Clark Howard’s Prostate Cancer Update
Since I first told you about my prostate cancer after my January diagnosis, I have been overwhelmed by the well wishes, prayers and suggestions that I have received from thousands of kind people.
As anyone who has or had cancer can tell you, it is a journey. Today, I want to let you know where I am in the journey.
I have long been an advocate of being tested for prostate cancer. That is because it is by far the most common cancer among men. In most years, it is the most-diagnosed cancer period, with a greater number of cases than the much more highly recognized breast cancer in women. White men should start being tested for prostate cancer at age 50, while black men need to start their testing earlier at age 40.
If prostate cancer is discovered early enough, it is almost never fatal. That fact makes it nearly unique among cancers.
Those with prostate cancer can be categorized as turtles, rabbits or eagles. Eagles have extremely dangerous, fast growing cancer that has spread well beyond the prostate. They have by far the toughest battle. Rabbits are those with cancer that has spread beyond the prostate and is more difficult to deal with and treat. Turtles have slow-growing cancer confined to what is known as the capsule.
In the United States, current medical practice does not generally refer to these categories, and too often diagnosis equals treatment. In the aftermath of my cancer discovery I read and read and read. Medical journals are very dry reading unless it affects your life.
I learned that in Europe a turtle normally is not treated immediately, if at all. Instead, turtles go into “watchful waiting” where they are tested with a PSA (blood test) every 90 days to see if there is a change in pattern. They also receive an annual biopsy to look for more cancer. This seemed reasonable to me.
However, I had to find out if I was a good candidate for watchful waiting.
I have had 5 biopsies since my first one in 2007. I have consulted 3 wonderful urologists: Dr. Bill Scaljon, Dr. Bruce Green and Dr. Skip Holden. I also did a consult with a robotic surgeon named Dr. Nikil Shah who spent a long time with me explaining the surgical option.
Of my 5 biopsies, I had a finding of cancer in one of 12 cores (samples). That was my 4th biopsy. That is generally the green light for treatment in America. However, based on my reading, I went a step further. I had a 5th biopsy in Los Angeles in May which failed to find any cancer. That happens 25% of the time following a prior biopsy finding cancer. So I still have cancer. However, the recent negative means that I have so little cancer that it couldn’t be found this time.
I also had a test common in Europe that’s still awaiting FDA approval called PCA 3. This is a genetic marker test still being refined and is one of several in research around the globe that would more accurately pinpoint the danger of death from prostate cancer. The PCA 3 score is on a scale of 100. A score above 35 indicates real danger. My score is a 10. It is one time in life that I guarantee you a low number is great.
Going back to the eagles, rabbits and turtlesÃ‚â€¦turtles are divided into 4 categories — turtle 1, turtle 2, turtle 3 and turtle 4. Turtle 1s are those in the least danger who have only 1 or 2 cores of cancer discovered over multiple biopsies; a Gleason score of 6 (Gleason is a pathologist’s ranking of the degree of cancer); and a slow progression of their PSA over time.
I fit all the criteria of a turtle 1. Therefore, I am doing watchful waiting. I am in a lucky group made up of around 25% of people who have this as an option. But 75% of people who are diagnosed with prostate cancer need treatment of some form within weeks or months.
I may eventually need treatment as well. However, although my numbers could deteriorate in my quarterly tests, I am not likely to need treatment for as long as 10 years or more. The key to this is to properly manage my cancer. Watchful waiting doesn’t mean to ignore it or forget about it. That could cost you your life. Rather it means to monitor it like clockwork.
Most Americans are too action-oriented for watchful waiting. Men just want the cancer out. That is your choice. I have chosen a different path and only time will tell if mine is the right one.