Men’s Health Week (11 – 17 June) is an opportunity to raise awareness of the signs and symptoms of male cancers and how to access help and support. In this blog, Professor Frank Chinegwundoh, explains that the risk of prostate cancer is increased in black men and how a blood test for PSA (prostate specific antigen) that is available to men over the age of 45 might save a life.
Prostate cancer is the most common cancer in men in the UK. Although it affects all men, black men are 2-3 times more likely to develop this cancer than their white counterparts. The death rate is twice as high. Furthermore, black men are more likely to develop prostate cancer at a younger age.
It is essential that black men, in particular, know about their increased risk of prostate cancer.
Why it is more common is unknown; there is much research worldwide to discover the reason.
Every black man over the age of 45 years is eligible to have the blood test, called PSA (prostate specific antigen) from their GP. All he need do is to request one from the GP and have a discussion about it. Every GP in the land has been sent a document called the Prostate Cancer Risk Management Programme, which says that men, even with no urinary symptoms, can have a PSA on request. There are some limitations of the blood test which the GP can point out. For example, a raised PSA (above 3 units) does not necessarily mean that there is prostate cancer. There are other reasons why a PSA may be raised.
More often than not, prostate cancer in its early and therefore curable stage does not present with symptoms, hence the importance of the blood test. Some men will have urinary symptoms, such as a slow urinary stream or passing urine frequently, or getting up at night, or having to get to the toilet in a hurry. These do not mean the man has prostate cancer. Far more common is an enlarged prostate gland that occurs as men age. However, as these symptoms are indistinguishable from those of prostate cancer, they should be checked out by a health care professional.
Black men face an increased risk of prostate cancer so a lack of urinary symptoms, should not be the basis for refusing to conduct a PSA test.
It is also worth noting that prostate cancer can run in families. So, if a first-degree relative, such as a father or brother, has prostate cancer, your risk is doubled. A family history of prostate cancer is therefore a reason for asking for a PSA blood test. A digital rectal examination is off-putting for many men. However, it can detect a problem with the prostate gland even where the PSA is normal. However, the PSA is more useful. Men should at least have the blood test even though they may decline the rectal examination (which is the only way of feeling the prostate).
A suspicion of prostate cancer, whether on account of an abnormal blood PSA or an abnormal feeling prostate on rectal examination, will lead to an urgent referral to see an urologist. Further tests include a MRI scan and a biopsy of the prostate gland. A biopsy is where samples of the prostate gland are taken and analysed in the laboratory for signs of cancer.
If cancer is diagnosed, keeping an eye on it may be advised as many prostate cancers will never cause a problem (‘active surveillance’). If there is more than a minimal amount of cancer a more aggressive treatment may be recommended, such as surgery or radiotherapy.
The success rate of treatment is very high when prostate cancer is detected early. Even if the disease has spread (called metastasized) there are good treatment options, if not necessarily curative.
In summary, black men are at increased risk of prostate cancer. I would urge all black men over 45 years old or even younger if someone in the family has had prostate cancer, to get themselves a PSA blood test from their GP. The cure rate is very high when the disease is found early. This Men’s Health Week I’m urging everyone to talk about prostate cancer, and prostate cancer in black men and their family background.