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1
E D I T O R I A L
Finally, Good News about
Prostate Carcinoma in African
American Men
Mack Roach III,
M.D.
Department of Radiation Oncology, University of California–San Francisco, San Francisco,
California.
I
See referenced original article on pages 88 –104,
this issue.
Address for reprints: Mack Roach III, M.D., Department of Radiation Oncology, University of California–San Francisco, 505 Parnassus Avenue, L-75,
San Francisco, CA 94143-0226.
Received March 1, 1999; accepted March 9, 1999.
© 1999 American Cancer Society
n this issue, Myers et al. provide evidence that strategic interventions can have a positive impact on our ability to reduce the disproportionate burden of prostate cancer among African American
men.1 It is well known that African American men tend to present
with more advanced disease and, probably as a result of this, have a
markedly lower survival rate than others in the general population.
The study reported by Myers et al. contains good news. This landmark
study suggests that if the appropriate resources are provided, African
American men can be selectively and successfully encouraged to
adhere to prostate cancer screening and follow-up.
Although there is ongoing controversy about the value of screening for prostate cancer, it continues to be done widely. Recent studies
demonstrate that the rate of mortality due to prostate cancer has
declined recently.2 This probably reflects the first evidence of the
beneficial impact of screening and early treatment. In addition to this
study, the recent report by Labrie et al. from Quebec, Canada, suggest
that it is possible for screening to result in a substantial reduction in
prostate cancer specific mortality.3 The point is, if anybody should be
screened, African American men should be, and there is evidence that
screening may reduce mortality.
Screening certainly results in patients’ being diagnosed at an
earlier stage, which should make them “more curable.” Prospective
randomized trials have demonstrated that once patients decide to
have treatment, the treatment may have a significant impact on
survival. For example, a study conducted by the Medical Research
Council (MRC) of the United Kingdom showed that early hormone
therapy resulted in a reduction in mortality due to prostate cancer
and overall mortality compared with no initial treatment, but only in
patients who had nonmetastatic prostate cancer.4 An additional study
by Bolla et al. showed that if patients with advanced disease were
given hormone therapy plus radiation, they had better survival than
patients given radiation therapy alone.5 Both of these studies made
the point that people can no longer argue that “no treatment has been
shown to prolong survival from prostate cancer,” but in fact early
intervention for men with a significant tumor burden does result in
prolonged survival. An additional point is that those patients who
have undergone treatment have had a good quality of life when
formal quality of life studies have been conducted.
2
CANCER July 1, 1999 / Volume 86 / Number 1
In the report by Myers et al. there are a number of
findings that need to be acknowledged and made
known the public. First of all, among the 548 men
available for the telephone survey, 75% completed the
survey and consented to participate, and only 10%
refused. This finding reinforces the fact that African
American men are likely to participate in clinical trials
and are interested in being treated appropriately. This
study also shows that the intervention (in this case,
calling the patient, which is a common practice in
private doctors’ offices), has an impact. Calling the
patient makes the patient believe that we do care, and
African American men, like others, are responsive to
this type of signal. A third finding is that 71% of the
participants were age 50 years or older and more than
50% of the men had had less than 12 years of formal
education. Despite these facts, the patients still complied. They were still interested in participating, so
being elderly and being less educated does not mean
that individuals, in this case African Americans, are
not likely to participate.
A fourth finding of this study was that only 14%
thought they were at increased risk and only 19% were
worried. This demonstrates a lack of awareness. However, 86% indicated that they wanted to know if they
had prostate cancer. This suggests that we (physicians) may be overly paternalistic in assuming that it is
better if people don’t know that they have prostate
cancer. Our bias against screening should not be
forced on patients. If a patient believes that he would
like to know, he should be given the opportunity to
know. One in five patients believe that early detection
could cause health problems. This reflects some degree of awareness of the potential pros and cons associated with screening and treatment.
Based on a multivariate analysis, the most important findings of this study were that men who 1) were
age 50 years or older, 2) were married, 3) believed that
early detection should be done in the absence of
symptoms, or 4) reported an intention to have an early
detection examination were likely to undergo the appropriate screening. In addition, the single most important predictor of the likelihood of undergoing early
detection was being a member of the enhanced intervention group. This had an impact. It highlights the
fact that if we want to reduce the excess mortality
among African American men we now know how. We
know that enhanced intervention has the potential to
save lives and reduce mortality from prostate cancer
in this high risk population. We believe these men are
as likely to benefit from treatment as anyone else.6
Myers et al. are to be applauded for this classic demonstration. Hopefully, society will not ignore their important observations and will make certain that the
appropriate resources are applied to reduce our excess
mortality rate.
REFERENCES
1.
2.
3.
4.
5.
6.
Myers RE, Chodak GW, Wolf TA, Burgh DY, McGrory GT,
Marcus SM, et al. Adherence by African American men to
prostate cancer education and early detection. Cancer 1999;
86:88 –104, 1999.
Brawley OW. Prostate carcinoma incidence and patient
mortality. Cancer 1997;80:1857– 63.
Labrie F, Dupont A, Candas B, et al. Decrease of prostate
cancer death by screening: first data from the Quebec prospective and randomized trial. Proc ASCO 1998;17:2a.
MRC. Immediate versus deferred treatment for advanced
prostatic cancer: initial results of the Medical Research
Council trial. Br J Urol 1997;79:235– 46.
Bolla M, Gonzalez D, Warde P, et al. Improved survival of
patients with locally advanced prostate cancer treated with
radiotherapy and goserelin. N Engl J Med 1997;337:295–300.
Roach M. Is race an independent prognostic factor for survival from prostate cancer? [review] J Natl Med Assoc 1998;
90(11 Suppl):S713–9.
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