Robert Crowley, 62, and his wife, Sandra, credit early detection via a PSA test for his successful recovery from prostate cancer and surgery. He had no apparent symptoms. Photo provided
By Jan Engoren
When former President Joe Biden was diagnosed last May with Stage 4 prostate cancer, the disease and its detection made national headlines.
The news that Biden was getting treatment for an aggressive form of cancer that had spread to his bones sparked renewed attention for a disease that often goes undetected until it’s in advanced stages. Prostate cancer is the most commonly diagnosed malignancy worldwide and the sixth-leading cause of cancer-related death in men, according to the National Institutes of Health.
By the numbers
The American Cancer Society lists prostate cancer as the second-most common cancer for U.S. men, after skin cancer. Its forecasts that there will be 313,780 new cases and 35,770 deaths from the disease in 2025 in this country, reflecting about a 3% increase in the incidence rate each year in the past decade.
Because most men diagnosed are older, many ultimately die of unrelated causes, especially since about two-thirds of prostate cancer cases are slow-growing.
According to the American Cancer Society, the five-year survival rate for localized stages of the disease is greater than 99% and the five-year survival rate for all stages of the disease is greater than 97%.
Testing and detection
Behind the numbers are stories like that of Robert and Sandra Crowley, both 62.
The diagnosis of prostate cancer for Robert, a retired house painter and musician, came as a surprise after a routine prostate-specific antigen test.
“Once you’re in a high-risk age, starting at age 50,” says Crowley, who lives in Boca Raton, “make sure you request a PSA test and check your PSA score.”
With no apparent symptoms and no family history of the disease, Crowley never would have thought to check, but thanks to his doctor’s diligence, the cancer was detected early. He is recuperating from surgery in June but calls it a successful recovery.
The Crowleys’ experience underscores a key message about early detection.
“Be your own advocate,” says Sandra Crowley. “Cancer can be aggressive. If your doctor doesn’t mention the screening test, ask him or her. If you catch it early, you can have a very good outcome.”
Signs and symptoms
For men at normal risk, the American Cancer Society recommends the PSA test annually beginning at age 50.
Those at higher risk, including African Americans and men who have close family members who have been diagnosed with the disease, should talk with their primary care doctors about getting screened earlier.
Additional risk factors include lifestyle issues such as lack of exercise and poor diet.
Prostate cancer begins in the small gland below the bladder that helps produce semen — a vital part of the male reproductive system.
Early stage prostate cancer signs and symptoms can include blood in the urine or semen.
Additionally, it can include the need to urinate more often, trouble getting started when trying to urinate and waking up to urinate more often at night.
Later stage symptoms may include accidental leaking of urine, back or bone pain, erectile dysfunction, feeling tired, losing weight and weakness in the arms or legs.
Because of Biden’s late-stage diagnosis, the medical community is examining the need to improve current testing guidelines by considering not just age, but also overall health, symptoms, PSA trends and patient preferences.
Treatment and recovery
For Crowley, the path from screening to treatment moved quickly.
After Crowley received an elevated PSA test result, his primary care physician referred him to Mourad Abouelleil, a urologic surgeon and member of the Palm Beach Health Network Physicians Group. It has headquarters in Boca Raton and offices throughout Palm Beach County.
An MRI and a PET scan revealed a mass, and Crowley’s Gleason score, which assesses aggression, was high and meant the mass was still growing.
A biopsy revealed the mass to be cancerous, and the need for surgery marked the beginning of a challenging but ultimately successful recovery.
Robert Crowley says meeting and being treated by Abouelleil was “a wonderful experience.”
He says he is happy with the results, despite having to learn how to urinate again and needing pelvic floor therapy to learn to control his bladder. He was continent after three months, whereas Abouelleil says many patients may take up to a year to relearn this function.
“Robert’s physical therapist was very impressed by his progress,” says Sandra Crowley. “Robert healed very well and very quickly and we both consider the surgery to be a complete success.”
Intimacy, too, returned — something they hadn’t expected and were pleased to discover.
Both Crowleys say having confidence in your physician is everything.
“We were fortunate to have Dr. Abouelleil,” says Sandra Crowley. “Having such a skilled doctor is a blessing.”
Advice and prevention
Their outcome highlights how medical advances — and a skilled, multidisciplinary team — can dramatically improve patient recovery.
Abouelleil performed a robotic radical prostectomy, the standard of care, whereby the prostate gland, seminal vesicles and tissue are removed using a robotic system through small incisions in the abdomen.
“Be proactive, see your doctor and don’t wait until you have symptoms,” Abouelleil says. Prevention, the physician emphasizes, begins long before symptoms appear.
He compares being proactive with one’s health to not waiting until one’s roof is leaking to have it inspected.
He credits advances in science and diagnostic tools to better outcomes, as cancers can be caught in their earlier stages and successfully treated.
To lower one’s risk for prostate or other cancers, Abouelleil recommends eating a low-fat diet, eating less red meat and more fruits and vegetables, and including antioxidants, such as berries. He follows a Mediterranean diet and exercises with weights to increase his testosterone levels naturally.
“My best advice to men to stay healthy includes getting screening beginning at age 50, or even at 45 if you’re at high risk for prostate cancer, taking an antioxidant, getting your testosterone levels checked every year, and weight lifting to raise your testosterone levels naturally,” Abouelleil says.
What the future holds
As science evolves, new technologies offer hope for options even less invasive than Crowley’s. For early stage prostate cancers, these include ablation using laser energy to destroy the cancer cells, a NanoKnife that destroys cancer with electrical pulses, and the Tulsa procedure, which uses ultrasound delivered through the urethra to destroy prostate tissue.
For the Crowleys, married 14 years, this is the start of a new chapter together.
“We never imagined this journey, but we’re grateful every day — for early detection, expert care and the chance to live life fully again,” says Sandra.
Jan Engoren writes about health and healthy living. Send column ideas to jengoren@hotmail.com.
Comments