How did early examination help him in the fight against prostate cancer?
Actor Ben Stiller has taken on a new role: an advocate for early detection of prostate cancer, after he recently revealed his diagnosis in 2014. In a humorous article published online, he also wrote about the positive effects on the prostate. Specific antigen (PSA) tests and the controversy surrounding them.
PSA measures a specific chemical in the prostate gland. PSA levels can be elevated in the blood for many reasons. Due to its low characteristics, the PSA test does not differentiate between fatal and non-fatal cancers, or even benign diseases. For this reason, PSA tests have been associated with overdiagnosis and the potential for overtreatment.
In Stiller’s case, after his doctor recommended a baseline test for his prostate-specific antigen, his levels rose for more than a year and a half before the urologist did a physical exam, suggesting an MRI, and then a biopsy, which turned out to be positive. His Gleason score, which is based on the appearance of cancer cells under a microscope, is recorded as 7 and classified as “medium-range aggressive carcinoma.”
“Crazy roller coaster ride”
“I was diagnosed with prostate cancer on Friday, June 13, 2014,” Stiller wrote. “On September 17 of that year, they took a test again that told me I was cancer-free. The three months in between was a crazy rollercoaster that could hook up about 180,000 men a year in America.”
Prostate cancer is the second most common type of cancer in men in the United States, after skin cancer. One in seven American men will be diagnosed with the disease in their lifetime. The medical community does not agree on whether or not men should get tested, and instead urges them to talk to their doctors about whether and when they should get tested.
The American Cancer Society (ACS) and the American Urological Society recommend that testing begin at age 40 for people at high risk, and the American Cancer Society says that screening should begin at age 50 for the general population. People at high risk of developing prostate cancer are African Americans and those who have a parent, child, or sibling diagnosed with prostate cancer at an early age.
“This is a complex and evolving topic,” Stiller wrote. “But in this imperfect world, I think the best way to determine a course of action for the most treatable, but deadly, cancer is to catch it early.”
Because the disease usually has no warning signs or symptoms until it has progressed to advanced stages, screening tests can help find it before it spreads. Such was the case with Stiller, who credits his doctor for being proactive. “If you wait, as the American Cancer Society recommends, until age 50, you won’t know you have a growing tumor until two years after treatment,” Stiller wrote. “If I had followed the guidelines of the US Preventive Services Task Force, I would not have been tested and would not have known I had cancer until it was too late to successfully treat it.”
Stiller was told the disease was caught early and could be cured. He chose to remove the tumor with a robotic-assisted laparoscopic radical prostatectomy.
Some media have speculated that the disclosure could lead to a so-called “Steller effect” in early prostate exams, similar to actress Angelina Jolie’s effect on BRCA1 genetic testing or an increase in colonoscopy attributed to journalist Katie Couric after she underwent genetic testing. The procedure that was performed right on the day turned out to be after her husband died of colon cancer in 1998.
But Sean Kavanaugh, MD, chief of radiation oncology at our hospital near Atlanta, is skeptical. “Unfortunately, I don’t see it being similar to those examples,” he says. “The colonoscopy and BRCA tests were recommended tests that celebrities are putting in the spotlight. Stiller is pushing something that is not part of current national guidelines; forces that are vehemently opposed to his view. While I wish his story would move the needle in the PSA scan, I would be surprised.”
Even if Stiller’s discovery sparked a conversation among men and their doctors about the optimal time to start prostate cancer screening, many may consider it a success.