Actor Ben Stiller has cast himself in a new role—advocate for early prostate cancer screening, after revealing recently that he was diagnosed with the disease in 2014. In a humor-filled essay posted online, he also wrote about the positive effects of his prostate specific antigen (PSA) tests and the controversy surrounding it.
The PSA measures a chemical specific to the prostate gland. PSA levels in the blood can be elevated for many reasons. Due to its low specificity, the PSA test does not differentiate between lethal and nonlethal types of cancers, or even benign conditions. For that reason, PSA screenings have been associated with over-diagnosis and the potential for over-treatment.
In Stiller's case, after his doctor recommended a baseline test of his PSA, his levels rose for more than a year and a half before his urologist performed a physical exam, suggested an MRI and then a biopsy, which came back positive. His Gleason score, which is based on how the cancer cells appear under a microscope, was recorded as a 7 and categorized as "mid-range aggressive cancer."
'Crazy roller coaster ride'
“I got diagnosed with prostate cancer Friday, June 13th, 2014,” Stiller writes. “On September 17th of that year, I got a test back telling me I was cancer free. The three months in between were a crazy roller coaster ride with which about 180,000 men a year in America can identify.”
Prostate cancer is the second-most common cancer in men in the United States, after skin cancer. One in seven U.S. men will be diagnosed with the disease in his lifetime. The medical community is not in agreement about if or when men should get tested, instead urging them to talk to their doctors about whether and when they should be screened.
The American Cancer Society (ACS) and American Urological Association recommend testing begin at age 40 for those at high risk, and the ACS says screening should begin at age 50 for the general population. Those at high risk for prostate cancer include African Americans, and those with a father, son or brother diagnosed with prostate cancer at an early age.
“This is a complicated issue, and an evolving one,” Stiller writes. “But in this imperfect world, I believe the best way to determine a course of action for the most treatable, yet deadly cancer, is to detect it early.”
Because the disease typically has no warning signs or symptoms until it has progressed to the advanced stages, screening may help catch it before it spreads. That was the case for Stiller, who credits his doctor for being proactive. "If he had waited, as the American Cancer Society recommends, until I was 50, I would not have known I had a growing tumor until two years after I got treated," Stiller writes. "If he had followed the U.S. 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."
Stiller was told that the disease was detected early and was treatable. He opted to remove the tumor with a robotic-assisted laparoscopic radical prostatectomy.
The 'Stiller effect'
Some in the media have speculated that the disclosure could lead to a so-called “Stiller effect” on early prostate screenings, similar to the impact actress Angelina Jolie had on BRCA1 genetic testing or the spike in colonoscopies attributed to journalist Katie Couric after she had the procedure performed live on the Today Show following her husband’s death from colon cancer in 1998.
But Sean Cavanaugh, MD, Chief of Radiation Oncology at our hospital near Atlanta, is doubtful. “Sadly, I don't see this being similar to those examples,” he says. “Colonoscopy and BRCA testing were recommended screenings that celebrities pushed into the spotlight. Stiller is pushing something that isn't part of current national guidelines—his viewpoint is deeply opposed by the powers that be. While I wish his story would move the needle on PSA screening, I would be surprised.”
Even if Stiller’s disclosure sparks a conversation between men and their doctors about the optimal time to begin prostate cancer screenings, many may consider that a success.
