Opening Up About Prostate Cancer

Albert Brunson and his wife, Delphine
Albert Brunson and his wife, Delphine

Albert Brunson didn’t tell anyone but his wife, Delphine, when he was diagnosed with prostate cancer in May 2009, or when his prostate was removed six months later.

“I had my surgery in Chapel Hill,” he says. “I have a brother who lived just down the road in Durham. I didn’t tell him I was at Chapel Hill getting surgery. I thought that it was shameful to allow people to know I had prostate cancer.”

For two years, he kept his cancer a secret. Then a neighbor died of cancer, and Brunson learned it was prostate cancer that had spread to his bones.

“I didn’t even know he was sick until there was a wreath on his door,” Brunson says. “That’s one of the things that launched me into talking about prostate cancer to other folks.”

Black Men Are at Greatest Risk

Prostate cancer is the most common type of cancer diagnosed in men in the United States, other than skin cancer. It’s the second-leading cause of cancer deaths in men, behind only lung cancer. The American Cancer Society estimates that more than 288,000 men will be diagnosed with prostate cancer in 2023, and about 34,700 will die from the disease.

The risk is greatest among Black men and men with a family history of prostate cancer. A greater proportion of Black men than white men get prostate cancer (178.3 cases per 100,000 Black men compared with 105.7 among white men). Also, Black men are more than twice as likely to die from prostate cancer than white men.

Researchers who study the disparity have found some genetic and biological factors that may contribute, but they also acknowledge additional factors. Black men may be more likely to distrust the healthcare system and may face more economic and cultural barriers to receiving care. Furthermore, racial diversity has been lacking historically in many research studies of cancer treatments.

“The reasons are unclear, but the results are obvious,” says UNC Health urologist Matthew Nielsen, MD. “Black men have a higher risk of getting prostate cancer and of having more serious outcomes. We need to encourage all men, but especially Black men, to talk to their doctor about the risks.”

More Aggressive Cases Among Black Men

Black men tend to develop more aggressive prostate cancers, Dr. Nielsen says. Screening to find prostate cancer early can be very helpful. This is why all Black men and men who have a father or brother who was diagnosed before age 65 should begin prostate cancer screening at age 45, while men of other races with low to moderate risk can begin at age 50. If a man has more than one close relative diagnosed before 65, he should start screening at 40.

Screening is typically done with a blood test looking for levels of prostate-specific antigen (PSA), a protein made by the prostate, and a digital rectal exam. In recent years, advanced imaging with MRI has emerged as an additional helpful tool.

“There’s been more evidence in recent years that there may be more benefit to PSA testing and early detection in Black men than in the general population,” Dr. Nielsen says. “We want to encourage Black men and the people who love them to talk to their doctor about testing.”

Symptoms of prostate cancer include difficulty urinating, blood in the urine or semen, persistent pain in the back, hips or pelvis, and erectile dysfunction.

“We don’t recommend that men wait until they have those symptoms before talking with their doctor, though,” Dr. Nielsen says.

Don’t Wait for Symptoms Before Getting Screened

Brunson, an Army paratrooper who served for 27 years, was in the habit of getting regular physical exams that included PSA tests.

“In 2009, I started having high-level PSA,” he says. “Thank goodness the doctor at the air base referred me to Chapel Hill, where I met Dr. Nielsen.”

Dr. Nielsen conducted further tests that found cancer in Brunson’s prostate.

“He said we could watch it for a while,” Brunson says, “but the danger was that it would eventually metastasize (spread). Dr. Nielsen, my wife and I talked, and we agreed to go ahead and get the surgery done.”

In nearly 14 years since his surgery, Brunson says he feels great. He continues to have follow-up appointments.

The Brunsons’ three sons followed in their father’s footsteps and joined the Army—their twins are both colonels, and the oldest is a three-star general. Brunson has talked with all of his sons about prostate health and screening. Because they have a family history of prostate cancer, getting screened is even more important, he says.

“One of my kids said, ‘You have something to say to your fellow veterans and other African Americans. If they don’t want to talk about it, they’ll tell you,’” he says. “So now, when I see someone, especially someone who has served in the military, I’ll strike up a conversation.”

His message isn’t always welcome, Brunson says. “Some of them, after I talk about it, they look at me funny, and I just move on. I know sometimes I strike a raw nerve. I’m not sure all of them do something about it and get screened, but this is a pretty big deal, and somebody needs to talk about it.”

Relying on His Wife for Support

Brunson says Delphine was a tremendous support for him when his cancer was diagnosed. Now, she reminds him to go back for follow-up appointments.

He talked to his sons’ wives about the importance of screening for prostate cancer. Spouses and partners are critical allies, he says.

“Once they understand the gravity of what you are facing and buy into the process, then they help you manage it all,” he says. “It becomes easier because it becomes a family issue.”

If you do get a diagnosis, it’s important to have someone with you when you talk with your doctor, Brunson says.

“You need to take your spouse or a close relative so they can hear what the doctor says,” he says. “When the doctor tells you there’s something impacting your body that’s pretty devastating, you’re focusing on his words, ‘You have cancer.’ You might block it out and not hear anything else the doctor is saying. Your person will listen, and you can have a discussion about it when you calm down.”

If you have questions about cancer screening, talk to your doctor or find one near you.