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Dr. Richmond Hill Shares His Journey Of Overcoming Prostate Cancer

by John Reid

According to the statistics, Black men are 1.7 times more likely to be diagnosed with- and 2.1 times more likely to die from prostate cancer than white men. They are also more likely to be diagnosed with advanced diseases. A person who appears healthy on the outside could be dealing with potential cancers on the inside.

That is what happened to Dr. Richmond Hill, Provost at Northern Virginia Community College in Woodbridge. What he thought was a routine checkup turned into something much more, it turned into an opportunity to save lives. He spoke about his journey with the PW Perspective's John Reid.

"When I was diagnosed with prostate cancer," he said, "one of the questions I asked God was 'Why me?' and I got a clear answer. 'It was not about you Richmond, it's about the lives you can help save if you share your story."

How it began was in a very innocuous way.

"I was 45 years old when I was diagnosed, and I didn't have any symptoms," he said. "It was time for my annual physical exam with my primary care physician. I was having a difficult time finding something for my schedule, so I just decided to skip it."

"When I got an appointment later in the year, I took the PSA Screening Test, and it came back elevated. My doctor shared at the time that we needed to do additional tests. We did a 45-60 day watch period, and it elevated a little more. He then scheduled an MRI, and it came back there were tumors and abnormalities, so they wanted to do a biopsy."

"They performed the biopsy," he continued, "and it was in the second week of December, and I remember going through the holiday season wondering the results. In the meantime, I was talking with other men who had experienced prostate cancer, and they said it was very painful. In the biopsy, they take a needle and insert it to a wall through your rectum, in order to get some tissue."

Hoping for the best, he met with his doctor and found out the results.

"Early the next year, I did meet with my doctor, and they told me it was malignant. It was stage two cancer, and we discussed treatment options, from radiation to prostate removal. I go through the process of meeting a radiation oncologist, and he recommended that if it wasn't removed, then it could return. I asked him for his recommendation, and given my age, he said to proceed with the removal."

"So, I call my cousin Keith who is a surgeon, and I asked him if I should get a second opinion. He said absolutely, I tell all of my patients to get one. Getting one is not a slight in my profession. We reached out to a doctor who worked at Johns Hopkins to discuss treatment options. He contacted me via email, and we scheduled a consultation. I'm originally scheduled to have a treatment within three to four months, but by divine intervention, they were able to move it up to within a week."

Dr. Hill described his experience at Johns Hopkins as one which gave him confidence in getting the treatment he needed.

"It was great because as a Black doctor, Dr. Burnette, I felt very comfortable about the process. It was like talking to my father. During the waiting process, I was doing a lot of scans to make sure it didn't spread to the bones and other parts of the body. You want to get a surgeon who has a number of surgeries under their belt to preserve as much of the nerve and tissues as possible, because that will help with your urinary control."

"In addition, I underwent a procedure called Stravix, which is using infant stem cells and insert it into deep wounds. During the trials, they were using it for car accident victims. It will help regenerate and restore cells in adults. I agreed to be part of the research trial. Being on the cutting edge in neurological developments, it helped me to feel much better about the process."

As he was being healed through the treatments, he sought to get continued support.

"Outside of a mutual friend, I didn't know many men who were my age who were going through the same situation. I reached out to Zero Prostate Cancer, who hosts the run/walk in June, and it gave me a place to go to and get the information I needed. We had weekly talks with neurologists to get the latest information in diets and supportive resources."

"While it was great to meet with different people and share their experiences," he continued, "one thing stood out to me was, 'Where were the Black people?' so I asked the people at Zero, and they appreciated me bringing it up, because they had wondered the same thing."

"In the Black community, we don't discuss health-related issues as often, especially as men when it comes to prostate cancer. We've seen it in a more public light with [Defense Secretary] Lloyd Austin and OJ Simpson, and hopefully it will bring up more discussion."

He was able to find a safe space to discuss these issues with Zero Prostate Cancer, and he was able to share his story at the Run/Walk event they hold in June.

"At Zero Prostate Cancer's run/walk last year, I told my story, and I remember at the time we had a lot of people come up to me and they were thankful for speaking out."

"It's personal, but if you don't share it, then in my opinion, you're not doing what you can to help someone else. I was at work before I had my surgery and when I told people about it, especially men, they would say, 'But you look so healthy." It's a reminder to get consistently checked, because you don't always have to have any symptoms."

Dr. Hill shares his advice for what men should request at physicals.

"I remind people that when you get a physical, to make sure you get a PSA Screening, and a digital rectal exam is included, because that could save your life. My doctor told me, had it been months later, it could've been a different story. Early detection is everything, and it means something completely when you experience it personally."

Through it all, was he ever concerned about making it through? It wasn't the fear of death, he said, but of something else.

"I was more nervous about what the journey would be like," he said. "Maybe it was due to my faith and optimistic nature, but at no point did I feel I was going to die. Will I have to go to chemo several times a week, will I be nauseous, and feel sick for months on end? I knew I was going to come out on the other side, but I saw a message in dealing with this to see it is important to be screened annually and talk about this with someone."

"Also," he continued, "I had a mentor who was very frank and honest about what I was going through. Having the support of family helped walk me through the process. Seeing the external messages about overcoming it, they encouraged me to get through it, especially in the tough times."

Now, he gets to share his experiences through his own team, Hill's Heroes. He talked about it on his LinkedIn Page and how people can support.

"I tell anyone I come in contact with that if they ever need me to share my story with a family member, or organization, I will do that," he said. "I think that it's a conversation starter, and an eye opener for both men and women. It's about the reality of this disease and what we need to learn. I also encourage Black women to keep Black men accountable to get their health checked out. Some of us need that push when something doesn't feel right, we need to see our doctor."

The event, which comes up on June 15 at Pentagon City, is an opportunity for people to meet with others who are going through, and have overcome, prostate cancer.

"It's a low impact 5K event, and it's a welcoming event for all run/walkers," he said. "Most importantly, it's an opportunity to get the necessary information at the Pentagon City area. At the end they will have a survivor story, and for anyone who wants to talk with a member of the organization, they will make themselves available."

"For anyone in the fight right now, and the people who have lost others to this disease, it changes their perspective."

If you would like to know more about supporting Zero Prostate Cancer and Hill's Heroes, please visit their website. Their goal is to raise $13,000. For those who would like to purchase a shirt in support of Dr. Hill and to bring awareness, please visit his Bonfire page.

Prostate Cancer 'super Responders' Live For Two Years On Immunotherapy

Treated prostate cancer cells (Mateus Crespo/Prof Johann de Bono, the ICR)

Image: Treated prostate cancer cells (Mateus Crespo / Professor Johann de Bono, the ICR)

Some men with advanced prostate cancer who have exhausted all other treatment options could live for two years or more on immunotherapy, a major clinical trial has shown.

Researchers found that a small proportion of men were 'super responders' and were alive and well even after the trial had ended despite having had a very poor prognosis before treatment.

The study found that one in 20 men with end-stage prostate cancer responded to the immunotherapy pembrolizumab – but although the number who benefited was small, these patients sometimes gained years of extra life.

The most dramatic responses came in patients whose tumours had mutations in genes involved in repairing DNA, and the researchers are investigating whether this group might especially benefit from immunotherapy.

The phase II clinical trial, called KEYNOTE-199, was led globally by a team at The Institute of Cancer Research, London, and The Royal Marsden NHS Foundation Trust, and involved 258 men with advanced prostate cancer who had previously been treated and become resistant to androgen deprivation therapy and docetaxel chemotherapy.

Evidence of tumour response to immunotherapy

The study is published today (Wednesday) in the Journal of Clinical Oncology and was funded by the drug's manufacturer Merck & Co., Inc., known as MSD outside the US and Canada.

Overall, 5 per cent of men treated with pembrolizumab saw their tumours actually shrink or disappear, while a larger group of 19 per cent had some evidence of tumour response with a decrease in prostate-specific antigen (PSA) level.

Among a group of 166 patients with particularly advanced disease and high levels of PSA, the average length of survival was 8.1 months with pembrolizumab.

Nine of these patients saw their disease disappear or partly disappear on scans. And of these, four were super-responders who remained on treatment at the end of study follow-up, with responses lasting for at least 22 months.

A second group of patients whose PSA levels were lower but whose disease had spread to the bone lived for an average of 14.1 months on pembrolizumab.

New larger trials are now under way to test whether men with DNA repair gene mutations in their tumours, or those whose cancer has spread to the bone, should receive pembrolizumab as part of their care.

Better tests to pick out who will respond best

The study also compared the effectiveness of pembrolizumab in men whose tumours had a protein called PD-L1 on the surface of their cancer cells and those whose tumours did not. Targeting PD-L1 activity with pembrolizumab takes the 'brakes' off the immune system, setting it free to attack cancer cells.

But the study found that testing for PD-L1 was not sufficient to tell which patients would respond to treatment. Men with PD-L1 in their tumours survived 9.5 months compared with 7.9 months for patients without PD-L1 in their tumours.

Identifying better tests to pick out who will respond best will be critical if pembrolizumab is to become a standard part of prostate cancer treatment.

Pembrolizumab was well tolerated, with 60 per cent of patients reporting any side effects and only 15 per cent of patients experiencing grade 3-5 side effects.

We are building a new state-of-the-art drug discovery centre to create more and better drugs for cancer patients. Take a virtual reality tour of the Centre for Cancer Drug Discovery.

'Small proportion of men are super responders'

Professor Johann de Bono, Regius Professor of Cancer Research at The Institute of Cancer Research, London, and Consultant Medical Oncologist at The Royal Marsden NHS Foundation Trust, said:

"Our study has shown that a small proportion of men with very advanced prostate cancer are super responders to immunotherapy and could live for at least two years and possibly considerably longer.

"We don't see much activity from the immune system in prostate tumours, so many oncologists thought immunotherapy wouldn't work for this cancer type. But our study shows that a small proportion of men with end-stage cancer do respond, and crucially that some of these men do very well indeed.

"We found that men with mutations in DNA repair genes respond especially well to immunotherapy, including two of my own patients who have now been on the drug for more than two years. I am now leading a larger-scale trial specifically for this group of patients and am excited to see the results."

'Tremendous benefits for some patients'

Professor Paul Workman, Chief Executive of The Institute of Cancer Research, London, said:

"Immunotherapy has had tremendous benefits for some cancer patients and it's fantastic news that even in prostate cancer, where we don't see much immune activity, a proportion of men are responding well to treatment.

"A limitation with immunotherapy is that there's no good test to pick out those who are most likely to respond. It's encouraging to see testing for DNA repair mutations may identify some patients who are more likely to respond, and I'm keen to see how the new, larger trial in this group of patients plays out."

Prostate Cancer In Younger Men, 8 Things To Know

Prostate cancer and younger men Prostate cancer is one of the most common cancers in men, with 1 in 8…

Prostate cancer and younger men

Prostate cancer is one of the most common cancers in men, with 1 in 8 men receiving a diagnosis in their lifetime. While it's typically considered a disease of older men, studies indicate that prostate cancer (like other cancers) is on the rise among young men. According to the American Cancer Society, about 10% of prostate cancer diagnoses in the United States are in men under 55 years old, though prostate cancer in men in their teens or 20s is very rare. However, younger men with prostate cancer can face somewhat different long-term concerns, including possible effects on fertility from treatment. Black men are also at higher risk.

Doctors encourage young men to maintain a healthy lifestyle to lower their risk of developing prostate cancer. But, because the disease tends to strike later in life, they encourage people not to stress about their risks prematurely. Here's what younger men should know about prostate cancer:

1. Prostate cancer is rare in young men

When it comes to prostate cancer, doctors say — typically — the lower your age, the lower your risk level.

According to the National Cancer Institute's Surveillance, Epidemiology and End Results Program's predictions for 2024, more than 60% of prostate cancer cases occur in those 65 and older, with the median age at diagnosis being 67. Only 6.7% of prostate cancer cases occur in men ages 35 to 54.

Dr. S. Adam Ramin, a board-certified urologist, urologic oncologist and the medical director of Urology Cancer Specialists in Los Angeles, says it's both "extremely" and "exceedingly" rare for a 20-year-old male to have prostate cancer. Among the thousands of patients he has treated over the last 20 years, Ramin says he has only seen two or three patients who have been in their mid-thirties. The youngest patient he treated was 35.

Nevertheless, about 10% of new diagnoses occur in men age 55 or younger, and these early-onset cancers often have a worse prognosis as the tumors tend to be more aggressive.

2. Why prostate cancer risks can increase with age

One of the reasons prostate cancer is uncommon in younger men is because risks accumulate over time.

Ramin explains that prostate cancer is thought to be "a hormonally driven type of cancer," primarily influenced by testosterone. He notes that someone must have "enough of a lifetime exposure to testosterone," for prostate cancer risks to arise. Older men have likely been exposed to more cumulative testosterone over their lifetime than younger men, he adds.

According to the National Cancer Institute, early-stage prostate cancer needs androgens, or male sex hormones, to grow. The two primary androgens are testosterone and dihydrotestosterone, or DHT. To combat this, men with prostate cancer are sometimes given hormonal treatments to reduce their production of testosterone and DHT. However, as the cancer progresses, it often stops responding to hormonal treatments and can continue growing regardless of androgen levels.

Despite the above, studies have found that taking hormonal therapies to increase testosterone production does not appear to increase the risk for developing prostate cancer, if the therapy is used for a moderate period of time. A 2018 study examined men with low starting testosterone levels and normal prostate cancer screening tests, finding no increased risk from testosterone-boosting therapies used for up to 12 months.

In addition to hormone exposure, Ramin says there are likely "other genetic factors that essentially become 'expressed' — or genes that start getting turned on — in later phases of a person's life," further explaining why prostate cancer risks increase with age.

3. How prostate cancer screening works/strong>

To check for prostate cancer, one of the first things your doctor may do is administer a prostate cancer screening test. Screening tests are not recommended for everyone and are rarely offered for men younger than 40 unless they show symptoms of prostate cancer.

A typical prostate cancer screening test involves a blood test for prostate-specific antigen, or PSA. A digital rectal exam, to detect abnormal areas or lumps in the prostate, may also be part of screening. High PSA levels can indicate that you may be at risk for prostate cancer. However, a screening test alone is not sufficient for a prostate cancer diagnosis — which can require additional steps like a biopsy.

If your screening reveals a high PSA level, you can then decide whether or not to undergo further diagnostic. Also, if your screening reveals a high PSA number, it can be a good idea to get follow-up screening in years to come.

For men with a PSA level of 2.5 or higher, the ACS recommends annual PSA testing. Those with a PSA level of 2.5 or lower may only need to be tested every other year.

4. Prostate cancer screenings aren't universally recommended

The ACS does not currently recommend prostate cancer screening for all men. However, they suggest that all men have a chance to make an informed decision about whether or not to get screened. These discussions should take place between ages 40 and 50, depending on a person's risk level. Higher risk can by influenced by factors such as race or a family history of prostate cancer.

Specifically, the ACS recommends starting the conversation with a health care provider at:

— Age 40, for men who have more than one first-degree relative (such as a father or brother) who was diagnosed with prostate cancer before age 65

— Age 45, for men who have one first-degree relative who was diagnosed with prostate cancer before age 65, and for people who are Black or African American

— Age 50, for men who are at average risk for prostate cancer and expected to live more than ten more years

Screening is not recommended for men who are younger than 40, due to the "low likelihood of prostate cancer" in younger men, says Dr. Justin Tiulim, a hematologist and oncologist at Hunt Cancer Center at Torrance Memorial Medical Center in Torrance, California.

Tiulim adds that PSA tests can at times produce false positives, later leading to unnecessary invasive testing and anxiety, especially in this young population. Even at age 40 and above, people may choose not to get screened for these reasons.

Sometimes, false positives result from infections, recent instrumentation, ejaculation or trauma — all of which can raise PSA levels, Tiulim says.

5. Why an "early screening" at 40 is early enough

Research shows that early prostate cancer screenings may be able to predict future prostate cancer risk. But in this context, "early" still means age 40 and above. For younger men, doctors and health organizations recommend waiting until your 40s or 50s to discuss screenings, expressing caution toward testing prematurely.

One reason for this recommendation is that PSA levels can fluctuate, such as due to infections or physical activity, making them less reliable for younger men. As Tiulum explains, over time, "PSA levels can change, dependent on multiple factors."

Additionally, tools like risk calculators designed to estimate an individual's risk for prostate cancer are primarily used to determine if patients should proceed with biopsy or not, rather than for general screening purposes. "These have not yet been validated by randomized clinical trials," Tiulum adds, meaning their accuracy and reliability have not yet been thoroughly tested in the most rigorous type of scientific study.

Another reason for hesitancy, according to the ACS, is the potential for PSA tests to produce false positive results, which can lead to anxiety and even unnecessary treatment. Prostate cancer treatments, like radical prostatectomy, can impact men's sexual function and fertility, potentially conflicting with their future sexual or family goals. While these side effects can be worth it to save someone from cancer, they are less desirable if someone is low-risk and had a false positive test.

Once men reach the age when screenings are recommended, Ramin encourages patients not to be scared away by false positives. Doctors shouldn't based their decision to conduct surgery solely on PSA tests; they'll conduct further diagnostic testing and evaluations before determining if someone has prostate cancer and how it should be treated, he says.

6. When to seek medical attention for prostate-related symptoms

Young men can feel relatively confident that they will not come down with prostate cancer. But that doesn't mean they are 100% in the clear. If you have a family history of prostate cancer or experience any red-flag symptoms, it could be a good idea to get checked out.

Likely, a visit to the doctor will alert you that you are experiencing a different problem — which your doctor should be able to help you treat or manage. Still, in the off chance that they hand you a suspected prostate cancer diagnosis, this is important to take seriously.

Many potentially prostate-related symptoms fall under urinary- and pain- based symptom categories. Some of these include:

Urinary symptoms

— Frequent urination, defined as urinating more than every three hours if not also drinking a lot of fluid

— Nighttime urination

— Feeling like you're not emptying your bladder after urinating

— Significant slowing of urination

— Having the urge to constantly urinate

— Leaking urine with an urge to urinate

— Straining during urination

— Blood in urine or semen

Pain symptoms

— Painful urination

— Suprapubic pain, or pain above the pubic bone area or in the lower abdomen

— Perineum pain, or pain on the area the person sits, between where the scrotum ends and the anus begins. Deep-seated perineum pain can be a signal of a prostate-related issue, such as prostate cancer, and is important to get checked out, Ramin says.

Dr. Richard Wender, professor and chair of the Family Medicine and Community Health department at the University of Pennsylvania's Perelman School of Medicine in Philadelphia, adds that the above pain symptoms may be a sign that prostate cancer has progressed to a later stage — or indicate that someone is experiencing a different issue altogether.

"Like most solid cancers that are common in adults, symptoms usually don't occur until the cancer is beyond its earliest stages," Wender says. "And the very earliest prostate cancers are very unlikely to be associated with symptoms."

He adds that in some cases, men may experience urinary symptoms from having an enlarged prostate, and not prostate cancer. When this happens, symptoms may be coming from the prostate being big rather than from having cancerous cells in the prostate gland, he says.

To verify, see your primary care doctor for any initial symptoms, but seek out a specialist — like a urologist — if symptoms persist or worsen.

7. Prostrate cancer in younger men tends to be more aggressive

Ramin says that because prostate cancer is so unlikely in younger men — and because screenings are not recommended for people under 40 — cases that are detected based on symptoms could be more aggressive.

"Because it's so rare to develop prostate cancer in a much younger population, when it does happen, it may be because of a more significant genetic derangement rather than just old age testosterone exposure," Ramin says.

Men diagnosed with prostate cancer at 55 or younger are more likely than others to eventually die from the disease itself, rather than outside causes. Researchers from the University of Michigan found that for certain types of prostrate cancer that strike at a younger age, tumors appear to grow more quickly and be more lethal.

8. A healthy lifestyle matters

Unfortunately, there is no Food and Drug Administration-approved vaccine to prevent prostate cancer. And there is no one exercise or diet plan that can reduce risks altogether, either. However, you may be able to reduce your risk to an extent by incorporating healthy lifestyle habits into your daily routines.

These can include:

— Following a nutritious diet

— Maintaining a healthy weight

— Being physically active

— Avoiding all tobacco products

— Limiting alcohol intake

The good news is, many of these habits can benefit other areas of health, like supporting a healthy weight and heart disease prevention, in addition to prostate cancer prevention."The important lesson is for all of us to be concentrating on the things that we know reduce overall cancer risks," Wender says.

What younger men should know about prostate cancer:

1. Prostate cancer is rare in young men

2. Why prostate cancer risks can increase with age

3. How prostate cancer screening works

4. Prostate cancer screenings aren't universally recommended

5. Why an "early screening" at 40 is early enough

6. When to seek medical attention for prostate cancer-related symptoms

7. Prostrate cancer in younger men tends to be more aggressive

8. A healthy lifestyle matters

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