There’s something about PSA: Ben Stiller fights the good fight

As a freshman at Dartmouth, I read numerous poems by Robert Frost, one of Dartmouth's most famous sons (class of 1896, 102 years before me for those who are curious). My conclusion? About one-third of what he wrote should be required reading (my personal favorite is "The Road Not Taken"), but about a third should probably have been sent back by his editor for significant revisions.

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I think Ben Stiller's cinematic work can be similarly summarized. "There’s Something About Mary" and "Meet the Parents" are simply hilarious, whereas "Little Fockers" (a sequel to "Meet the Parents") was not worth the $1.39 I paid Redbox to rent the movie.

With that in mind, I approached Stiller's blog about his experience with prostate cancer with some trepidation. My take-away? Read it, print it out, and post it in your office.

In summary, at the age of 46, Stiller received a baseline PSA that was elevated. It was repeated a few times on a 6-month interval by his primary care doctor who eventually referred him to a urologist. The urologist performed a rectal exam and ordered an MRI before performing a biopsy. This led to the unfortunate discovery of Gleason Score 3+4 disease.

I say “unfortunate,” as I do not wish cancer on any man, but as Stiller pointed out in his blog, the discovery itself was incredibly fortuitous. Fortuitous because if his doctor had followed the USPSTF recommendations, as most doctors do, Stiller’s cancer would only have presented itself in 5 to 10 years when Stiller developed symptoms of metastatic disease.

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After telling his survival story, Stiller goes on to talk a little about the controversy surrounding PSA and then asks the question: “But without this PSA test itself, or any screening procedure at all, how are doctors going to detect asymptomatic cases like mine, before the cancer has spread and metastasized throughout one’s body rendering it incurable?”

Good question.

He continues: “Or what about the men who are most at risk, those of African ancestry, and men who have a history of prostate cancer in their family?”

Another good question.

He concludes by suggesting that, “I think men over the age of 40 should have the opportunity to discuss the test with their doctor and learn about it, so they can have the chance to be screened. After that, an informed patient can make responsible choices as to how to proceed.” Tough statement to argue with.

Next: It's been a long time since I've read a more condescending statement from a doctor

But some are. For example, a blog by Kevin Lomangino of HealthNewsReview.org commenting on Stiller’s post states, “Although Stiller dismisses those harms–incontinence, impotence, among others-as being “in the purview of the doctor treating the patient” (whatever that means), the fact is that the treatments themselves can be deadly or cause serious disabling side effects.”

Excuse me? “Whatever that means?” What that means is that some patients value life, or even the chance thereof, more than erections and continence. I have four beautiful little girls and if I had to choose between being dead or being wet and impotent but watching them grow up, well, diapers it is. My apologies to my wife.

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Lomangino’s post goes on to quote oncologist Vinay Prasad, MD, MPH, stating, “Frankly, I am sick of celebrities telling anecdotes about cancer screening.”

It’s been a long time since I’ve read a more condescending statement from a doctor. I thought the goal of modern medicine was to include the patient in their care; it is their life after all. Further, it’s not like the so-called “experts” are perfect when it comes to recommendations (think about the dramatic change in the expert’s opinion on prescribing narcotics or hormone replacement for women, just to name two examples).

This is the modern war against men’s health. This is the battle that small-town urologists fight every day. The “experts” would prefer we simply ignore prostate cancer until it spreads, and then spend millions on various drugs that at best extend life a few months rather than take the fight to the disease when we can cure it.

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Stiller is right. We have a tool, PSA, that detects early-stage prostate cancer. We understand the risks of the tool and the limitations of both the tool and of our treatments. Through genetic markers, we have an even better understanding of which patients benefit from treatment. Further, we understand the natural history of the untreated disease. It is our responsibility as urologists to be willing to explain this complicated process to our patients so they “can make responsible choices as to how to proceed,” as Stiller correctly stated.

I am curious if anyone has had a patient mention Stiller’s blog and if it has helped to change the dynamic of the conversation. Please feel free write me at UT@advanstar.com or sign in below to post your experiences here.

More from Dr. Rosevear:

Marijuana and me: A Colorado urologist’s experience

Do you ERAS? The future of post-cystectomy care

Out-of-control drug pricing requires creative solutions

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