I had never seen my dad so angry. It was two decades ago in a Florida examination room. My dad had just been diagnosed with cancer, and he was directing an outburst at my mom. Her face expressed unconditional love and support, but I knew what hid beneath that mask: fear. She was afraid, and I was too. 

That memory has left an impression on me to this day. 

At Everglades Correctional Institution, in south Florida, a large portion of the 1,800 residents I live alongside are men over 50 who suffer from various disabilities and conditions, including cancer.

The chances of being diagnosed with prostate cancer rise rapidly after age 50. About 60% of instances of prostate cancer are discovered after age 65, according to the American Cancer Society. And for those who are diagnosed while incarcerated or recently released from prison, the risk of dying from cancer is higher than for those who had never been incarcerated, a study from the Yale Cancer Center found.

In prison, cancer is the leading cause of death, according to the Bureau of Justice Statistics. An analysis of mortality in state and federal prisons, from 2001 to 2019, found that cancer accounted for 27.5% of all prison deaths over that period.

A stigma persists

How has the prison population reacted to such frightening statistics? 

Many have chosen to avoid the topic, said ECI resident Al Burgess, a staunch proponent of raising awareness of prostate cancer.

“Men are not talking about such controversial or challenging subjects,” he said.

Burgess has been self-testing for prostate cancer since he was 32 years old and detained in a county jail. He has been afraid of the disease since he was 19 years old when he was visiting his grandfather and saw large tubes protruding from his groin — tubes to drain his urine and control prostate enlargement. 

Fear is one reason the topic is avoided. But Burgess believes the reluctance to discuss prostate cancer is more than about fear and has to do with machismo. Many men don’t want to be tested because it commonly requires a digital rectal examination. 

“There is a fear of the exam itself and finding out you may have [cancer],” Burgess said. “It’s an extreme that men aren’t willing to talk about.”

When men find out the prostate is a gland that helps make semen, they feel that a prostate cancer diagnosis means “something is wrong with them as a man,” he explained. 

“Men are actually afraid of a health exam,” Burgess said. “You can run from the examinations only to discover the cancer years down the line.”

Raising prostate cancer awareness

In the weeks leading up to National Breast Cancer Awareness Month in October, pink ribbons can be seen almost everywhere — on TV and in print, as well as proudly worn on many a lapel, by men and women. This is largely due to the meteoric growth and popularity of Susan G. Komen for the Cure, a nonprofit that has helped make the ribbons a ubiquitous sighting. It is also due to the fact that breast cancer is the second-most common form of cancer in the U.S. behind skin cancer. 

The estimated cases of prostate cancer for 2023 are not far behind breast cancer, and the estimated number of deaths for both cancers are also close, according to the National Cancer Institute. Despite being similarly prevalent, breast cancer has historically garnered much more funding than prostate cancer, according to the National Cancer Institute. 

Burgess said he believes women are socially conditioned to better deal with the emotional implications of breast cancer than men are with prostate cancer.

“We [men] haven’t even started the conversation,” he said.  

A health services administrator for ECI’s medical provider reported that our prison has seen six cases of surgical removal of the prostate over the past year. 

“We don’t see [these patients] until it’s a little too late,” she said. “Why won’t the men speak up and notify medical staff?”

But how do you have the conversation no one wants to have? 

Over years of incarceration, Burgess has freely talked with men about prostate cancer. He suggested we start the conversation within our own communities.  

“There are people among us that do have information, residents who were formerly doctors. Medical staff could offer seminars to help get the men talking,” Burgess said. “We are conditioned to stay quiet about most things. But, by providing a safe forum and a sympathetic ear, you will find those willing to open up.”

If ECI residents can already openly talk about alcohol addiction or drug dependency in support groups, why shouldn’t we open up about prostate concerns? Why shouldn’t we exchange our fears and preconceived notions of masculinity for awareness, prevention and longevity?

“What are we running from?” Burgess said. “The disease? Fear of the unknown? If you detect it early, the treatment isn’t that severe. … We have to establish a pattern of dialogue to leave a better legacy for the generation coming up.”

I still vividly remember my dad consumed by an anger he didn’t understand in the wake of his cancer diagnosis. Today, I feel certain he was scared, and understandably so. We want those we love to see us as powerful protectors — not helpless in the grip of disease.

Fear prevented my dad from having an honest conversation with his providers and his family about his health. Don’t let it stop you.