Part 2: Painting A Portrait of Prostate Cancer

By Terrance Afer-Anderson

[Note: This article is the second of a three-part series on prostate cancer and it contains mature health subject matter.]

Welcome Back! I do so hope you read and shared the first edition of this special three-part series on the unnerving African-American prostate cancer disparity. Ignorance of the ravages of the disease can have dire consequences. That said, I am pleased to report that, due to the importance of the awareness of this public health crisis, New Journal and Guide Publisher Brenda Andrews approved this three-part series.

I closed the first edition of this series speaking on the DRE, the digital rectal exam. I referred to it as ‘dreaded.’ If your physician recommends it – fewer physicians are doing so now, it should not be viewed as dreadful. Here’s why.

If cancer is present in the prostate, the gland can potentially have abnormalities such as lumps, a nodule, a hardened surface or some asymmetry between the two lobes of the gland. I noted earlier that the rectum is behind the prostate gland. The DRE is scorned and avoided by many men because it requires the insertion of a lubricated finger into the rectum to search for any abnormalities in the gland.

It should also be noted that the DRE does have limitations. It can only exam the back surface of the prostate gland.

While neither an abnormal PSA (Prostate-Specific Antigen test) nor DRE, even if they done in tandem, can provide a definitive assessment of the presence of prostate cancer, each might prompt a physician to order a biopsy, a surgical procedure to collect samples of tissue, examined under a microscope, to discern the presence of cancer. In 2009, I had 12 tissue specimens removed, of which 4 were found to be cancerous. Cancerous specimens gleaned during a biopsy are used to create a Gleason score.

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A grading system developed by Dr. Donald Gleason, the Gleason score places cancerous cells into 5 distinct patterns, graded from 1 to 5. The Prostate Cancer Foundation notes, “Grade 1 cells resemble normal prostate tissue. Cells closest to 5 are considered ‘high-grade’ and have mutated so much that they barely resemble normal cells.” PCF furthers notes, “The pathologist looking at the biopsy sample will assign one Gleason grade to the most predominant pattern in your biopsy and a second Gleason grade to the second most predominant pattern.” The two grades are added together to create the Gleason score.

PCF further observes that, “Since Dr. Gleason’s original classification, pathologists do not use the lowest Grades 1 and 2. Thus, Gleason scores assigned will range from 6 to 10, with 6 being the lowest grade cancer.” A Gleason score of 6 is considered low grade, while a score of 7 is intermediate grade, and a score of 8 to 10 is considered high grade cancer. My score back in 2009 was 3+4, a 7, an intermediate grade. However, if the numbers had been reversed, it would have painted a more serious portrait of the disease.

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So, how is prostate cancer treated? In 2010, I had a procedure known as brachytherapy, the surgical insertion of radioactive seeds right inside the cancer sites. It proved successful for 14 years. In late 2023, the cancer returned and had metastasized, having spread to sites outside the prostate gland. I then had twenty treatments of external beam radiation. Following my latest metastasis in the Spring of this year, I am under consideration for participation in a promising clinical trial, featuring radioactive drug therapy, supplanted by traditional external bean radiation.

There are, however, various treatments for prostate cancer beyond standard or experiential modalities. These include a radical prostatectomy, robotic surgical removal of the entire prostate gland; proton therapy, a type of radiation therapy using high-energy protons; chemotherapy, systemic drugs that kill cancer cells throughout the body; hormone therapy, which blocks or reduces the production of male hormones that feed prostate cancer; cryotherapy, freezing the tumor; high-intensity focused ultrasound (HIFU); and active surveillance, often referred to as “watchful waiting,” simply closely monitoring low-risk cancers.

Please note that I attest I am no matter a physician, clinician nor therapist. All that I reference in this series “Painting a Portrait of Prostate Cancer” is based on my own personal experience and research. The latter I earnestly suggest you too do. I am but a mere storyteller who, as a prostate cancer survivor-warrior, am committed to telling the story of the ravages of the disease amongst Black men, their families and communities, and to arm you with information I have gleaned while on my own journey, via collaboration with a number of agencies who share such impassioned advocacy.

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These include the Robert Wood Johnson Foundation, Hampton Roads Prostate Health Forum, Prostate Health Education Network, Greater Norfolk Medical Society of South Hampton Roads, Michigan Men’s Health Foundation, Boston Scientific, Brave Men, Inc., Lantheus Pharmaceuticals, Zero Prostate Cancer, Prostate Health Matters, Emmanual Health Education, American Cancer Society, Howard University Cancer Center, Virginia Commonwealth University Massey Cancer Center, University of Illinois-Chicago Health Justice Speakers Bureau, University of Alabama O’Neal Comprehensive Cancer Center, University of Cincinnati Cancer Center, University of Rochester Medical Center, Rochester, New York’s Faith Leaders Roundtable, Columbia, South Carolina’s First Nazareth Baptist Church Men’s Health Forum, and the Mohawk Valley Health System.

Additionally, I have moderated panel discussions at the U.S. Capitol Building, the Russell U.S. Senate Building, have participated in a panel discussion during the Congressional Black Caucus 2024 Legislative Conference, and have been a guest on Joe Madison’s immensely popular “The Black Eagle” nationally syndicated radio program. Mr. Madison died from prostate cancer on January 31, 2024.

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The reason I list such a litany of agencies is most played some role in bringing my award-winning docudrama film “The Black Walnut,” on the African-American prostate cancer disparity, to a national audience. I will highlight that in the third and final edition of “Painting A Portrait Prostate Cancer.”

Terrance Afer-Anderson is a writer, actor, director and producer. He is also President/CEO, TerraVizion Entertainment Network.

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