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At the end of last year, the New York State Department of Health released its prostate cancer maps as part of Governor Pataki's Cancer Surveillance Improvement Initiative (CSII). The maps depict prostate cancer incidence across the state. One of the maps reveals that two Brooklyn neighborhoods, Bedford-Stuyvesant (Bed-Stuy) and Crown Heights, have "elevated incidence of late-stage prostate cancer." ("Late stage" means that the cancer has spread to other areas in the body.)
Crown Heights and Bed-Stuy are predominantly black, and black men in New York, as in the nation, have the highest rate of prostate cancer. Black men in New York State are one-and-a-half times more likely to get prostate cancer and twice as likely to die from it than white men. "It appears as though we are predisposed to prostate cancer," says Dr. Rupert Thompson, attending urologist at St. Mary's Brooklyn, a division of the Saint Vincent Catholic Medical Centers. The hospital treats prostate cancer patients from both neighborhoods. "The disease is a more aggressive disease in black men," says Dr. Errol Mallett, chief of urology at Interfaith Medical Center in Crown Heights. "We don't know why."
Although a gene that predisposes men to prostate cancer has been identified, only 8 percent of prostate cancer cases are inherited, according to Larry Thompson, director of communications at the National Human Genome Research Institute.
"I think it reflects cultural lifestyle or eating, like higher-fat diets," says Dr. Alfred I. Neugut, co-director of the Cancer Prevention Center at New York Presbyterian Hospital and professor of medicine and epidemiology at Columbia University College of Physicians and Surgeons. Black men in Africa have a lower incidence of prostate cancer, he says. If you take those African men and put them in the U.S., the next generation will have a prostate cancer incidence equal to that of African American men. "If it was genetic, this difference would not exist."
Diets high in fat are associated with cancer. "There is a higher correlation between fat and cancer than any other thing that is known," says Dr. Andre Balla, professor of pathology at the Medical College of Wisconsin. High-fat diets can lead to elevated levels of testosterone in men's blood, which can overstimulate the cells of the prostate, increasing cancer risk.
"It is more economics and living in a climate of stress," says Dr. Kamau B. Kokayi, medical director for the Kings County Acupuncture Clinic and head of a private primary-care holistic medical center in Park Slope, Brooklyn. Many men in the area, he says, who work two or three jobs, don't take care of themselves. "There is an aspect of being poor, an aspect of being black," he adds, "and an aspect of being in a material culture that causes stress."
Given that prostate cancer generally grows slowly, and doesn't have to spread, why aren't black men in Crown Heights and Bed-Stuy catching the disease before it spreads? Despite President Clinton's apology for the Tuskegee Syphilis Studyin which the U.S. Public Health Service conducted a 40-year experiment on the effects of untreated syphilis on 400 poor black menblacks often don't trust the medical system. There is a "great suspicion of the system" that goes back to Tuskegee, Thompson says. Kokayi agrees. "There is a general reluctance and hesitancy to deal with the system deliberately."
Dyer sees the vestiges of Tuskegee in resistance he finds when trying to recruit black men into clinical trials for CaP CURE. (CaP CURE was founded by former junk bond king Michael Milken after his prostate cancer diagnosis.) Says Dyer, "The clinical trials are full of white guys. . . . Tuskegee set a bad example." Delaying visits to doctors may then contribute to the high incidence of late-stage prostate cancer in Crown Heights and Bed-Stuy.
"What could be happening in that area is a lack of early diagnosis and treatment," says Kristine Smith, associate director of the health department's public affairs office. According to CSII, 14 percent of black men in New York State are diagnosed with the disease after it has spread, compared with 7.5 percent of white men. "We have been promoting screening vigorously," Mallett adds. However, "the turnout for the free screening is dismal."
Prostate cancer screening has two parts. The first is the prostate specific antigen (PSA) test. PSA is a protein produced by prostate cells, which is elevated in men with prostate cancer. The second is the digital rectal exam (DRE), which involves a physical examination for abnormalities of the prostate. The DRE is one reason for the poor turnout. Says Rupert Thompson, "The men might come by for the screening then disappear when they find out about the digital rectal exam."