The news of President Biden’s “sudden” illness with a form of prostate cancer that has spread into his body has people wondering how that could happen to someone who is presumably receiving the best medical care in the world.
The conclusion that one should NOT draw is that prostate cancer is a disease that can come from nowhere and very rapidly progress to life-threatening status. That is simply not the case.
I speak to this issue as the President of the health education non-profit Fundamentals of Health Alliance. I speak to it also as someone has been diagnosed with prostate cancer and successfully treated.
My personal journey through prostate cancer started with a rise in my PSA level—that’s a chemical produced by the prostate. PSA can increase when there are cancerous growths in the prostate (though not all forms of prostate cancer will cause that to occur). However, a rise in PSA in itself is not sufficient reason to make sure your will is up to date. There may be other causes, and in any case prostate cancer grows very slowly. In fact, most of the men who have prostate cancer will very likely die of something else in the years that it takes for the prostate cancer to become dangerous.
This fact has not always been widely understood, and for a time the standard medical handling for a PSA rise was to do multiple simultaneous biopsies of the prostate, extracting several samples with a needle. If any of those tested positive for cancer then the prostate, or a part of it, was removed surgically, posthaste. This was for many thousands of men a needless and tragic outcome.
The modern handling for rising PSA is to first monitor it closely with annual or semi-annual blood tests. If it continues to rise, then images are taken of the prostate to determine if there are any suspicious nodules and, if so, how big they are. It there are, then monitor those nodules every 6 or 12 months. If the rate of growth or size of the nodule is concerning, you can take a biopsy of just the nodule (easy enough to do since you know exactly where it is). Based on that, you make a decision as to whether to treat the cancer or just continue to monitor it. In a relatively small number of cases it’s necessary to treat the cancer (in my case with implanted radioactive seeds).
I learned about all of this through research and experience, and largely due to the good fortune of having a close friend refer me to a prostate oncologist who is a leader in the field.
Unfortunately, the rest of the field is taking some time to catch up to the leaders, and the solution that has been broadly adopted instead is simply to quit monitoring PSA in older men to avoid the risk of unnecessary surgery.
Here’s an analogy: Imagine that you live in a cold climate and your house is heated with natural gas. When your thermostat drops too low, you turn up the heat. But some folks have faulty furnaces and end up burning their house down. The solution? Advise people to get rid of the thermostats.
It’s easy to look back at past decisions and second-guess them with the benefit of hindsight and more experience. But now that we know better, we should act accordingly.
