October 13, 2016 | by Samantha Bonar
Actor Ben Stiller recently revealed that he was diagnosed with prostate cancer two years ago, at age 48. He credits early screening and diagnosis with saving his life.
Stiller’s doctor recommended a baseline PSA (prostate-specific antigen) blood test when Stiller was 46, even though he had no symptoms, family history or other risk factors. PSA tests measure how much of a substance called prostate-specific antigen is being produced by the prostate — high levels can be a sign of prostate cancer.
Stiller’s PSA numbers were a little elevated, so he had repeated testing for a year and a half. His PSA levels continued to rise, so an MRI was performed and a tumor was spotted. A biopsy confirmed cancer when Stiller was 48.
After exploring all of his options and getting several opinions, Stiller had his prostate removed and says were it not for this early screening, his cancer would not have been detected until it had reached a stage where it would have been much more difficult to treat.
"If he [his doctor] 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 wrote in an online essay.
For that reason, most guidelines, including those of the American Cancer Society, recommend that men not start getting screened for prostate cancer until they reach age 50, when they are told to get their first baseline PSA test. (From ages 40 to 59 years, the incidence is only one in 38 men.) But that may be changing, as Stiller’s case illustrates.
“Prostate cancer in men under 50 is uncommon,” said Clayton Lau, M.D., interim chief of the Division of Urology and Urologic Oncology at City of Hope. But Lau says he is “absolutely open to 45 to 50 to start” screening.
An early baseline at this age will “find the more aggressive tumors before they spread, and also helps guide subsequent testing,” Lau said. “If the PSA at this age is <1, then no additional testing is needed until age 60. If the PSA is between 1 and 3, then we would recheck every two to four years. Early screening decreases unnecessary testing.”
Men who are at high risk should without a doubt be tested before age 50, typically starting at age 45, Lau says. This includes men with a first-degree relative (father, brother or son) with prostate cancer, those of African-American ancestry (African-American men are 56 percent more likely to develop prostate cancer than Caucasian men, while Asian-American men are least likely), those who test positive for certain genetic factors such as the BRCA2 gene in their family or Lynch syndrome, possible exposure to Agent Orange, and firefighters.
“This is a complicated issue, and an evolving one,” Stiller — while no doctor, clearly passionate about the topic — concluded his essay. “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.”
Learn more about prostate cancer risk factors, diagnostic tests and our Prostate Cancer Program and research. If you are looking for a second opinion or consultation about your treatment, request an appointment online or contact us at 800-826-HOPE. Please visit Making Your First Appointment for more information.