Difficulty urinating is one of signs and symptoms of an enlarged prostate. Others include, difficulty maintaining a constant flow, dribbling at the end of urination, feeling you need to urinate frequently, increasing need to urinate during the night, urgency to urinate, not being able to empty your bladder completely, urinary tract infections, blood in your urine.
In his spare time 56-year-old Karl S. Greene, a self-described "cereal lover," likes to ride motorcycles and bicycles and walk. But the motorcycles rides are on hold for at least a month because Greene recently had an operation to fix what he called "repeated going problems."
After a year of frustrating visits to another hospital, Greene, now retired, ended up at Cleveland Clinic at The Minority Men's Health Center, which was established in 2003 and is focused on the early detection and treatment of early stage prostate cancer in minority males.
"When it comes to cancer," Greene said, "I don't have time to play."
On June 24, 2009, Urologist Charles Modlin, director and founder of the Minority Men's Health Center, performed a transurethral recession of the prostate (TURP) on Greene to determine the problem.
According to the National Cancer Institute , it is estimated that 192,280 men will be diagnosed this year with prostate cancer and 27,360 will die of the disease. Among the different ethnic groups, African-American men are disproportionately affected by this type of cancer, with an incidence rate of 239.8 per 100,000 compared to 153.0 per 100,000 in Caucasian men.
Although some researchers think that prostate cancer might be more aggressive in minority populations, white and black men have similar outcomes when compared stage for stage, Modlin said. One of the problems is that prostate cancer is diagnosed at a more advanced stage among black and other minority men, which underscores the importance of early detection screening programs, he said.
"We think it's partly related to the later presentation--where the disease is more advanced at the time of diagnoses," said Modlin, one of the country's few African-American transplant surgeons, "so that may be a major factor in terms of the difference of outcomes."
Prostate cancer is the second-leading cause of cancer deaths in all males-lung cancer is number one-- but it is the most prevalent. Modlin said he also sees higher rates of bladder and kidney cancer in African Americans. Testicular cancer is more prevalent in white men; however, the death rate for black men is higher. This is probably related to later stage presentation, Modlin said.
The recommendation from the American Urological Association is that black men start prostate cancer screening at the age of 40, as opposed to age 50 for white males who don't have a strong family history of prostate cancer.
"African-American males have a seven- to eight-year shorter life expectancy from birth compared to their Caucasian male counterparts, and a lot of that is directly related to the incidence of health care disparities," said Modlin, an expert on conditions that are prevalent in minority populations.
Need for Diversity in the Workforce and Increased Education
Derek Raghavan, M.D., Ph. D., who works at the Cleveland Clinic and chairs the American Society of Clinical Oncology's (ASCO) Disparities of Care subcommittee, says this difference in outcomes of cancer treatment between the majority and the minority population, is partly due to education, access and trust.
According to Raghavan, there is a lack of education about cancer and of the benefits of early diagnoses and treatment; no insurance or means to pay for healthcare; and inadequate care in underserved areas with a scarcity of cancer specialists.
An ASCO survey revealed that only 2 to 3 percent of oncologists are black. Raghavan thinks the numbers should be closer to 10 to 12 percent.
Raghavan is known nationally and internationally for his research and involvement, enacting several initiatives and programs at Cleveland Clinic and through ASCO, which has developed programs, mentorships and fellowships to attract minority medical students to the specialty. ASCO has also renovated its cancer-specific Web site with content written by minority experts in English and Spanish.
The Center has also met with African-American physicians, politicians, and community and church leaders, set up a patient navigator program in collaboration with the Ralph Lauren Foundation , and run minority-focused health fairs.
He said he's especially excited about a new program run by the Center to educate barbers and beauticians on the benefits of frequent check-ups.
"In the black community--apart from church leaders--barbers and beauticians are probably among the most influential because they have people coming back on regular basis, they hang out together, and people go into the store and will get to know these folks."
To further reach into the community, every April, the Center hosts its Annual Minority Men's Health Fair. The fair has provided free screening to all males, but has specifically targeted minority men. Although there are usually about 25 different types of screenings, prostate cancer is the most popular.
"Back in 2003, during the first health fair, about 35 men showed up for the screenings and over the past two years it has really dramatically grown to where each of the past two years we have brought in over 2,000 men to undergo these free screenings," Modlin said.
"We have a higher detection rate than what is published nationally through men coming in through the health fair and the Minority Men's Health Center. It's about 47 percent detection rate out of those who actually go on to get a prostate biopsy, nationally average is about 25 to 35 percent."
On the Road to Bike Again
And although a biopsy following Greene's operation revealed that the tissue contained cancerous cells, his prostate specific antigen levels are low and "the cancer is negligible."
Greene also feels satisfied with the care he received at the Center.
"I went from a small stream that was like a needle to a stream that was almost like a straw, which relieved a lot of my going problems," Greene said. "These people thoroughly took care of me."
Even with this news there is not much Greene has changed about his routine and eating habits.
"My diet has always been the same. I don't eat red meat that much. I primarily eat chicken and fish, fruits. Dairy products-I'm learning now I have to stay away from (milk) because I am a cereal lover, but I'm learning that because of my age I have to try to cut back."