On Call for Men's Health

Filmmaker Landi Maduro on "The Silent Killer," Prostate Cancer

Episode Notes

Today, Dr. Michael Lutz's guest is award-winning filmmaker Landi Maduro.  Her documentary, The Silent Killer: Prostate Cancer in the African American Community has been screened by the Congressional Black Caucus and has been used by health care professionals and scholars educating on healthcare disparities and prostate cancer survivorship.

As a Black female, Landi got involved with this topic when her filmmaking partner, Chris Edwards, learned of his father's prostate cancer diagnosis.   Then, within 6 months of working on the film, Landi's own father was diagnosed with the same disease.

Armed with what she learned making the movie, Landi took an active role in her father's treatment and care.   And when the movie came out, she found a number of females actively engaged with it - those helping to care for a spouse or other family member.

In researching her film, Landi heard every excuse in the book for why men, particularly Black men, don't get screened for prostate cancer.  She set out to attack those excuses, one by one, leaning on clergy and other community leaders to get the message out.  She also featured a number of prostate cancer patients, all but one of whom survived.

Another focus of today's guest is sharing family history.  For many, they don't know what their relatives died from.  And knowing this history can lead to more advanced and preventative screening.

We also touch on an important subject in underserved communities - disparities in treatment.  While Landi's father was undergoing active surveillance for his prostate cancer, his team found pancreatic cancer.  They gave him a death sentence.  It was a sentence that Dad accepted, but his daughter would not.   She advocated for him, found him the best treatment, and he's still here.  It's also important for Black men to participate in clinical trials, despite some very ugly history in that area.  This is a prioirty for Landi as a member of the ZERO Prostate Cancer Health Equity Task Force.

More information:

ZERO Prostate Cancer Health Equity Task Force Website: https://zerocancer.org/our-mission-impact/zero-team/health-equity-task-force

The Silent Killer documentary on Tubi: https://tubitv.com/movies/100003487/the-silent-killer-prostate-cancer-in-the-african-american-community

MIU Men's Health Foundation Website:https://www.miumenshealthfoundation.org/

Episode Transcription

Dr. Michael Lutz: Today, we're going to be talking about prostate cancer as a silent killer with Landi Maduro. I really am very happy to have her here today.

She's an award-winning writer, director, and producer. She's directed and produced short films, features, music videos, small business commercials, and documentaries since launching her production company, Bluechild Entertainment, in 2012. Her award-winning documentary, The Silent Killer: Prostate Cancer in the African American Community, is currently available on Tubi TV and has been screened for the Congressional Black Caucus and used by healthcare professionals and scholars educating on healthcare disparities and the African-American men facing and dealing with prostate cancer survivorship.

Landi is a member of the ZERO Health Equity Task Force and the Blue Earth Diagnostic Patient Engager Program, where she continues to advocate for prostate cancer awareness. She recently worked on the holiday film Loved After, the faith-based film Driving Force, and the female boxing franchise Lola 2 available on AMC and Allblk network. She is also the proud founder and president of Women of Color Filmmakers, a 501(c)(3) nonprofit organization that garners support, skill-building, and networking for female filmmakers as they pursue careers in film and television. I'd like to welcome you here today. Thank you so much.

Landi Maduro: Oh, thank you so much for having me. It's such an honor to be here.

Dr. Lutz: I saw the movie. I love the movie. I think it's an incredible film.

Landi: Thank you.

Dr. Lutz: What is interesting to me is why a Black female like yourself says, "I'm going to take prostate cancer and make this my mission." Why did you choose that?

Landi: [chuckles] Well, the reason why I decided to do that is my filmmaking partner on this project, Chris Edwards, came to me and he said, "My father has prostate cancer. My brother was a prostate cancer survivor. I know I'm at risk, yet no one is talking about it. If it wasn't for them, I wouldn't have known anything about prostate cancer." He was like, "I want to do a film." He really wanted to go to football games and barbershops and just talk to men about it.

I thought, yes, that would be great as a film, but it would also really add a personal touch if we could follow men at different stages of prostate cancer and really watch their personal stories because I feel like people really connect when they see themselves in other people. We set out to work on this. We did six months of research so I could really understand why prostate cancer was so prevalent in African Americans, why it was more aggressive in them, and why they were getting it at younger ages.

Within six months of working on this film, my father got diagnosed with stage 1 prostate cancer. I was just like, "That is crazy." It just was so surreal but a blessing too because, now, my dad was very open about his diagnosis. I was able to share the things I'd learned in my research. When he talked to his doctor, he had educated questions. He was diagnosed with stage 1, but he realized it wasn't a death sentence because of all the information we had.

That's what made me really want to get even more involved beyond the film because it was like, "Okay, if men know that it doesn't have to be a death sentence, that there are opportunities for them to still have a sex life and have a good quality of life, then I want to make sure that they have that information." Beyond the film, it just became my mission to help educate about prostate cancer and early detection.

Dr. Lutz: Oh, being the good daughter. I think that's really something special because a lot of men and particularly fathers don't want to share their prostate cancer diagnosis with their families. I'm just kind of curious. When he mentioned it to you, how did you deal with it internally? How did you reflect upon your own life when he mentioned it?

Landi: It was actually very shocking. It was surreal. I remember I was out with some girlfriends at happy hour and I got this call. I literally had to step outside and be like, "Are you serious?" The irony of the fact that I was working on a film about it and he got diagnosed just blew our minds. It really put a lot into perspective. One, the mortality of my parents like your dad's your hero. You expect them to live forever, even though that's not how that works.

It still was something that I felt like, "Oh, my God. This is real." Now, we're coming into a possibility that this could be a life-altering or changing thing for my entire family. I feel a blessing that he was willing to share it because he didn't know I was working on the movie in advance. He didn't know when he told me that I was working on the movie. This really became a family matter and a family issue and drew us closer because he had the love and support of his family.

I think that's really important to share because a lot of men, we run into specifically in minority communities, they don't want to talk about things like this. It's very well-known within Black and Hispanic communities that we don't know what our family members died from. We know Granddaddy died of something, but we don't know what. Then you learn later, "Oh, it was prostate cancer," and you're like, "What? Am I at risk?"

The fact that he was so willing to share his diagnosis put my brother on alert. I have a son, put us on alert for my son. My uncle also had prostate cancer now we learned. It just put our whole family on alert and we were all able to come together and be there for him and support him. He agreed to be in the movie. My father is in the movie and is very open about his treatment, his diagnosis, and his journey.

Dr. Lutz: We'll get into some of the details on the movie, but I'm always curious when you do a story like this. Who is your audience? Is it the men? Is it the women? Do you talk to both of them in a different way?

Landi: That's a great question. For us, it's actually both men and women. I didn't know this going into working on the movie, but more women were interested in the film and interested in whenever we were having a screening, and then they drug their husbands or significant others or fathers and brothers to the screening because women really are normally the ones who push for care.

If you have a wife or a daughter, they're the ones who are going to, "Okay, wait. What did the doctor say? No, you didn't get all that information. What is your treatment? When do you need this? When's your next exam? Did you get your physical? Did they do a PSA?" They're the ones who are asking the questions where guys are normally, and this isn't all, I'm just speaking generally, are the ones that are like, "Well, I just did what the doctor said."

We found that more women were really engaged with our film, and then they, in turn, wanted us to screen it again or ask, "Could they watch it?" Then they shared it with their husbands or significant others. Then when we got them in to watch it, then they had a ton of questions. Like at screenings, it's always funny. The guys will say, "Oh, my wife drugged me here, but now I got a whole bunch of questions." We started realizing we had to have a doctor on panel or another prostate cancer survivor because they had a ton of questions, but it's getting that initial, "Just sit down." It usually starts with a female in their life, to be honest.

Dr. Lutz: Well, you're so spot-on because whenever I have conversations with men about their newly-diagnosed prostate cancer, I always insist that they bring their spouse with them or a family member, somebody that they trust because an extra set of ears is so essential to hearing it. Because I remember when I once received a cancer diagnosis and I went there with my wife, I didn't hear anything. I was like a deer in the headlights. You really don't absorb a lot of the things that you need to hear. It's really important to have somebody there with you that you trust-

Landi: Exactly.

Dr. Lutz: -that will take care of you and transmit the information accurately without coloring it in such a way that they just try to make you feel better, but they give you the facts.

Landi: Exactly.

Dr. Lutz: You're giving this message, the silent killer. Do you have a message in your mind that you think might really stick when trying to transmit the information to the audience?

Landi: Yes, when we were doing this film, we made sure we got men from all walks of life and that we touched on all the excuses we were hearing in our research as to why men didn't want to get screened for prostate cancer. Especially within the Black community, a majority of African Americans come from a spiritual or religious background. We got a lot of, "Well, I'm going to pray about it and God will deliver me."

We really want to attack that avenue, so we interviewed three of the biggest pastors and bishops in Houston, Texas, who really were very real and candid. We were shocked at how honest they talked about sex, sexuality, and tackling prostate cancer, which normally, in the Black community, it was specifically within religious segments. You don't talk about sex. It's like children are immaculate conceptions.

It was very amazing to have these pastors be so candid and really talk about it from that perspective. We also made sure we followed one of the gentlemen. Unfortunately, he is the only one who passed away out of the men that we followed. We really wanted to attack this. If I'm a vegan and I'm completely healthy and I do everything I was supposed to do from an eating-healthy-and-exercise perspective, then I'm no longer susceptible to prostate cancer.

We wanted to show that that is not true. Unfortunately, the only person who passed away was the gentleman who was the vegan and the super holistic, healthy person, but that's because he had such a strong genetic history of prostate cancer, all his brothers. I think he had six brothers. His father all had prostate cancer and he hadn't had a PSA. It'd been 10 years since he had PSA by the time he was diagnosed. We wanted to show, yes, these are important things for all factors, diabetes, blood pressure, all of that.

If you have this strong history, there's no reason why you should not be getting screened on a regular basis. We just really tried to dispel all the myths from a cultural perspective as to why you shouldn't do it, and really advocate for early detection is key and taking responsibility for your health is key. That's really the driving point. It's the things that I really, really, really try to push in all my travels with the film and being on the task force and just really being an advocate for the community that early detection is key. It can really save your life and give you better quality of life if you're diagnosed.

Dr. Lutz: You talk about spirituality. We know from our research in men's health that the men who are the most religious or prayerful have the best overall survivorships and usually have the best quality of life in the sense that they follow better eating habits, exercise habits, and overall lifestyle. How do you feel that the Black church can actually be helpful and being better for men in surviving and getting diagnosed and screened for prostate cancer?

Landi: That's an excellent question. I really feel the Scripture talks about, "Faith without works is dead." Yes, God can deliver you from this ailment, but you must do the work. You must get your regular checkups. You must eat healthy. You must do all those things. Unfortunately, we're seeing that a lot of times. That comes after the fact, after a diagnosis. We really want to get that implemented ahead of the diagnosis.

The fact that churches that have brotherhood programs, some of them have breakfasts or lunches where they just get together and talk about issues that men face. I think really implementing a prostate cancer program within that type of fellowship is super important. Because if you can start to establish that, then it no longer becomes this taboo thing that we can't talk about. I think the more churches are willing to embrace that and have these candid discussions, the better overall outcomes we'll see.

Dr. Lutz: Well, there's no question that the Black church is so essential to overall men's health survivorship. There was a documentary that was created approximately 10 years ago called The Black Men Are Killing Themselves with Their Forks. They show all of the food that is being served on Sundays at churches. It's just incredible. There's no question that it is the most unhealthy meal you could possibly eat.

When we look at the other silent killers that are obesity and hypertension, those are probably what are stemming the subsequent malignancies such as prostate cancer and others because of the centripetal obesity. It'd be great if we could get that message out there to try and improve lifestyle and behavior patterns, starting it with the Black community at the Black church. Then can we do something about barbershops and other places of work? Do you have any thoughts in that regard?

Landi: Well, first, I want to say I totally agree with you. I grew up in a COGIC church, which is Church of God in Christ. Definitely, we have Fried Chicken Sundays and Cafe Sundays. You're absolutely right.

Dr. Lutz: Sounds great.

Landi: [laughs] Potato salad with a lot of mayonnaise and eggs-

Dr. Lutz: Yum.

Landi: -and cornbread that was probably more like cake because there's so much sugar in there. You're absolutely right that diet is not the best. The African-American diet definitely is not the best. Definitely starting there is super important and offering healthy options in those church meals, I think, is important. Even for those who don't, nowadays, more people are spiritual than religious. I love how you brought up the barbershops. I think having this very real conversation in the barbershops is key.

Even though we did not include it in the movie because we shot over 20 hours of footage, which we had to condense down to an hour and a half, but we did go into some barbershops. Barbershops are the place where men can metaphorically, I guess, let down their hair and have real conversations about everything from women, cars, you name it, and really starting to have these conversations in the barbershops, which there are several barbershop programs that are advocating for prostate cancer.

I think it's a great place because that is where you can have real conversations. Women aren't normally in the barbershop so that you can talk about the nitty-gritty and talk candidly and get real answers to certain questions you may have. I think having barbershop programs where prostate cancer survivors can go in and share or even health educators or healthcare professionals can really answer some of their questions from a general standpoint, I think that's really important.

In Atlanta, there's a program. I think it's called Haircuts and Hams, which is definitely interesting, but they do haircuts and they give away hams to men who are willing to come in and talk about prostate cancer, which I think is awesome. They're finding ways to connect to the community, whether it's through motorcycles or whatever it is. I think meeting men where they are, not expecting them to only be in one place and really talk to them in ways that connect with them, I think, is important.

Dr. Lutz: We put on an immense health event every year at Ford Field, where we take over the entire arena and all we do is screen men. We make it the most non-affronting environment. I call it the Ikea way of doing men's health where they basically follow the trail through the event. We offer everything in screening services from vitals, BMI, mental health, suicide prevention, vision, hearing, and then free blood work. Everything we do at the event is free. About 60% to 70% of our attendees are African-American males.

Landi: Awesome.

Dr. Lutz: We know that every year, we diagnose significant numbers of prostate cancer, oral cancers, thyroid cancer, and see incredible amount of hypertension and obesity. Then we offer follow-up care thereafter. The real story about this event is that what concerns me is that these 1,000 to 2,000 men that we screen every year are the ones that choose to get screened and want to be healthy.

The thousands that don't come to this event, I can only imagine how unhealthy they really are. If there's another way that we can approach our community, we'd love to find a way. I know we're working with our health department in the city of Detroit and with the MDHHS in the state of Michigan to try and improve the services. It's a challenge. It's just such a challenge, but it needs to be done.

Landi: It really does. I want to just commend you, first of all, for doing that. Because oftentimes we feel when we do events like this, we're preaching to the choir. I heard a friend say the other day, "But even the choir needs the sermon," right? By doing what you're doing, you never know who's attending will then go and share it in a locker room, on the basketball court, at the barbershop, who will touch a life that would have never known that they were at risk for prostate cancer had you not done that event. I just wanted to put that out there. Kudos to you because you never know who you're touching when you do things like that.

Dr. Lutz: I was raised Jewish. In the Talmud, there's a saying, "To save one life is as if you've saved the world," which is like repairing the world. "Tikkun olam," they call that. I've always believed that that is really our role as humans. It is a focus in Judaism that your human life is the most sacred thing that we have. That is what we do. We try to just save that one life each year whenever we do these events because we know that that's what our job is to do.

Landi: Exactly.

Dr. Lutz: I would like to talk about The Silent Killer, the movie itself. One expression on there that I thought was so poignant was that silence is deadly. What does that mean to you?

Landi: When we choose not to share what's going on in our lives, specifically with our family, we don't realize how much we're putting them at risk. As I mentioned, it is very common within the Black community to not know what grandma or grandpa died from. Now, we're finding that not having that information, that genealogical information, can really be a detriment to your other family members.

My own family, for example. My dad now, as I shared, was diagnosed with prostate cancer. Through having prostate cancer, he chose active surveillance. Three years ago, he had an MRI because his PSA was elevated. Turns out he has also pancreatic cancer now and that was terminal. They gave him six months to live. They didn't know who his daughter was though. [laughs] I got him into MD Anderson Cancer Center and got him in with some real good doctors.

Now, three years later, my dad is still here. Knowing that information as a family, and also my uncle had renal cancer, which is a very rare form of cancer, we knew that, "Okay, cancer seems to be running rapid on Dad's side of the family. Now, we all chose to do genetic testing to find out if we were at risk. At least me and my sister did. Now, we have information that we can now see, "How will that affect us or our children?"

That "silence is deadly" really stems from, "Look, we have to talk about these things." There's nothing embarrassing by saying that you have prostate cancer. Sharing that could truly save your grandson, your son's life, your niece, and nephew because they now know, "Okay, I'm at risk. I can now have a conversation with my doctor. Let's not wait till I'm 50 or 45. Can I, at 40 or 35, have a PSA," because I know there is a strong case of prostate cancer in my family.

At least let me get a baseline so then we can start checking this on a regular basis just in case I get diagnosed early because of my family history. "Silence is deadly" really resonates with me in regards to, you could really protect your family member. Keeping things like this to yourself is selfish because it's not just your life that is affected. It's your entire family. Not just with you being gone if you were to pass away, but for their own health and wellness. It's essential to share what's going on with you.

Dr. Lutz: There's nothing worse than family members taking their history to their graves and not sharing it before because it's so valuable. I have a number of patients who come in who are adopted and they say, "I don't know my history." I said, "Well, you can find it out." You can go and do genetic testing, 23andMe. There's a lot of resources now available where you can actually find out more about who you are and transmit that information to your children in addition to what the history is you're developing in real-time. I'm hoping that people take advantage of that and use technological advances to actually help their families.

Landi: I totally agree.

Dr. Lutz: Speaking up is one of those things that just a lot of people don't do. Back in 2015, our foundation partnered with Bayer Pharmaceuticals and US TOO International with Ken Griffey, Sr., who went on a campaign across the United States in a campaign called Men Who Speak Up. He and his son, Ken Griffey, Jr., were going around telling the message of sharing that conversation between fathers and sons and their families about their diagnosis, their prostate cancer diagnosis, and how important it is. I think that that's really a lot of it. A lot of what needs to be done is the messaging of just speak up because it's important to share your knowledge with others because it may save their life as well.

Landi: I totally agree.

Dr. Lutz: You said that your father chose active surveillance. Is he still on active surveillance?

Landi: He is. Honestly, crazy enough, active surveillance is probably why he's still here because he was getting it monitored on a regular basis. He was prostate cancer-- Oh, he was stage 1. His Gleason score was a low-to-medium grade. We knew that, "Okay, it was detected super early," and his doctor felt like we can watch this and just see if he felt like surgery might be a little too aggressive for how slow-growing his prostate cancer was.

Honestly, it has been a blessing because, like I said, they've been monitoring him because my dad was diagnosed in 2012. Once the MRI was really starting to be utilized more as an effective way of tracking his prostate cancer, that's how they learned he had pancreatic cancer. I'm grateful for that because if it wasn't for that, we wouldn't have known and he probably wouldn't be here now.

Dr. Lutz: That's quite a story. The prostate cancer journey was something you referred to in the movie and it's not the same for everyone. We talk about it being a life sentence but not a death sentence, and that many men within the United States are perhaps-- through up to three million men in the United States are now in active surveillance. We know that it's been a safe way to follow men. We know that by following them this way, we can always pull the trigger for treatment. About 60% of men will end up choosing some form of treatment.

Subsequently, when they're a little bit older and maybe the treatments get better and maybe won't affect some of their aspects of their quality of life, whether it be sexuality or just overall urinary control issues. I thought that was great. In the movie, you addressed the individual journeys. I think that one thing you mentioned was you referred to-- at least one of the survivors in the movie called it the "monster." It was very anthropomorphic. That term was really strong, calling prostate cancer the monster. What did you want to get people to react to when they would hear that? When they would hear the monster, how did you want that to be internalized by the audience?

Landi: Well, for that specific person, he's the person who was a vegan, totally health advocate, but had such a strong family history of prostate cancer, had only had one PSA and one prostate cancer screening test, and had waited 10 years. By the time they finally tested him again and realized his PSA levels were in the thousands, they tested him four times because they kept thinking that those were false. The lab made a mistake because, usually, it's a PSA elevated above four. His were in the thousands.

His prostate cancer was so aggressive. He literally passed away within six months of us interviewing him. Does it have to be a monster? No, it doesn't. When you let things progress, specifically, he did know he had a family history of it. It just, in his mind though, he's healthy. He's a vegan. He doesn't drink. He doesn't smoke. He drinks a lot of water. He exercises. He does everything you're supposed to, so he's good. This monster's not going to catch up with him, right? He's good. We wanted to dispel that myth that that's all you had to do.

Dr. Lutz: There's four words I think of when I think of prostate cancer. Trust, faith, fear, and knowledge. I always wonder for someone like yourself, what words, same or not, have a significant meaning to you whenever you want to transmit the message of the importance of prostate cancer in the African-American male community?

Landi: My number one word is "advocate." You have to advocate for yourself. Unfortunately, there are health disparities in the medical community when it comes to African Americans and not just in prostate cancer. You have to ask questions. You have to be knowledgeable. I always joke and say, "Get on your doctor's nerves. Ask them so many questions." They're like, "Oh, my God. You're making me crazy." [chuckles]

This is your body and your health. At the end of the day, if something's not right, it's you who suffers. My son, when he was in high school, one time, he told me, "Well, I didn't do my best on the test because I was mad at my teacher." I was like, "Well, who does that hurt? It doesn't hurt your teacher. Your teacher has a degree and is teaching you. You're the one who's trying to graduate from high school, so you doing that is not hurting your teacher."

It's the same when we don't ask questions, when we just take things at face value, when we don't research a diagnosis or find out, "Okay, is this the only option I have? Can I have a second opinion?" We are literally leaving our lives in the hands of someone else. I think it's super important to advocate for your own health to get all the information you possibly can so you can make educated decisions regarding your health and the next best steps for you as an individual. "Advocate" is definitely my word of choice.

Dr. Lutz: Since everything's on the table, I have to ask you one question. Disparities in health care are strongly present. I don't know when they're going to ever go away, if they ever will go away. When your dad was diagnosed with pancreatic cancer and was given a death sentence, yet you knew it wasn't, do you think that that was playing a role?

Landi: Definitely. I went with him to one of his appointments. My dad lives in Washington State and we all came home when he got diagnosed that Father's Day. Because when he told us he got diagnosed in April, as a family, we all came home that June to be with him. Luckily, I went with him to one of his appointments. As I listened to this doctor talk doom and gloom, I just got very angry. My dad was at peace with his diagnosis by this time.

He had made peace that whatever happened-- my dad is a-- He's not a religious person, but he's definitely spiritual, and he's like, "Baby, if God says I can stay, if God calls me home, I'm good." I was like, "Well, Dad, I'm glad you got that attitude, but mine doesn't match yours." [chuckles] I had questions because they weren't willing to do any other tests for him. You accidentally found pancreatic cancer by doing an MRI of his prostate, so I asked, "Can we do further testing?" I didn't know what the testing should be.

I'm not a doctor, but I was like, "Can we do a CT scan, a PET scan, something? Can we make sure-- What else are we doing?" They were like, "Well, the radiologist was very adamant that this man has a significant mass on his pancreas. This is pretty bad. His mass was sitting on a blood vessel that leads to his colon, so they knew they couldn't operate, so I think he should accept his diagnosis." This is literally what his doctor said, the urologist, "Accept his diagnosis and enjoy the time he has left," and I was pissed.

Dr. Lutz: I was going to say, on a scale of 1 to 10, were you about 20 for anger?

Landi: I was 30. I was so angry. We walked out of the office and my dad's cheering me up because I was so angry. I said, "Dad, when we get home, we're having a family meeting," because all my siblings were home because we all came home for Father's Day. I told them, "This is unacceptable."

It does not make sense to me that they're not doing further diagnostic studies for the fact that they accidentally found his pancreatic cancer and I'm getting him out of there. He fought me a little bit. He was like, "Well, babe, we got the best docs in--" He was switching docs. I was like, "No, you don't. You're cute, Dad, but no." Luckily, my dad respects me and he listened to me. We were able to give him the MDM. He's my dad. He's not my child. It wasn't like I could do it all for him. He had to.

Dr. Lutz: I'm impressed that he listened to you.

Landi: I think he knows. Well, one, he always jokes at me and my sister. He's like, "If you give my daughters--" He said we're alpha females. He's like, "Give him a laptop and a cell phone and they'll rule the world." That's how my dad feels about it. [laughs] He was just like, "Okay." He was a little reluctant. Once he got there and how MD Anderson was willing to team with Seattle Cancer Care Alliance is where he ended up going.

Now, he has a team of doctors who aren't just focused on his pancreatic cancer but also looking at his prostate cancer and making sure that they're monitoring that. Of course, pancreatic cancer throws off your blood sugar. He's also been diagnosed with diabetes now and they're also monitoring that. They're looking at him as a whole patient where he wasn't getting that kind of care before. It took us advocating for him and saying, "Oh, absolutely not," to make that difference. That's why I'm so adamant about advocacy.

Dr. Lutz: I have that discussion with my patients all the time about holistic care. Whole, meaning the whole of you, because people forget that it's not just one piece. Without all of you, you don't survive. As urologists, we sometimes get blinders on and we just focus on prostate cancer survivorship, but it's really men's health that actually will afford you the best chance to have overall quality of life and survivorship. That's really our mantra when we talk about fighting like a man for men's health. That's what we do.

One of the areas that always concerns me is research trials, particularly in the African-American male community. It doesn't take anybody very long to start talking about the Tuskegee experiments and say, "Okay, there's a lot of baggage and it's going to take generations to get rid of this baggage." Now, with your story about your dad and perhaps the malfeasance and his care and all of these things just play such a role.

Our goal is to find ways that we can get Black males involved in our research trials because we need their representation to really make sure that we're giving them the best care possible. You can't just base a study on white males and say, "Okay, this will work for everybody." It may not. We need help. It's you doing stories like The Silent Killer that are really important to get that message out and to show the importance of proper care and guidance and understanding that there are people in the community that do want to give the best care possible through research trials and getting Black men involved in these services.

Landi: I absolutely agree. You're right. The Tuskegee experiment, even hearing about Henrietta Lacks from a female perspective, yes, there are the horror stories, but there are institutions that really are trying to make a difference. That is definitely something that I have a kink for. Again, it all goes down to asking questions and making sure that you're comfortable with the answers because, yes, we do get hit with that a lot.

Most people who want to be in clinical trials are people who feel like all their options have run out. I'm talking about African-American people. Usually, all their options have run out. Now, they're like, "Okay, can we try clinical trials?" We don't want it to just be that because you definitely need that information research. We need to see how these cells look in a research setting. We definitely advocate for that and for trusted institutions and physicians and doctors who really do care and want to make a difference because there are a lot out there.

It's a few bad seeds that have made people terrified. In my opinion, the majority of doctors and research centers and clinicians, they really do want to make a difference and held in this disease. Don't be afraid to ask questions so that you feel secure if you decide to do a clinical trial because I have seen them say-- One of the people in our film, he was diagnosed at 46. We know his cancer has metastasized, but it's the clinical trials that has kept him living. He would not still be here if it wasn't for that. Now, he's knocking on 60. What a blessing, right? [laughs]

Dr. Lutz: It really is. In the movie, you had an individual who shared his story with Chris about, "Yes, I lost my house, I lost my job. I've virtually lost everything. I'm financially destitute." The financial toxicity with cancer survivorship is so incredible and it's just not discussed enough. We know that the survivorship rate in men facing financial burdens goes down by 50%. As a result, back in 2015, we formed a fund in our foundation for men in the greater Detroit area called the Blue Fund so that any individual who's facing a newly diagnosed prostate cancer and is trying to research out treatment and get treated, we will offer them up to $1,000 a month for their personal financial expenses while they get treated-

Landi: Oh, that's awesome.

Dr. Lutz: -so that they will keep them whole. We don't try to make them whole, but we will help keep them whole. We're hoping to be able to do something like this throughout the country once we can get proper funding and support because we believe that this is such a needed entity across the United States, particularly in the underserved population, where those individuals, when they get prostate cancer, they don't know where to turn. They feel the fear of losing their livelihood and supporting their families. It comes at a very challenging part of life when you're starting to think about how I can maybe slow down and want to retire versus, now, I may lose everything.

Landi: So true. I'm so glad you said that because, yes, that is definitely things that when we were filming the documentary, in the short version, we don't touch on it. In the feature-length film, we touched on it a little bit. That was something that came up. Some people didn't have insurance or they couldn't afford it or they're just trying to maintain. Now, you're asking me to screen for something that I may or may not have, right? Then if I do have it, what is that going to mean to me and my family from a financial standpoint?

Yes, thank you for what you're doing because that is important. Again, caught early, the financial implications may not be as much. Definitely, if it's caught at later stages, of course, there's a financial burden that's going to come with that. There are quite a few programs out there that people don't know about that are available to them if they are diagnosed and are struggling to maintain their household and medical bills.

Dr. Lutz: Well, you've shared a lot with me today. I hope that everybody listening to this would take it personally. Because if you don't, then you're wasting your time because this is really what it's all about. Take this message back home to your own family and try and find that time to communicate. I just have one last question I'd like to ask you is, how would you like to be remembered after all that you've been doing? I know you're still young and still active and everything, but there must be something that inside of you is the way that you want to be viewed and remembered.

Landi: Just from doing this film and even my other work in the nonprofit space, with my own nonprofit, I want to be remembered as a person who looked out for others. I do believe in being the change you want to see. I'm not a person who, "Oh, I wish this was better," and then we just sit back and keep hope and praying and wishing that somebody does something about it.

I'm definitely a person who will step in and do whatever I can with my limited resources to support and advocate for others. I think if everyone could do just that one step, man, what an amazing world this could be. I hope that people remembered me as someone who cared, someone who wanted to see the world be a better place. I know that sounds so cliché, but it's such the truth. [laughs] As someone who really gave all that I could to help make humanity just better, that's definitely my ultimate goal.

Dr. Lutz: Well, it's people like you who truly are changing the world and giving a voice to the silent killer