If a man lives long enough there is almost a certainty that he will develop prostate cancer. Autopsy studies in men over 85 years old showed that almost 90% of these elderly men had prostate cancer even though they died from other causes. In the U.S. almost 36,000 men die each year from prostate cancer with the following producing a heightened risk:
- Obesity
- Age (especially those men 50 years and older)
- Race (African American men have a higher risk
- Family history
- Alcoholism
- High intake of red and processed meats
- Exposure to certain chemicals such as Agent Orange
A screening blood test called “prostate specific antigen” (“PSA”) was developed in the early 1980s and was first approved by the FDA to follow the course of prostate cancer starting in 1986 and then in 1994 the PSA was approved to detect early prostate cancers. The widespread use of doctors ordering PSA tests resulted in a number of over-aggressive biopsies and other testing so the recommendations for drawing the PSA in men has been curtailed. For example, those men over 70 years old are not recommended to have PSA screening and the ages of PSA screening are now 55-69 years old. If there is a first degree relative with prostate cancer, screening should start at age 45.
Finding prostate cancer early should result in a good outcome with very little risk of death. When the cancer is confined to the prostate gland itself and not spread to bones or other organs, the prognosis is excellent for cure/recovery.
This post was inspired by the recent news of former President Biden’s recent diagnosis of aggressive prostate cancer that has spread to his bones. He will undergo hormonal treatment (lowers testosterone ) and perhaps other modalities of treatment but the disease has been described in the media as “aggressive” with a Gleason score of 9. The Gleason score is based on the type of cancer cells with a lower score meaning that the cancer cells appear more normal than the higher scores which indicate the cells are much more atypical. The Gleason score is different than “Staging”, which is a measure of how far the cancer has grown/spread.
As a primary care doctor, I find it sort of unfathomable that a President of the United States has been diagnosed with a metastatic prostate cancer. I believe members of Congress/Senate/Presidency all receive yearly check-ups. It has been my experience that someone does not go from a “normal” PSA to metastatic prostate cancer in a short period of time. Were his doctors negligent in not following yearly PSA levels? Was this known but hidden from the public? There will certainly be more news to follow. But, let’s get back to YOU, my patients: Please have that PSA checked (even if you are above 70) as there really should be no-very, very few deaths from prostate cancer.
President Biden’s first year in the Senate was 1973. The top song of the year? Enjoy Tony Orlando and Dawn.
