Prostate Cancer Stories
from Patients and Oncologists
Explore the in-depth stories from our prostate cancer patients, who share their stories of symptoms, diagnosis, and treatment in-depth. We also feature medical experts, like urological oncologists, and stories from caregivers.
As a celebrated TV personality, journalist, meteorologist, and author, Al Roker is a familiar face for so many of us. That’s why when Al announced his prostate cancer diagnosis at the end of 2020, it created many waves and galvanized a large outpouring of support from around the world.
In this interview with The Patient Story founder, Stephanie Chuang, Al opens up about his patient experience and especially about how important it is for men to get screened for prostate cancer through the PSA test (and digital exam).
He’s also passionate and vocal about the importance of African-American men being vigilant in particular, as they are disproportionately affected by prostate cancer.
Prostate cancer begins when cells in the prostate gland start to grow out of control. The prostate is a walnut-sized part of the male reproductive system, below the bladder and in front of the rectum. It makes some of the fluid that is part of semen.
What are common symptoms of prostate cancer?
Symptoms may vary depending on individuals, but here are some of the more commonly reported symptoms in men2:
- Changes in urination (more frequency, slower or interrupted flow)
- Difficulty urinating
- Difficulty completely emptying the bladder
- Burning sensation or pain during urination
- Persistent pain in the hips, back, or pelvic region
- Blood in either urine or semen
- Pain during ejaculation
Note: These symptoms can represent a condition other than prostate cancer.
Who is most at risk for prostate cancer?
Every man has a risk for developing prostate cancer. In the U.S., about 13 of 100 men will get diagnosed with prostate cancer. Two-thirds of those diagnosed will die from prostate cancer2.
Age is the most common risk factor for prostate cancer. As a man gets older, his chance of getting prostate cancer grows.
There is heightened risk for African-American men or those with family history of prostate cancer.
How do you screen for prostate cancer?
There are two basic tests commonly used for screening:
pROSTATE sPECIFIC ANTIGEN (PSA) TEST
The PSA test is a blood test that measures the level of prostate specific antigen, or PSA, in the blood. The prostate creates the PSA. If the levels of PSA are higher in a man, it may be a sign of prostate cancer or another condition that impacts the prostate.
PSA levels may also be affected by other factors, including but not limited to:
- Specific medications
- Specific medical procedures
- Infected or enlarged prostate
If the PSA test shows a higher level, your doctor may suggest a biopsy as a next step.
Digital Rectal Examination (DRE)
In this case, digital refers to the finger. A digital rectal examination or DRE is when a health care worker puts a lubricated, gloved finger into a man’s rectum to try and feel for any signs of abnormalities, including cancer.
Pros and Cons of Screening
According to the U.S. Preventive Services Task Force (USPSTF, 2018), the recommendations include3:
- Men aged 55 to 69 years who may consider screening using a PSA test
- Every man should discuss the benefits and risks of screening, tests, and treatment with their doctors before making a decision
- Any man who is at least 70 years old should avoid being screened routinely for prostate cancer
- Men who are 70 years old and older should not be screened for prostate cancer routinely.
When there is a prostate cancer diagnosis, doctors will usually give a grade or Gleason score, to assess how aggressive the tumor is. The scoring is based on how aggressive or abnormal the cancer cells are (under a microscope lens).
The Gleason Score is the grading system used to determine the aggressiveness of prostate cancer. This grading system can be used to choose appropriate treatment options.
The score ranges from 1 to 5, and each patient is given two grades. There’s a primary grade to describe the largest area of cancerous cells, and a secondary grade to describe the next largest area of cancerous cells. The healthier the tissue, the lower that score o the 1 to 5 scale. That means the total score maxes out at 10.
One example is a Gleason score of 3+4=7. That would indicate that most of the tumor is given a grade of 3 and the next biggest section of the tumor has been described as grade 4. The total Gleason score would be 7.
gleason score 6 and below
A Gleason score 6 and below is considered “low grade,” or less aggressive. This means there’s less of a chance the cancer will grow and spread, compared to a higher Gleason score.
Most men who get a prostate diagnosed that is localized and low-grade will “die of something other than prostate cancer” (NCI).
gleason score 7 to 10
A Gleason score of 7 indicates an intermediate risk of the cancer being aggressive. Primary tumors that are scored 3 with a secondary score of 4 have a “fairly good outlook,” compared to the inverse of 4 then 3, which have evidence of being more likely to grow and spread to other areas4:
A Gleason score of 8 or higher indicates a cancer that is more likely to grow and spread more quickly. This can be described as “high grade” or “poorly differentiated.”
Our prostate cancer patients share their in-depth experiences of going through treatment, from first symptoms through navigating life outside cancer.
Clarence S., Early Stage
Cancer Details: PSA levels fluctuated but were never extremely elevated, cancer contained to prostate
1st Symptoms: No symptoms, caught at routine physical with PSA test
Treatment:Radical prostatectomy (surgery)
Steve R., Stage 2
Cancer Details: Started at stage 2 and gradually progressed to stage 3, and then to stage 4 with metastasis to lymph nodes
1st Symptoms: Rising PSA score
Treatment: IMRT (radiation therapy), brachytherapy, surgery, and lutetium-177
Bruce M., Gleason 8/9, Stage 4A
Cancer Details: Staged Gleason 6/7 pre-surgery, post-surgery changed to 8/9, PSA level at 27
1st Symptoms: Urination changes, brother's prostate cancer diagnosis
Treatment: Radical prostatectomy (surgery), salvage radiation, hormone therapy (Casodex & Lupron)
Dennis G., Gleason 9 (Contained)
Cancer Details: Staged Gleason score 9
1st Symptoms: Urinating more frequently middle of night, slower urine flow
Treatment: Radical prostatectomy (surgery), salvage radiation, hormone therapy (Lupron)
Oncologists & Experts
1. Prostate Cancer-Patient Version. National Cancer Institute. https://www.cancer.gov/types/prostate. Accessed December 17, 2020.
2. Basic Information About Prostate Cancer. CDC. https://www.cdc.gov/cancer/prostate/basic_info/index.htm. Accessed December 17, 2020.
3. Final Recommendation Statement, Prostate Cancer: Screening. USPSTF. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening. Accessed December 17, 2020.