MUSC Health

Piece by piece, 76-year-old Friedrich Andreas is methodically building an outdoor kitchen for his son in Charleston. Andreas said the project reminds him of a recent bout with prostate cancer – you have to take both one step at a time.

Andreas, a native-born German, moved to Charleston in 2015 to enjoy mild weather during retirement. When he’s not working on a construction project, Andreas advocates for other men to pay attention to their health and get routine prostate-specific antigen (PSA) screenings.

“The only reason I even knew I had prostate cancer at first was because of a routine PSA test with my primary care physician,” Andreas said. “It really can be the difference between life and death. I think that really speaks to the importance of maintaining routine visits with your doctor.”

Andreas has battled prostate cancer twice – first in 2018, when he had his prostate removed at another medical facility in Charleston, and then again in June of 2021, when the cancer returned. Andreas decided to switch his care to MUSC Hollings Cancer Center after learning that the cancer had returned.

“At the other facility in Charleston, I felt more like a number. While at Hollings, I felt like my team of doctors really cared about my treatment and outcome,” he said. “They told me about the tumor board, comprised of prostate cancer specialists, who would meet to review my case and design a program specifically tailored for me.”

Andreas first was seen by Thomas Keane, MD, a Hollings urologist specializing in prostate and genitourinary cancers. Upon results of a PSA test showing elevated levels, Keane referred Andreas to David Marshall, MD, a Hollings radiation oncologist who specializes in prostate cancer.

“My approach with any patient is that when that person walks out of the exam room, they should feel better than when they walked in,” Marshall said. “You do that through education and talking with them about their options and what to expect.”

Marshall said Andreas is among the Hollings prostate cancer patients who have benefited from improved imaging. In Andreas’ case, a device called an Axumin, or fluciclovine F18 PET scan, was used, as its improved-imaging capabilities can pick up on and locate prostate cancer recurrences better than older types of scans. Improved imaging enables doctors to provide effective therapy to the affected areas.

“That really helps us to refine our treatment approach by giving us a better understanding of where the cancer cells making the PSA are located,” Marshall said. “That lets us target our radiation therapy to limit exposure to otherwise healthy cells.”

In the fall of 2021, Hollings also began offering prostate-specific membrane antigen (PSMA) tracers during PET scans to patients whose prostate cancer has returned in an effort to understand more fully where cancer cells are located in the body. PSMA is a type of protein found on the surface of prostate cancer cells.

“This improved imaging helps us to locate the cancer if it has already spread beyond the pelvis to determine if a radiation regimen is needed. It also lets us know if we should focus in on one area and provide a higher dose of radiation in that specific location,” he said.

Marshall said Andreas’ treatment for his prostate cancer recurrence consisted of 37 rounds of radiation over two months that ended at the beginning of September. Andreas said he is thankful for Marshall and his team of doctors who not only treated his cancer but also put his fears to rest.

Andreas said he fared well during radiation and didn’t experience any side effects besides being a little more tired. He continues to come back for checkups every six months to ensure there isn’t another recurrence. “There was no reason for me to be nervous or concerned. From the moment I walked into Hollings, I was at ease. Everyone was friendly and professional, and I just felt like I was in good hands. I still am in good hands.”

Andreas now shares his story with other men to raise awareness about prostate cancer. He said he’s looking forward to spending more time with his wife of 43 years, children and four grandchildren. It’s also a good bet you’ll find him with tools in his hand tackling yet another project.

“It keeps me busy and gives me something to look forward to. I also enjoy being creative, so these projects are fun for me. I’m able to complete them now, thanks to the care I received at Hollings.”

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The patient's treatment included prostate-specific membrane antigen (PSMA)–PET imaging.

Hollings patient advocates for screenings after two battles with prostate cancer

Ending health disparities isn’t just something Nicholas Shungu, MD, preaches – it’s something he practices every day as an MUSC Health family medicine physician. It’s one reason he led a new study revealing barriers, and presenting solutions, to improving prostate cancer screening decision-making among Black men.

“Historically, Black men haven’t been included in studies that guide screening recommendations,” Shungu said. “I’ve always had a desire to change that.”

That desire became even stronger during medical school when Shungu’s father was diagnosed with and treated for prostate cancer near their New Jersey home. That experience was a driving factor in a study led by Shungu that was published in the Journal of the American Board of Family Medicine.

In the study, titled Barriers and Facilitators to Informed Decision-Making About Prostate Cancer Screening Among Black Men, researchers found that the majority of the 21 Black men who participated didn’t feel as though they had adequate information to make an informed decision about prostate cancer screenings.

“We know that Black men have a higher incidence rate and mortality rate of prostate cancer than white men,” Shungu said. “Despite that, we are still falling short in providing adequate education about screenings and reaching the populations that are at a higher risk.”

Participants in the study took part in a focus group to discuss their experiences as patients, their knowledge of prostate cancer screening and their attitudes toward screening recommendations. A majority of the men, 61.9%, had a friend or family member diagnosed with prostate cancer and had also talked with a doctor about prostate cancer screening before. However, only 47.6% of participants had been screened for prostate cancer using a PSA blood test.

“I think there are two big takeaways. One, we as clinicians must do a better job about educating and talking with patients, especially Black men, about prostate cancer and screening options available to them,” Shungu said. “Second, we really need to help patients feel more comfortable making a decision about prostate cancer screening.”

Researchers identified several barriers in the study that affected the likelihood of making an informed decision about prostate cancer screening. In addition to not feeling educated enough to make an informed decision about screening, participants also told researchers that they hadn’t had proper discussions with their doctors about the perceived benefits and risks of getting tested. There also was concern about pride and the fear that being screened could impact a man’s sexual function.

“Screening doesn’t affect sexual function,” Shungu said. “If diagnosed with prostate cancer, there is the possibility of erectile dysfunction and urinary incontinence stemming from treatment, but that is down the road and not something caused by screening itself.”

Katherine Sterba, PhD, an MUSC Hollings Cancer Center researcher and co-author of the study, said she was also surprised about the confusion and misconceptions participants had about the types of screening tests available and the difference between prostate cancer screening and a colonoscopy. Sterba said many of the men thought that the only way to screen for prostate cancer was through a digital rectal exam and were unfamiliar with the PSA blood test option.

“This study is a great example of research questions coming directly out of clinical practice,” Sterba said. “It’s so important to listen to patients, understand their experiences and use research findings to guide clinical practice about how best to talk with and advise patients.”

By providing better resources and education about prostate cancer screening and encouraging dialogue about it in the community, researchers believe more Black men would make informed decisions about screenings.

Shungu said efforts already underway at Hollings, such as the 

, will play an important role in education and awareness within the Black community. Shungu believes that those efforts, along with candid discussions with their doctors about prostate cancer screening, could save lives moving forward.

“These are difficult conversations to have. We as doctors have to do better. We need to be more comfortable having real conversations with these men,” he said. “I hope that this study and my work in medicine can help to reduce health disparities and save lives. That’s my ultimate goal.”

“This study is a great example of research questions coming directly out of clinical practice. It’s so important to listen to patients, understand their experiences and use research findings to guide clinical practice about how best to talk with and advise patients," says Katherine Sterba, PhD.

New Hollings study reveals barriers, presents solutions to improve prostate cancer screening among Black men

Like a cheerleader at a pep rally before the big game, Marvella Ford, PhD, leads participants of the SC AMEN Program in a cheer.

“Early detection,” she chants, pausing for the response.

“Saves lives!” respond the participants.

It’s a call and response that’s not standard fare for the more than 25 members of Mt. Moriah Missionary Baptist Church, who have gathered virtually on Sept. 11 for this inaugural session of a prostate cancer prevention, awareness and navigation to screening program. That’s the point, though. Ford, associate director of Population Science and Cancer Disparities at MUSC Hollings Cancer Center, wants to get out into the community to drill home the message.

“One of the most positive aspects of the SC AMEN Program is that it focuses on Black men, who have sometimes been overlooked by the medical community,” Ford said. “This program creates a safe space for participants to share their comments, concerns and stories to help improve prostate cancer screening rates.”

The SC AMEN Program aims to reduce prostate cancer mortality rates in South Carolina Black men age 40 to 65 by increasing their prostate cancer knowledge and improving their prostate cancer screening rates. The program, supported by the TD Bank Foundation, hopes to raise awareness about prostate cancer, which disproportionally affects Black men who oftentimes present with later-stage disease and have worse overall outcomes. In fact, the prostate cancer death rate in South Carolina is 2.5 times higher for Black men than for white men with this disease.

Participants of the SC AMEN Program begin by attending a training session, led by Ford and program manager Melanie Slan, which covers topics including the importance of exercise and listening to your body, tips on a healthy diet and prostate cancer screening and early detection. They are then evaluated using a pre-test, post-test and three-month follow-up survey to gather information about whether they received prostate cancer screenings and increased their knowledge of prostate cancer. Those who complete the program receive monetary compensation.

“We fully expect that this inaugural session of the SC AMEN Program is just the beginning,” Ford said. “As more people learn about the prostate cancer education and screening navigation services that are offered through the program, they will choose to participate.”

Ending health disparities and saving lives in South Carolina is a personal mission for dentist Larry J. Ferguson, DMD, who served as the keynote speaker and primary organizer for this session. Ferguson knows just how important screenings, early intervention and education are. His own journey with prostate cancer began in 2012, when Ferguson and his primary care doctor noticed his prostate-specific antigen (PSA) levels were above normal.

“When I saw my PSA levels rising above the recommended levels, I went into denial,” he said. “I didn’t want to think about the possibility of having prostate cancer and going through treatment. Fear was setting into my heart, and I’m a doctor.”

Ferguson shared his story with the other men who took part in the SC AMEN Program session. In 2016, following his annual PSA blood test, Ferguson’s primary care physician referred him to Hollings researcher Thomas Keane, MD, who is also the chair of the MUSC Department of Urology.

“Having attended school at MUSC for dentistry, there wasn’t a question in my mind where I wanted to go for treatment,” Ferguson said.

For the next four years, Keane actively monitored Ferguson’s cancer through rounds of biopsies and MRIs. Active surveillance was chosen as the course of treatment due to the size and nonaggressive nature of Ferguson’s prostate cancer. In 2020, results of surveillance tests showed the tumor pattern was becoming more aggressive. In February 2021, Ferguson was put on hormone reduction medication to reduce testosterone levels to help to prevent the cancer from growing further.

In addition to that medication, Ferguson was referred to Hollings researcher David Marshall, MD, who is also the chair of the MUSC Health Department of Radiation Oncology, for radiation treatment. Due to his tumor responding well to the hormone reduction medication, Marshall told Ferguson he would only need 20 rounds of radiation, versus the 28 they had originally planned for. Radiation wrapped up in June, and Ferguson came off the hormone medication in August 2021.

“My journey with prostate cancer continues today. I am walking my journey as I speak with other men in the SC AMEN Program. That is important to me because I want to develop a prostate cancer ministry so that we can encourage one another — both current patients and prostate cancer survivors.”

By sharing his experiences, Ferguson hopes to affect other men and encourage them to get early, and routine, prostate cancer screenings. He’s excited about starting the conversation about a cancer that many men don’t feel comfortable talking about.

“I know of too many men who have suffered from this disease, and they suffered in silence. They didn’t feel like they could talk to anyone. I want to be as transparent as I can with other men about my story to encourage other men to talk about prostate cancer and get screened. That’s what the SC AMEN Program helps to do.”

Improving prostate cancer screening with the SC AMEN Program

Marshall said early detection of prostate cancer truly saves lives. It is a big reason why he is supportive of the SC AMEN Program’s efforts to educate medically underserved communities about lifesaving screenings.

“The more we can communicate the need for screenings and the availability of treatment options at Hollings that result in a high quality of life, the better,” Marshall said. “I applaud the efforts of Dr. Marvella Ford and her team to get this important message out and to navigate the participants to prostate cancer screening.”

Ford said the inaugural session was a huge success, and they’re already getting calls to book more sessions throughout the state. “This is the tip of the iceberg, and this is going to snowball. We’re so appreciative of the support of the TD Bank Foundation to launch this key initiative in our state.”

Ferguson also believes that this is just the beginning for the SC AMEN Program. He credits his doctors at Hollings for helping to make life after cancer possible so he can educate others. “My own cancer journey helped open my eyes to just how important Hollings is to Charleston and South Carolina as a whole.”

By educating and encouraging a space for dialogue among men, Ferguson believes more lives will be saved, thanks to early screening, prevention and treatment.

“I think this is a tremendous opportunity for the Black community and for Black men,” he said. “I hope my story can encourage other men to get prostate cancer screenings and possibly save a life. Every life is important. These men represent somebody’s father, husband, brother and an important community member. Those lives are needed. Those lives count.”

Black men age 40 to 65 who are interested in participating in the SC AMEN Program should contact program manager Melanie Slan at 843-876-2427 or slan@musc.edu.

“I think this is a tremendous opportunity for the Black community and for Black men. I hope my story can encourage other men to get prostate cancer screenings and possibly save a life. Every life is important," says Larry J. Ferguson, DMD.

MUSC Health

Articles

Hollings patient advocates for screenings after two battles with prostate cancer

New Hollings study reveals barriers, presents solutions to improve prostate cancer screening among Black men

Hollings' SC AMEN Program for prostate cancer screening launches with enthusiastic support