April 15, 2024
O.J. Simpson dies from prostate cancer. What are the risks and benefits of prostate cancer screenings?
Key Takeaways
- O.J. Simpson died on April 10 following a battle with prostate cancer.
- Prostate cancer is the leading cancer diagnosis among men in the United States, but most people diagnosed with prostate cancer survive.
- Prostate cancer treatments can be lifesaving, but they can also impair sexual function, causing some survivors to regret procedures or diagnosis.
- Still, some doctors encourage people not to let the fear of potential treatment discourage them from getting screened.
O.J. Simpson, infamous for his football career, acting roles, and murder acquittal died of prostate cancer this Wednesday. He was 76.
Simpson’s family took over his social media account on Thursday to announce that he had “succumbed to his battle with cancer” and to ask for privacy and grace from the public.
While few may relate to O.J.’s time in the spotlight, his cancer diagnosis represents a commonality among many men in the United States. Today, prostate cancer is the leading cancer diagnosis among men and the second leading cancer diagnosis overall, following breast cancer.
Despite its high case rate, most people with prostate cancer will outlive the disease. But while some medical experts attribute healthy recoveries to early detection and proper treatment, some survivors say they regret screenings that later prompted them to undergo treatments that impacted their sexual function.
Prostate cancer figures
According to the American Cancer Society (ACS), about one in eight men will be diagnosed with prostate cancer in their lifetime. The ACS estimates that in 2024, 299,010 new cases of prostate cancer will emerge, and about 35,250 people will die from prostate cancer.
Most men who are diagnosed with prostate cancer do not die from the disease, and “3.3 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today,” according to the ACS. The society says the cancer’s high survival rate is most likely due to earlier detection and advances in treatment.
Controversies over prostate cancer screenings and surgeries
In an award-winning 2010 article in Men’s Health, Laurence Roy Stains describes getting screened and diagnosed for prostate cancer. Later, Stains—regretfully—undergoes surgery to remove his prostate. In the piece, he retroactively weighs the positives of his surgery (mitigating potential cancer complications, including death) against the negatives (changes in sexual function, including those pertaining to erections and ejaculation).
“Now, almost two years later, I'm not going to say, ‘thank god they caught it in time ... I'm so blessed, each new morning is a miracle...Blah blah blah blah,’” Stains wrote in 2010. “No, what I'm thinking is more along the lines of: I want my prostate back.”
Intertwining his personal experience with research studies, Stains poses a question to readers in and out of the medical community: “We're finding more cancer, with fewer fatalities. Just how much cancer is not worth finding?”
According to the Mayo Clinic, prostate cancer deaths have decreased since the availability of prostate-specific antigen (PSA) testing, but whether the drop is “substantial enough to justify the cost and possibility of harm to the person undergoing the testing” is unclear.
Prostate screenings: ACS recommendations
Currently, the ACS does not recommend that all men get screened for prostate cancer but rather that they make an informed decision with their healthcare provider about whether to be screened. To make this decision, they suggest holding discussions at the ages of:
- 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.
- 45 for men at high risk of developing prostate cancer, including African American men and those with a first-degree relative (father or brother) who has been diagnosed with prostate cancer before the age of 65.
- 40 for men at even higher risk, including those with more than one first-degree relative who was diagnosed with prostate cancer before 65.
For those who choose to be tested, the ACS says that men with a PSA level of less than 2.5 ng/mL “may only need to be retested every two years,” whereas men whose PSA level is 2.5ng/mL or higher should be tested yearly.
Not all medical experts, however, agree with these looser recommendations and suggest that screenings—not just discussions—should be more universally recommended.
S. Adam Ramin, MD, a board-certified urologist, urologic oncologist, and medical director of Urology Cancer Specialists in Los Angeles, CA, encourages all men to begin annual screenings for prostate cancer at age 55—or at 45 if they have immediate family members with histories of prostate or breast cancer—warning that when cancer goes unscreened it can grow to more aggressive stages or take the form of more complex cancers, which are more harmful to the body.
“Prostate cancer screenings are vital and very important,” Dr. Ramin says.
Prostate cancer screening positives and drawbacks
Prostate screenings use a variety of tests and tools, including blood tests, urine tests, and MRIS, to paint a picture of a person’s prostate cancer risk. If screens show that a person is at high risk, a doctor may recommend that they go through diagnostic testing—more tests including a biopsy—for a clearer picture of the case. If diagnosed, a person may then decide whether they want to undergo more invasive treatments to rid themselves of the cancer.
Prostate cancer treatment can look different for different people but can include radiation or surgery to remove the prostate gland. These treatments can be lifesaving yet can also have lasting impacts on patients’ sexual function, discouraging some from seeking screenings.
Dr. Ramin says it is important to view side effects and fears about prostate cancer interventions in the context of their “stage of the process.” For instance, he explains, erectile dysfunction can be a risk of prostate surgery but is not a risk that will come up in a screening blood test or diagnostic biopsy.
Dr. Ramin reminds patients that just because they undergo a screening, this does not mean they will receive a diagnosis or have to undergo cancer treatments.
“Unfortunately, that gets lost in the general discussion about prostate cancer screening—when people don’t understand those steps,” Dr. Ramin says. “It’s best not to fear getting screened and to allow the process to determine what the problem is.”
One of the first tests in a prostate screening is a blood test that looks at a patient’s PSA levels. This number is not a direct indication of prostate cancer, as people with benign and malignant prostate tissue can have some level of this antigen. However, people with prostate cancer will generally have elevated PSA levels. What PSA level is considered “high” is relative to a person’s age, and results should be read in the context of the patient’s age and history, Dr. Ramin says.
In some cases, a PSA test may reveal that a patient has some risk for the disease but not so much that a biopsy is needed right away. A good physician will couple a PSA test with other screening tools, like MRIs and urine tests, and know when to wait and conduct more surveillance before moving to next steps, Dr. Ramin says.
He adds that a good medical professional should listen to their patients' concerns and not force them into treatments before determining what is necessary.
Dr. Ramin tells patients to “continue to advocate for themselves and make sure they see the correct specialist who really understands the pros and cons of treatments.”
What this means for you
The American Cancer Society recommends talking to male patients about prostate cancer screenings in their 40s and 50s, depending on risk level. Whether or not a patient chooses to get screened is an individual decision and may have positive or negative impacts, depending on the person.
Sources:
https://www.menshealth.com/health/a19540939/coping-with-prostate-cancer/
https://www.mayoclinic.org/tests-procedures/psa-test/in-depth/prostate-cancer/art-20048087
https://www.mayoclinic.org/tests-procedures/psa-test/in-depth/prostate-cancer/art-20048087
