In an article written for Medium, actor Ben Stiller revealed that he was diagnosed with early prostate cancer—and beat it—in 2014. When I saw him on television recently, he looked fit, alert, and vigorous and bore no apparent adverse effects from his battle with cancer.
Stiller reported that his diagnosis was initially made because his PSA (prostate-specific antigen) level was elevated. The controversy surrounding the efficacy of PSA testing in a man who shows no cancer symptoms and is not deemed at high risk (no family history of cancer and not of a vulnerable ethnicity) has been hotly debated, but in this case, the test seems justified.
“I was incredibly fortunate,” Stiller said. “Fortunate because my cancer was detected early enough to treat. And also because my internist gave me a test he didn’t have to. Taking the PSA test saved my life.”
The only reliable way of diagnosing early-stage localized prostate cancer is with a PSA blood test. A subsequent digital rectal exam almost always finds a lesion in the prostate if the cancer is advanced but may not detect the type of early-stage cancer diagnosed in Stiller. In Stiller’s case, his urologist found his rising PSA level concerning enough to recommend further diagnostic tests. After an MRI and a biopsy, Stiller was diagnosed with a “midrange aggressive cancer.” He consulted several doctors to discuss treatment options, and the verdict was unanimous: the tumor needed to be surgically removed as quickly as possible. He found a surgeon skilled in robotic surgery, and “due to a lot of skill and a little beneficence from some higher power,” as Stiller put it, the tumor was completely removed, eliminating the need for any further treatments like radiation therapy and ending his cancer nightmare in only three months.
As Stiller notes, the PSA blood test is far from foolproof and usually not sufficient on its own to diagnose prostate cancer. Regular PSA screening for men over forty years old was initially discouraged by the US Preventive Services Task force in 2012 due to complaints that physicians who were unsure how to interpret the results of the screening often recommended additional, more invasive tests that were not actually needed. In addition, PSA screening sometimes reveals tumors that turn out to be low-risk and not life-threatening, especially in older patients, but doctors trying to play it safe may overtreat such low-risk cancers with unnecessary surgeries or radiation therapy, resulting in health complications and impaired urinary or sexual function. However, the PSA blood test is currently the only test that can reliably detect prostate cancer early enough that the cancer can be easily removed with minimal distress for the patient.
The prognosis for the type of cancer that Stiller apparently had is extremely favorable. His tumor was completely removed, and so far, the cancer has shown no signs of returning. But just in case, his condition will be monitored by regularly checking his PSA level and perhaps performing biopsies in the future.
Most men diagnosed with early-stage localized prostate cancer thanks to PSA screening, as in Stiller’s case, die of something other than prostate cancer. As Stiller himself says, “I believe the best way to determine a course of action for the most treatable, yet deadly cancer, is to detect it early.”