Reducing prostate cancer morbidity and mortality in African American men: issues and challenges

Metastatic Prostate Adenocarcinoma Presenting as Acute Quadriplegia: A Case Report and Racial Disparity Analysis

Prostate cancer is the most frequently diagnosed malignancy in males with the highest incidence and mortality among African Americans. Most prostate cancers are low-grade and slowly progressive.  Prostate cancer can be asymptomatic in the early stages, as exemplified by diagnosis through incidental findings, but typically manifests as a change in urinary habits and characteristics, including frequency and dysuria. If diagnosed at the time of distant metastases, then the patient may complain of bone pain in the hips, legs, or feet, or lower extremity edema.

We present the case of a 74-year-old African American male with no past medical history who presented to the emergency department with acute quadriplegia secondary to metastatic spinal cord compression. The patient required admission to the intensive care unit (ICU) and his quadriplegia was successfully treated with cervical arthrodesis, laminectomy, spinal instrumentation, and fusion, high-dose intravenous (IV) steroids, and physical and occupational therapy.

Overall, the purpose of this case report is to critically review and investigate the factors behind a patient's atypical, rare, and underreported initial presentation of metastatic prostate cancer. The study discusses the literature on advancements in prostate cancer screening and highlights the importance of a broad differential. Most remarkably, the vignette prompts an analysis of the racial disparity gap in prostate cancer diagnosis and treatment demonstrates the need for further research toward improved health outcomes, and proposes multiple avenues to promote health equity.

Prostate Cancer Disparity, Chemoprevention, and Treatment by Specific Medicinal Plants

Prostate cancer (PC) is one of the most common cancers in men. The global burden of this disease is rising. Its incidence and mortality rates are higher in African American (AA) men compared to white men and other ethnic groups. The treatment decisions for PC are based exclusively on histological architecture, prostate-specific antigen (PSA) levels, and local disease state. Despite advances in screening for and early detection of PC, a large percentage of men continue to be diagnosed with metastatic disease including about 20% of men affected with a high mortality rate within the African American population. As such, this population group may benefit from edible natural products that are safe with a low cost. Hence, the central goal of this article is to highlight PC disparity associated with nutritional factors and highlight chemo-preventive agents from medicinal plants that are more likely to reduce PC. To reach this central goal, we searched the PubMed Central database and the Google Scholar website for relevant papers. Our search results revealed that there are significant improvements in PC statistics among white men and other ethnic groups. However, its mortality rate remains significantly high among AA men. In addition, there are limited studies that have addressed the benefits of medicinal plants as chemo-preventive agents for PC treatment, especially among AA men. This review paper addresses this knowledge gap by discussing PC disparity associated with nutritional factors and highlighting the biomedical significance of three medicinal plants (curcumin, garlic, and Vernonia amygdalina) that show a great potential to prevent/treat PC, as well as to reduce its incidence/prevalence and mortality, improve survival rate, and reduce PC-related health disparity.

Quality of Life Among Black Prostate Cancer Survivors: An Integrative Review

The purpose of this integrative review was to explore the impact of prostate cancer (PCa) on the quality of life (QoL) and factors that contribute to the QoL for Black men with PCa. Prostate is recognized as the prevalent cancer among men in the United States. Compared to other men, Black men are diagnosed more frequently and with more advanced stages of PCa. Black men also experience disproportionately higher morbidity and mortality rates of PCa, among all racial and ethnic groups. The initial diagnosis of PCa is often associated with a barrage of concerns for one's well-being including one's QoL. As a result, men must contend with various psychosocial and physiological symptoms of PCa survivorship. Whittemore and Knafl's integrative review method was utilized to examine empirical articles from the electronic databases of the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, PubMed, Project Muse, and Google Scholar. The time frame for the literature was January 2005 to December 2016. A synthesis of the literature yielded 18 studies that met the inclusion criteria for the integrative review. A conceptual framework that examined QoL among cancer survivors identified four domains that measured the QoL among Black PCa survivors: (a) physical; (b) psychological; (c) social; and (d) spiritual well-being. Social well-being was the dominant factor among the studies in the review, followed by physical, psychological, and spiritual. Results indicate the need for additional studies that examine the factors impacting the QoL among Black PCa survivors, using a theoretical framework so as to develop culturally appropriate interventions for Black PCa survivors.

Determinants of Prostate Cancer Screening Intentions of Young Black Men Aged 18 to 40 Years

INTRODUCTION

Black men are more likely to be diagnosed with prostate cancer, with higher stage and higher grade at presentation. Evidence suggests that for education in health promotion behaviors (such as screenings) in early adult years, young Black men can be better equipped to make informed decisions in later years.

OBJECTIVE

Using the theory of reasoned action (TRA), we assessed the intention of young Black men to screen for prostate cancer when it is recommended and determined its correlates.

METHODS

This was a cross-sectional study of 267 Black men aged 18 to 40 years. A 47-item questionnaire collected information on demographics/personal factors, attitudes toward prostate cancer screening, social influence, comfortability with prostate examinations, cues to action, health screening experiences, knowledge of prostate cancer and screening, and intention. Descriptive statistics were calculated for all variables and hierarchical logistic regression was employed to determine significant predictors of prostate cancer screening intentions.

RESULTS

The regression model accounted for 46% of the variance in intention (p < 0.01), with excellent perception of health, having private or public health insurance, longer regular source of care, positive attitude, positive social influence, positive cues to action, and higher knowledge levels being significant predictors of intentions.

CONCLUSION

This study provides support for the use of TRA in predicting prostate cancer screening intentions among young Black men when it is recommended by a physician. Findings may inform the development of empirical-based interventions to educate and inform at-risk young Black men about the pros and cons of prostate cancer screening so that they can make informed decision on screening when recommended later in life.

Oxidative stress in prostate hyperplasia and carcinogenesis

Prostatic hyperplasia (PH) is a common urologic disease that affects mostly elderly men. PH can be classified as benign prostatic hyperplasia (BPH), or prostate cancer (PCa) based on its severity. Oxidative stress (OS) is known to influence the activities of inflammatory mediators and other cellular processes involved in the initiation, promotion and progression of human neoplasms including prostate cancer. Scientific evidence also suggests that micronutrient supplementation may restore the antioxidant status and hence improve the clinical outcomes for patients with BPH and PCa. This review highlights the recent studies on prostate hyperplasia and carcinogenesis, and examines the role of OS on the molecular pathology of prostate cancer progression and treatment.

Why Police Kill Black Males with Impunity: Applying Public Health Critical Race Praxis (PHCRP) to Address the Determinants of Policing Behaviors and "Justifiable" Homicides in the USA

Widespread awareness of the recent deaths of several black males at the hands of police has revealed an unaddressed public health challenge-determining the root causes of excessive use of force by police applied to black males that may result in "justifiable homicides." The criminalization of black males has a long history in the USA, which has resulted in an increase in policing behaviors by legal authorities and created inequitable life chances for black males. Currently, the discipline of public health has not applied an intersectional approach that investigates the intersection of race and gender to understanding police behaviors that lead to "justifiable homicides" for black males. This article applies the core tenets and processes of Public Health Critical Race Praxis (PHCRP) to develop a framework that can improve research and interventions to address the disparities observed in recent trend analyses of "justifiable homicides." Accordingly, we use PHCRP to offer an alternative framework on the social, legal, and health implications of violence-related incidents. We aim to move the literature in this area forward to help scholars, policymakers, and activists build the capacity of communities to address the excessive use of force by police to reduce mortality rates from "justifiable homicides."

Meeting the unmet support needs of BME men with prostate cancer

Men with prostate cancer from black and minority ethnic (BME) communities have reported many unmet information and support needs. A literature review identified the many challenges health professionals face in addressing these unmet needs, and suggested that not enough is known about the psychosocial effects of a prostate cancer diagnosis on men from BME communities in the UK. Affected men may have little or no awareness or knowledge of prostate cancer, receive inadequate information and fear the disease. Nurses can address these issues through improving patients' knowledge and awareness of prostate cancer, providing high-quality information to patients and their families, alleviating fear and promoting survivorship among this minority group; they can also facilitate staff training. Health professionals should look beyond the physical effects and consider the psychosocial effects of such a diagnosis when assessing the needs of these men. Practitioners need to overcome the various challenges to meeting these needs to provide more effective care to men from BME groups.

Building Capacity in a Rural North Carolina Community to Address Prostate Health Using a Lay Health Advisor Model

Background Prostate cancer is a critical concern for African Americans in North Carolina (NC), and innovative strategies are needed to help rural African American men maximize their prostate health. Engaging the community in research affords opportunities to build capacity for teaching and raising awareness. Approach and Strategies A community steering committee of academicians, community partners, religious leaders, and other stakeholders modified a curriculum on prostate health and screening to include interactive knowledge- and skill-building activities. This curriculum was then used to train 15 African American lay health advisors, dubbed Prostate Cancer Ambassadors, in a rural NC community. Over the 2-day training, Ambassadors achieved statistically significant improvements in knowledge of prostate health and maintained confidence in teaching. The Ambassadors, in turn, used their personal networks to share their knowledge with over 1,000 individuals in their community. Finally, the Ambassadors became researchers, implementing a prostate health survey in local churches. Discussion and Conclusions It is feasible to use community engagement models for raising awareness of prostate health in NC African American communities. Mobilizing community coalitions to develop curricula ensures that the curricula meet the communities' needs, and training lay health advisors to deliver curricula helps secure community buy-in for the information.

Prostate cancer screening among chinese american men: a structural model

OBJECTIVE

To test the Sociocultural Health Behavior Model in relation to the health behavior of prostate cancer (PCa) screening among Chinese American men.

METHODS

Confirmatory factor analysis and structural equation model analyses were conducted among Chinese American men.

RESULTS

The path analysis supported the components of the sociocultural model and indicated a positive and significant relationship between PCa screening and the enabling factors; between cultural factors and predisposing, enabling, and access/satisfaction with health care factors; and between enabling factors and access/satisfaction with health care.

CONCLUSIONS

The model highlights the significance that sociocultural factors play in relation to PCa screening.

Disparities at presentation, diagnosis, treatment, and survival in African American men, affected by prostate cancer

BACKGROUND

Prostate cancer (PCa) remains the most common malignancy and the second leading cause of cancer death among men in the United States. PCa exhibits the most striking racial disparity, as African American men are at 1.4 times higher risk of being diagnosed, and 2-3 times higher risk of dying of PCa, compared to Caucasian men. The etiology of the disparity has not been clearly elucidated. The objective of this article is to critically review the literature and summarize the most prominent PCa racial disparities accompanied by proposed explanations.

METHODS

The present literature on disparities at presentation, diagnosis, treatment, and survival of African American men affected by PCa was systematically reviewed. Original research as well as relevant review articles were included.

RESULTS

African American men persistently present with more advanced disease than Caucasian men, are administered different treatment regimens than Caucasian men, and have shorter progression-free survival following treatment. In addition, African American men report more treatment-related side-effects that translates to the diminished quality of life (QOL).

CONCLUSIONS

PCa racial disparity exists at stages of presentation, diagnosis, treatment regimens, and subsequent survival, and the QOL. The disparities are complex involving biological, socio-economic, and socio-cultural determinants. These mounting results highlight an urgent need for future clinical, scientific, and socio-cultural research involving transdisciplinary teams to elucidate the causes for PCa racial disparities.

Benefits, barriers, sources of influence, and prostate cancer screening among rural men

OBJECTIVE

The objective of this study was to explore 3 research questions: (1) What are the perceived benefits of screening for prostate cancer (PC)? (2) What are the perceived barriers to screening for PC? and (3) Is there an association with perceived benefits or perceived barriers and participants' reported source of influence related to prostate cancer screening (PCS) decisions?

DESIGN AND SAMPLE

A nonexperimental exploratory design was used for the study. Sample included 94 rural-dwelling male participants aged 40 and older.

MEASURES

The instruments used included an adapted version of Champion's (1999) revised Health Belief Model scale and a researcher-developed demographic and PCS patterns form.

RESULTS

Both benefits and barriers were significantly associated with PCS and sources of influence. Health care providers and family were highly reported, at 81.8% and 59.5%, respectively, as sources of influence regarding PCS decisions.

CONCLUSIONS

In this primarily African American sample, significant barriers to PCS among rural men were indentifed. PC health education may need to include family, whom study participants highly reported as a source of influence regarding their PCS decisions.

Examining the influence of social ecological factors on prostate cancer screening in urban African-American men

African-American men experience a disparate burden of prostate cancer (PC). Little is known about how social factors influence PC screening in this population.

METHODS

African-American men over the age of 18 (N = 229) were recruited from a community health fair and anonymously surveyed about their PC screening behavior and conditions of their social environment. Analysis included logistic regression.

FINDINGS

Fifty one percent of respondents reported receiving any form of PC screening within the past five years. Older age, higher levels of education, and access to a usual health care provider were associated with PC screening.

CONCLUSIONS

Social workers in preventive and community health settings should be increasingly attentive to the PC screening barriers facing African-American men, particularly those who may be undereducated and lack access to care.

Barbershop communications on prostate cancer screening using barber health advisers

OBJECTIVE

The authors report the outcomes of a community-based, barber health adviser pilot intervention that aims to develop customized educational materials to promote knowledge and awareness of prostate cancer (CaP) and informed decision making about prostate cancer screening (PCS) among a predominantly African American clientele.

METHOD

First, the authors implemented a series of learner verification processes with barbershop clients (n=15) to adapt existing CaP health promotion materials. Following intervention implementation in the barbershop, they conducted structured surveys with barbershop clients (n=40) to evaluate the intervention.

RESULTS

Findings from the posttest showed both a significant increase in barbershop clients' self-reported knowledge of CaP and in the likelihood of discussing PCS with a health care provider (p<.001). The client's cultural model of CaP risk factors revealed cultural consensus (eigenratio=3.3) and mirrored the biomedical model. All clients surveyed reported positively on the contents of the educational materials, and more than half (53%) had discussed CaP at least twice with their barber in the last month.

CONCLUSION

Based on the pilot results, the barber-administered intervention was an appropriate and viable communication channel for promoting CaP knowledge and awareness in a priority population, African American men.

A gender-centered ecological framework targeting Black men living with diabetes: integrating a "masculinity" perspective in diabetes management and education research

Blacks have traditionally experienced a disproportionate burden of diabetes in the United States. Research published from 1980 to 2008 revealed a paucity of diabetes education and management research targeting Black men. There is a paucity of published research that takes into consideration attributes of "being male," such as masculinity, and how its attributes influence diabetes self-management behaviors. This article discusses three important factors that may help explain diabetes-related disparities among Black men.These factors include absence of consistent sources of health care, lack of health insurance, and the absence of a masculinity perspective in diabetes education and management research. This article offers a gender-centered ecological framework that examines pathways between demographic factors, family functioning, knowledge and psychological health, biological health, behavioral health and medical compliance, masculinity, and diabetes-related outcomes. Recommendations for future research that consider how aspects of masculinity might lead to the identification of gender-based risk factors are presented.

Strategies for recruiting African American men into prostate cancer screening studies

BACKGROUND

Recruitment for research and clinical trials continues to be challenging. Prostate cancer is the most commonly diagnosed cancer in men and disproportionately affects African American men; thus, effective recruitment strategies are essential for this population.

OBJECTIVES

The aim of this study was to focus on innovative and effective recruitment strategies for research on prostate cancer with minorities.

METHODS

A systematic description is provided of the recruitment efforts for a hermeneutic phenomenological qualitative study of African American men's experiences in decision making on whether to have a prostate cancer screening.

RESULTS

Seventeen African American men were enrolled from rural Central Virginia. Recruiting strategies were targeted on places where African American men usually are found but that are rarely used for recruitment: barbershops, community health centers, and churches. Word of mouth was also used, and most of the participants (n = 11) were reached through this method.

DISCUSSION

Recruitment efforts have been noted to be particularly challenging among minorities, for numerous reasons. Making minority recruitment a priority in any research or clinical trial is essential in gaining a representative sample. Word of mouth is a powerful tool that is often forgotten but should be looked at in further detail.

Creating community-academic partnerships for cancer disparities research and health promotion

To effectively attenuate cancer disparities in multiethnic, medically underserved populations, interventions must be developed collaboratively through solid community-academic partnerships and driven by community-based participatory research (CBPR). The Tampa Bay Community Cancer Network (TBCCN) has been created to identify and implement interventions to address local cancer disparities in partnership with community-based nonprofit organizations, faith-based groups, community health centers, local media, and adult literacy and education organizations. TBCCN activities and research efforts are geared toward addressing critical information and access issues related to cancer control and prevention in diverse communities in the Tampa Bay area. Such efforts include cross-cultural health promotion, screening, and awareness activities in addition to applied research projects that are rooted in communities and guided by CBPR methods. This article describes these activities as examples of partnership building to positively affect cancer disparities, promote community health, and set the stage for community-based research partnerships.

Social and ethical implications of genomics, race, ethnicity, and health inequities

OBJECTIVES

To review ethical, ethnic/ancestral, and societal issues of genetic and genomic information and technologies in the context of racial and ethnic health disparities.

DATA SOURCES

Research and journal articles, government reports, web sites.

CONCLUSION

As knowledge of human genetic variation and its link to diseases continues to grow, some see race and ethnicity well poised to serve as genetic surrogates in predicting disease etiology and treatment response. However, stereotyping and bias in clinical interactions can be barriers to effective treatment for racial and ethnic minority patients.

IMPLICATIONS FOR NURSING PRACTICE

The nursing profession has a key role in assuring that genomic health care does not enhance racial and ethnic health inequities. This will require utilization of new genomic knowledge and caring for each patient as an individual in a culturally and clinically appropriate manner.