American Cancer Society reports rates of advanced prostate cancer are on the rise
As president of the New England Patriots Charitable Foundation, Joshua Kraft, has backed major initiatives in education, health, social justice, and youth development. With his announcement today that he is a prostate cancer survivor, he takes on the role of advocate for screening for the disease.
Kraft was diagnosed with prostate cancer in 2018 and received treatment at Dana-Farber Brigham Cancer Center. He underwent surgery in January 2019 to remove the prostate gland. When follow-up tests indicated the cancer was starting to return, he received radiation and hormone therapy, and today his prostate-specific antigen (PSA) level – used to gauge the presence of prostate cancer – stands at zero.
Kraft, 55, credits the frequent monitoring of his PSA level with the detection of his cancer at a relatively early stage when he was 51 years old when it could be successfully treated.
"When prostate cancer is caught early, it's treatable and often curable," Kraft said. "I tell people all the time to get their PSA tested or have a digital exam. It's one form of cancer that getting ahead of it allows you to get rid of it before it gets worse."
Kraft's advocacy message is especially welcome at a time when prostate cancer rates are rising, says his oncologist at Dana-Farber Cancer Institute, Atish Choudhury, MD, PhD. "Prostate cancer is the second leading cause of cancer deaths among men in the United States, after lung cancer," remarked Choudhury, the chair of the Gelb Center for Translational Research at Dana-Farber. "The American Cancer Society reported that prostate cancer diagnoses in the United States went up by 3% per year from 2014 through 2019 and there seems to be an increased number of prostate cancer deaths over the past several years, despite all the advances that have been made in treatment. This suggests many patients are being diagnosed much later in the course of the disease."
Most advisory organizations recommend that men discuss receiving an initial PSA test with their healthcare provider by around age 50 for those at average risk for prostate cancer to establish a baseline level – a point of comparison for later tests. Black men, those with a family history of prostate cancer or with a high risk of developing the disease may be advised to begin PSA screening earlier. The frequency of testing after that will depend on the baseline level. An individual with a high age-adjusted PSA level or whose PSA levels jump significantly from the prior values can then undergo a biopsy – in which a small amount of prostate tissue is removed for examination under a microscope – to determine if cancer is present. Many doctors will recommend a magnetic resonance imaging (MRI) exam beforehand to identify suspicious areas within the prostate that can be specifically targeted at the time of the biopsy.
Prostate cancer can produce a variety of symptoms including difficulty starting urination, weak or interrupted flow of urine, frequent urination, especially at night, and blood in the urine or semen. These symptoms can also be a sign of non-cancerous conditions such as benign enlargement of the prostate, and, in early stages, prostate cancer often produces no symptoms. That's why doctors say it's critical that men be screened regularly for the disease. Downsides to regular screening include the discomfort, risks and anxiety associated with the testing and the possibility of overtreatment – that is, treating cancer that may never cause problems for the patient. However, many tools are available to help doctors identify which patients who are diagnosed with cancer do not need treatment at all and can just be monitored closely.
Kraft cites his experience as he advocates for screening. He'd been receiving annual screening tests when, in 2018, his PSA level rose to a level where his primary care physician referred him to Dana-Farber Brigham Cancer Center, where it was suggested he undergo an MRI. The exam did not show evidence for prostate cancer, but to be cautious, a follow up PSA test every three months was recommended. Subsequent tests showed the PSA level to be increasing slightly over time. After several months of monitoring these increases, it was agreed he should undergo a biopsy, which diagnosed the cancer.
Kraft opted to have his prostate removed, with the surgery performed by Quoc-Dien Trinh, MD, of the Dana-Farber Brigham Cancer Center. He continued to have his PSA level checked every three months, and by 2020 it had begun to rise. Though the increases were small, they indicated that some of the cancer might remain in his body. He then began treatment that included six months of hormone therapy to reduce the level of testosterone in his body, which can fuel prostate cancer growth, and a 38-day course of radiation therapy with Paul Nguyen, MD, of the Dana-Farber Brigham Cancer Center.
Today, he has no signs of cancer.
He advises men "not to fear PSA testing, the digital exam, or biopsy. The most important thing is to detect the cancer early and get rid of it."
Prostate cancer screening is usually done as part of a routine physical exam. Men can have screening discussions with their primary care physician or seek out screening services such as those available through Dana-Farber's Cancer Care Equity Program, which operates at federally qualified health centers in the Boston area.