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Similarly, men's attitudes toward treatment may also aid the spread of the disease. Many of the men in the area who do get screened and are diagnosed with the cancer "don't want to get cut," says Thompson. "I don't think we've done a good job with men with allaying their fears," he says. Men fear the treatment's possible side effectsimpotence and incontinence. However, Thompson says, "Impotence can be spared and they can maintain their water." Dyer, who had a radical prostatectomy (removal of the entire prostate) says, "I'm next to perfect."
But treatment is dependent on access to doctors. Some of the men are not "plugged into the system," says an oncologist who treats late-stage cancer patients from the two neighborhoods and wants to remain anonymous. "What amount of this population is really going to the doctor?" And the quality of medical care may be an issue. Although there are a "handful of doctors with heart," Dyer says, there are those who, "because they are working in the bowels of Brooklyn, don't care." During a speech at a Brooklyn hospital Dyer mentioned PC-Spes, a dietary supplement used to extend the life expectancy of men with prostate cancer. Developed over four years ago, it is "widely used by every white man and intelligent black man," he says. After the talk, a doctor with 15 years of experience asked him, "What's PC-Spes?"
But these factors do not fully differentiate the black men in these neighborhoods from those in other black neighborhoods throughout the city. The answer may be in the Caribbean. A 1989 to 1994 study of 1121 cases of prostate cancer in men in Kingston, Jamaica, showed that they have a higher incidence of prostate cancer than black Americans. The study, which was conducted by Johns Hopkins University and Hopkins medical institutions, the James Buchanan Brady Urological Institute, and the University of the West Indies, is not the only one to support a Caribbean connection.
Dr. Rajiv Dhir, assistant professor and staff pathologist at the University of Pittsburgh Medical Center, is part of a group conducting a study of the incidence of prostate cancer in Trinidad and Tobago. The group, which is collaborating with local medical experts, has done DREs, PSA tests, and needle biopsies. So far, says Dhir, between 40 and 50 percent of the men have prostate cancer. Dhir says there is a "predilection for a higher grade" of prostate cancer. Why? "We don't really have a specific answer," says Dhir.
These studies are significant, Mallett says, because "there is a tremendous migration of Caribbean men to this area [Bed-Stuy and Crown Heights]." Thompson and Dyer also agree that there is a Caribbean connection. "It is the influx of Caribbean men," says Dyer, who is also from the Caribbean. "It has nothing to do with Brooklyn."