Dr. Janice Lee Arnold, M.D.
Chair, Prostate Health Symposium
American Cancer Society

Dr. Janice Arnold is a Board Certified urologist and surgeon in Reston, Virginia and has served as Department of Urology chair a Reston Hospital where she is a member of the Cancer Committee and the Tissue Committee. She has been in practice for 14 years, having earned an MD in a specialty that includes, even today, only a handful of African American doctors. When Dr. Arnold earned her urology residency diploma in 1986 from the University of Chicago, where she also served as chief resident, it was even rarer for a woman to specialize in urology, let alone a black woman. She became the first woman to finish a urology residency in the State of Illinois. Dr. Arnold is currently a member of the Board of Directors for the National Society of Women in Urology.

She is reflective in explaining why she chose urology as her specialty. "I get asked that a lot. I’m still not sure how to answer it. When I was going through medical school, I knew from the beginning I wanted to be a general surgeon. I felt as a general surgeon I should know a little bit about various sub-specialties. I took a rotation in several, including urology and literally just fell in love with it. I fell in love with urology. I think it was a combination of things. One, I really did enjoy working with the male patients, particularly older men. "The University of Chicago was doing a lot of terrific research and clinical research in urologic oncology, particularly with prostate cancer and I happened to be there at that time. I also had a chairman who was always in my corner. He and the other urology faculty were very instrumental in encouraging me to do what I truly enjoyed more than the norm. So to go into urology as a woman at that time was very much unheard of and particularly as a Black woman. I think there was only one other Black woman that I knew of that was a urologist. And when I started my residency, to my understanding, there were only seven female urologists in the country. So this was not a field that was opened to women readily."

Dr., Arnold’s primary focus and practice is on urinary tract disorders which include bladder dysfunction, urinary leakage, urinary tract infections, painful bladder disorder, prostate disease, etc. With the increased incidence of prostate cancer, she says that a fair amount of men come through with prostate disease and some with early disease, others with advanced prostate cancer, sometimes, unfortunately in its terminal stages.

There is nothing in her voice, even after 14 years, to belie her love of urology and working with her male patients that she spoke of. Dr. Arnold is devoted to putting her male patients at ease at what might be an anxious and frightening time and especially when she senses their unease at being examined by a female doctor. She fells it’s very important for physicians to establish rapport with their patients early on and says that she usually has her patients relaxed enough, in about 15 minutes, so that they can express those facts that are important for diagnostic purposes and to get the exam done. Dr. Arnold pinpoints some of the reasons that she’s come up with for why establishing this rapport, decreasing anxiety and making her patients as comfortable as possible during these exams are so important.

"I’ve seen some men come in a little bit or very anxious, sometimes very timid for various reasons and many times at the encouragement of their wives. One, it is an inconvenience to go in and get checked. Men very seldom have an opportunity to go in and see a doctor,. unlike women who start at a very early age- they’re going in to get pelvic examinations and pap smears regularly. So by the time they’re 40 or 50, they’re used to seeing doctors. Men on the other hand typically won’t go unless there are some symptoms or there’s something wrong. That’s changing but very slowly. Secondly, there are some men that really are adverse to having the rectal exams done. Some feel that it is an invasion of their privacy, of their manhood and sometimes fell they are being "violated." Men, I think, sometimes feel that they are being sexually violated when they have a Digital Rectal Exam (DRE) done. And I think for that reason men actually prefer to have the exam done by a woman rather that a man. But, obviously not all men feel that way. Third, some men actually find the exam very uncomfortable and sometimes painful, but I am hoping that will change also. Years ago, that exam was routinely done in "the military style where men were asked to pull their pants down to the floor and lean forward with their elbows on an exam table and the rectal exam was done from behind.

"A more comfortable position would entail lying on their side with their knees up to the chest in the fetal-type position. Another position that I find is even more comfortable is when a man is lying on his back with his knees bent and his feet planted on the exam table-almost in the gynecological position like women are in for a pelvic exam. It causes them to relax their muscles. The prostate falls right down on our fingers and I literally find that exam to be the easiest. I think it is important when urologists or primary physicians do the rectal exam,. they make the patient as comfortable as possible and often just slow forward will get the rectal sphincter to relax and you can do a very good examination of the prostate and one that should be painless. Often the potential pain will keep men out of the office. Lastly, I believe that one of the problems that men will have with female physicians is a worry that they will get an erection during an exam. And if I suspect that a person is extremely anxious or nervous over this, I tell them right off, particularly if they happen to get an erection, which is very rare; if that should happen, as a female urologist, we typically tell them it’s not an unusual response- it’s normal. It will happen. Don’t be embarrassed by it. And I think the thing is to get it right out in the open when you sense that is a problem; it’s really important to discuss it early so that they can [know that] this person understands."

With the alarming increase in prostate cancer, the equal concern that Dr. Arnold shows for her patients physical and emotional issues is extremely important in prostate cancer awareness and action on the part of men, especially African American men. According to Dr. Arnold, American Cancer Society (ACS) statistics accurately reflect the more than 50% increase in African American men being diagnosed with prostate cancer than white American men, starting at a younger age (often a decade earlier) and with a doubled mortality rate. Dr. Arnold cites a Walter Reed Army Medical Center study which showed that in spite of equal access to healthcare in the military, the rate of prostate disease in African American men is still much higher, presents at an earlier age and at a more advanced stage of disease.

She adds, "Something is making the cancer more aggressive in African American men. That’s why they can’t or shouldn’t wait until they’re 50 years old to get checked. African American men need to start thinking about this a least by age 45 tears if not before. Data from a Wayne State University study showed there was evidence of pro-cancerous lesions and cells in the prostate gland of men age 20 to 29, ages much sooner that expected in the past. Those men with the very aggressive looking pre-cancerous cells are are more likely to show up in African American men that white American men and that when men are young and get prostate cancer, particularly African American men, it tends to be a more aggressive form of the disease."

For urologists, and perhaps for African American urologists, in light of these statistics, the controversy over when and even if screening should be done presents a double-edged sword.

According to Dr. Arnold, the study hasn’t been done that shows that annual screenings improve survival and that such a study won’t yield any conclusive facts for another 10 to 12 years. While the recommendation for screening is still in the 40’s for African American men and 50’s for w3hite American men, Dr. Arnold reiterates that men often present at a very early age with a very aggressive lesion and if there are no symptoms of early prostate cancer, how else can you pick up on the cancer without doing the DRE and the PSA blood test. According to Dr. Arnold, when prostate cancer become symptomatic, the disease is usually at an advanced stage that can be treated but no longer cured.

"I think it’s good science, good practice, good medicine to have science behind you-medicine substantiated by research. However, if we didn’t screen African American men, it’s obvious that the mortality rate will continue to climb. As an African American urologist, I have to be very concerned about our position on prostate cancer screening. However, because the proof isn’t in, and because there can be significant consequences of treatment, the ACS and more recently the American Urological Association are both saying that men should go in and ‘discuss’ with their doctors whether or not they should be screened." she adds.

In addition to her practice, and as a member of the American Cancer Society Northern Virginia Division Board of Directors and the National Advisory Panel for prostate Cancer, Dr. Arnold has, for the past three years, chaired the Prostate Health Symposium introduced in 1998 as a community education event on prostate cancer. - by Susan Blakes

Susan Blakes is a freelance writer and editor in the Chicago area and a breast cancer survivor.

NEW Damon Harris Cancer Foundation Clinical Trial Service NEW

Site Hosted and maintained by The Texas Network