A Prostate Cancer Surgeon (and Survivor) Reflects On What He’s Learned

Prostate cancer is the second most common type of cancer affecting men. In fact, the World Cancer Research Fund stated that 2018 saw 1.3 million new cases of prostate cancer. With millions of people being diagnosed with prostate cancer, there is no shortage of unique perspectives and experiences.

This article from the American Council on Science and Health fits very well into the theme of Prostate Cancer Awareness Month, bringing a perspective as both a prostate cancer survivor and a prostate cancer surgeon.

What I’ve Learned As A Prostate Cancer Surgeon…And Survivor

Source: acsh.org

By Paul Lange, MD, FASC

Like many so-called surgeon-scientist experts in urology, I’ve spent my life caring for men with prostate cancer (PC) and doing research on it. However, in addition, I developed prostate cancer, had the surgery, and am cured without side effects. Actually, I’m glad I had this cancer, for it made me a more empathetic physician and a better spokesman for the disease. Finally, I was very involved in the early development of PSA.

The subject of prostate cancer is too big to cover all of it here. In passing one should know that it is the most common cancer in men: currently men have a 30% chance of getting it and a 2-3% chance of dying from it. Like breast cancer, PC is influenced by sex hormones (e.g. testosterone in men and estrogen and progesterone in women), and there is a significant hereditary factor in disease development and prognosis. Finally, like breast cancer, before efforts to diagnose PC early, a majority of men had advanced and thus fatal disease when first detected. What we can discuss here is the controversy of PSA and screening.

But before we discuss this topic, we need to relate two issues that will enhance understanding. One is the metaphor of “turtles” and “birds”. Briefly, years ago, I resurrected a metaphor that I applied to prostate cancer.  Namely this cancer is like many animals enclosed in a barn yard fence. Most prominently, there are the “turtles” that grow very slowly and rarely achieve the characteristics allowing it to escape (i.e. metastasize beyond the prostate). Then we have the “birds” that, depending on growth rate and inherent characteristics, will always metastasize (e.g. spread to other organs which in prostate cancer is most often to the bone). There are also other animals (we can group them into one animal called “rabbits”) who exhibit combinations of characteristics between “turtles” and “birds”. We’ve known for decades that there are many more turtles than birds (or rabbits) in prostate cancer.  For example, for many decades we’ve known that over 70% of older men who die have the “turtle” type of prostate cancer and die never having known they had the disease. Yet there are enough “birds” in the disease that PC is the number 2 cancer killer in men.

The second issue is the phenomenology of PSA, which stands for Prostatic Specific Antigen. It is a protein that is made exclusively by normal prostate tissue but also prostate cancer. PSA is found in the blood of all normal men and most importantly in people with prostate cancer. Normal prostate cells generally make more PSA than prostate cancer cells, but it seems that PSA leaks out into the blood more with PC cells. Thus, if the prostate is removed by surgery or mostly destroyed with radiation treatment, then if PSA is found in the blood afterwards, it can only come from PC that still remains in the body. This makes PSA one of the best cancer “markers” for following disease status after initial therapies.  

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Prostate Cancer Resources

If you or someone you love has recently been diagnosed with prostate cancer, we have a number of prostate cancer resources to help give you some guidance. Visit our resource library to find questions to ask your oncologist and more.