Prostate cancer survivor promotes screening for men at high risk

For Bill Rhodes, the endless debate over the value of PSA screening trivializes the anguish of men who are at high risk of prostate cancer.

A partner at Ballard Spahr LLP, Rhodes is also a prostate cancer survivor.

"My first PSA test was for my mother's mental health," said Rhodes. "My doctor raised an eyebrow at the idea of a 29-year-old getting a PSA, but he understood my mother's worry - my father had died of prostate cancer about two months before."

Diagnosed in 1990 at age 60, Rhodes' father had been treated for the disease with what were then state-of-the-art surgical procedures at Johns Hopkins. But the cancer had already metastasized. He died at 64.

Because his father had a particularly lethal form of the disease, Rhodes' urologist recommended that he aggressively track his own PSA results.

Prostate-specific antigen (PSA) is a protein shed into the blood by the prostate gland. Elevated PSA levels may indicate prostate cancer, noncancerous conditions such as prostatitis, or an enlarged prostate.

The use of the PSA test to check average-risk men with no symptoms of cancer has always been somewhat controversial. But in 2012, an influential federal advisory panel, the U.S. Preventive Services Task Force, declared that routine PSA testing should be abandoned, even for high-risk men.

The panel concluded that most cancers found by screening are slow-growing and would never cause problems if left undetected; treatment leaves many men with sexual and urinary problems; and major clinical trials have found that screening saves few, if any, lives.

Rhodes, however, is among those who say screening has worked for them.

He followed his urologist's advice and had a PSA test performed annually or biannually during his regular physical exams over the next 30 years. Apart from one scare in his late 30s when his reading jumped to 1.6 (it turned out to be false result), his baseline averaged about 1.2.

Like most men's, Rhodes' numbers rose a bit with age, but at 48, his PSA test came back at 2.2. When he called his urologist, the doctor ran a second test to confirm the number and then followed that with a series of other, more invasive tests and a biopsy, which showed cancer throughout his prostate.

"I couldn't have had the surgery fast enough," said Rhodes. "I was scared, but at such times I think you do your research and you find a surgeon with whom you feel comfortable and you put yourself in their hands."

"I was aware that it was very treatable if caught early enough," he said. "And though the cancer appeared in a majority of biopsy samples showing that it had spread in different areas of the prostate, it was still early."

Quickly, before his cancer had the chance to go beyond the prostate wall, Rhodes found a surgeon at Memorial Sloan Kettering Cancer Center and had his prostate removed. At the same time he went through genetic testing to learn as much as he could about his disease.

"One of the takeaways from my experience was the importance of establishing a baseline PSA," said Rhodes. "A single score on a PSA test doesn't tell you anything. The goal is to identify the rate of change, not the absolute number. Plenty of people who get screened at age 50 have a PSA rate of 2. It's a normal or low score for a man of 48 unless you have a well-established baseline that tells you differently."

"For me that 2.2 set off bells and alarms."

Rhodes said he discussed "watching and waiting" with his urologist and surgeon, but in the end decided that surgery was necessary.

"Watching and waiting is no picnic," he said. "It's not only mentally draining but would have involved biopsies effectively every six months. I had a bad family history and I was in my 40s. The risks of quality-of-life issues had to be balanced with the idea of watching and waiting and the risk of waiting too long."

"After what happened to my father, I didn't want to do that."

In February, Rhodes passed his two-year checkup with an undetectable PSA.

September is designated Prostate Awareness month. Rhodes has joined with his law firm and the Prostate Cancer Foundation to promote prostate cancer awareness. In an email campaign, the firm is working to inform employees about early detection, treatment, and identification of risk factors for prostate cancer, as well as information about advancements in diagnosis, treatment, survival rates and quality-of-life issues.

"I'm fairly open about my diagnosis and recovery, and I've tried to help people who have been diagnosed and explain to them everything I've been through," he said. "I have a pretty good support network at my firm and I'm glad to be in the middle of it."

"My message to people is to get yourself checked during an annual physical," Rhodes said. "If you're doing an annual physical and having blood tests anyway, have them add PSA testing."

"For someone like me, with a history of prostate cancer in the family, waiting until I was 50 to get PSA testing could have been an unfortunate choice," he said. "In a case like mine, the PSA was lifesaving."

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