Some people are driven to seek fame, but no one wants to be a prostate cancer celebrity. And yet, as of this writing, a several notables have made recent headlines due to their prostate cancer (PCa). After some initial secrecy, it was revealed that Defense Secretary Lloyd Austin was diagnosed, treated, and re-hospitalized for complications related to his PCa. King Charles was brought into royal limelight due to his PCa diagnosis and subsequent treatment. OJ Simpson, former NFL pro (and notoriously accused of murder) once again made unfortunate news when he died from aggressive PCa on April 10, 2024. A few months prior, Martin Luther King Jr.’s son Dexter King sadly succumbed to the disease after a three-year PCa battle.

These men’s stories were featured by media giants like People magazine, USA Today, CBS News, Fox News, the New York Times, and many more. Embedded such articles are cautionary tales: GET ANNUAL PSA SCREENING. PAY ATTENTION TO CHANGES IN HOW YOU PEE. DON’T WAIT FOR SYMPTOMS.

A warning from one man’s story

Perhaps nowhere are these messages clearer than in the personal story of media executive Ed Manning, “What I Didn’t Know about my Prostate almost Killed Me.” You may never have heard of Mr. Manning, but his Apr. 17, 2024 opinion piece for CNN News contains words you should hear about nearly every step of a PCa patient’s journey:

• Ignorance about the prostate gland
• Early digital rectal exams that found nothing concerning
• Lack of PSA screening
• Chalking up changes in urination to aging
• Late detection of PCa
• Treatment decision and recovery
• Concern about possible recurrence.

With the voice of experience, Manning warns, “While it’s too late for me to catch my own cancer early, I encourage anyone with a prostate or anyone who loves a person who has one to talk to a physician. Learn about testing options and the importance of nutrition and staying active. Understand the warning symptoms. Listen to your body or your significant other who might be a better listener than you.”

Words to the wise

PSA screening is so inexpensive and available that it’s almost absurd to not have an annual blood test. And yet, for over a decade, national guidelines have presented a confusing seesaw. Now, the inability to formulate a simple recommendation for all men is understandable, given the harms to body and lifestyle from conventional PSA screening that has led to overdetection, overdiagnosis, and overtreatment of PCa that was unlikely to become deadly. But let’s not forget the flip side of the coin, harms that have resulted from skipping a PSA test, like not catching PCa until it’s too late for a cure.

All of us at the Sperling Prostate Center have continually been promoting a better way to avoid the harms in either direction that result from relying solely on the PSA test. It involves three steps:

• ✓ First, have an annual blood draw that measures a) PSA and b) PSA density (PSA-D) ? Second, if results are suspicious, talk to your doctor about having a repeat blood draw in 2-3 months to rule out lab error.
• ✓ If results are still suspicious, have a multiparametric MRI (mpMRI) of the prostate done on a 3T magnet.
• ✓ Combine the MRI result with the PSA-D.

Why the extra steps? Because the combination of the MRI plus the PSA-D will indicate whether or not a biopsy is needed. If it is, there’s one more step:

• ✓ Have a real time in-bore MRI guided targeted biopsy into the area of suspicion seen on the first MRI. This is the most precise way to gain the most accurate diagnosis.

The benefit of the most accurate diagnosis is the ability to match treatment strategy to the disease. In turn, this means the potential to have a treatment that will not only defeat the cancer, but do so with the least risk of urinary, sexual or bowel side effects—in short, that will preserve your quality of life.

We all have heroes we look up to, be they leaders, athletes, military figures, award-winning actors, spiritual gurus, and more. They have many admirable traits we’d like to emulate. Perhaps one or more of your heroes is already in the ranks of the PCa Survivor Club, men like Nelson Mandela, Arnold Palmer, Colin Powell, Robert DeNiro, Archbishop Desmond Tutu and many more. Of course, having a PSA test won’t protect you against PCa. However, if you do develop it, you want to detect it at the very earliest, when all treatment options (including Active Surveillance) are open and have the greatest chance of success. Or, to put it another way, when you have the best chance of joining great men in the PCa Survivor Club.