This year has seen a surge in debate on whether or not prostate cancer screening is beneficial to men. Prostate-Specific Antigen (PSA) Tests, which screen for genetic markers that are present on prostate cancer tumors, have largely been the subject under fire.
Who should get a PSA test and when, and what action should be taken when the results are in, are just some of the questions that are being raised. What cannot be disputed are the facts: the National Cancer Institute estimates that in 2009 there will be over 192,000 new cases and 27,000 deaths from prostate cancer.
The Project to End Prostate Cancer
The Drive Against Prostate Cancer is a CRI-supported program that offers free PSA screenings to men around the country. It is run by an organization called ZERO - The Project to End Prostate Cancer.
Amidst the confusion of PSA tests and prostate cancer screening, Skip Lockwood, CEO of ZERO, is seeing great strides being made by their efforts to reach men all across America. There’s no debating the importance of educating men about their health and providing them a way to take action.
CRI: What is the Drive Against Prostate Cancer?
Skip Lockwood: The Drive Against Prostate Cancer is the Nation’s only mobile men’s medical unit designed to deliver education, awareness, and prostate cancer early detection to men across the country. So many men don’t participate in regular healthcare for themselves, and these two, 40-foot mobile medical units seem to engage men to come and get into the medical system. We find a lot of health issues besides prostate cancer, like enlarged prostates, or prostatitis, for which these men need treatment. While these men spend time with our doctors on the vehicle and with our staff as they wait in line preparing for their blood tests educate them and get them enthusiastic about the fact that they’re doing something for their health.
CRI: What tactics does the mobile medical unit use to educate men about the prostate and prostate cancer?
Skip Lockwood: We consistently find that men are aware of the prostate and know they should be paying attention to it, but they don’t necessarily know the details of what it does. Men don’t want to discuss it or get touchy-feely; they just want some questions answered.
In response to this, over the years we have developed what we call “man-centric healthcare.” The trucks feel a little bit like a club house or locker room. It begins as an unassuming group of guys talking sports or about the day and then somebody asks a medical question. We then have an opportunity to educate these guys about something that’s important to them. The trick that we’ve learned is what I refer to as “squirt education.” It is ineffective to try to give a man an entire library of everything they need to know about prostate cancer, but you can effectively give them a few tidbits that they’ll take home with them and share with their own social groups.
CRI: What is the importance of having men talk about prostate cancer in their social groups?
Skip Lockwood: One of our great challenges is accessing the informal social networks between men. We have found that men talk to each other a lot in small groups and these informal social networks are where a lot of information gets transmitted. We hope that by providing a message for one man, he will take the message back to his informal social networks.
Men really rely on each other much more strongly than we anticipated for information. The nearest analogy that I can put together is from the teenage boy standpoint. There’s one guy in the class who is the resident “girl specialist” and he imparts a ton of information to the rest of the guys because they’re certainly not going to ask a teacher or their parents, so this guy becomes the one that they go to for advice.
It’s similar with prostate cancer; men are not interested in necessarily going to see professionals, they need to go to somebody they trust first before they move on. We feel that the Drive is an excellent way to be one of those intermediary advice-giving mechanisms.
Another benefit is the theoretical work we’ve been able to do on how men relate to their prostate, prostate cancer, and prostate cancer early detection. Being out in the trenches has really helped us to get a sense of what is happening in the real world. For example, we’ve been able to use the vehicle for studies on correlations between obesity and PSA, so the Drive is an extremely versatile tool. We have had a way of engaging men all over the country in an activity that they wouldn’t undertake on their own if left to their own devices.
CRI: What has been the impact of participation on men’s health?
Skip Lockwood: Since the program began in 2002, we’ve seen a very steady increase in the usage of the vehicle. We started with an average of 69 men per day, the year after that we averaged 97 men per day, and last year we averaged 205 men per day. This past September, we screened our 100,000th man. The overall trend has been for more and more men to take advantage of the Drive, especially in places where we have a repeat presence and good partnerships.
We are extremely proud of the fact that when we visited Chicago in 2007, we screened 4,000 men with both vehicles over six days. Even more importantly, 2000 of those men, including a significant African American cohort, agreed to participate in three different prostate cancer clinical trials.
Because of their participation, two very important studies were published. One study definitively proved the “PSA standardization bias,” which means that the two available standard PSA tests from the World Health Organization and Hybritech do not get the same standard results. The PSA test works by detecting important molecular factors that tell us whether to continue with further testing or not. The Hybritech and WHO tests both have different cutoff numbers that are used to tell a doctor or patient that they should get a biopsy. It is important to know the type of test you’re getting and understand how to interpret the results so as not to confuse your treatment plan. Because of this clinical trial finding, we have started a program to educate patients and physicians about “PSA standardization bias” to improve the accuracy of PSA test findings.
CRI: How has CRI funding played a role in the success of the Drive?
Skip Lockwood: CRI participation has been critical. The underwriting that we get from CRI allows us to help certain groups host a visit from the Drive who don’t have all of the funds that are required. Some of the funding that we receive from CRI is used to basically provide a scholarship to these groups so they can have successful events. The other thing CRI underwriting has really done over the years is help us with our PSA testing. We have a wonderful relationship with the University of Michigan labs and they have given us an excellent price for processing PSA tests. We do so many tests that our volume is substantial and so CRI helps us to offset those costs so that we can get very fast, very accurate PSA processing. CRI support is really critical to our efforts and we are just so pleased.
CRI: There has been a lot of news recently questioning the credibility of PSA tests. Are you seeing an effect on the Drive due to these debates?
Skip Lockwood: Let’s think of the issue of prostate cancer as an elephant; these last few sets of studies that have come out are doing an interesting job of describing a very tiny portion of the elephant while ignoring all the rest of the elephant. These studies are great for internal discussions among academics, but they’re also out in the press and in the media. The media don’t really know or report on the entirety of the issue and this causes confusion among men out there rather than being helpful. These reports and studies also operate under the assumption that the men are actually going to the doctor. We see a lot of men that haven’t been to a doctor for 5, 10, even 15 years.
The media are sending out blanketed messages on PSA testing that do not account for everyone. What scares me about some of these discussions is that we have a lot of men who are at the highest risk of prostate cancer, such as African American men with multiple family members with prostate cancer, who are looking at this information and they make the decision not to get screened because of all that they’ve heard in the media. There’s nobody telling these men that they are a high-risk person and that high-risk people need to be much more vigilant than a healthy 75-year-old Caucasian man with no family history. So it is important to think of this information in the broader context of prostate cancer and in terms of risk level, and in the general importance of men taking care of themselves and actually going to a doctor. PSA tests are just one small part of the issue of men’s healthcare and prostate cancer.
CRI: What did you do for prostate cancer awareness month?
Skip Lockwood: We planned to screen about 7,000 men this year and are on target right now to screen 10,000 men. For prostate cancer awareness month in September we worked on an event with the Baltimore Orioles. We spent 11 days at the Kentucky State Fair from August to the 1st of September. The vehicles were basically booked all that month and in many cases were coordinated with our national race series called Dash for Dad. Our Dash for Dad series was in Buffalo, New York, and Washington, D.C. We also worked with another conglomerate of races called the Great Prostate Cancer Challenge and those are in Kansas City, Memphis, Harrisburg, Baltimore, and several other cities. This was actually one of the largest prostate cancer awareness months in the history of the organization.
CRI: Where can people find the truck route and request that it visit their area?
Skip Lockwood: You can find an application to have the vehicle come to your area on ZEROcancer.org. There’s also information where the vehicle will be, but if we’re not going to be anywhere near you in many cases people can call their local hospital to get screened.