Actor Ben Stiller revealed last week that he is cancer-free after a controversial screening test diagnosed him with prostate cancer in June 2014. He credits his good health today on early detection and surgery to remove the tumor three months later.
“Taking the PSA test saved my life,” Stiller wrote in the essay.
The trouble is Stiller’s doctor tested his baseline prostate-specific antigen (PSA) levels when he was 46, and he choose to have surgery at 48, much too early according to many in the medical community.
The American Cancer Society recommends men begin PSA screening at age 50. And the U.S. Preventative Services Task Force (USPSTF), a group of independent medical experts that issue medical guidelines for doctors to follow, declared in 2012 that no man of any age should have the PSA test to screen for prostate cancer unless he has urologic symptoms.
PSA tests detect an enzyme that is released by prostate cells. Elevated levels of PSA could indicate cancer. In many cases, however, the cancers would progress so slowly that it would not threaten a man’s health or life.
Stiller said his doctor started monitoring his PSA levels after a year and a half of “rising PSA numbers.” He went for an MRI and biopsy and after learning he had a “mid-range aggressive cancer,” he elected to have his prostate removed.
But sometimes the surgery may not be worth taking.
“PSA tests find a whole lot of prostate cancers that will never kill people,” urological surgeon Dr. Peter Albertsen of the University of Connecticut Health Center told STAT – a national publication focused on telling compelling stories about health, medicine, and scientific discovery – in 2015.
USPSTF’s 2012 recommendation was partly based on evidence that 90% of men with PSA-detected prostate tumors opt for treatment — biopsy, surgery and chemotherapy — but at least 20% of them will have adverse effects such as erectile dysfunction or incontinence.
Stiller wrote, “If he (his doctor) had followed the US Preventive Services Task Force guidelines, I would have never gotten tested at all, and not have known I had cancer until it was way too late to treat successfully.”
The good news is that prostate cancer diagnoses seem to have declined slightly. But a 2015 editorial in the Journal of the American Medical Association worried that fewer PSA tests would lead to more men dying from prostate cancer.
“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,” Stiller wrote. “After that an informed patient can make responsible choices as to how to proceed.