Arguably, no one knows more about prostate cancer’s grim toll on African-American men than Buffalo-based urologist Willie Underwood III, MD, MPH. He has studied racial disparities in prostate cancer for almost two decades (see “Unequal Care”).
But Underwood’s knowledge of the subject isn’t just academic. It’s personal.
Early in 2009, at age 44, he had a routine blood test for prostate specific antigen (PSA), a marker used to detect and monitor prostate cancer. His numbers had doubled, from about 1 to 2. As a urologist, Underwood knew that was a bad sign. When he opened the test results, he lifted his 1-year-old daughter from her crib—and cried. “I’m holding her, and all kinds of fear and anxiety came over me—to the point that I remember her patting me on the back,” he says.
Having cancer changed Underwood. He has become a more empathic doctor and rededicated himself to breaking down the barriers that keep Black men from getting the best care. And he turned his life around.
A Suspicious All Clear
To rule out an infection, which can spike PSA numbers, Underwood’s urologist recommended a course of antibiotics. But after finishing them, his PSA was still high, so he had a biopsy. It was negative, so he didn’t ask for the report.
Fast-forward two years to 2011. Underwood’s marriage was unraveling, and he was facing challenges at work. On instinct, he obtained a copy of the biopsy report. It turned out that four out of six areas of prostate tissue had been missed. He needed another biopsy. Underwood asked a trusted urologist, a close friend, to do the honors. Again, the results were negative.
But his PSA numbers kept climbing. It was September 2012. He and his wife were separated. Even though both biopsies had been negative, he decided to get another one. “My gut just said, Get it done,” he says. Underwood convinced his urologist to do a saturation biopsy, which involves taking multiple tissue samples from each of the prostate’s six areas.
That biopsy found cancer. It was confined to a small section of his prostate. On the Gleason grading system, which measures a cancer’s aggressiveness, it scored a 7, meaning it was intermediate. His urologist was reassuring, but Underwood was concerned. He knew that for about a third of men who have surgery after a biopsy, more cancer is found; he also knew that prostate cancer in Black men is more likely to be aggressive.
“Dude, Your Life Is a Mess”
Now distraught, Underwood called his close childhood friend Nate and ranted. Underwood lamented that he couldn’t beat cancer, that he might never see his daughter graduate or marry, that the odds were stacked against him. Stunned by his friend’s uncharacteristic doom-and-gloom attitude, Nate reminded him of all the ways that he had already defied the odds, including going on to earn three advanced degrees after being raised by a single mom, ending by exclaiming, “Your whole life has been a statistical improbability!”
The words sank in.
It was a turning point. Underwood inventoried his entire life and didn’t like what he saw. “I said to myself, Dude, the life you’re living is a mess! I decided then to be a better man. A better doctor. A better father. I couldn’t be a better husband—that was too late.”
Underwood decided to forgo active surveillance, meaning the deferral of treatment until regular testing shows disease progression. Instead, he chose bilateral nerve-sparing robotic surgery to remove his prostate (see “Prostate Cancer Treatment”). He didn’t need posttreatment radiation or hormone therapy.
Surgery can cause erectile dysfunction, which Underwood did not experience, and urinary incontinence, which he did. As a former marathoner, he knew the value of exercise and religiously practiced the pelvic floor exercises called Kegels, which helped him recover in a matter of months, though “it felt like an eternity,” he says.
I decided to be a better man. A better doctor. A better father.
Willie Underwood reconnected with his faith and recommitted himself to making a difference in the lives of people less fortunate than him, keeping a promise he had made to his grandfather at age 12. When he returned to work, he found that how he practiced medicine changed too.
At first, he kept his diagnosis and surgery secret. But one day, with a newly diagnosed man, “I could feel in my heart that he was in the place that I had been in,” he recalls. He asked the physician’s assistant to leave the room and shared what no one knew—that he, too, had been diagnosed with prostate cancer. “I told him how I felt in the process, and he just starts crying. Two grown men, and we’re both just sitting there crying. And then I said, ‘Let’s talk about it. Let’s forget about you making a decision [about treatment] and talk about how you feel right now. And let’s deal with that.’”
For the next year, Underwood continued these “undercover” conversations with his newly diagnosed patients. Then it dawned on him: “The most powerful thing I do in this business is share.” So he went public. He now tells patients and their partners or spouses, “I know. I know how you feel. I’ve been there. I tell them, ‘By the way, your whole life has changed, whether you want it to change or not. Whether it’s good or bad, happy or sad, that’s up to you.’”
His advice is to scoop up information, especially from men who’ve survived prostate cancer, and to make sure you get your doctor to answer all your questions—or find another doctor who will. And then? “Try not to worry, but live your life instead,” he says. “Fear doesn’t help.”
Step by step, Underwood has overhauled his postdivorce, post-cancer life. He founded a biotech company to develop a blood test to improve prostate cancer detection. He is on the medical advisory board of the nonprofit organization Fans for the Cure and fields questions at minor league baseball games to promote PSA testing in underserved communities. The American Medical Association invited him to join its board of trustees. And he launched Will U Enterprises to help disadvantaged people achieve the five forms of wealth—economic, emotional, mental, spiritual and physical.
December marks the seventh year that Underwood is cancer-free. In July, he became engaged to Kadi Petridis, whom he met at a surprise 50th birthday party for a college friend. He also signed up with Locum Tenens, a “doc in a box” program, and now travels to small communities to provide short-term urological care where it’s needed. “It’s been an amazing experience for me,” he says, “because it allows me to interact with people that I normally would not have—to bring not only my clinical expertise but other things. At this point in my life, I want to have a positive impact on as many people as I can.”