Once America’s Most Beloved TV Doctor, Tim Johnson, 89, Was Shocked By Advanced Prostate Cancer Diagnosis- The Powerful Argument To Start Screening Older Men

Dr. Johnson, who retired in 2019 from ABC News and 2012 from WCVB-TV, said he was surprised to learn about his high PSA score, as he hadn’t been advised to continue screening—current guidelines generally don’t recommend prostate cancer tests for men over 70.

He expressed further, “I’m quite convinced it will be controlled, maybe even cured. But if I had gotten a PSA much earlier, it would be much more simple. The treatment much easier.”

Referring to if he was told to get checked more frequently, he said, “Presumably, I would have noticed it creeping up year to year, and that would have triggered some tests to see if there was cancer there and if there was cancer that was causing the higher PSA, we would have treated it very simply.

“But now, because it’s more advanced, we have to do some anti-androgen therapy, anti-testosterone therapy and then probably some radiation.”

Dr. Johnson, who remains “very optimistic” about how his cancer fight will go, advised, “If you’re over 70 but you’re healthy, your mind is intact, get a yearly PSA for a while.

“And if they stay low, maybe every two years, maybe every three years… but don’t wait 14 years like I did.”

It’s important to note that for men 70 and older, routine PSA screening is usually not suggested unless they are in very good health and have a longer life expectancy. Like other medical tests, PSA exams are helpful, but have possible risks. Speak with your doctor on what’s best for you.

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John R. Green, the current Senior Executive Producer at SurvivorNet, was a producer and executive for 26 years at ABC News where he worked closely with Dr. Tim Johnson on dozens of medical reports.

Green tells us, “It does not surprise me that Tim would use his diagnosis as an opportunity to educate people about prostate cancer and the need for more screening.”

“I can say he has always been committed to the very best tenet of being a medical doctor.”

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He continued, “I have no doubt that even with a diagnosis of metastatic cancer, Tim will continue to thrive and be an example for millions of other survivors.”

Based in Boston for many years, Tim began filing medical reports for ABC News over 40 years ago, Green recounted. He later became the official medical editor for Good Morning America, where he appeared multiple times a week, delivering breaking news on health and wellness, as well as feature stories on patients defying the odds.

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Why Are Aspects of Prostate Cancer Screening Controversial?

Dr. Shirin Razdan, director of the Robotic Surgery Department at the Comprehensive Urological Surgery Institute in Miami, previously discussed with SurvivorNet how prostate cancer screening has remained a topic of debate for the past decade.

While early detection can be life-saving, there is also a genuine risk of overdiagnosis and overtreatment. Because of this, the decision to pursue screening isn’t one-size-fits-all and should be made only after a careful conversation with your healthcare provider.

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That said, there are age- and risk-based guidelines that many experts generally recommend following.

“PSA screening should begin around the age of 45 to 50 and can be done every two to four years, although I believe most urologists and primary care physicians do an annual screening,” Dr. Razdan explained.

“There is a recommendation, however, to start that screening as young as 40 in men who are high-risk. Now, who are those men? [Those with] family history and African-American men.”

Prostate cancer is a common diagnosis among men, especially those over the age of 50. Yet, not every prostate cancer progresses rapidly or demands aggressive intervention. Some tumors grow so slowly that they might never produce symptoms or impact a man’s lifespan. Because of this, screening can occasionally identify cancers that would never have posed a threat, and treating these cases can lead to side effects such as urinary incontinence, erectile difficulties, and other complications.

For this reason, many organizations, including the U.S. Preventive Services Task Force (USPSTF), now recommend a shared decision-making approach, where your doctor discusses the potential risks and benefits with you to help you make a decision that aligns with your personal risk factors and preferences.

Making Decisions

The prostate-specific antigen (PSA) blood test is the primary method used to screen for prostate cancer. PSA is a protein produced by the prostate, and higher-than-normal levels may indicate the presence of cancer. However, elevated PSA can also result from non-cancerous issues such as benign prostatic hyperplasia (BPH) or inflammation of the prostate, known as prostatitis.

Widely-support recommendations are as follows:

• Men age 55 to 69 are the group most likely to benefit from PSA screening. If you are in this age range, discuss screening with your doctor.
• Men younger than 55 with high risk — which includes those with a strong family history, African American men, or those with known genetic mutations (like BRCA1 or BRCA2) — may need to start screening earlier, even in their 40s.
• For men age 70 and older, routine screening is generally not recommended unless you are in excellent health and have a long life expectancy.
  There are both benefits and risks to undergoing regular PSA screening.

As per American Cancer Society, here are the issued prostate cancer screening guidelines for men based on age:

• Men aged 50 and older with an average risk of the disease should discuss screening with their doctors
• Men aged 45 and older who have a high-risk (due to a family history or other factors) should discuss screening early with their doctors
• Men aged 40 and older who have multiple family members who were diagnosed with prostate cancer at a young age (younger than 65) should discuss screening early with their doctors

It’s important to understand that screening can detect cancer before it spreads, allowing for potentially curative early treatment and providing reassurance for high-risk individuals.

However, it also carries risks such as false positives leading to unnecessary biopsies, the discovery of slow-growing cancers that may never cause harm, and psychological stress from unclear or inconclusive results.

When Should I Get Tested for Prostate Cancer?

Screening generally involves a PSA (prostate-specific antigen) test and a digital rectal exam to feel the prostate gland. The prostate-specific antigen is a protein secreted by the prostate gland, large amounts of which can indicate prostate cancer.

Though the PSA test is not always accurate and an elevated PSA test does not always mean you have prostate cancer, our experts maintain that these tests are helpful. Make sure to discuss your options with your doctors and decide what screening should look like for you.

Surgery Isn’t Always the First Option; Some Choose ‘Active Surveillance’

It’s common for prostate cancer to grow very slowly. Some men, especially those who are older and those who have a low risk of the cancer spreading, may not need aggressive treatment, making active surveillance a viable option.

WATCH: People With Low-Risk Prostate Cancer Can Rely on Monitoring the Disease

Active surveillance means the doctor watches the cancer carefully for changes, with a PSA blood test every six months and a digital rectal exam about once a year. You may also get prostate biopsies and imaging tests every one to three years.

SurvivorNet experts stress active surveillance is not “watchful waiting.” Active surveillance is a treatment, and as the name implies, it is active. This path requires coordination between the patient and their healthcare team.

“[It’s] not just kind of check in once a year—hey, how are you doing—but actively have a physician check a PSA and do a rectal examination,” Dr. Edwin Posadas, told SurvivorNet.

“We can actually see some of the metabolic information within the cells through our next-generation imaging and find high-risk areas that are or are not changing in a patient to let us know, yeah, that cancer’s still sleeping. Let’s not bother– let’s not put that young man through the risk of losing his sexual quality of life or his urinary quality of life,” Dr. Posadas added.

Half of men who choose this approach will avoid unnecessary treatment and potential side effects. But the other half of men do end up having treatment, whether as a personal decision to remove the cancer or to treat the disease as it progresses. Your doctor will determine if this is necessary based on the results of your ongoing tests.

Hormone Therapy and the New Treatments Available for Late-Stage Prostate Cancer

Hormone therapy is used when patients are unable to have cancer surgically removed because it has spread to other parts of the body.

Although hormone therapies do not cure stage 4 prostate cancer, they may help keep it from growing and spreading further.

“The traditional standard of care for metastatic prostate cancer is androgen (male sex hormone) deprivation therapy or hormone therapy,” explains Dr. Jeff Tosoian, a urologic oncologist.

Androgen deprivation therapy is a type of hormone therapy that works by inhibiting androgen production, including testosterone, or blocking androgen receptors, which can slow down tumor growth.

“Prostate cancer feeds off testosterone,” explains medical oncologist Dr. Mary O’Keeffe. “When you lower testosterone with androgen deprivation therapy, it’s no longer feeding the cancer.”

As metastatic prostate cancer progresses, the cancer cells can adapt and become resistant to therapy.

According to Dr. O’Keeffe, this is true for most cancer treatments. “You have some men that are on it for many years, and some men can progress in less than a year if they have a more aggressive type of cancer.”

Two newer androgen deprivation therapies for late-stage prostate cancer include:

Xtandi (enzalutamide)

• FDA-approved to treat non-metastatic (nmCRPC) and metastatic castration-resistant prostate cancer (mCRPC) and metastatic castration-sensitive prostate cancer (mCSPC)
• It’s a once-daily oral pill that can be taken with or without food
• The most common side effects include fatigue, weakness, hot flashes, back pain, joint pain, changes in bowel habits, high blood pressure (hypertension), and decreased appetite

Erleada (apalutamide)

• FDA-approved to treat metastatic castrate-sensitive prostate cancer (mCRPC)
• It’s a once-daily pill taken by mouth
• The most common side effects include rash, hot flashes, high blood pressure, itching, and joint pain

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Targeted Cancer Therapy Options

Targeted therapy is a developing treatment option for prostate cancer. Unlike cytotoxic chemotherapy, which also damages healthy cells as it attacks cancer, targeted therapies interfere with specific molecular pathways.

These drugs can target and destroy specific cancer cells with fewer side effects than traditional chemotherapy.

Targeted therapy has three major mechanisms of action:

• Blocking the growth factor that encourages tumor cells to grow
• Interfering with the synthesis or function of DNA
• Disrupting cell signaling pathways essential for the survival and growth of cancer cells

Pluvicto is part of a newer class of targeted cancer therapies called radioligand therapies (RLTs). It delivers a small but powerful dose of radiation directly to prostate cancer cells that express a protein known as PSMA (prostate-specific membrane antigen). This protein is found on most prostate cancer cells but not on normal tissues — making it a valuable target for treatment.

Before receiving Pluvicto, patients must undergo a PSMA PET scan using an approved imaging agent, such as Locametz, to confirm that their cancer cells express PSMA.

This treatment is now approved for men with mCRPC — which means the cancer has spread beyond the prostate and is no longer responding to hormone therapy — who have already been treated with one ARPI (like abiraterone or enzalutamide) and who are not yet ready for chemotherapy.

Other Treatment Options

There are an array of treatment paths someone with stage four prostate cancer may choose to take, each with their own risks and benefits.

Here is a breakdown of the options:

• Chemo: The goal of this therapy is not to cure prostate cancer but rather to slow its growth and reduce symptoms.
• Radiation Therapy: This therapy uses high-energy rays or particles that are focused on prostate cancer cells to damage or destroy them. This treatment is effective for helping to ease symptoms related to prostate cancer, but it’s not used as a cure.
• Surgery: Surgery isn’t common in late-stage prostate cancer. However, sometimes, doctors may surgically remove the testicles (called an orchiectomy or surgical castration) in order to stop the production of testosterone.
• Clinical trials: Clinical trials are being conducted for many types of advanced prostate cancer. Participation can give patients access to new drugs and treatments.
• Cancer vaccine: Provenge, an immunotherapy treatment given over the course of one month, is the first FDA-approved vaccine for metastatic castration-resistant prostate cancer (mCRPC). It helps the patient’s immune system attack prostate cancer cells that have been growing and dividing throughout the body. Common side effects include fatigue, chills, fever, back pain, nausea, joint pain, and headaches.

WATCH: Genetic testing can help doctors tailor advanced prostate cancer treatments

Each of these treatment options involves careful considerations, including the patient’s age, past health history, and current health status.

Bone Therapy

Due to metastatic cancer’s ability to destroy bone tissue and release substances that cause additional bone damage, doctors often manage bone loss with treatment to stop or slow bone destruction (such as bisphosphonate drugs), reduce pain, and prevent fractures.

New drugs available to prevent bone loss and fractures in those whose cancer has already spread to the bones include Xgeva (denosumab), which is FDA-approved for preventing skeletal complications in men with advanced prostate cancer who are at high risk for fracture.

It’s an injection given under the skin every four weeks. The most common side effects include shortness of breath, fatigue, nausea, and low phosphate levels in your blood.

Contributing: SurvivorNet Staff

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