By Rachel Crumpler

Victor Taylor is proud to be known around New Bern as “Mr. Prostate Cancer Man.”

That’s because ever since he was diagnosed with prostate cancer 18 years ago, he’s been a vocal force working to educate others on the disease. He doesn’t want to scare people, he wants to raise awareness — particularly among Black men, who are nearly two times more likely to develop prostate cancer than white men.

He constantly urges men to get screened. To advocate for themselves with doctors. To take their health seriously — for themselves and for their families.

“I’m going to talk prostate cancer until I can’t talk anymore,” Taylor said.

Taylor’s diagnosis of prostate cancer at age 42 caught him by surprise. He said he had no symptoms and no family history of cancer. He didn’t even intentionally seek out getting screened. It was only at the last minute, after he’d taken dozens of other men to a prostate cancer screening event, that he decided to get tested himself.

He’s glad he made that decision. The testing revealed that he had the disease. 

Fortunately, Taylor said, the cancer was detected early and he’s now living cancer-free.

“You can survive,” Taylor said. “Early detection saves lives.” 

Taylor shared his story Saturday with about 200 attendees at a “Men, Know Your Numbers” free screening event held by the UNC Men’s Health Program in New Bern. 

UNC basketball legend Phil Ford, a prostate cancer survivor, also emphasized the importance of screening.

“The fact is that I was really aggressive about finding out whether I had it or not,” Ford said, who was diagnosed with cancer in 2018.

About 150 men at the three-hour event got a free prostate-specific antigen (PSA) blood test. This blood testing is the main way to screen for prostate cancer, as higher levels of PSA, a protein made by the prostate, can indicate the presence of cancerous cells in the prostate. The blood test also means men often don’t need a rectal exam, which has long been a turnoff for many. 

Taylor said some people got their PSA levels checked for the first time at the event. Others took advantage of the free opportunity to get their levels rechecked.

Eric Wallen, a urologic oncologist at UNC treating prostate cancer, said early detection is vital to improve survival rates. 

“We’re trying to raise awareness and bring people to action to bend the arc of prostate cancer because, if we hit it early, we can cure it,” Wallen said.

Rising cases

Prostate cancer cases are on the rise, according to the American Cancer Society. Since 2014, prostate cancer incidence rates have increased sharply by about 3 percent per year overall and by about 5 percent for advanced-stage prostate cancer. 

This year, the American Cancer Society estimates there will be about 299,010 new cases of prostate cancer and about 35,250 deaths.

In North Carolina, the incidence rate is 124 cases per 100,000 men based on the latest five-year averages available from the National Cancer Institute’s State Cancer Profiles — higher than the national average of 110.5 cases per 100,000. 

There’s also a significant disparity in cases and deaths between white and Black men. Black men are 1.7 times more likely to be diagnosed with prostate cancer and 2.3 times more likely to die from the disease than white men.

Prostate cancer is the second leading cause of cancer death for men in North Carolina (behind lung cancer), according to the latest data from the N.C. Department of Health and Human Services. 

In North Carolina, based on preliminary 2021 data, there were 6,964 cases of prostate cancer — an incidence rate of 104.2 per 100,000 — and 1,033 people died. But there was a significant disparity in cases for white men at 89.7 per 100,000, compared with a rate of 146.4 per 100,000 for all minorities.

New prostate cancer cases and deaths vary across the state’s 100 counties. The UNC Men’s Health Program and Carolina Demography launched an interactive web-based tool in December to provide insight into the distribution of prostate cancer across the state. 

“I’m hoping that the hotspots are a little bit of a wakeup call,” said Wallen, who helped create the map. “What are we going to do in our communities to address that? How are we going to do better in identifying prostate cancer cases?”

In Craven County where the event was held, the rate of new cases is higher than the state average. Jeffrey Odham, mayor of New Bern, said the free event helped reach people who don’t usually interact with the health care system or who face cost or transportation barriers.

He was there, and he rolled up his sleeve for PSA blood testing. 

“It’s important people understand that you can’t avoid something,” Odham said. “The best thing to do is tackle it head-on.”

Need for more early screening

Wallen said prostate cancer screening isn’t happening nearly enough.

“PSA testing is not done commonly — not done enough, not done in young-enough men,” Wallen said. 

He explained that screening plummeted in 2008, after the U.S. Preventive Services Task Force recommended against routine PSA testing because it can lead to overdiagnosis and overtreatment of prostate cancers that aren’t dangerous.

Wallen and other providers viewed that recommendation as a mistake. In the years since, the proportion of prostate cancers diagnosed at a late stage has grown, and prostate cancer deaths have risen. Wallen said that’s been driven by more aggressive prostate cancers not being identified at a time when they could be addressed — something PSA testing can often help with.

Wallen also said that there’s been a big shift in how prostate cancer is treated. Providers have learned which prostate cancers to treat and which to leave alone. Many are slow-growing and require no intervention — just monitoring — Wallen said.

Now, early screening is recommended, particularly for high-risk populations such as Black men and people with family histories of prostate cancer. The primary care community has not necessarily kept up, Wallen said, as many providers are still missing the opportunity to screen men just like they would screen women with annual mammograms.

That’s exactly what happened to Angelo Moore, director of the Office of Health Equity at Duke Cancer Institute. When he first relocated to Durham, he met with a primary care provider, who ordered lab work. When the labs came back, he saw his PSA level wasn’t tested — something he had the clinical background to know should have been tested for as a 51-year-old Black man. He asked for the test.

“Just imagine all the other men who came through there, that weren’t even offered a PSA,” Moore said.

Moore said there needs to be better messaging around PSA testing. It is recommended that Black men start testing at age 40. Other men should start testing by age 50.

Wallen emphasized that early testing can help catch prostate cancer at a treatable stage. However, for now, he’s often seeing people come to him too late — after the cancer has progressed. 

“The most important thing is not to wait for symptoms,” Wallen said. “If symptoms are happening, you may be behind schedule because prostate cancer is very, very treatable when there are no symptoms and when it is confined to the prostate.”

Empowered with information

Another factor contributing to gaps in prostate screening and treatment is men’s health care seeking behaviors, Moore said.

Moore explained that men often downplay the importance of screening and interventions for many health concerns. For Black men, the reluctance to seek health care can be even greater.

“​​Unfortunately, for a lot of us, especially the African American population, we wait until something is wrong, then we go in,” Moore said. “When it comes to cancer, we’re diagnosed in the later stages of cancer, which means the treatment is much more harsh, we have less options, it’s very costly and you have poorer outcomes.”

He said there needs to be a mindset shift, adding that men often treat their cars better than themselves.

“If you have a car, and you get it inspected every year, you get your tires rotated, your oil changed every certain number of miles or quarterly, why don’t we do our health like that? Just think of it like that — maintenance.”

Overall, men who attended the event said they found the information and testing empowering, not scary. 

They wanted to roll up their sleeves for PSA testing to get peace of mind about their health status.

“We all need it,” Horace Brockington said. “I didn’t want to take a chance. I want to live.”

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