ORLANDO, Fla. – On Jan. 30, 2024, I was diagnosed with prostate cancer.
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“I’m a little shocked, but not really, because my dad had it,” I recorded in my phone as I decided to chronicle the journey that I was forced to take. “I don’t know what to feel. They said it was low-to-mid-grade, but they were still urging me to remove it because I’m still young and healthy and probably have 30 more years to live. Still, a little sobering.”
My diagnosis was one of the 299,010 new cases estimated by the American Cancer Society. The organization also estimated 35,250 would not survive as prostate cancer is the No. 2 cancer killer among men.
Many men, like me, do not know they have the disease. It usually has very few – if any – symptoms. In fact, The National Institutes of Health Cancer Institute estimates 3.4 million men are living with prostate cancer right now, and many do not know they have it.
Enough with the statistics.
What is the prostate?
Here is a quick anatomy lesson:
The prostate is part of a man’s reproductive system.
It’s a gland that sits right below a man’s bladder and helps in the production of semen.
Doctors measure its health by checking for swelling with the infamous finger stick.
They also test the gland’s PSA – or Prostate Specific Antigen – levels.
A normal range is anywhere between 0 and 2.5 nanograms per milliliter.
Mine was 10.5, so my doctor knew something was not right.
Younger men facing diagnosis
Dr. Oni Okotie is a urologist from Indiana.
Yes – he’s a urologist, and he was diagnosed with prostate cancer.
He said he found out through a routine PSA test, where he found out his levels were also high.
He also did not have any symptoms
“I definitely had a family history of prostate cancer, so it’s something that was kind of on my radar, definitely,” he said. “Maybe not at this age, but I kind of imaged it.”
Okotie is 46 years old.
Treatment
Okotie and I both opted for prostate removal surgery, and we both went to the same surgeon at AdventHealth Celebration just outside of Orlando.
Dr. Vipul Patel is known all over the world as a pioneer in treating prostate cancer.
I first met Patel 10 years ago when I did a story on his cutting-edge robotic surgery. I never thought I would be on the other side.
“Imaging this many cases, you would expect someone to be completely burned out and hate what they do,” Patel said. “It’s the opposite. Each year, I think we do better.”
Patel has now performed more than 18,000 prostate removal surgeries.
In fact, I was surgery 18,001.
He uses a machine called The DaVinci Robot.
“I’m looking through a camera that has 10-times magnification and 3D vision and depth perception,” he said while looking through a viewfinder that resembled a video game console.
“These robotic hands are tiny, but these eight millimeter instruments can do exactly what my hands can do inside the body,” he said.
Over the last 10 years, Patel said the age of his average patient has gotten younger.
“We know it’s a different discussion. They’re scared. The last thing they want to know is they have prostate cancer,” he said. “They have other issues going on – work, kids, young kids – and they’re like, ‘why me?’ I think it’s always a harder discussion because everything is on the line.”
Expanded Screening
Patel and his colleagues authored a research paper, where they tracked more than 11,000 patients who had prostate removal surgery.
They found they were treating “younger patients with higher-grade diseases, and the increasing number of high-risk patients has led to worse” side-effects after surgery.
“It makes no sense to me why you would not screen for the second leading cause of death in men of cancer, when you screen for other things that are less morbid, in many ways,” he said. “(The U.S.) has fallen behind.”
The guidelines on who should be screened and when are created by the U.S. Preventative Services Task Force.
Currently, they recommend men ages 55 to 69 years old discuss the possibility of testing their PSA levels with their doctor, especially if they have a family history.
No testing is recommended for men over 70 or under the age of 55.
“Guys less than 55 are a huge part of our practice,” Patel said. “They are getting high-risk prostate cancers, and they are not even mentioned in the guidelines, and that’s a problem.”
During my surgery, Patel and his team discovered my cancer was Stage 3, and it was an aggressive form of the disease.
We contacted the USPSTF and asked if they plan to update their recommendations.
They responded:
“Prostate cancer is one of the most common cancers to affect men, and all of us at the U.S. Preventive Services Task Force caredeeply about ensuring that men have the best information available to them as they make a decision about prostate cancer screening together with their clinician. However, the decision about whether to be screened using PSA-based testing is complex.
When the Task Force last reviewed this topic in 2018, we recommended that men discuss the benefits and harms of screening for prostate cancer with their clinician so that they can make the best choice for themselves based on their values and situation.
We are currently reviewing the latest evidence to update our recommendation. While we can’t speak to what we will find, since we are still in the middle of this process, the Task Force is deeply committed to understanding everything that the research tells us and using that to provide guidance that can help men live the longest, healthiest lives possible.”
U.S. Preventative Services Task Force
A spokesperson said they could not predict when their review would be finished.
So, why don’t all men just ask for a PSA test?
It’s not that simple.
Insurance may not cover it. Some states mandate PSA test coverage, others do not.
Some insurance companies only cover the test if the patient has a family history, or if they are over 55.
“I think (PSA test) is one of the solutions,” Patel said. “If we can catch prostate cancer early enough, we know the cure rates are very high. Ultimately, we need to do a better job in screening. We need to have better options for screening and for management. You know, I still think we have a long way to go.”