\n<\/p>\n
\u201cYou will feel a little pressure.\u201d<\/p>\n
My doctor had instructed me to lower my boxers, bend forward and place my elbows on the table. As with most men over 50, it was time for my annual digital rectal exam, or DRE: those riveting moments when the doctor takes a \u201clook\u201d at the prostate gland, which is just below the bladder and in front of the rectum.<\/p>\n
Its position makes the examination difficult. The physician inserts a well-lubricated finger into the patient\u2019s rectum to feel for abnormalities such as lumps, nodules or areas of hardness. As uncomfortable as the procedure can be, in my experience, it rarely lasts for more than 10 seconds.<\/p>\n
As always, she said everything looked fine. In my rush to pull my boxers up and change the subject, I didn\u2019t bother to ask any more questions. At the time, I was clueless that as men age, the prostate becomes increasingly susceptible to cancer.<\/p>\n
In the rare event the disease tops the news cycle, it\u2019s because of high-profile diagnoses, such as for former US president Joe Biden in May, Nelson Mandela, Robert De Niro and the Chicago Cubs hall of famer Ryne Sandberg, who died in late July. Even so, important details of the illness often go unreported. I \u2013 like many others \u2013 typically dismissed the topic with a yawn, being of the uninformed but persistent impression that it\u2019s \u201cthe best cancer to have\u201d. All I knew was that prostate cancer tends to move slowly and can be successfully treated when detected early.<\/p>\n
Now I am a prostate cancer survivor, whose prostatectomy in 2020 almost came too late. I didn\u2019t know that in the US, prostate cancer is the second leading cause of cancer death in men. One in eight will be diagnosed with it. One in 44 will die from it.<\/p>\n
Being uninformed about those details and testing options could have killed me.<\/p>\n
\u201cP<\/span>rostate cancer has been called the Silent Epidemic,\u201d said Dr Samuel L Washington, a urologic surgeon who specializes in oncology at the University of California in San Francisco. Even with an active lifestyle, healthy nutritional regimen and digital screenings, cancer can sneak in undetected.<\/p>\n \u201cMany men with prostate cancer won\u2019t experience any outward signs or symptoms until the disease is advanced, which is why testing is so critical,\u201d said Dr Clifford Gluck, a urologist and Founder of Dr Gluck\u2019s Wellness Center in Massachusetts. \u201cIf not caught early, it can break free of the prostate and run unchecked through the body, with a particular penchant for bone.\u201d Once prostate cancer has spread to other parts of the body, the five-year relative survival rate is only 37%.<\/p>\n \u201cIn 2023, only about 38% of men between 50 and 64 were screened for the disease,\u201d said Washington. \u201cSadly, a lack of screening remains one of many factors leading to increased rates of men presenting with more advanced disease over the last decade. The more advanced the cancer, the harder it is to treat.\u201d<\/p>\n Before my 62nd year, I routinely postponed my annual physical, assuming I was bulletproof. I was athletic and ate a plant-based diet. My life was free of processed foods, recreational drugs, tobacco, asbestos and weapons-grade plutonium. I experienced no symptoms indicative of prostate cancer, such as erectile dysfunction or urinary issues that reportedly led to the former president\u2019s diagnosis.<\/p>\n Then, after a couple of cross-country moves with my family, I no longer had a primary physician. Dismissing my claims of invincibility, my wife handed me a list of internists. I booked a physical, and my new doctor ordered my first-ever PSA (prostate-specific antigen) test. PSA is a protein produced by the prostate. Normal and cancerous prostate cells produce it, but cancerous ones tend to produce more. That said, an elevated PSA level is not always indicative of cancer.<\/p>\n Generally, a normal, or non-elevated score for men over 60 is under four; for men under 59, under two-and-a-half; and for younger men, under one. But \u201cPSA levels differ for each person,\u201d said Dr Ash Tewari, professor and chairperson of the department of urology at the Icahn School of Medicine at Mount Sinai. \u201cWhile scores below four are preferred, it is most important to understand whether a PSA level is changing from year to year.\u201d Variables such as family history, overall health, nutrition and race can have an effect. \u201cAt the very least, I urge patients to have the conversation with their doctor,\u201d he said.<\/p>\n Graphic with three lines of text that say, in bold, \u2018Well Actually\u2019, then \u2018Read more on living a good life in a complex world,\u2019 then a pinkish-lavender pill-shaped button with white letters that say \u2018More from this section\u2019<\/p>\n Mine was a harrowing 17. My doctor called, speaking with a breathless urgency that made me feel I might not live to the end of the conversation. \u201cIt\u2019s almost certain,\u201d he said, \u201cthat you have prostate cancer.\u201d<\/p>\n The PSA test is a common, though imperfect, screening test for prostate cancer recommended by many urologists and primary care physicians for men starting at age 50. It is also one of the only ways to catch prostate cancer early. I asked my two previous primary care physicians why they had never ordered one, and they argued that the test sets off too many false alarms and causes undue stress; elevated PSA levels can be symptomatic of issues other than cancer, such as an infection. Also, I had never asked for one. (They must have confused my BA in English with a medical degree.)<\/p>\n After hearing I had been diagnosed with prostate cancer, one conceded: \u201cIn hindsight, a PSA test would have been a good idea.\u201d<\/p>\n Their reluctance is not unusual. Many doctors in the US shy away from prescribing the test because of the uncertainty of what an elevated score means, how patients react to that uncertainty and risks associated with subsequent exploratory procedures like biopsies.<\/p>\n A PSA test can correctly indicate that prostate cancer is present, as it did for me. But it can also result in a false positive, suggesting cancer is present when it isn\u2019t (6 to 7% per screening round); a false negative, or not picking up that cancer is present (according to the UK\u2019s National Institute for Health and Care Excellence, 15% of people with a normal PSA test result may have prostate cancer); or catch slow-growing cancers that might never have caused issues.<\/p>\n The latter is called overdiagnosis, and treatment can expose \u201ca person unnecessarily to potential complications\u201d, according to the National Cancer Institute: these include urine leakage, increased urination, loose stools or rectal bleeding, and loss of erections or decreased erections. Current estimates suggest that 20%\u201340% of screen-detected prostate cancers may never have caused harm, with risk varying by age, PSA levels, and Gleason Score.<\/p>\n \u201cThere are risks to the test,\u201d said Dr Nancy L Keating, MD, MPH, professor of healthcare policy & medicine at Harvard Medical School. The PSA test has a C rating from the US Preventive Services Task Force (USPSTF). For context, an A rating means the USPSTF strongly recommends the test. A C means doctors may offer it, \u201cbut that patients should make an individual decision about screening after discussing potential benefits and harms with their doctor\u201d, said Keating.<\/p>\n skip past newsletter promotion<\/p>\n Practical advice, expert insights and answers to your questions about how to live a good life<\/p>\n Privacy Notice: <\/strong>Newsletters may contain info about charities, online ads, and content funded by outside parties. For more information see our Privacy Policy. We use Google reCaptcha to protect our website and the Google Privacy Policy and Terms of Service apply.<\/span><\/p>\n after newsletter promotion<\/p>\n \u201cThere appears to be a modest benefit to screening for some men,\u201d said Keating. \u201cBut most prostate cancers are not likely to be deadly, and many men will experience the harms of screening, such as anxiety and unnecessary biopsies, and treatments like radiation or removal of the prostate that can lead to incontinence and erectile dysfunction, without experiencing benefits,\u201d said Keating, who thinks it is important for patients to understand the test\u2019s limitations.<\/p>\n In one 2024 study that followed more than 400,000 men aged 50-69, one invitation to do a PSA test produced a small mortality benefit. \u201cThe small reduction in prostate cancer deaths by using the test to screen healthy men does not outweigh the potential harms,\u201d Professor Richard Martin, lead author of the study and cancer research scientist at the University of Bristol in the UK, said at the time. \u201cThis results in some men going on to have invasive treatment that they don\u2019t need, many years earlier than without screening, and the test is also failing to spot some cancers that do need to be treated.\u201d<\/p>\n Regret following a prostate biopsy isn\u2019t rare \u2013 even when no cancer is found. A 2024 multicenter cohort study reported that about 5% of men regretted undergoing the procedure, often due to pain, bleeding, or unexpected psychological distress. In qualitative studies, men who believed they had been overdiagnosed and unnecessarily treated reported lasting regret, uncertainty, and emotional distress \u2013 even years after treatment.<\/p>\n Men more susceptible to prostate cancer, and therefore more likely to benefit from a PSA test, include African American men, men with a family history of prostate cancer, and those with genetic mutations such as BRCA1 or BRCA2, according to the American Cancer Society.<\/p>\n Gluck noted that the PSA test has a low USPSTF grade \u201cprimarily due to concerns about side-effects from surgery or radiation treatments\u201d. But advances in technology, treatment and surgical techniques \u2013 such as high-intensity focused ultrasound (HIFU), a non-invasive treatment that uses targeted sound waves to destroy prostate cancer while preserving urinary and sexual function \u2013 make screening a \u201cfar more favorable proposition\u201d now, he said.<\/p>\n M<\/span>y PSA score definitely spiked my anxiety, despite knowing I might only have an infection. The only way to determine what it meant was an MRI and a prostate biopsy. I dreaded the biopsy, which was to a digital exam what a root canal is to flossing. My urologist explained that there were some risks, such as infection and false negatives, but for me, confirming whether I had cancer far outweighed them.<\/p>\n Nothing about these processes counted as pleasant. For the MRI, I was ensconced in the machine for about 40 minutes. A week after that, the doctor inserted an ultrasonic probe into my rectum to guide him as he extracted 12 small samples of my prostate. The biopsy redefined my concept of vulnerability, but although it seemed like hours, it took less than 20 minutes \u2013 and anticipating the pain was worse than the actual pain. After a few days of mild tenderness, I was back to normal.<\/p>\n For all of the worry and discomfort, if the biopsy revealed no trace of cancer, I would have uncorked the champagne. Unfortunately, my results showed a high Gleason score \u2013 which measures how different cancer cells look under a microscope compared with normal cells \u2013 consistent with aggressive prostate cancer. But I was relieved to hear that the disease hadn\u2019t spread beyond the prostate membrane. Had I waited another two or three months, according to my post-operation pathology report, it probably would have.<\/p>\n Six weeks after the biopsy, I underwent a radical robotic nerve-sparing prostatectomy, a roughly five-hour operation to remove the prostate using minimally invasive tools. Finding data on success rates was frustrating given the myriad factors that can affect the outcome, which include Gleason scores, age, health, obesity, comorbidities and whether or not the cancer has metastasized beyond the prostate. I banked on my fitness and the skill of my surgeon as deciding factors to undergo the operation. My greatest fears were long-term incontinence or erectile dysfunction, but I was fortunate not to suffer either.<\/p>\n As lucky as I was, earlier testing and detection would have afforded me more treatment options. \u201cThe benefits of early detection can\u2019t be overstated, which is why I advise men between 50 and 70 years of age to have a PSA discussion annually,\u201d said Tewari. \u201cPSA screening combined with imaging is an important approach to effectively screen for prostate cancer.\u201d<\/p>\n It took moving across the country, my wife\u2019s diligence and a doctor who routinely prescribed PSA tests for my cancer to be diagnosed. It was a complicated road, and experts\u2019 divergence on the effectiveness of screening show just how difficult it can be for a layperson to make these kinds of medical decisions. It\u2019s not ideal to rely on a testing option that at best results in an estimated 10 out of 1,000 people avoiding death from prostate cancer, with treatment options that can result in incontinence and sexual dysfunction.<\/p>\n But taking the test when I did had a dramatic impact. It saved my life. At the very least, I wish I\u2019d had an earlier opportunity for a detailed discussion with my doctor. Given what I know now, I would have preferred screening and early detection, because for me, there is no such thing as the best type of cancer.<\/p>\n","protected":false},"excerpt":{"rendered":" \u201cYou will feel a little pressure.\u201d My doctor had instructed me to lower my boxers, bend forward and place my elbows on the table. 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