Men’s Health Talk to be Held at
Second Baptist Church
Fighting Disparities
Joshua Wright (l-r) and Dr. Tracy Downs are working to reduce the
incidence of prostate cancer
among African American men.
Cancer Fellowship at the University of California-San Francisco.”

Today, Downs is associate dean for diversity and multicultural affairs at the University of Wisconsin School of Medicine and Public Health, professor in the
Department of Urology and director of the UW Health Bladder Cancer and Intravesical Therapy Programs and has a joint appointment with the UW Carbone Cancer
Center. What is very important to Downs is he is in a place to do something about the disparities of the incidence of prostate cancer among African American men.

Few of us even know what the prostate is.

“If you wondered if God had a sense of humor, he put this structure in us that doesn’t do a lot,” Downs said with a chuckle. “It’s kind of in front of our rectum. It
provides some secretions when we are romantic. It also gets bigger when we get older and blocks our urinary channels. We also have to get up at night
occasionally as we get older. It’s not a really important organ for us. The part that’s not so great about it is that it is kind of nested around these nerves that are
important for our sexual function. And also in removing it, we have to remove one of the sphincters, the kind of gate that gives us better control over our urine so
we do not boo boo. One of those muscles is almost like an automatic muscle reflex. It’s like if we try to poke our eye, we automatically blink for protection. One of
the gates or sphincters actually works that way. So if we had three cups of coffee and someone makes us laugh and our bladder is full, that will close so that we
don’t leak urine. But after surgery, we if remove that gate or sphincter, the one that is there is one that we have to control almost like an exercise to close it. So
when you get up or sit down, at the weakest moments for a man, you can have high pressure in the bladder and that’s when you leak. It’s a challenging location to
treat well without causing some side effects.”

In Downs view, prostate cancer surgery is almost like life insurance. You have to pay the price now for a benefit that you may receive 10-15 years from now.

There are three primary considerations when treating prostate cancer, usually either through surgery or radiation. They are stopping the cancer, impact on sexual
performance and impact on urinary control. The cost/benefit can be looked at differently depending on the individual’s point of view and preferences.

“As you can imagine, not a lot of patients want surgery, although the ones who do, I think they have, in their mind, that they can’t live with that organ in their body,”
Downs said. “‘Oh my gosh, it’s in there. I’m thinking about it. Let’s get it out.’ Not too surprisingly, I think those who are married and they have a heterosexual
partner, their wives, in this case, are very adamant that they want surgery. ‘I want it out. I want it done.’ You’ll see that sometimes they are equally invested in that
decision. And the wives probably have a different perspective because they are thinking about those three areas. ‘I want you alive. I want you living. We’ll figure out
the other two.’ Whereas the guy is thinking that sex is most important. Life is third. When you hear that you’ll reap the benefit of the cancer control 10-15 years later,
you can see why the male might get tripped up on that. Sexual drive is a big part of our ego.”

While there have been some studies that seem to indicate that biology may play some role in the disparities in the incidence of prostate cancer among Black men,
Downs said that they have been disproven or haven’t been able to be duplicated in other studies. So that leaves it up to the things that people can control that
contribute to the disparities.

“We know that obesity is a factor,” Downs said. “So those who are obese can have worse outcomes with prostate cancer. That may also trigger diabetes, with
some things regarding insulin. Insulin is not only a way to control blood sugar, but there are also growth factors as well that may actually propagate cancer. There
are those things as well as basic social determinants of health, which are your education and being aware. And then there is screening. Do you utilize or have
access to healthcare? When you look at the Race to Equity report and things like that, you are like, ‘Cancer disparities, but when you drill down, there are income
disparities.’ For a person who is in survival mode instead of creativity or longevity mode, it’s not surprising that they aren’t able to think on a different plain, not that
that is a higher or better plain. It’s just ‘I can’t support my family and I feel bad about that. I can’t even tell you where the prostate is located in my body, so when do I
start to think about prostate cancer?’ Some of it is access and utilization. And unfortunately doctors are human too. When we look at delivery care, we find out that
African American men are less likely to be given curative treatment. And even in the case of African American men with high-risk cancer — the ones where there
should be little quibbling about if this is a cancer to treat and what is the best approach — they are less likely to get their lymph nodes removed, which is a very
important part to make sure that the cancer hasn’t traveled beyond the prostate. They are less likely to get that.”

In order to combat these trends, Downs is working with Joshua Wright in the Cancer Health Disparities Initiative. Wright is the community project coordinator who is
disseminating information about prostate and other forms of cancer through the curriculum Cancer Clear and Simple that is offered in community settings.
Information is power and Wright is trying to empower Black men to make informed decisions about prostate and other forms of cancer.
On November 10, Wright and Downs will be teaming up with Aaron Perry for Men’s Health Talk at Second Baptist Church at 10 a.m.

“Prostate cancer is going to come up,” Wright said. “We want men to understand what their anatomy is and we want to have men understand the risk and benefits of
doing screening and being able to have that information so that they can make a good decision when they get into that doctor space and start having that
conversation. We don’t want terms to start coming up and being thrown around and they are caught like a deer in the headlights. We don’t want that surprise. And I
know for myself, once I get done with the doctor’s appointment, I’m like, ‘I should have asked this.’ In this opportunity, we want to do that preparation work. We want
to get that conversation out there. We want men to have the opportunity to share about some of their experiences. We want to get it out there and have some ways to
do some problem-solving in the moment and be able to see how things are happening in this kind of space and this dynamic of being in Madison and Dane County.”

What is very important is the doctor-patient relationship. And Black men need to feel they empowered to make decisions about their own health and are co-decision-
makers with the doctor.

“I’m starting to learn how this relationship with doctors is a partnership,” Wright said. “We want to give that reminder to men that it is more beneficial for you to ask
questions if you are uncertain and might walk out of there with unanswered questions. We want people to understand patient-centered care and informed decision-
making. These are the moments where we really get to talk about what that means or what that looks like and being able to encourage people to prepare for those
doctor visits. I think that is really instrumental in being able to get the best care delivery. When a doctor is making a suggestion, just being able to be on your toes
and say, ‘I heard about a therapy. What is that all about? Dr. Downs, can you tell me a little bit about what that treatment is and how it impacts what these side effects
could be or how much that is a curative thing versus something that is kind of slowing things down a bit?’”

And it is important to break through any barriers, racial or otherwise, between the doctor and the patient, allowing them to see each other’s humanity in order to
establish a connection that will be beneficial for the patient.

“What are some of the useful types of ways to approach things,” Wright asked. “I’ve heard that humor is a way to break the ice in those situations. Life experiences
are also important. As I am talking to a doctor, I can understand that they have had their whole life experiences. Maybe that’s going to make me a little bit more
comfortable in saying, ‘Hey I used to play football too. I remember what it was like lining up against the other guys and trying to best them.’ Once we are able to
share whatever those things are in that moment, that can hopefully get to a place where, ‘Okay, I can relate. I can see this doctor as a person and I’m going to let
them know that I’m a little bit apprehensive in saying that things are not working well for me in the middle of the night and I’m getting up and going to the bathroom
and I need to understand what this is about. Can you help me out doc?”

Men’s Health Talk on November 10th at Second Baptist Church, 4303 Britta Parkway, 10 a.m.-noon, is a free event and includes breakfast. Get the straight facts from
the folks who know about prostate cancer. And become empowered to make decisions about your health and future. Your loved ones will appreciate having you
around for a long time to come.
By Jonathan Gramling

When Dr. Tracy Downs entered California Lutheran University, he was intent on “settling”
to become a high school math teacher and football coach. But a professor encouraged
him to enter medical school and Downs entered the University of California-San Diego
medical school. Downs observed that two African American students were entering the
field of urology and piqued his curiosity. For his clinical rotations, he chose urology and
has been enmeshed in the field ever since.

Upon receiving his medical degree, Downs headed for the East Coast.

“I did a residency at the Brigham and Women’s Hospital, which is part of the Harvard
program,” Downs said. “That was a six-year program. You’re pretty green behind the ears
in terms of being an intern and what you really can do. You know more than what you can
actually be useful for. That was a great experience. I learned and grew as a person. And
then I started to focus on ending cancer. In my fifth year, we kept hearing stories about the
same thing we are going to talk about, prostate cancer disparities and African American
men being the worst and everyone having an idea about it. Some were right and some
were wrong. I started getting kind of a social consciousness. I was a surgeon and I
wanted to figure this out or at least attempt to figure it out. To do that, I tried to do two
additional years to focus on cancer and I did that with a two year Urologic
Oncology/