Black men develop prostate cancer 60% more often than white men. In addition, they have a higher chance of dying from it. Because of this heightened risk, Black men are encouraged to start prostate cancer screening early with yearly PSA tests and physical exams at age 40, and even earlier if they have a strong family history of prostate cancer exists.
This is a lesson that the preeminent Colin Powell knew very well.
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“When I was diagnosed with prostate cancer at 66, I wasn’t terribly surprised or shocked,” says Powell, a retired four-star United States Army general, 65th United States Secretary of State, and former National Security Advisor, Commander of the U.S. Army Forces Command, and Chairman of the Joint Chiefs of Staff. “For the five years before that, I had been going for very regular checkups and my PSA was always high. It floated up and down. PSA alone doesn’t indicate cancer, it just says something is going on.”
Thankfully, Powell had the knowledge he needed to deal with this challenge, in addition to the understanding that cancer doesn’t care about reputation. In fact, Powell had been tracking and preparing for the diagnosis for several years. He was so diligent about watching for potential issues with his prostate that he had already gone through two biopsies before the third turned up positive for cancer.
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“At that point, I knew sooner or later that something would show up,” he says. “And because I’m black, I have a higher propensity for prostate cancer than white folks do.”
Powell’s proactive approach to diagnosis then turned to a treatment strategy after consulting with his longtime doctor and bringing in a radiologist.
“I was just at the age where I decided, ‘I don’t want to fool with this, I don’t want to think about it’ and so I decided to go for the radical prostatectomy [removal of the prostate gland], as opposed to the radiation treatment,” he says. “As Secretary of State, I didn’t want to face the prospect of regular radiation therapy, as opposed to doing it all at once and taking care of it.”
Due to his high profile, Powell didn’t make his surgery public until the actual morning of the procedure. He was back at the State Department less than a week after the surgery, and with the support of his wife, children and office assistants, jumped right back into his daily routine.
While the choice to remove his prostate was something others facing treatments might not opt for today, Powell doesn’t want the impact of his individual story to get lost.
“The important point is that it is vitally important for men, particularly as you get older—say the age of 40 and beyond—to be regularly evaluated and go through the somewhat unpleasant procedures they
take you through, because it could be lifesaving,” he says. “Place a premium on taking care of yourself and getting the examination. I’m a great believer in preventive medicine…when something
is wrong, don’t hide it, look away from it and pretend it’s not there. Deal with it.”
New Advances In Prostate Therapy
As Powell said, his treatment option isn’t the only one. And today, men who need treatment for an enlarged prostate may soon have a new nonsurgical option, a small, early study suggests.
Called prostatic artery embolization (PAE), the technique uses a catheter threaded into an artery in the leg. The catheter is guided to the artery that supplies blood to the prostate. Then, tiny beads are injected into the artery, which temporarily block the blood supply to the prostate.
The temporary loss of blood supply causes the prostate to shrink, relieving symptoms, according to study lead author Dr. Sandeep Bagla. What’s more, the new treatment doesn’t appear to have the same risk of serious complications, such as incontinence and impotence, that often accompany enlarged prostate treatment.
“This is fantastic news for the average man with benign prostatic hyperplasia. Many men decline current treatments because of the risks. But, for the average man, PAE is a no-brainer,” said Bagla, an interventional radiologist at Inova Alexandria Hospital, in Virginia.
The procedure has only been available as part of Bagla’s trial until recently, but he said some interventional radiologists have started doing prostatic artery embolization, and he expects the procedure will become more widely available by the end of the year.
Benign prostatic hyperplasia is the medical term for an enlarged prostate. An enlarged prostate is very common as men get older. As many as half of all men in their 60s will have an enlarged prostate, according to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). By the time men are in their 70s and 80s, up to 90 percent have benign prostatic hyperplasia, according to the NIDDK.
Some men experience no symptoms, while others may feel the need to urinate frequently, but they have a weak urinary stream, the NIDDK says. There are a number of treatments available for benign prostatic hyperplasia, including medications and surgery.
Bagla said that interventional radiologists in Europe and South America have been using prostatic artery embolization, and that the current study is the first in the United States to test the procedure.
He and his colleagues hope to treat a total of 30 patients, but they’re reporting on the results from the first 18 patients on Monday at the annual meeting of Society of Interventional Radiology, in New Orleans. The data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.
For the study, the average age of the patients who underwent prostatic artery embolization was 67 years. None of the men had to be admitted to the hospital after the procedure.
Ninety-four percent of the men (17 of 18) had a significant decrease in their symptoms one month after surgery. And, none reported any major complications following the surgery.
Bagla said the exact cost of the new procedure is difficult to estimate right now, but prostatic artery embolization will be cheaper than most of the currently used procedures, he said, because there’s no need for an operating room and overnight hospital stays. In addition, he said, because the new procedure doesn’t appear to cause complications, that will save health care dollars as well.
