Get on the Path to Prostate Health

Transcription

1 Get on the Path to Prostate Health Native American Cancer Research (NACR) 3022 South Nova Road Pine, CO Phone: ; Fax: Native American Cancer Survivors Network Get on the Path to Prostate Health Chuck [Chippewa] Walter Woods [Cheyenne River Sioux] Abe Conklin [Ponca-Osage] 1. Introduction QUESTION: Why are There Walnuts Around the Room? What do Walnuts have to do with Today s Workshop? The walnut is the size of a man s prostate gland So this is a pretty small organ, but it is very important. The prostate is part of the man s reproductive and sexual systems Native American Cancer Research ; 4 Abe Conklin [Ponca-Osage] Dx 1987 Prostate Excerpt from the story of prostate patient [I] noticed that I had been having problems urinating, and it was getting worse and worse. So I went on to the [ceremonial] dances in Chicago, when I got back I went to my doctor and he took me to this hospital And said my prostate gland was enlarged and we should go check it out, and do a... biopsy Native American Cancer Research ; 5 Excerpt from the story of prostate patient They did this, and it come back benign and I was really happy about that. [Later the provider] said "We should go in and do some a surgery on this prostate gland. He came in and he said "You know after we got all that tissue out of there, it was cancerous". That was the first time that it really hit me. It kind of put fear into me. I knew then that I should have gone earlier, Native American Cancer Research ; 6 Research 1 Abe Conklin [Ponca-Osage] Dx 1987 Prostate

2 QUESTION: Why Don t Native Men Talk About Prostate Cancer? Men think if they talked about it, they are inviting the disease into their body The word, cancer has too many bad feelings and beliefs Native men don t know how to talk about it Native American Cancer Research ; 7 Native Men Talk About Prostate Cancer A lot of Native men don t know how to say, prostate The don t want to see women in the waiting room Men don t talk about some things if the women are close by At the clinic for a prostate exam, men don t want their name called out in the waiting room Native American Cancer Research ; 8 QUESTION: Why is it Hard for Men to Talk about Prostate Cancer? Embarrassed Ashamed Afraid Shy (especially if female provider) Uneasy with male provider (homo-phobia) Native American Cancer Research ; 9 QUESTION: Why Don t Other Family Members Learn That Anything Is Wrong? The men come back from their exam and say everything was fine then later say I have to come back in 6 months Native men don t want to talk about this at all not even with other men QUESTION: What may help Native men feel more comfortable talking about prostate cancer? Native American Cancer Research ; Yesterday and Today Native Americans Prostate Cancer Facts and Myths OBJECTIVES By the end of this segment, the learner will be able to: 1. Distinguish between accurate information and common myths about prostate cancer in Indian Country. Research 2

3 Native American Prostate Cancer Facts Prostate cancer was uncommon in our ancestors because Active daily lifestyle (hunting for food) Healthy eating (no alcohol, fast food) Possibly fewer numbers of lifetime sexual partners Possibly daily eating of foods that Included a lot of fruits and vegetables (vitamins and minerals) QUESTION: Why Don t Native Women Get Prostate Cancer? Women (of any race) do not have a prostate gland If you don t have the organ / gland, you cannot get the cancer in a place that does not exist Native American Cancer Research ; 13 Native American Cancer Research ; 14 Native American Prostate Cancer Facts about Prevention Healthy diet with fruits and vegetables Choose healthy foods rather than vitamin or mineral supplements Exercise most days of the week Maintain healthy weight Talk to your doctor if 50 or older Believe you are at high risk Native American Cancer Research ; 15 Native American Prostate Cancer Facts Prostate cancer may not be cured or it can recur, even after the man has been treated for it This is true for men of all races This is also why you still need to go in for your annual prostate check-ups Veterans can get a 2 nd opinion about a prostate cancer diagnosis from the Veterans Administration Hospital Native American Cancer Research ; 16 Native American Prostate Cancer Facts Native men who are at normal risk for prostate cancer, should begin having annual prostate health screenings by age 50. Native men from the Northern Plains probably should be screened beginning age 40 This is because prostate cancer is more common in the Northern Plains Native American Prostate Cancer Facts Native men who have had a lot of problems with their prostate (like infections or enlarged prostate), should talk with their provider about starting prostate health screenings earlier than age 50. The screening tests can be conducted in a local clinic Native American Cancer Research ; 17 Native American Cancer Research ; 18 Research 3

4 Prostate Cancer Screening Prostate health screenings may include: A Digital Rectal Exam (provider wears plastic gloves and inserts finger into the man s rectum) A blood test called the Prostate Specific Antigen or PSA These screenings are discussed in more detail later Native American Cancer Research ; 19 Prostate Cancer Survivor and Providers If you are diagnosed with prostate cancer, you will work with many different types of providers Radiologist oncologist Surgeon Vocational Rehabilitation Doug Six Killers St. Clair [Cherokee / Shoshone] Dx 1990 Lymphoma I [am a] rehabilitation counselor [I could see] what kinds of processes that I could do through counseling and guidance and cooperative communication between this consumer and myself, it became really easy. Native American Cancer Research ; 20 Native men rarely develop prostate cancer. Is this fact or myth? MYTH Prostate cancer may actually be a normal part of aging Science actually suspects that all men, regardless of race, may develop prostate cancer by the time they are in their 80s. About 1 in 6 men will be diagnosed with prostate cancer during their lifetime. Only 1 in 34 men die of prostate cancer. 1.8 million prostate cancer survivors. NCI Prostate Cancer Outcomes Study Fact Sheet NCI, Native American Cancer Research ; 21 Native men rarely develop prostate cancer (cont.) Most of these men did not die because of prostate cancer The cancer may just exist and cause the man few or no problems But, for those who have problems, treatment choices are available Native American Cancer Research ; Anatomy of the Prostate Gland OBJECTIVE By the end of this session, the learner will be able to: 1. Identify the anatomical structures of the prostate gland. Research 4

5 QUESTION: What is prostate cancer? Cancer cells form in the prostate gland The prostate gland is part of the male reproductive system (part of semen) It is located below the bladder, in front of the rectum It surrounds the urethra (tube that empties urine from the bladder) Native American Cancer Research ; 25 QUESTION: What is the Prostate Gland? The prostate is inside the male s body It is behind and below your bladder Think about hunting and cleaning the carcass The guts between the legs includes the prostate gland Native American Cancer Research ; 26 What is the Prostate Gland? Sex gland in men It makes up part of the semen or the semen / fluid that allows the sperm to swim / move If the prostate gland can t make its fluid, the sperm cannot get a woman pregnant The prostate gland is about the size of a walnut before the walnut has its shell removed Native American Cancer Research ; 27 Location of the Prostate Gland Hard to find because it is small and embedded in the tissues All male four-legged and two-legged have a prostate gland just like human males We are all related Native American Cancer Research ; 28 Prostate Side View Side of View Male of Reproductive the Male Reproductive System System Prostate Gland Anatomy The walnut does look similar to the prostate gland Native American Cancer Research ; 29 Native American Cancer Research ; 30 Research 5

6 Different Layers or Zones of the Prostate Gland Animated, Shows the Dimensions of the Gland Native American Cancer Research ; 31 Native American Cancer Research ; Prostate Cancer in Indian Country OBJECTIVE By the end of this session, the learner will be able to: 1. Identify regions where prostate cancer incidence (new cases) and deaths are highest among Native men. Cure? Chronic disease? Pass on? Older Men and Prostate Cancer While some with prostate cancer are cured and others will live a long time with disease, sadly, some also will pass on from prostate cancer. By the time men are 80 years old, they have prostate cancer, but it is not why they pass on In other cultures, medical scientists have done autopsies on elder men and found prostate cancer in almost all of the 80+ year old men Native American Cancer Research ; 35 Native American Cancer Research ; 36 Research 6

7 Older Men and Prostate Cancer (cont.) Because it is culturally prohibited for many Native tribes to have autopsies performed, there is no information specific to our cultures But it is probably true that our men also have prostate cancer by the time they are in their 80s Older Men and Prostate Cancer (cont.) Prostate cancer may not be An invasive cancer The cause of death Other causes of death are listed on the death records unless the prostate cancer was the actual cause of death Native American Cancer Research ; 37 Native American Cancer Research ; 38 Gay, Homosexual Two-spirited Men Also Develop Prostate Cancer. This is also true for American Indians and Alaska Natives What Type Of Cancer Statistics Are Available In Indian Country? Very limited information until 2007 Espey s incidence report (2007) and Haverkamp s mortality (death) report (2008) Other good information may be Local tribal or urban Indian data IHS data for reservations Native American Cancer Research ; 39 Native American Cancer Research ; 40 Limitations of Cancer Statistics Are In Indian Country State data (state s racial misclassification makes the AIAN data of little use) National Cancer Institute (NCI) (basically only for the SW region and Alaska) Centers for Disease Control (CDC) = too much misclassified data received from the states It is very difficult and tedious to correct databases; no easy solutions Native American Cancer Research ; 41 Cancer Statistics In Indian Country There is no good / accurate information about how many new cases are diagnosed each year (prevalence) The 2007 Report to the Nation does document how common prostate cancer currently is in reservation Indian Country (incidence) Underreports urban data much more difficult to correct Native American Cancer Research ; 42 Research 7

8 DEATH RATES, LEADING CAUSES: AGES 45 TO 64 YEARS Diseases of the Heart Malignant Neoplasms Cancer Accidents Chronic Liver Disease Diabetes Mellitus Get on the Path Deaths to Prostate per 100,000 Health Population Office of Native Planning, American Evaluation and Cancer Legislation, Research Indian Health ; Services, Regional Differences in Indian Health: Rockville, MD: Indian Health Service), AIAN Cancer Incidence Data (finally) THANK YOU! CHSDA Counties = IHS Contract Health Service Deliver Areas NHW = Non- Hispanic White Native American Cancer Research ; 45 All Breast Cervix Incidence Rates ( )* AIAN Colon 46.3 Kidney 17.9 Lung 48.5 Prostate US NHW So. Plains AIAN NHW No Plains AIAN NHW Source: Cancer registries in Centers for Disease Control and Prevention's (CDC) National Program of Cancer Registries (NPCR) and National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results Program (SEER) D. Espey, Monograph Group. IHS Cancer Mortality Note cancers other than breast, cervix, colon, lung and prostate This is why AIAN comprehensive cancer plans cannot be limited to only those sites! Native American Cancer Research ; 48 Research 8

9 The 1994 and 2008 IHS Cancer Mortality Reports In both the 1994 and the 2008 IHS Cancer Mortality Reports, Northern Plains have the highest deaths from prostate cancer The 2008 show Southern Plains (basically OK) as separate group for the first time = much higher than for other regions of US Scientists do not know why Native American Cancer Research ; Prostate Cancer Risk Factors and Protective Behaviors OBJECTIVES By the end of this segment, the learner will be able to: 1. Identify at least 2 factors that help protect you from developing prostate cancer. 2. Identify at least 2 factors that increase your risks for developing prostate cancer. Protective Factors Low-fat, high fruits and vegetable diets Almost daily physical activity Maintain recommended body weight Follow prostate health screening guidelines QUESTION: How does Cause of cancer differ from cancer Risk Factors? Cause means there is a direct link between the behavior or factor eventually resulting in cancer (like habitual use of manufactured tobacco causing lung problems) Risk Factor(s) usually refers to behaviors / exposures to something that increases your chances of getting cancer (see risk shield) Native American Cancer Research ; 53 Native American Cancer Research ; 54 Research 9

10 The shield in these slides represents your protection (shield of health) against things that may make you more susceptible to cancer (cancer risks) The larger the holes and the more number of holes in the shield, the less likely it is to protect you from cancer or other health problems NOTE: the web page version is animated Native American Cancer Research ; 55 The shield of health against prostate cancer may include daily physical activity, healthy, low fat, limited or no alcohol, and so on What does this shield tell you about this man s cancer risks? Native American Cancer Research ; 56 Cancer risks that damage the shield of protection include: 1. Male 2. Age: Men over 50 (risk increases as you get older) 3. Family history ( 1st degree relative ) 4. Race a. African Americans have 2 X the incidence as white men b. Northern or Southern Plains higher incidence than other tribal Nations 5. Diet (high-fat, especially animal fats) increase risks 6. Alcohol (>14 drinks a week) More Known or Possible Risk Factors Hormones (high testosterone) Chemical exposure (Cadmium exposure; rubber industry) Abuse of alcohol (possible risk) Abuse / habitual use of tobacco (possible) Multiple sexual partners ( STDs) Diseases / disorders (urinary tract infections) Native American Cancer Research ; 58 Behaviors that help protect the shield of health include: 1. Low-fat, high fruits and vegetable diets 2. Almost daily physical activity 3. Maintain recommended body weight 4. Follow prostate health screening guidelines 5. Reduce or abstain from alcoholic drinks 6. Screening for Prostate Cancer Research 10

11 OBJECTIVES By the end of this session, the learner will be able to: 1. Identify the types of recommended prostate cancer screening tests. 2. Identify who may pay for the costs of prostate screening other than IHS. You can take your time about following up on an abnormal test MYTH Taking your time means 1-2 weeks, not a couple of months There is nothing wrong with taking a couple of weeks to discuss your abnormal test findings with Other doctors Your family Your traditional Indian healer Native American Cancer Research ; 62 What is the Digital Rectal Exam (DRE)? Physical exam by the provider Provider feels the prostate with a finger through the wall of the rectum Provider feels for Unusual lumps Uneven surfaces Recommended as part of annual checkups for men over 50 years old Native American Cancer Research ; 63 What is the PSA Test? Prostate Specific Antigen = PSA Blood test Recommended as part of annual checkups For men over 50 years old For younger men who are at high risk for the disease Native American Cancer Research ; 64 PSA Tests (nanograms per milliliter circulating in the blood (ng/ml)) 0-2 ng/ml 2-4 ng/ml 4-10 ng/ml >10 ng/ml PSA Level Probability of Cancer 1% 15% 25% >50% As cited on from MD Anderson website: Native American Cancer Research ; 65 What is the PSA Test? Healthy men have small amounts of prostate-specific antigen in their blood Less than 4.0 ng/ml Levels higher than 4.0 ng/ml can mean conditions other than prostate cancer A man who has prostate cancer will have higher PSA in the blood because this is how his body fights the disease Native American Cancer Research ; 66 Research 11

12 Examples of What can Cause Higher PSA Levels Other Than Cancer? Enlarged prostate (benign prostatic hyperlasia [BPH]) Infected or inflamed prostate Biopsy or operation on prostate Pre-cancerous cells in the prostate Native American Cancer Research ; 67 You can spread prostate cancer to your family and friends. Is this fact or myth MYTH QUESTION: Why is this a myth? Prostate cancer is not contagious If treated with internal radiation, protect others! When a lot of prostate cancer occurs in a specific area, like in the Northern Plains, there is some other cause for the cancer rather than it being contagious Native American Cancer Research ; 68 The prostate symptoms will go away. Is this fact or myth? Sort of both The symptoms may come and go If the symptoms are due to an infection that caused the prostate gland to get bigger, once the infection is treated, the symptoms will go away Or they may become worse as the prostate continues to enlarge Native American Cancer Research ; 69 Prostate Cancer in a 50-year old has usually already spread to other parts of the body at the time of diagnosis. usually MYTH For men who are at average or normal risk, rarely is prostate cancer advanced to spread to other parts of the body Prostate cancer usually takes a long time to spread to other parts of the body EXCEPTION: Northern & Southern Plains men seem to have elevated risk & 50 years old at diagnosis may result in cancer spread Native American Cancer Research ; 70 Prostate Cancer Spread (cont.) It is important to take part in your annual prostate health screening If the screening tests show some problems that may or are related to prostate cancer, the provider can describe treatment choices to you Where Is Prostate Cancer Screening Available In Indian Country? Veterans Administration (VA) Hospitals and outreach clinics (for vets only) Indian Health Service Clinics Tribal or Urban Indian clinics But, some do not have anyone present who is qualified to do a DRE Rural health clinics (e.g., Prairie Health Clinics, Eagle Butte Clinic, Faith Clinic) Native American Cancer Research ; 71 Native American Cancer Research ; 72 Research 12

13 How Can I Get a PSA Blood Test? How Can I Get a PSA Blood Test? (cont.) If you are 65 years or older, Medicare can pay for the PSA blood test. Private insurance can pay for PSA blood test. Some State grants also pay for PSA Native American Cancer Research ; 73 The VA pays for the PSA test if you ask for it State, Cancer Centers, and/or community programs may also pay for the cost of PSA blood test Native American Cancer Research ; 74 OBJECTIVES By the end of this session, the learner will be able to: 7. Symptoms that May be Related to Prostate Cancer Identify common signs and symptoms of problems with the prostate gland Some signs are for an enlarged prostate that may or may not indicate cancer Native Men Talking About Prostate Symptoms Occasionally, frequent desire to urinate / pee (but sometimes with little success) Night-time sensation is more common Trouble urinating Decreased force in the urine stream Blood in your urine (Native men rarely refer to blood for any health concerns) Blood in your semen (ditto) Native American Cancer Research ; 77 Symptoms (cont.) Swelling in your legs (most of the Native men had an explanation for why their legs were swollen other than a potentially serious health problem) Discomfort in the pelvic area (some Native men thought they had a minor hernia) Bone pain (this is very painful and most Native men refused to discuss such pain) http: Mayoclinic.com; http: cancer.gov Native American Cancer Research ; 78 Research 13

14 Common Prostate Gland Problems Benign prostatic hyperplasia (BHP) Enlarged prostate More than half of the men over age 50 have this NOT CANCER Infected or inflamed prostate Usually not cancer! 8. Prostate Cancer Diagnosis Native American Cancer Research ; 79 QUESTION: What is a Gleason score? A way to grade prostate cancer tissue based on how it looks under a microscope A low Gleason score (<2) means the cancer tissue is similar to normal prostate tissue and unlikely to spread A high Gleason score means the cancer tissue is very different from normal and the tumor is more likely to spread Gleason Scores Grading System started in the 1980s Gleason Scores <2 = similar to normal Between 2-4 = well differentiated Between 5-7 = moderately differentiated Between 8-10 = Undifferentiated Native American Cancer Research ; 81 Native American Cancer Research ; 82 Prostate cancer treatments are controversial. Is this FACT or FACT MYTH? Researchers and medical scientists disagree on the treatments. Each treatment has some benefits and some problems. This is why you need to fully understand your choices You may also want to discuss the information with your sexual partner Issues with Ceremony and Western Medical Treatment If your traditional Indian healer wants you to do ceremony, most of our ceremonies take several months of preparation May want or need a family member to do ceremony on your behalf You need to make a choice about which treatment you want to do before doing a full traditional ceremony Native American Cancer Research ; 83 Native American Cancer Research ; 84 Research 14

15 Issues with Ceremony and Western Medical Treatment (cont.) Your healer can do prayers and a brief ceremony to help you prepare for Western Medical care Some ceremonies that require fasting and other physical challenges may harm your immune system and you need the immune system strong for your treatment Issues with Ceremony and Western Medical Treatment (cont.) After you have recovered from your treatment and with the guidance of both the Western Medical doctor and the traditional healer, you may be able to go through the full ceremony You will need to bring bottled water with you to the ceremony Native American Cancer Research ; 85 Native American Cancer Research ; 86 Issues with Ceremony and Western Medical Treatment (cont.) You may need to rest more often than you would normally. This is why the traditional healer needs to understand your Western Medical treatment If your ceremony is done outdoors, you may need to wear sunblock and sun glasses Issues with Ceremony and Western Medical Treatment (cont.) You may need to avoid body piercing (if that is part of your ceremony) or have the traditional healer only use sterile knives You may need to avoid any restrictive bindings on your legs, especially close to your groin and lymph nodes Native American Cancer Research ; 87 Native American Cancer Research ; 88 Issues with Ceremony and Western Medical Treatment (cont.) You may have difficulty handling heat or cold (due to treatment side effects) and need the traditional healer to help you You are more susceptible to infections for a long time after some of the cancer treatments Issues with Ceremony and Western Medical Treatment (cont.) You need to talk with your Western Medical provider and Traditional Healer about ways to avoid infections Native American Cancer Research ; 89 Native American Cancer Research ; 90 Research 15