68-Year-Old Comedian Diagnosed With ‘Very Early Stage’ Prostate Cancer After Routine Checkup. Now He’s Encouraging Others To Get Screened

The former BBC Scotland radio show host, whose late dad and older brother were diagnosed with prostate cancer, admitted that his family history of the disease prompted him to figure out whether he was at a heightened risk.

After recounting how his dad passed away after battling prostate cancer and mesothelioma at age 73, more than 20 years ago, MacAulay stressed how his brother Duncan’s diagnosis eight years ago, at age 72, encouraged him to see a doctor.

He explained, “When it became clear I’m more at risk because of the prevalence of prostate cancer in my family, I’ve been getting tested every couple of years.

“After the last test a few weeks ago, my doctors got back to me and advised further action was needed.”

RELATED: Prostate Cancer: Overview

MacAulay, who admitted to not experiencing any symptoms prior to his diagnosis, said he was informed of his diagnosis this month and is awaiting his treatment plan.

“I hope by speaking up this will encourage other men to get checked out too. It could save their lives,” he said. “My brother and my family and friends are all good about speaking up about prostate cancer, but I know not everyone does.”

MacAulay, who plans on not letting cancer affect him from living fully, continued, “It’s always been a scary thing to talk about, but with all the progress in medicine the best thing to do is be aware, get tested and catch it quickly as it gives you the best possible chance of beating it.”

He noted that some of his plans and upcoming tour schedule may need to be cancelled or postponed, however, he has decided to join his friend, cyclist Chris Hoy for a Prostate Cancer UK charity event.

RELATED: Olympian Chris Hoy Announces Cancer Diagnosis He Initially Hoped to Keep Private — Deciding When to Speak Up About Cancer is Personal

MacAulay also praised Hoy as an a “true hero” and an “inspirational figure” in fighting prostate cancer.

Understanding Prostate Cancer

If you or a loved one has been diagnosed with prostate cancer, it’s important to remember that most types of prostate cancers are treatable. According to the National Cancer Institute, the five-year survival rate of prostate cancer in the U.S. is 97.1%. There is, however, a small number of men whose type of prostate cancer may become unresponsive to treatment, for example, when cancer cells develop a resistance hormone therapy, the treatment may no longer work.

RELATED: Prostate Cancer: Overview 

Prostate cancer begins in the prostate the walnut-shaped gland located between the rectum and bladder that produces the fluid that nourishes sperm. Outside of skin cancers, prostate cancer is the most common cancer in American men with about one in eight men being diagnosed with this disease during his lifetime.

It’s important to remember a prostate cancer diagnosis is not always preceded by symptoms. And even when symptoms do occur, they can be inconsistent and hard to pinpoint.

“Prostate cancer is a very odd disease in that it doesn’t have a particular symptom,” Dr. Edwin Posadas, director of translational oncology and the medical director of the Urologic Oncology Program at Cedars-Sinai, told SurvivorNet.

Still, it’s important to note changes in urinary function, like urinating more or less often or waking up at night to go more than usual, could be a sign of prostate cancer. So, even if you think there’s nothing to worry about, always talk to your doctor about changes to your health when they occur.

There are many different treatment options for both early and later-stage prostate cancer including active surveillance, watchful waiting, surgery, radiation, cryotherapy, hormone therapy, chemotherapy, immunotherapy and targeted therapy. The disease is one where doctors may have differing opinions on the best treatment path to take, so don’t hesitate to ask lots of questions and seek out multiple opinions.

Second (& Third) Opinions Matter When Deciding Between Surgery or Radiation

“I think it behooves the patient to have multiple discussions or second opinions, not only by the urologist who did the biopsy and diagnosed that man, but also with other surgeons and other radiation oncologist just to get a very circumspect view of what the treatment options are,” Dr. Jim Hu, a urologic oncologist at Weill Cornell Medicine, told SurvivorNet. “Oftentimes, I think patients need to understand that our health system is based a lot on fee-for-service medicine.”

“And so therefore, a lot of physicians, I think, who are very well intentioned, will believe that their treatment is best for that particular man,” Dr. Hu added.

Treatment Decisions After a Prostate Cancer Diagnosis

Although there are numerous treatments available for prostate cancer, what your doctor recommends will depend on what category of risk your disease falls under. Sometimes that may mean doing nothing at all.

Prostate cancer is a slow-growing disease, so unless it’s been a majorly delayed diagnosis and in a more advanced stage, medical experts will sometimes suggest actively monitoring the growth, and the patient will go in for check-ups every six months or whatever timeframe the doctor deems best.

Dr. David Wise, NYU Langone medical oncologist, explains how Gleason score affects treatment and prognosis

The National Comprehensive Cancer Network (NCCN) guidelines divides prostate cancer into one of six risk categories based on how aggressive the cancer looks under the microscope and the chance of it coming back after treatment. These risk categories help guide treatment for the different subtypes of prostate cancers.

The main risk categories for prostate cancer are:

• Very-Low-Risk (VLR) and Low-Risk (LR)
• Favorable- (FIR) and Unfavorable-Intermediate-Risk (UFIR)
• High-Risk (HR) and Very-High-Risk (VHR)

Prostate cancers classified as VLR or LR represent the least aggressive forms of cancer. This categorization will be diagnosed depending on number of factors, including:

• Your doctor can’t feel the cancer on a physical exam, or it occupies one-half or less of one side of the prostate
• Your PSA is less than 10
• Your total Gleason (which is how the prostate cancer is graded) score is 6
• If your cancer is categorized as VLR or LR, your doctor may recommend active surveillance, which is sometimes called “watch and wait.”

Dr. Nicholas Nickols, a radiation oncologist at the UCLA Department of Radiation Oncology, summarizes active surveillance as follows, ‘We carefully monitor the prostate cancer for evidence of progression or not, and then initiate treatment later, if at all.”

During active surveillance, you won’t receive any treatment but your doctor will key an eye on your cancer with a series of tests including:

• PSA Levels
• MRIs
• Repeat biopsies

It’s possible that your cancer may never progress to more aggressive forms of prostate cancer. Active surveillance should help your doctor catch any changes or progression.

RELATED: What is Active Surveillance?

Patients on active surveillance can be spared the side effects of pursuing the traditional ways of treating prostate cancer. If and when the disease becomes more aggressive, as indicated by a rising PSA, development of aggressive-looking disease on MRI, or increasing Gleason score, it can then be treated with surgery, radiation, hormone therapy, chemotherapy, or a combination of these therapies.

Dr. Edwin Posadas tells you what clues might signal that you have prostate cancer

How Do Doctors Stage Prostate Cancer?

Once your doctor has established that you do have prostate cancer, the next step is to learn its stage. The stage tells how far the cancer has spread, and knowing it can help your doctor decide on the right treatment for you.

The staging system doctors typically used for prostate cancer is called TNM, and it’s based on five factors:

• The extent of the main tumor
• Whether it has spread to any lymph nodes
• Whether it has spread (metastasized) to other parts of your body
• Your PSA level at the time of diagnosis
• The grade (based on your Gleason score), which is how aggressively your cancer is likely to behave

Prostate cancer has four stages, each of which is broken down further with a letter based on its extent.

Stage I

The doctor can’t feel the tumor or see it with an imaging test such as transrectal ultrasound. It was found during transurethral resection of the prostate (TURP) or biopsy. The cancer has not spread to nearby lymph nodes or to other parts of your body. Your Gleason score is 6 or less, and your PSA level is less than 10.

OR

The doctor can feel the tumor by digital rectal exam (DRE) or see it with imaging, and it is in one half or less of only one side (left or right) of your prostate. The cancer has not spread to nearby lymph nodes or elsewhere in the body. The Gleason score is 6 or less, and the PSA level is less than 10.

OR

You’ve had surgery to remove your prostate, and the tumor was only in the prostate. The cancer has not spread to nearby lymph nodes or elsewhere in your body. The Gleason score is 6 or less, and the PSA level is less than 10.

Dr. David Wise, NYU Langone medical oncologist, explains how Gleason score affects treatment and prognosis

Stage IIA

The doctor can’t feel the tumor or see it with imaging. It was either found during TURP, or was diagnosed by needle biopsy. The cancer has not spread to nearby lymph nodes or elsewhere in your body. The Gleason score is less than or equal to 6, and the PSA level is at least 10, but less than 20.

OR

The doctor can feel the tumor by DRE or see it with imaging. The tumor is in one half or less of only one side of the prostate. Or, the prostate has been removed with surgery, and the tumor was only in the prostate. The cancer has not spread to nearby lymph nodes or elsewhere in the body. The Gleason score is less than or equal to 6, and the PSA level is at least 10 but less than 20.

OR

The doctor can feel the tumor with DRE or see it on imaging. It is in more than half of one side of the prostate or in both sides of the prostate. The cancer has not spread to nearby lymph nodes or elsewhere in your body. The Gleason score is less than or equal to 6, and the PSA level is less than 20.

Stage IIB

The cancer has not yet spread outside the prostate. Your doctor might feel it with DRE or see it with imaging. The cancer has not spread to nearby lymph nodes or elsewhere in your body. The Gleason score is 7, and the PSA level is less than 20.

Stage IIC

The cancer has not yet spread outside the prostate. Your doctor might feel it with DRE or see it with imaging tests. The cancer has not spread to nearby lymph nodes or elsewhere in the body. The Gleason score is 7 or 8, and the PSA level is less than 20.

Stage IIIA

The cancer has not yet spread outside the prostate. It might be felt by DRE or seen with imaging. The cancer has not spread to nearby lymph nodes or elsewhere in your body. The Gleason score is 8 or less, and the PSA level is at least 20.

Stage IIIB

The cancer has grown outside the prostate and might have spread to the seminal vesicles, or into other tissues next to the prostate, such as the urethral sphincter (the muscle that helps control urination), rectum, bladder, and/or wall of the pelvis. It has not spread to nearby lymph nodes or elsewhere in your body. The Gleason score is 8 or less, and the PSA can be any value.

Stage IIIC

The cancer might be growing outside the prostate and into nearby tissues. It has not spread to nearby lymph nodes or elsewhere in the body. The Gleason score is 9 or 10, and the PSA can be any value.

Stage IVA

The tumor might be growing into tissues near the prostate. The cancer has spread to nearby lymph nodes, but has not spread to other parts of your body. The Gleason score and the PSA can be any value.

Stage IVB

The cancer might be growing into tissues near the prostate and might have spread to nearby lymph nodes. It has spread to other parts of the body, such as distant lymph nodes, bones, or other organs. The Gleason score and the PSA can be any value.

Contributing: SurvivorNet Staff

Learn more about SurvivorNet's rigorous medical review process.

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