BERKELEY, CA (UroToday.com) - Dr. Frencher, MD, MPH participated in all three MAP events earlier this year and reflects on that experience and what urologists can learn from these kinds of events.
Dr. Frencher also leads the Prostate Education Program (P.E.P) ( http://blackbarbershop.org/about-the-prostate-education-p/ ) for the Black Barbershop Health Outreach Program (BBHOP). Look for upcoming events:
Coming soon to a barbershop near you, “P.E.P. Talks” -- these events are designed to help African American men access culturally appropriate educational materials and resources. Discussions will include whether to undergo screening or not, and men requesting to be screened or need prostate cancer-related services will receive referrals from BBHOP staff.
During the MAP events, what surprised you most about the questions that were posed by the participants?
For many men who we encountered, the issue is not that they have not heard about prostate cancer. It’s that many of them have been affected by prostate cancer and did not have the forum in which to discuss their concerns or be educated about it. Man after man would stand up to the mic and recount a story of his personal experience with prostate cancer, often for the first time telling his own story. Others would tell us about a father, brother, cousin, friend or even son who had been diagnosed. So, it wasn’t the questions that surprised me. It was how open many of the men were about talking about the disease after hearing Charlie Wilson and I speak.
For men, especially African American men, what is the singularly most important fact they need to know about prostate cancer?
The most important fact they need to know is that African American men are at higher risk than any other racial/ethnic group for the disease. African American men are diagnosed at early stages, with more aggressive disease and die at higher rates. The other important fact they need to know is that for most men, the disease is curable or otherwise so slow growing that they will die from something else. At the end of the day, determining whether he has prostate cancer is something that every man needs to discuss with his physician.
| Dr. Frencher is currently the first Robert Wood Johnson Clinical Scholar, supported by the American College of Surgeons, and is conducting surgical quality-of-care research at UCLA/RAND. He interrupted his general surgery residency training at Yale New Haven Hospital to transition to a surgical career in urology. His research interests include understanding patterns of screening and awareness of prostate cancer among minorities within healthcare systems and in community settings. To that end, he has teamed with Dr Releford and the Black Barbershop Health Outreach Program (BBHOP) to initiate an informed dialogue among African American men about the controversies surrounding prostate cancer screening and treatment. |
What is your practice policy regarding PSA screening?
We focus our message on "shared decision making" when it comes to prostate cancer screening and PSA testing. Prostate cancer will not kill most men. However, for African American men and men with family history of prostate cancer, obtaining a PSA tests is not thought of as screening per se, but rather targeted early detection in at-risk populations.
An example of how this has made a difference occurred in Los Angeles, when I initially began reaching out to men in barbershops through The Black Barbershop Health Outreach Program, screening efforts aimed at identifying men with undiagnosed diabetes and hypertension. We took blood pressures and random blood glucose measurements in the barbershops and collected information from men about their access to a usual source of care and insurance status. Using these platform and information, we were able to connect at-risk men with physicians regardless of ability to pay. Moreover, we enabled several men to obtain PSA tests who were ultimately diagnosed and treated for prostate cancer.
Our message at the barbershop was not only of universal PSA testing but rather to inform a healthy dialogue about prostate cancer and other disease in order for men to seek care with a physician or healthcare professional. It is important, I think particularly for African American men who often harbor mistrust of the healthcare system, to educate them in a place and in ways that are comfortable and familiar to them. We as physicians tend to make patients come to us. I believe that if we go to them, African American men will be more responsive, and we showed that through a community-based participatory research project in Los Angeles called, "P.E.P. Talk," Prostate Education Project.
What is the scope of the barbershop outreach effort?
We traveled the country to more than 20 cities, in more than 750 barbershops, screening thousands of men for diabetes, hypertension, and informing them about prostate cancer. Our efforts were chronicled on NBC Nightly News, the Today Show and several periodicals. We also published our model for outreach in peer-review research journals so that others can replicate it. But most important of all has been the lives we've touched. I have priceless vignettes and stories of men who I have encountered who claim we saved their lives through our work. For that, I am grateful everyday for the opportunity as a doctor to help men who look like me and come from the same neighborhoods I grew up in (I'm a native Detroiter).
Are you encouraged by the new advanced treatments for metastatic castrate-resistant prostate cancer? If so, how will you as a urologist incorporate these new drug treatments.
I'm encouraged, particularly because this is a group that is often forgotten. Most Americans, at this point, likely believe that prostate cancer won’t kill you. Most of the lay press does not parse that data and deliver a message that explains the whole story about prostate cancer. That for some men, especially African American men and men with a family history of prostate cancer, the disease can and will kill you if not treated. Our job as doctors and scientists is to develop better ways to identify those patients and create better treatments with fewer side effects. For the men who have CRPC, new medications have been developed that may help at this stage of disease.
Does mCRPC appear to be more aggressive in the African American man than other races? If so, what is your treatment protocol for diagnosing and treating this at-risk group?
In my personal opinion, I would not recommend specific treatment protocols based on race. It is important to know that African American men tend to have more aggressive forms of prostate cancer. Therefore, it is important that we encourage participation of African American men in trials that study the origin of prostate cancer, including CRPC, and understand what puts these men at higher risk. Additionally, it is important that men participate in clinical studies to help improve the care for men who progress to this stage of disease.
Interview conducted by Karen Roberts, Medical Editor, UroToday.com
