Tayson has prostate cancer. How heís been living with it for
nine years says a lot about the state of the disease today.
author and professor of poetry at New School University in New
York City went to his primary-care physician at age 44 for a
routine checkup, including a digital rectal exam. When the
doctor felt something abnormal, Tayson had a biopsy and was
told he needed immediate surgery to remove his prostate.
hear the word cancer Ö I panicked," he said, but he
refused the operation. Instead, he embarked on a regimen of
regular testing, physical exercise, a careful diet, meditation
and constant research into the cancer with which one out of
seven American men will be diagnosed.
He had a
PSA test, the common diagnostic tool for prostate cancer, but
it is imperfect and controversial. Some experts believe that
the testís risks of harm, either from accurate results
unleashing unnecessary treatment or from frequent inaccurate
results, outweigh the benefits. Taysonís level of the
prostate-specific antigen protein was 0.76, way below the 4 to
5 that is considered a warning because cancerous cells make
more PSA, or prostate-specific antigen, than benign cells.
biopsy was very invasive. I should have just tracked my PSA
over time," he said.
that aggressive treatment could mean urinary incontinence or
erectile dysfunction, he found new doctors when those
advocating surgery told him, "You canít make love if
a terrible decision to make; you feel doomed no matter what
you do," Tayson said. "Iím walking around with
cancer cells, but Iím handling it. If I make the wrong
decision, Iím willing to live ó or die ó with it because
Iím taking control of my situation."
just what the American Urological Association and the American
Cancer Society, among other groups, want to see: informed men
who get tested for prostate cancer and then carefully consider
their options if signs point to disease. Both groups concede
that men were overdiagnosed and overtreated when PSA screening
was newer. That overtreatment gave rise to a kind of
no-testing backlash and cynicism over whether the real motive
was making money. Nevertheless, there is a danger.
lung cancer, prostate cancer "is the second leading cause
of cancer death in men," said Jeffrey Karnes, a urologist
with the Mayo Clinic in Rochester, Minn., with 27,540 deaths
estimated for 2015. "There is overtreatment, and weíre
mindful of that. But I canít say men should bury their heads
in the sand and not get screened."
Durado Brooks, the American Cancer Societyís director of
prostate and colorectal cancers, said that although the case
for screening is not as clear cut for prostate cancer as for
breast cancer, there is a "higher likelihood" of
decreased mortality in men diagnosed in the initial stages of
the disease. Catching it early and better treatments are why,
should learn everything they can about the risks and harms and
make a decision based on their values and preferences,"
the waters on the screening issue was a 2012 recommendation by
the U.S. Preventive Services Task Force, which examines
evidence on the effectiveness of clinical preventive measures.
It said men should not be tested, regardless of age, because
the harms outweigh the benefits. In an emailed statement, task
force chairman Dr. Albert Siu said the recommendation may be
updated in five to seven years after a review of new studies.
said he believes that recommendation was the pendulum swinging
too far in the opposite direction after PSA screening
initially led to overtreatment.
started to use the results aggressively without thinking of
the negative consequences," he said. "There are many
instances of men who would have been better off if they were
never diagnosed because their cancer is slow-growing. Theyíd
die and not know they had it.
I think, personally, that urologists thought they were doing
the best for their patients. Death from prostate cancer can be
an ugly, painful thing, and they didnít want to see their
men suffer. The idea that money was behind it is just not
true," Brooks said.
help that the PSA test, while simple and inexpensive, often is
inaccurate, showing elevated levels that might indicate cancer
but also can be due to medicines or inflammation. The opposite
also is possible: that no elevation is evident when cancer is
present and particularly virulent. Fast-growing cancer cells
may not produce as much PSA.
recommended once PSA levels are known is evolving. Rather than
rush to biopsy, as Tayson did, or even surgery, more
physicians suggest tracking PSA over time. "Active
surveillance" means repeated tests of blood and urine for
other cancer markers, MRIs for suspicious areas of the
prostate and, more recently, a look for other compounds in the
body that dogs are trained to sniff out as being associated
with cancer, Brooks said.
surveillance is an alternative to surgery or radiation after
cancer is diagnosed. Another option, "watchful
waiting," applies to men whose PSA levels may be elevated
even though no cancer has been found.
still somewhat an art and not a science," Karnes said of
advising patients what course to follow.
does not foresee a new test replacing PSA any time soon. But
new treatments are an active area of research; Brooks points
to imaging and robotics that help surgeons better pinpoint
cancerous areas and avoid tissues and nerves that can lead to
bowel, urinary and sexual problems. Imaging also is aiding
radiologists in targeting tumors, and the latest therapy,
mostly with other cancers, involves proton beams designed to
activate only when reaching diseased cells, he said.
developments are encouraging to Sherry Galloway, of Santa Fe,
N.M., whose husband had his prostate removed at age 50 and
whose son died of prostate cancer at 36. She is a board member
of the nonprofit Zero ó The End to Prostate Cancer, which
raises money for research and provides information.
husband, she said, had a slightly elevated PSA when he was 48,
but it rose to 8 in two years. A prostatectomy was chosen
because "we wanted him alive."
young age contributed to doctors initially not considering
prostate cancer when he was suffering from intense hip and
bone pain. A PSA was ordered only after no cause for the
symptoms was found. The PSA was 441.
a registered nurse, advocates a PSA test at age 21 and then at
five-year intervals. "Not to screen before age 50 is
murderous," she said.
been accomplished in the eight years since her son died, she
said, with much more to do.
was very despondent. Working with Zero gave me a place to pay
forward his life and keeps him alive for me," Galloway
said. "I fight because one of the last things he asked
was for me to help find a cure for prostate cancer."