Screenings for prostate cancer and other preventive medical care have been down in the U.S. since the start of the COVID-19 pandemic. The lack of recommended testing is increasingly resulting in more cancer diagnoses at stages that make effective treatment more difficult, doctors say.
Penn Medicine and the Philadelphia Flyers have teamed up this year to hold a series of free screening events that educate people about prostate cancer and steer them toward appropriate follow-up care based on their test results.
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"We know that 1 in 8 men in America are going to be diagnosed with prostate cancer. For Black men, it's 1 in 6," said Mallorie Jones, the Penn Medicine project manager who is leading the screening program. "Not only are Black men more likely to get prostate cancer, they're twice as likely to die from prostate cancer."
For Black men, the higher risk of prostate cancer is often related to disparities in medical care.
"One of the barriers to care is transportation and getting these screenings done in locations that are feasible for people," Jones said. "All of our initiatives our mobile. We travel out into the community."
The prostate is a chestnut-sized gland located just below the bladder in men. Apart from its primary reproductive function, the prostate produces hormones and regulates the flow of urine. Medical problems with the prostate — including cancer — become more common as men get older.
The standard tool used to detect signs of prostate cancer is a blood test called a PSA screening. It stands for prostate-specific antigen, a type of protein that's produced by both healthy and cancerous cells in the prostate. Elevated PSA levels may be a sign of prostate cancer and often warrant additional medical attention and testing. Prostate cancer is most often diagnosed in men 63-67 years old, but warning signs also can be found in younger men.
"It's the first way to let your doctor be alerted about the possible presence of prostate cancer," Jones said. "We like to catch it as early as we can because prostate cancer can become more difficult to treat as it progresses."
Since April, Penn has held six screening events in the Philadelphia region, and four more are scheduled through the end of the year. Some of them are open to the general public, including all men 45 and older and Black men 40 and older. Others are targeted to specific at-risk groups.
"We're also looking at populations that are more susceptible to prostate cancer, including those with environmental and occupational exposures," Jones said.
On Friday, Penn is holding an event for firefighters and paramedics from 10 a.m. to 2 p.m. at the union headquarters for IAFF Local 22, 415 N. Fifth St.
Older firefighters and paramedics are at higher risk of developing prostate cancer and other types of cancer. Many retired firefighters – and those late in their careers – worked in an era when protective headgear and masks were not required.
"What we're seeing are some of the side effects from smoke inhalation," said Dr. Daniel Lee, a urologic oncologist at Penn. "We do know that our firefighters who served during that time are at increased risk for a whole slew of cancers. It's somewhere around 10-15% higher. We really want to serve those who are on the front lines."
Other groups — like sheet metal workers, military veterans and people exposed to certain pesticides — also face a higher cancer risk.
Prostate cancer is among the most common types of cancer that runs in families, too. The genetic tie is especially strong with immediate relatives. People who have relatives with a history of prostate cancer or breast cancer, for example, are more likely than others to develop prostate cancer.
"When you are thinking about cancer, you should pay attention to what your family members had," Lee said. "That has a direct link to what you have or may develop. The 'why' is very personal and case-by-case."
Getting screened for prostate cancer is important because most men do not experience any early symptoms related to the disease. Men with enlarged prostates — known as benign prostatic hyperplasia, or BPH — may experience urinary symptoms. BPH isn't a known risk factor for prostate cancer, but the two conditions can overlap.
Some men choose not to get PSA screenings because there has been conflicting federal guidance about them over the last 15 years. Although the tests sometimes lead to overdiagnoses and treatment of cancer in low-risk patients, PSA screening can be lifesaving for those who are able to detect more aggressive cases early. An elevated PSA result of more than 4.0 ng/mL in the blood can help steer men toward more definitive testing.
Lee said PSA screening is imperfect, but it's a useful step for men to take as they get older.
"It's one piece of the puzzle. When we think about the PSA in conjunction with family history and physical exams, there are other tests we can add on to help improve screening accuracy," Lee said. "All these things together can help improve and find potentially deadly disease."
Those who attend Penn's screening events and find that they have elevated PSA levels may be eligible for free transportation to attend follow-up appointments at Penn, with additional check-ins at three and six months. People with high-risk results may be directed to other screening programs at Penn Medicine to give doctors a better understanding of the care they need.
"One of the things that we've been finding is that there's sometimes too much information that's hard for patients, caregivers and loved ones to figure out what is trustworthy information," Lee said. "During the pandemic, we found that a lot of folks just simply did not get their screenings done. We have almost a three-year period where people did not come in to get screened for cancer or get care."
That lack of preventative care, combined with mixed messaging about the value of PSA screening, has led to more serious and life-threatening cases of prostate cancer, Lee said.
"Directly because of that, we actually saw an increased risk of metastatic disease over the past 10-15 years," Lee said. "What we're trying to do is counteract all of that now by letting folks know about some of these other risk factors people have to be worried about — and encourage them to get screened. It does save lives."
The Flyers and Penn Medicine plan to continue holding regular, free screening events until at least the start of 2025. They often work with faith-based organizations and other community partners to get the word out and find suitable locations for the events, which may include other types of health screenings for those who attend.
Men who go to the screening events receive $10 gift cards and free giveaways from Penn and the Flyers. The next four events are listed below. The first two are open only to firefighters and paramedics. The second two are open to the general public.
• Friday, Nov. 17, 10 a.m. to 2 p.m. Local 22 headquarters, 415 N. Fifth St.
• Friday, Dec. 1, 10 a.m. to 2 p.m. Local 22 headquarters, 415 N. Fifth St.
• Saturday, Dec. 9, 11 a.m. to 3 p.m. Men's Tailgate Health Resource Fair at Salus University Eye Institute, 1200 W. Godfrey Ave.
• Saturday, Dec. 16, 11 a.m. to 3 p.m. North Light Community Center, 175 Green Lane
One of the primary goals of the screening programs is to reach people who are often left at the margins of medicine.
"We want to engage people who are not likely to follow up with a doctor or even have one, or they don't have insurance coverage," Lee said. "With this initiative, we're starting to see more people like that."