Al Roker's diagnosis puts a spotlight on prostate cancer - Palm Beach Post
While the world was watching battleground states tally their votes, you may have missed the news that longtime Today show weatherman Al Roker disclosed he’d been diagnosed with prostate cancer and would be undergoing surgery.
During the Today episode that aired on the Friday after Election Day, Roker, 66, explained, “It's a good news-bad news kind of thing. "Good news is we caught it early. Not great news is that it's a little aggressive, so I'm going to be taking some time off to take care of this."
By “catching it early” — in other words, before the tumor’s growth had spread beyond the prostate — Roker and his doctors are confident that he’ll be able to recover from the disease relatively quickly.
However, the aggressiveness — that is, the speed of the tumor’s growth — is why, Roker surgeon, Dr. Vincent Laudone, noted “we wanted to treat it, and after discussion regarding all of the different options — surgery, radiation, focal therapy — we settled on removing the prostate.”
Roker’s disclosure puts an important spotlight on a disease that will afflict 1 in 9 men during the course of their lifetime — and which afflicts 1 in 7 Black men at some point in their lives.
According to the American Cancer Society, other than skin cancer, prostate cancer is the most common cancer in American men. Some 192,000 men will be diagnosed with prostate cancer this year and more than 33,000 will succumb to the disease.
Because early-stage prostate cancer rarely causes symptoms, the ways in which doctors diagnose it are twofold:
Via a protein-specific antigen (PSA) blood test and/or a digital-rectal exam (DRE).
Once Roker’s doctor detected an elevated PSA test score and did a DRE, the diagnosis was confirmed via prostate biopsy.
The biopsy’s pathology is what alerted them to the tumor’s aggressiveness — which is why, surmises Cleveland Clinic Weston urologist Dr. William Gans “active surveillance, which involves following the cancer closely with PSA and DRE every four to six months as well as repeat biopsies every 12 to 18 months, was not an option” for Roker.
According to Palm Beach urologist Dr. Diego Rubinowicz, “The biggest misconception about prostate cancer is that it is ‘slow’-growing,’ which it can be for some patients, but it can certainly be quite aggressive and require aggressive treatment in other patients. It really depends on the grade (degree of aggressiveness), which doctors refer to as Gleason Score.”
Rubinowicz also laments the controversy around the aforementioned PSA tests as an early-detection screening tool.
“Another prostate cancer misconception I see stems from the fact that a few years ago, the PSA blood test got a bad report from certain health agencies, and some physicians followed these erroneous guidelines, suggesting that getting screened with a PSA blood test was not as important. Although not perfect, the PSA is a good diagnostic tool. But it requires careful interpretation by a urologist and can help assess the risk of a patient in getting prostate cancer.”
When it comes to prostate cancer treatment, the most common traditional options are either radical prostatectomy (removal of the prostate — what Roker is doing) or some form of radiation therapy (there are different modalities).
As Gans explains, “Radical prostatectomy removes the prostate, seminal vesicles, and sometimes lymph nodes in order to cure the cancer. One benefit of surgery is the entire prostate can be analyzed by the pathologist to accurately determine the grade of the cancer because sometimes the grade is underestimated on the prostate biopsy.”
Gans also notes that “some patients feel better knowing the cancerous organ has been removed” despite potential drawbacks of the surgery being “erectile dysfunction, stress urinary incontinence, no guarantee of cure, infertility, and the side effects of surgery, such as infection or bleeding.”
Conversely, radiation therapy enables patients to avoid the downsides of surgery and is often a viable option for certain patients with locally advanced prostate cancer.
Again, though, according to Gans “the drawbacks of radiation therapy are erectile dysfunction, infertility, injury to surrounding organs such as the bladder or rectum, difficulty urinating, and no guarantee of cure.”
The downsides of both surgery and radiation are why, in recent years, prostate cancer patients have been availing themselves of such newfangled treatments as cryotherapy and high-intensity focused ultrasound (HIFU), as well as experimental therapies, including photodynamic therapy or nanoparticle treatment.
Both Gans and Rubinowicz stress that while early detection is the key to having treatment options and better outcomes, how a man chooses to treat his prostate cancer is a highly personal decision in which a multitude of factors must be considered.
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