When it comes to preventing any number of serious health conditions, medical guidelines and expert recommendations always stress the importance of screenings. In the case of prostate cancer and African American men, early screening is stressed. But according to one renowned prostate cancer expert, screenings alone may be missing the mark when it comes to catching prostate cancer early, particularly in Black men. “I would say that I do not believe in ‘screening’ of prostate cancer. I do believe very strongly in early detection,” revealed Dr. Fleming of Virginia Oncology Associates in a recent interview with BlackDoctor.org. “Because early detection saves lives.”
At first read, this may sound a little confusing. Wouldn’t screenings be a part of early detection? Screenings are a good thing, right? Dr. Fleming explains, “Screening implies that you take a random population of patients and you do some testing and you attempt to diagnose a disease with the hope of starting treatment earlier. Early detection really is more appropriate when you have an informed patient and informed physician who looks at what are the optimal treatment strategies for prostate cancer.”
Many times, you will hear of churches, barbershops or health fairs conducting mass screenings by providing free prostate-specific antigen testing, more commonly known as the PSA test. A blood sample is taken and tested for the levels of protein produced by cells of the prostate gland. The blood level of PSA is often elevated in men with prostate cancer.
Individualized attention that takes into account family history and current health conditions may be lacking from the group efforts. The randomized screening of men is what Dr. Fleming disagrees with. In addition to the PSA, Dr. Fleming states providing digital rectal exams and patient education in conjunction with PSA are necessary and it’s these three together that help men optimize their chances of early detection. To do one without the other two is insufficient and not early detection, according to Dr. Fleming.
Think of these as your winning trio.
A digital rectal exam is when the doctor uses a gloved finger to feel the prostate gland, checking to see whether it is smooth or not. Just the thought of this is enough to keep men from having this procedure performed, Dr. Fleming describes it an “uncomfortable” rather than painful. For those men who look to get out of having a rectal exam, Dr. Fleming likens its necessity to women getting mammograms for breast cancer. “A mammogram isn’t comfortable, but if you’re interested in early detection, trying to take control of your health, then digital rectal exam and a PSA is appropriate for the early detection of prostate cancer. It’s really the only way to optimize the early detection of prostate cancer.”
Education refers to not only doctors educating their patients about prostate cancer and their options, but also doctors being more educated themselves. “The American Urological Association does not provide really good guidance in terms of African Americans. Just the fact that we’re African Americans we’re at higher risk. We’re not at, quote ‘average’ risk. And so their guidelines do not address African Americans whatsoever.” Informed providers must know that when working with African American men, age 40 to 45 is appropriate to begin early detection.
Dr. Fleming works closely with local health systems to educate doctors in his SE Virginia community, where rates of prostate cancer and mortality are disproportionately high.