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MDNewsline recently interviewed international urologic surgeon, Dr. Howard Aubert, to discuss the effects of prostate cancer on African American patients. Dr. Aubert currently practices in Riverside, CA, and specializes in prostate, kidney, bladder, testicular cancer, incontinence, infertility, BPH, and low T.

MDNewsline: Dr. Aubert, what are some of the biggest differences in the way prostate cancer manifests and develops in patients of color and white patients?

Dr. Howard Aubert: African Americans tend to get prostate cancer at a younger age and are affected at a 50% higher rate than their Caucasian counterparts.  Prostate cancer in African Americans also tends to be more aggressive than in other populations. 

MDNewsline: Why is it that patients of color are more likely to be affected and die from Prostate Cancer?

Dr. Howard Aubert: Prostate cancer has no symptoms until it is advanced. Men of color tend to avoid seeing a physician until symptoms become severe. This can lead to being diagnosed at later stages which equates to higher death rates. With less access to care and specialists, men of color lose out on early treatment options, also increasing death rates. 

MDNewsline: What can physicians do to help change outcomes and bridge the disparity gap?

Dr. Howard Aubert: In order to change outcomes, we need to change the stigma around prostate cancer evaluations and the side effects of prostate cancer treatment. As physicians we need to ensure updated information is widely dispersed through community education and social media:

        • Digital rectal exams are no longer a mainstay of diagnosis.
        • There are surveillance protocols for patients with low-risk disease, where no treatment is necessary for a period of time.
        • African Americans should start prostate cancer screening at the age of 40 with yearly PSA checks.

MDNewsline: What are some of the latest technologies and breakthrough treatments that doctors should know about for prostate cancer?

Dr. Howard Aubert: There are new advances in every phase of prostate cancer therapy. 

        • In diagnosis, there has been the advent of MRI guided biopsies which targets lesions not normally identified on standard biopsies.
        • If diagnosed, there is genetic testing that can predict the aggressiveness of prostate cancer, which helps choose the proper treatment.
        • If one chooses surgery as a treatment option, we can now use robotic surgery in combination with nerve mapping to decrease the risk of incontinence and erectile dysfunction. We can also map lymph node involvement to target distant disease
        • If one chooses radiation, there are new advances in cyberknife technology that decrease the number of necessary treatments. There is also proton therapy which decreases the risk of radiation exposure to other organs. SpaceOAR is a new technology used to increase the distance between radiated and normal tissue to decrease side effects. 
        • If one has had treatment for prostate cancer and it recurs, there are now new forms of hormone deprivation therapy that increases overall survival by 2-4 years. 

As Urologists, we have to modernize our approach to treatment options and dispersing information to our community. 

You can connect with Dr. Howard Aubert on Twitter @HowardtheDoc.

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