of good and healthy behaviors. Well, I recall him having an episode while at an out-of-town conference that he had driven 90 miles to attend. During a restroom break at the conference, he couldn’t pee, so he drove the 80 miles back home to his doctor only to be sent to the hospital for emergency surgery. I can only imagine that not being able to pee with a full bladder for all that time must have been painful and torturous. Long story short, his prostate had become enlarged and constricted his urine flow. I’m fairly certain that it was removed during the surgery and if it was cancerous, we, his offspring, (my sister and I) will never know. To his benefit, prostate removal can be due to a noncancerous increase in the size of the prostate, but I don’t know that either for he never discussed it.

Firstly, driving home with a condition like that was extremely dangerous. He could have passed out and injured or killed himself or others on the road. Secondly, my dad not sharing his diagnosis (cancer or not) with his son and daughter jeopardizes our health. At this point, I can only assume it was cancerous. Therefore, I take proactive steps to detect cancer in my prostate early so that I can have a fighting chance to survive it if ever diagnosed. I am also sharing my information with my kids about any familial cancer risks so they can respond appropriately. Of all human cancers, prostate cancer is the most common cancer among family members with 57% of prostate cancer attributable to genes that run among families according to the Prostate Cancer Foundation (PCF). If you have received a prostate cancer diagnosis, it’s important to speak with your family about risk, prevention, and screening.

In the last 25 years, hereditary genetic mutations that occur in families have been discovered that may increase the risk of developing certain cancers. As many of you may recall, Angeline Jolie is probably the most famous beneficiary of genetic testing when she had her breasts removed to prevent cancer that ran in her family due to a mutated gene. Some of these same gene mutations that increase risk for not only breast, ovarian, colon or pancreatic cancers, but also for prostate cancer share similar genes. Therefore, it’s important to also know and discuss your family history of all cancers. Moreover, PCF research has shown that men of West African descent may have an increased risk for aggressive disease, based on inheritance of certain gene combinations for prostate cancer.

There are famous Black men who have shared their diagnosis publicly. The list includes Sidney Poitier diagnosed nearly 30 years ago, Harry Belafonte diagnosed at age 69, Colin Powell who underwent surgery to remove his prostate in 2003, Ken Griffey Sr. (a retired Major League Baseball All-Star for some who might not know of him) was first diagnosed at age 55, and Al Roker who had his prostate removed in 2020. AS these celebrities have proven, raising awareness, and speaking out is crucial to saving lives.

Yet still, we Black men have a hard time discussing this disease and other maladies with our family and friends. In Western culture, the social expectations of being a man may explain a commonly held belief that men should not be or appear weak. This a cultural construct that carries over, for us as American Descendants of Slaves, (ADOS) into a common psyche also influenced by the historical social construct of slavery. We may unconsciously try to prevent diminishment of our “manhood” and maintain some level of “credibility” – our power, strength, and sexual potency – however inappropriately placed or not. It was the slave trade that catapulted our bodies to perform as a “commodity.” America in the late 18^th century until the start of the American Civil War was a period of economic growth predicated on the power, strength, and virility of Black male bodies. These bodies were able to endure and survive the worst conditions to work the fields. Additionally, as legal property supported by the US and European power structure, we in turn were bred like animals to produce more “commodities” or offspring for continued use by slave owners.

My Dad and our reticence to discuss prostate health is that as a man, we do not want to appear weak or vulnerable. Moreover, when our health threatens us “down there,” we continue to fiercely protect the only historical value that was granted to us. Perversely, this value system continues to this day in one disguised form or another. We may treat the threat of disease to our manhood by preventing it by letting it go unrecognized and not made public. For many men, it may be an embarrassment.

I firmly believe in not overgeneralizing or attributing problematic issues to just one cause therefore it is worthwhile to add that there are most likely other factors or a combination of factors that contribute to the silence. I can respect privacy rights, but enough of us has to give up that right for our own health and the wellbeing of our family and community. I encourage a conversation on this topic and welcome other thoughts especially from Brothers after reading this post. As we can see, we do not want to shortchange our children and their offspring.

---

The prostate is a small walnut-sized gland below the bladder that produces the seminal fluid that nourishes and transports sperm. Sperm is made in the testes and travels through tubes to the prostate. There is a mass of nerve bundles near the prostate that control erections and these nerve bundles are often disturbed during cancer treatment. When cancer occurs in the prostate, the cells grow uncontrollably, and form masses of abnormal cells known as tumors. Prostate cancer is one of the most common types of cancer. Many prostate cancers grow slowly and are confined to the prostate, where they may not cause serious harm. Other prostate cancers grow more aggressively and can spread quickly.  

According to ZERO: The End of Prostate Cancer, African American men are 1.8 times as likely to be diagnosed with prostate cancer and 2.2 times as likely to die from prostate cancer compared to non-Hispanic white men. It appears that genetics, biology, and environment contribute to this disparity. At the time of diagnosis, Black men tend to have a more advanced and aggressive disease. This may be linked to genetics (risk of more aggressive disease) or socioeconomic factors (less access to proper screening) or, most likely, a combination. Our environment creates risk factors that are complex, but some part of the increased risk is linked to systemic racism: lack of access to healthcare, poor interaction with providers, and mistrust of the healthcare system. This coupled with stress and little opportunities for developing healthy lifestyles create conditions that are not good for our bodies.

Let’s look at screening for prostate cancer. The current medical guideline on screening is to have a discussion with your doctor about the benefits and risks associated with it at age 40 if you are Black according to the PCF. The fact that it’s a discussion then followed by a patient’s decision with advice from his doctor and not just a standard blood test that you take and respond to like a deficiency in Vitamin D, first off, deserves a deeper dive!

Apparently, the medical establishment has found issues with the test’s accuracy since being marketed in the mid-80s. The original intent of the test was to follow the progression of a patient’s disease. I suppose what happened after that is that the manufacturer(s) of the test looked for other opportunities to sell their product and won FDA approval to use it for early detection too. Now here is where the conundrum lies, the test alerts doctors to the presence of cancer, but until recently there was no precise way to definitively figure out whether the cancers detected would have ever caused symptoms or harm during a man’s lifetime unless a biopsy is performed. Recent advances in genetic testing can aid in figuring out the aggressiveness of the cancer. These tests developed by “Myriad Genetic Laboratories” and “oncotypeIQ” helps guide treatment decisions. At the time of this writing, it is unclear whether these tests are FDA approved or just clinically approved.   

In my case, after getting a high PSA reading in September 2018, I went back for a follow-up about a month later and my reading went down a bit but was still elevated above the normal range. Finally, after waiting about 6 weeks for it to go down, I decided to have a biopsy in October 2018. It was an awful experience. My urologist stuck a device up me and took 12 tissue samples for laboratory analysis. I could hear the device snipping away at my prostate. Thank God the tests came back negative for cancer, yet my PSA number remained elevated. I was grateful to take that win, but it wasn’t until April 2019 that my numbers went back to the normal range.

I don’t remember my stress level, but I do remember it was occupying my mind a fair amount time. Bottom line, I’m glad I had the biopsy because it relieved the associated stress with wondering and waiting for my PSA number to come down. It really makes me stop think about the thousands of men who may have died needlessly from this disease and the millions of survivors out there who have survived it.

---

For those newly diagnosed with prostate cancer, the good news according to Zero is that 97% of African American men will be alive 5 years after their diagnosis. This survival number has increased due to us knowing our risks, getting tested, keeping a healthy lifestyle, and spreading the word to friends and family members.

In closing, although living a healthy lifestyle and eating right are good for you, they will not eliminate your risk of prostate cancer, nor will they cure you by themselves if you are diagnosed with prostate cancer. Prostate cancer can remain symptomless for a long time, so we need to educate ourselves about the risks and have regular screenings with a doctor. Early detection is critical as prostate cancer is always treatable and often curable.