The urgency of the matter was reiterated by health care professionals during a forum at George Washington University on Monday: Black men in the nation's capital still have one of the highest rates of prostate cancer in the world.

District officials say they will propose legislation this year to promote prostate cancer prevention, and some of the provisions are sure to call for more upbeat public service announcements.

But if previous efforts are any indication, sugarcoated messages won't work. Not only do black men need to know the hard truths about prostate cancer, they also need to know that nobody is going to save them but them.

Without adequate health insurance, it will take much luck, if not a miracle, to obtain proper care. The average cost of a prostate exam is $70, although free screenings are offered occasionally. A follow-up biopsy costs about $1,500, and if cancer is detected, the first year of treatment alone can cost as much as $30,000.

But paying for treatment isn't the problem if you don't know, and won't find out, if you have the disease.

This is not breast cancer, with first lady Betty Ford publicly acknowledging her battles with the disease and paving the way for a nationwide crusade to find a cure.

And although former senator Bob Dole's progress from prostate cancer to promoting Viagra may have eased the fears of some elderly men, no such celebrity has emerged with the power to pull the wool from the black man's eyes.

The American Cancer Society predicts that prostate cancer will be diagnosed in 600 District residents this year and that 100 of them will die. Just the fact that such deaths can be counted in advance, year after year, ought to make people wonder.

"We know that many people just won't see a doctor unless they are bleeding from some orifice," said Michael Richardson, interim chief medical officer for the D.C. Department of Health. "By then, it could be too late."

CeCe Dorough, programs manager for the National Prostate Cancer Coalition, said many black men don't understand the disease and "may not feel comfortable talking about prostate cancer because it occurs in a part of the body that represents their manhood."

For those who believe manhood emanates from between their legs, a mental makeover is prescribed. Maybe that would help some men put mind over matter when it comes to those intrusive prostate exams.

According to the District's Cancer Incident and Mortality Report for 1999, Wards 4 and 5 -- largely hardworking and predominantly African American areas -- have the highest rates of prostate cancer in the city, with equally hardworking Wards 6 and 7 not far behind.

Why?

At the Howard University Cancer Center, researcher Flora Ukoli is investigating a possible link between prostate cancer and diet. But she can't find enough black men willing to participate in the study.

Perhaps people don't want to know whether, say, the consumption of rich foods and foods high in animal fat contributes to prostate cancer. Or whether tomatoes really lower the risk.

The mere possibility of such a link, however, ought to spur changes in eating habits. But most corner stores in the city still sell far more tobacco, alcohol and fatty foods than fruit.

"The wild card in all of this is the role of genetics," said Michael J. Manyak, chairman of the Department of Urology at George Washington University. "There is research into whether black and white men metabolize testosterone differently and in such a way that accelerates growth of prostate cancer in black men."

The proper response to that possibility is for black men to become more vigilant and begin screening for prostate cancer by age 40, instead of 50 as recommended for white men, doctors say.

The fact is, a healthier diet may or may not reduce the risk of prostate cancer. But it can't hurt. Most men who detect the disease early say the occasional impotence and incontinence caused by certain treatments still beat death. And those who wait too long to seek treatment inevitably wish they hadn't.

That's the truth. Hopefully, more black men will face up to it in time.

E-mail: milloyc@washpost.com