Building Trust to Beat Cancer

Black men tend to be diagnosed with prostate cancer at a later stage compared to white men, and they are twice as likely to die from the disease.

A program accelerated by donor support aims to reduce that disparity by increasing the number of men who receive screening, education, and follow-up care to find the disease earlier, when it’s more curable.

Current national guidelines recommend that each man decide individually whether or not to be screened via a prostate specific antigen (PSA) blood test. An elevated PSA may be a sign of prostate cancer, but not in every case, said Dan George, MD, a medical oncologist and co-leader of the Duke Cancer Institute (DCI) Prostate & Urologic Cancer Center.

At Duke, since 2017, the electronic medical record has included a health maintenance check to discuss prostate cancer risk and an algorithm to guide screening developed by a team of doctors from the Duke Departments of Primary Care, Family Medicine, Radiology, Urology, and Medical Oncology, George said. The algorithm requires that doctors in the Duke Primary Care Network have conversations with men about whether to have their PSA checked. Since 2017, Duke Primary Care has seen an increase in prostate cancer screening, from 50% of men to 75%.

As a result, at Duke Health system, more than 60,000 men have their PSA checked each year. Out of those, thousands need further follow-up, George said. “This is where the one-to-one conversations with our patient navigators are so vital.”

A fund established by DCI Board of Advisors member Donna Bernstein allows the center to dedicate a patient navigator to have those conversations with Black men at greatest risk of having aggressive prostate cancer: those with a screening PSA level above 10 ng/ml. The Prostate Cancer Fund Honoring Coach Clifford Ray is named for Bernstein’s lifelong friend, a former National Basketball Association player and coach and two-time cancer survivor.

“It can be difficult to have somebody come in for cancer screenings, get treatment, and see a specialist when they feel fine,” said Angelo Moore, PhD, RN, NE-BC, assistant director of community outreach, engagement, and equity for DCI. “Some people are just afraid that they’re going to get bad news. They think about being a burden on their family,” said Moore, an Army veteran who has had three aunts die from cancer.

“So we have to overcome all those issues before they’re able to come for a referral.”

Community-facing navigators help men understand that the goal of PSA screening is to find cases of aggressive prostate cancer and treat it before it becomes lethal, said LaSonia Barnett, community-facing navigator lead at Duke Cancer Institute. “We’re building a relationship with the patients over the phone,” she said. “We get to know their thoughts. Are they fearful? How do they feel about the next steps?” Barnett also helps men understand what an elevated PSA level means, and she explains what the treatment options are if they do have cancer, and can connect them to support resources, such as transportation or financial assistance.

This project is part of a larger effort in which Moore’s team builds relationships in the community to reach people before they ever need cancer care (see “The Path to Care".) “We’re trying to reach historically marginalized and medically underserved populations with education and early detection,” Moore said.