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Men's Health Issues:

Black Men and The Stress of Divorce

After conducting a study on fifty African Americans divorced males, two public health experts from Harvard University conclude that divorce takes a particularly heavy toll on black men, resulting in mental health problems that commonly present as physiological symptoms.

The subjects included in the study consisted of middle-aged, working/middle-class black men who were recently divorced for the fist time and were parents. The data were collected through face-to-face interview in the settings of the men's choice by a black man himself divorced (Source: Minority Health Today, July/Aug. 2000, Vol.1, No. 5)

Prostate Cancer and Black Americans

Prostate cancer presents a serious problem for all Americans men. However, it is widely recognized that prostate cancer is a particular serious problem for black men: mortality from this disease is higher in black Americans than in all other races. This is due to a higher incidence, more advanced stage at diagnosis, and lower rate of survival. This article will examine each of these factors, and present clinically useful reference ranges for using PSA to diagnose prostate cancer in black Americans.

High Incidence

African Americans have the highest prostate cancer incidence rates in the world. In contrast, the disease is rare in Africa, the Near East, and South America. According to the American Cancer Society, some of the increase in rates may be related to socioeconomic differences reflected in lifestyles behaviors that contribute to cancer risk. This may include a diet high in saturated fats and tobacco and/or alcohol use. Whatever the reason, the incidence of prostate cancer in American Blacks is currently 50% higher than in American whites.

When the National Cancer Institute analyzed black and white cancer rates by socioeconomic status, they found that, in general, cancer incidence was higher in low-education and low-income groups regardless of race. However, the incidence of prostate cancer remained higher among blacks, even after adjustment for income or education.

Late stage at diagnosis

Significantly more blacks than whites are diagnosed with advanced disease. In fact, blacks are more likely than white to have all cancers, regardless of site, diagnosed at a late stage.

Poor Survival Experience

Prostate cancer mortality rates are more that 2 times higher for black Americans than white Americans. Data from the Surveillance, Epidemiologic, and End Results program of the National Cancer Institute indicates that the relative 5-year survival rate of black Americans with prostate cancer is less than that of white American for all stages of disease.

Age and PSA (Prostatic Specific Antigen)

Because serum PSA increases with patien age, primarily due to the increase in prostatic volume with age, the use of age-specific reference ranges may make the test more sensitive in younger men and more specific in older men. Age-specific reference ranges might find more organ-confined, "curable" cancer in younger men, and spare more older men an invasive and costly biopsy. Some urologists recommend using age-specific reference ranges only for patients 40 to 59 years of age, and the conventional range of 0.0 to 4.0 ng/ml for men 60 and older. Age-specific reference ranges for white men have been determined from a study in Olmsted County, Minnesota.

Race and PSA

Subsequent investigations with a Japanese population revealed significantly lower PSA levels than seen in white men. This indicated the importance of considering the patient's race when using PSA to diagnose prostate cancer. A study of military personnel at Walter Reed Army Medical Center became the first to apply, to black men, PSA reference ranges determined from a black population. These values were significantly different from those in white men, but also correlated directly with age.

PSA in Practice

The American Cancer Society currently recommends that every man over 40 have a digital rectal exam as part of his annual physical. In addition, the American Urological Association recommends that annual PSA blood tests also be initiated at age 40 for black Americans or those with a family history of prostate cancer.

The high incidence and mortality of prostate cancer in black men justify aggressive detection using race-specific ranges derived from a black population. This should allow the practicing clinician to detect more clinically significant cancers at an early, potentially curable stage.

The article was originally written by Joseph E. Oesterling, M.D., Professor and Urologist-In-Chief Director, The Michigan Prostate Institute, The University of Michigan, Ann Arbor, Michigan (An educational service of MERCK & CO., Inc.)

Healthy Diet and Exercise Could Slow Prostate Cancer

By Dr. Carl Gilbert

A study published in The Journal of Urology by researchers from the Departments of Physiological Science, Medicine and Urology, University of California-Los Angeles, Los Angeles, California, suggests that high-fiber diets and exercise could slow prostate cancer cells growth by 30 percent.

The researchers tested serum of two groups of participants: a short-term category of 13 overweight men age 42 to 73 and a long-term group of 8 men whose age varies between 38 and 74 and who had eaten well and exercised regularly during a period averaging 14 years. The participants in the short-term group were maintained on an 11-day regimen of meals containing less than 10 percent of calories from fat, 15 to 20 percent from protein and 70 to 75 percent from starch. Their exercise consisted of brisk and slow paced walking. Their serum ( a blood derivative) was combined with prostate cancer cells then then analyzed.

Prostate cancer cells exposed to serum from the long-term group of men on the other hand demonstrated in the labs a 40 percent reduction in prostate cancer cell growth when compared to baseline samples from the short-term group of men.

In view of those results, the UCLA team has begun a new clinical trial to evaluate new nutritional programs that prostate cancer victims may use to fight the advance of the disease.

Source: The Journal of Urology 2001 September;166(3):1185-1189