A Former Mayor's Call for Prostate Cancer Screening
- Former Philadelphia mayor Michael Nutter had surgery to remove his prostate last December after the monitoring of his PSA (prostate-specific antigen) levels for years suggested his prostate cancer was worsening.
- Nutter believes he has an “obligation” to encourage PSA screening because of his race. African American men face a greater risk of getting a more aggressive form of prostate cancer and at a younger age than white men.
- The PSA test is not perfect. It’s been a subject of controversy since high levels may lead to over-treatment in men who are more likely to die from something else, but our experts maintain that the PSA tests are helpful in detecting prostate cancer. It’s important that you discuss your risk levels with your doctor and go from there.
Now he’s encouraging people to get the PSA (prostate-specific antigen) blood test to screen for prostate cancer. “All you have to do is give a little blood. See where you are. It’s not like they’re drilling a hole in your head,” he said in an interview with the Philadelphia Inquirer.Read More
After a biopsy, an ultrasound, a CAT scan and a bone scan, the urologist discovered he had a small, relatively nonaggressive cancer confined to his prostate. He had the option to have surgery or radiation immediately, or he could wait and monitor this situation with follow-up PSA tests and biopsies. He chose the latter.
“I’m working and traveling and teaching,” Nutter recalled, according to the Philadelphia Inquirer. “I said ‘I’d like to do active surveillance.’”
After more than four years of medical monitoring, Nutter, with his doctor’s support, decided it was finally time to remove his prostate in December. Now that he’s fully recovered, Nutter is encouraging others to get screened for prostate cancer. He believes he has an “obligation” to encourage PSA screening because of his race.
African American men face a greater risk of getting a more aggressive form of prostate cancer and at a younger age than white men. Research surrounding race disparities in cancer often points to socioeconomic differences and access to care, but some researchers insist there’s more to the story.
“Some of these differences are socioeconomic, but even when you take that into consideration, there’s clearly something biological there as well,” Moray Campbell, a researcher in the Molecular Carcinogenesis and Chemoprevention Program at the Ohio State University Comprehensive Cancer Center, told SurvivorNet in a previous interview.
Campbell and his colleagues have completed research suggesting a link between vitamin D and prostate cancer survival. But, Campbell says, “In our preliminary studies, we saw a potential footprint of the actions of vitamin D receptor in prostate cancer.”
Their research provides some evidence for the claim that there’s something about the way vitamin D is processed in the body that drives some of the racial differences in prostate cancer. African Americans run higher risk for vitamin D deficiency than their white counterparts. More research is needed, but it is possible that a lifetime of vitamin D deficiency in some African Americans accumulates to lead to the development of more aggressive types of prostate cancer.
Understanding Prostate Cancer
Prostate cancer is the most common cancer in men. According to the American Cancer Society, about one in eight men will be diagnosed with prostate cancer during his lifetime. The disease begins in the walnut-shaped prostate gland located between the rectum and bladder. This gland produces the fluid that nourishes sperm.
Symptoms of the disease are inconsistent and hard to pinpoint. “Prostate cancer is a very odd disease in that it doesn’t have a particular symptom,” explains Dr. Edwin Posadas, director of translational oncology and the medical director of the Urologic Oncology Program at Cedars-Sinai. But 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 the disease. However, it’s important to note that these potential symptoms could also could be caused by a urinary tract infection or even an enlargement of the prostate gland (which is not cancer).
Expert physicians that have spoken with SurvivorNet shared a hopeful outlook when considering a prostate cancer diagnosis, because there are many treatment options, and there’s been significant treatment progress over the past decade. Surgical and radiation options, for example, have made improvements in reducing side effects of treatment while still providing excellent cure rates. Even for men with an advanced-stage diagnosis, many new options exist to treat prostate cancer and help them maintain an excellent quality of life.
Prostate Cancer Screening
In the United States, most prostate cancer cases are caught with screening examinations. Screening guidelines depend on your risk for the disease. The American Cancer Society cites age, race/ethnicity, geography, family history and gene changes as main risk factors for prostate cancer. It’s important to talk with your doctor regardless, but here are some things to consider when gauging your risk for the disease, according to the American Cancer Society:
- Men younger than 40 are less likely to get prostate cancer, but age-related risk quickly rises after age 50. Approximately six of ten cases of prostate cancer are found in men older than 65.
- Prostate cancer develops more often in African-American men and in Caribbean men of African ancestry than in men of other races, and these men tend to develop the disease at a younger age.
- Prostate cancer is most common in North America, northwestern Europe, Australia and on Caribbean islands. It is less common in Asia, Africa, Central America and South America. The reasons for this risk factor are unclear, but more intensive screening and lifestyle differences like diet might be contributing factors.
- Most prostate cancers occur in men without a family history of the disease, but it’s still important to look at your family history because prostate cancer does seem to run in some families. Having a father or brother with prostate cancer, for instance, more than doubles a man’s risk of developing the disease with a higher risk for men with a brother with prostate cancer than those with a father who have it. The risk is also especially high if a man has several affected relatives that developed the cancer at a younger age.
- Inherited gene changes, or mutations, like that of the BRCA1 or BRCA2 genes can also elevate risk, but this probably accounts for a small percentage of overall cases.
Screening for prostate cancer generally involves a PSA (prostate-specific antigen) test and a digital rectal exam.
“It’s slightly uncomfortable but painless, and takes less than 30 seconds,” Dr. Posadas says. “The amount of information that is gained from that is tremendous, and it can be a life-and-death type decision that is made.”
But it’s important to note that the PSA test is not perfect. The prostate-specific antigen is a protein secreted by the prostate gland. Men have a small amount of PSA in their blood all the time, but large amounts can be a sign of cancer because when cancer cells grow, PSA spills into the blood.
An elevated PSA test, however, does not always mean you have prostate cancer. It can simply reflect that your prostate is enlarged – which is quite common – or it could signal an infection or inflammation. Because of this, the PSA test is controversial since high levels may lead to over-treatment in men who are more likely to die from something else. Regardless, our experts maintain that the PSA tests are helpful, and you should talk with your doctor about your own risks for the cancer and screening options.