Prostate Cancer Awareness: An Act of Joyful Resistance

A few years ago, I incorporated a new ritual into my life. Annually, around my birthday, I visit my doctor for a thorough checkup. My screening regimen varies from year to year depending on my health needs, but it always includes a prostate-specific antigen (PSA) blood test. I am keen to complete the PSA ritual out of necessity. Prostate cancer runs in my family and as a Black man, I am 1.7x more likely to be diagnosed with and 2.1x more likely to die from prostate cancer than white men. It is a sobering fact.

Admittedly, bloodwork doesn’t carry the same reverence as my other rituals, like morning prayer or pruning my flower bed. A quick and relatively painless draw of blood, a day’s wait for the results delivered through a non-descript message in my health portal… On the surface, there’s nothing consecrated about it. But the PSA has become sacred to me as an act of joyful resistance.

Destigmatizing Conversations About Prostate Health

While our understanding of prostate cancer and its treatment has advanced in recent decades, the disease remains the second leading cause of cancer death in men in the United States. Sixty percent of US men diagnosed with low-risk prostate cancer are now being managed under active surveillance, with the rate doubling from 2014 to 2021. 

The statistics hit home for me when we consider prostate cancer facts for the Black community. One in six Black men are diagnosed with prostate cancer in their lifetime. Yet, we’ve only recently begun to talk about the disease openly as a community. Prior to the 1990s, you were hard-pressed to find a Black man willing to openly share his experience with disease. In plain terms, people used to think of prostate cancer as a cancer that threatened a man’s virility.

In the 1990s, a number of Black men began to open up about their experiences with prostate cancer––Harry Belafonte, Colin Powell, Ken Griffey Sr., Al Roker, and perhaps most notably for his candid interviews about the disease, Sydney Poitier. In a 2007 Proust Questionnaire with the magazine Vanity Fair, when asked when he was happiest, Poitier said, “I was happiest making films, writing books, and surviving prostate cancer.”

I imagine Poitier’s happiness in surviving the cancer had to do with beating the health odds stacked against him. But I also think his happiness was an output of his vulnerability. He openly discussed his health journey and his fears, pushing against the Tough Guy Syndrome that is so deeply embedded in the culture of Black and Brown men. 

In The Man Up Man Down Research Program, a Michigan-based initiative led by Woody Neighbors, PhD from 2010-2019, 25 focus groups were held across six cities to explore commonly held notions of manhood amongst Black men, like Tough Guy Syndrome. The study offered objective conclusions that validated what many Black men experience when it comes to matters of health, mind, and spirit: We are often raised to believe we should "man up" in stressful situations. We’re told to “Handle your business.”

“This communicates two unhealthy messages,” Neighbors says. “First, it says, ‘I cannot help you.’ Second, it recommends using individual problem-solving strategies without seeking the help of others. Of course, sometimes significant time alone spent praying, meditating, and strategizing is helpful. But ‘Tough Guy Syndrome’ forces men to engage in ‘manning up’ to such an extreme that they cut themselves off from family, friends, and professional help — and even from themselves.”

When Poitier shared an honest account of his battle with prostate cancer in the 90s, he offered a construct of masculinity that effectively deconstructed the ‘tough guy’ narrative for Black men. His vulnerability became a cultural wedge, opening up a dialogue for other Black men to engage in safely about their own experiences with the disease.

When my book The Joy of the Disinherited was published in October 2021, I wrote about my personal efforts to deconstruct the narratives I’d been told about masculinity and what it means to be a Black man. I wrote:

“We cannot process what it means to be a Black man without first processing what it means to be a man. …As a Black man, I must discern the heaviness of the load on my back, only in part, to preserve my spirit and joy. It takes tremendous energy to simply be while carrying the memory and vulnerability of racial traumas, while also being denied a forgiving emotional outlet.” (Essay: Every Conscious Black Man Needs to Be in Therapy)

Deconstructing false beliefs like Tough Guy Syndrome is often a necessary step along the path to mental and physical well-being for Black men and other historically marginalized communities. Our understanding of diseases like prostate cancer and access to effective treatment for the communities hit hardest will continue to improve, God willing. But parallel to this we must dismantle the beliefs that tell us to simply “man up” or “push through.” Culturally ingrained beliefs that hold us back from vulnerability, can also hold us back from seeking help, finding community, getting well, and ultimately finding joy.  

The Need for Nuance

Similar to Poitier, at one point in my life, I began to share an aspect of my health journey as a means to reject the constructs I had been told to conform to as a Black man. It led me to my work in health equity. It also led me to uncover decades of clinical research that showed the direct impacts of racism on a person’s health.

There is a need for America to lend its ear to the amassing medical and social research that qualifies the impacts racism has on the health of people of color. And to do so with an ear for nuance. I speak from my experience as a Black man, because it is what I know inherently.

Yet the aperture of this conversation is broader. It is not a Black and White dialogue. Too often when I speak of matters of health equity – like the inequitable rates of prostate cancer in Black men – I am asked “Why limit the discussion to the Black community?” If I could find a bullhorn that would project loud and clear enough to the world, I would use it to reply to that question: “I’m not limiting the discussion to the Black community.” It is simply – yet profoundly – my starting point, as it is my lived experience.

For progress in health equity, we must mature how we listen and hear the dialogue. Health equity does not mean good health for Black people, only. Health equity aims to create a world where everyone, regardless of their race, can achieve a healthy life.