Implications for Reducing Prostate Cancer Disparities: DISCUSSION


Socioeconomic disadvantage and being an African-American man heighten the risk of experiencing the most profound negative consequences. The interplay of their knowledge barriers and attitudinal barriers to care predisposes these men to poor prostate health, late stage diagnosis, treatment delays, and, ultimately, poor survival. Theoretically, however, these barriers can be overcome much easier than biology or genetics. This strongly implies that the disparity in the target population’s poorer prostate cancer outcomes can be significantly reduced if the nonbiologic barriers are addressed.

The findings in this study highlight the urgency of effectively educating socioeconomically disadvantaged, medically underserved, African-American men about prostate health and prostate cancer. Their knowledge base was full of misunderstandings, misinformation and myths that inextricably linked to their attitudinal barriers (i.e., fear, denial, and apathy), thereby, preventing participation in prostate health activities as well as prostate cancer control activities at the appropriate age. Therefore, accurately educating these men could produce dual results, i.e., alleviating both the knowledge gap and the attitudinal barriers to care. levitra uk

To illustrate their knowledge limitations, several participants believed their age (33-47 years old) placed them safely beyond the age to be at risk for prostate cancer. Although the age of the sample was not targeted to older men, because of the transgener-ational cultural norms related to prostate health it is important to begin addressing attitudes early. These misunderstandings, miseducation, and myths around prostate cancer become ingrained in and are pervasive among younger African-American men and affect their health behaviors and decisions to undergo screening in the future when it is age-appropriate. Moreover, the misunderstandings and myths are perpetuated throughout their social interactions at work, within the family, and in the community.

As another illustration, the participants were shocked to learn that prostate cancer can be present without manifesting symptoms. That reaction was particularly informative in that the efficacy of prostate cancer screening is predicated on identifying the disease in asymptomatic men. Therefore, their lack of such knowledge precluded early detection, diagnosis and treatment. If the men did not know and understand the possibility of early prostate cancer without overt symptoms, they would not be motivated to undergo periodic screenings. They would only seek care when symptoms were present, the point at which the disease is more advanced.

Fostering of supportive relationships with family, peers, and health professionals is also needed. Patient-sensitive and culturally sensitive health professionals and indigenous lay health workers, in concert with existing social networks, can develop, implement, and evaluate prostate health promotion initiatives tailor-made for the target population. In addition to disseminating basic facts, these initiatives must address debunking the myths for the men, their wives/female partners, family members, friends, and the community-at-large as well as enhancing the self-esteem of the men. canada viagra online

In patient-physician interactions, it is critical that substantive, two-way, reflective communication between the physician and the patient be conducted on a level understandable by the patient. The physician, the most respected source of health information, can ensure full disclosure of information about prostate health and prostate cancer screening, diagnosis, treatment and its consequences in ways that are culturally sensitive and linguistically appropriate for the target population. The “how,” “why,” and “when” of procedures should be fully explained and the appropriate recommendations made, respecting the patient’s right to make an informed decision.

Health professionals must also be aware that there is no single, best way to reach, teach and impact all men. Thus, efforts to positively change the behaviors of the target population must take into account and respect the unique barriers that render them less receptive to mainstream health resources, as reflected in their stoicism regarding health matters. Therefore, the establishment and institutionalization of innovative, client-driven, custom-made programs is warranted. Otherwise, efforts to superimpose standard programs on a unique group of men will be futile.

Several limitations are inherent in this study. First, the participants comprised a convenience sample of men who met the eligibility criteria (i.e., African-American, asymptomatic for prostate problems, no prior history of any cancer, and low SES). Secondly, the sample size was small (n=15). Thirdly, data collection was limited to two, single point-in-time focus group discussions with participants from the target population. Less than three focus groups may result in a failure to discover critical information to support the research hypothesis. However, the funded study protocol only allowed two focus groups. Fourthly, these findings may not be applicable to African-American men of higher SES nor can the investigators determine if the findings differ from those of low-SES men of other races/ethnicities. Given those limitations, generalizability is limited. Lastly, the inductive coding and thematic extraction of focus group data may vary between investigators, resulting in consensus-derived themes.

In spite of the limitations, however, the focus group approach was appropriate for the inquiry and provided a unique opportunity to delve into sensitive concerns that result in underutilization of prostate health education and prostate cancer control activities, and, ultimately, poor prostate cancer outcomes. This approach encouraged African-American men to openly discuss and share feelings, perceptions, and experiences, and facilitated teachable moments when participants’ misunderstandings could be immediately and sensitively corrected. Furthermore, the themes succinctly and intuitively summarize the feelings, perceptions, and experiences of the men, and suggest relationships for further exploration with a larger cohort of the target population in the 45-65-year-old age range, additional focus groups exploring the themes which emerged from the pilot study, and a quantitative study guided by the focus group results. A complimentary study could be conducted with prostate cancer survivors from the target population to corroborate the findings from the pilot study related to barriers to prostate cancer screening behavior.


Fundamental to leveling the unequal burden of prostate cancer in socioeconomically disadvantaged, medically underserved, African-American men, is closing the knowledge gap. Increasing their knowl edge is necessary to banish the pervasive myths, misinformation, and misunderstanding and to replace them with factual and accurate prostate health and prostate cancer information. Information is the critical element of informed participation and decision-making. It is empowering and democratic. It transforms realities based on myths and misunderstanding to realities based on truth. Prostate health promotion and prostate cancer control efforts, based on cutting-edge information delivered with cultural relevance, sensitivity, and linguistic appropriateness, offer promise in helping to reduce the unequal burden of prostate cancer. suhagra 100