HJAR Sep/Oct 2022

HEALTHCARE JOURNAL OF ARKANSAS I  SEP / OCT 2022 47 Gerald Heulitt, MD Arkansas Urology to theAmerican UrologicalAssociation’s 2021 urology workforce census, around 89% of urologists practiced in major metro areas. However, Arkansas Urology has several sat- ellite offices throughout the state to try to better reach patients closer to their home. While the socio-economic roots of the ur- ban/rural health divide are still being stud- ied, one thing we do know is that it seems to have a real impact on whether rural patients seek treatment following an initial prostate cancer diagnosis. A 2020 study of over 51,000 prostate can- cer cases in Pennsylvania found that rural patients diagnosed with prostate cancer were less likely than urban patients to un- dergo definitive treatment of their prostate cancer (23% of rural patients compared to 18% of urban patients). Attempts were made to further elucidate this by controlling for urologist density and socioeconomic fac- tors, but the likelihood of receiving treatment still remained low compared to their urban counterparts. 7 While there are many factors that can positively and negatively impact a patient in their risk for prostate cancer, I would leave you with this: knowledge is power. Knowing a patient’s PSAprovides us with information to risk stratify and counsel that patient to provide themwith the appropriate workup they need. Failure to screen keeps a com- mon and potentially morbid disease in the dark until it surfaces when treatment options are limited. n REFERENCES 1 Kelly, S.P.; Anderson, W.F.; Rosenberg, P.S.; Cook, M.B. “Past, Current, and Future Incidence Rates and Burden of Metastatic Prostate Cancer in the United States.” European Urology Focus 4, no. 1 (Jan. 4, 2018): 121-127. doi: 10.1016/j.euf.2017.10.014 2 American Lung Association. “Lung Cancer Fact Sheet.” Last Updated May 27, 2020. https://www. lung.org/lung-health-diseases/lung-disease- lookup/lung-cancer/resource-library/lung-can- cer-fact-sheet 3 Weight, C.J.; Kim, S.P.; Jacobson, D.J.; et al. “Men (aged 40-49 years) with a single baseline prostate-specific antigen below 1.0 ng/mL have a very low long-term risk of prostate cancer: results from a prospectively screened population cohort.” Urology 82, no. 6 (December 2013): 1211-7. doi: 10.1016/j.urology.2013.06.074 4 Carter, H.B.; Albertsen, P.C.; Barry, M.J.; et al. “Early detection of prostate cancer: AUA Guide- line.” The Journal of Urology 190, no. 2 (August 2013): 419-26. doi: 10.1016/j.juro.2013.04.119 5 Sritharan, J.; MacLeod, J.; Harris, S.; et al. “Pros- tate cancer surveillance by occupation and in- dustry: the Canadian Census Health and Environ- ment Cohort (CanCHEC).” Cancer Medicine 7, no. 4 (April 2018): 1468-1478. doi: 10.1002/cam4.1358 6 Nair, S.S.; Chakravarty, D.; Dovey, Z.S.; et al. “Why do African-American men face higher risks for lethal prostate cancer?” Current Opinion in Urol- ogy 32, no. 1 (Jan. 1, 2022): 96-101. doi: 10.1097/ MOU.0000000000000951 7 Maganty, A.; Sabik, L.M.; Sun, Z.; et al. “Under Treatment of Prostate Cancer in Rural Locations.” The Journal of Urology 203, no. 1 (January 2020): 108-114. doi: 10.1097/JU.0000000000000500 RESOURCES American Cancer Society: Prostate Cancer Risk Factors. https://www.cancer.org/cancer/pros- tate-cancer/causes-risks-prevention/risk-factors. html American Cancer Society: Cancer Facts & Figures for African Americans 2019-202. https://www. cancer.org/content/dam/cancer-org/research/ cancer-facts-and-statistics/cancer-facts-and- figures-for-african-americans/cancer-facts-and- figures-for-african-americans-2019-2021.pdf American Urological Association: Census Results. https://www.auanet.org/research/research-re- sources/aua-census/census-results Gerald “Jay” Heulitt, MD, is a board-certified and fel- lowship-trained urologist who specializes in urologic oncology and complex kidney stone treatment. He graduated summa cum laude from Syracuse Uni- versity with a bachelor’s degree in biology prior to obtaining a medical degree from the University of Arkansas for Medical Sciences. He completed urol- ogy residency training at the University of Mississippi Medical Center in Jackson, Mississippi. After resi- dency, Heulitt completed the one-year Robotic and Laparoscopic Surgery Fellowship at SwedishMedical Center in Seattle,Washington,withJames Porter,MD. He joinedArkansas UrologyAugust 2017.Heulitt and his wife live in Little Rock and have one child. PMS2, or EPCAM).AtArkansas Urology, men who receive a diagnosis of prostate cancer undergo germline testing to help identify those with an inherited mutation. This can help not only the patient but allows for oth- er members in the patient’s family to obtain germline testing to determine if they need early screening or treatment. Another important factor in determining prostate cancer risk is the race of the patient. Studies have found that African Americans are 76% more likely to be diagnosed with prostate cancer than non-Hispanic white men and are 2.5 times more likely to die from the disease. The underlying reasons for this disparity have not been clearly elucidated; however, socioeconomic, tumor biology, access to care, and genetic factors all appear to play a role. Recent evidence has shown that African Americanmen have upregulated expression of genes related to inflammatory pathways with downregulation of DNA repair genes. Whereas, white men have higher DNArepair pathways and metabolic pathways involv- ing glycolysis and cell cycle activity. These differences may explain why we see in the PROCEED registry of over 1900 men with metastatic castrate-resistant prostate can- cer treated with sipuleucel-T, an autologous immunotherapy, overall survival was sig- nificantly better for African American men at 54.3 months compared to 33.4 months. 6 Further research into the unique tumor biol- ogy of our patients may lead to more indi- vidualized treatments. Another risk factor that is particularly rel- evant in Arkansas is whether a patient lives in a rural or urban area. Accessing screening and preventative care for prostate cancer in rural America can be challenging. According