It was announced today that Phantom of the Opera composer Andrew Lloyd Webber, 61, has prostate cancer. It was apparently caught at a very early stage, and he is expected to do well. According to his spokeswoman, “Andrew is now undergoing treatment and expects to be fully back at work before the end of the year.” The composer, who also wrote Cats, Jesus Christ Superstar and Evita, is currently working on a sequel to Phantom of the Opera, called Love Never Dies, which is to open in London in March, 2010 and Broadway the following November.
As we have touched upon the general subject of prostate cancer in stories about General David Petraeus and Senator Christopher Dodd, this blog will touch on a little more controversial subject- the PSA test. PSA stands for prostate specific antigen, which is a protein produced in the prostate. Normally this protein is present in the blood in small amounts, although the amount does increase with age. In disease states, such as prostate cancer, increased levels of the protein can be found in the blood. However, other diseases, such as benign prostatic hypertrophy (BPH) and prostatitis (an infection of the prostate gland) can also cause elevated levels. To complicate matters further, prostate cancer can either be rapid growing and aggressive, or so very slow growing that it is unlikely to cause symptoms or death, and the PSA test can’t distinguish between these two types.
There are other limitations to the test. As mentioned above, PSA levels can be artificially high in benign diseases such as BPH and prostatitis. They can be artificially low in men who are obese, those being treated for BPH, or those taking some dietary supplements for prostate health. There are also problems with false positives (abnormal test but no disease). Approximately 75% of men who have an elevated PSA level who are later biopsied, do not show cancer on the biopsy. There are false negatives as well, men with normal PSA levels who turn out to have cancer. Lastly, there can be over-diagnosis – 29-44% of men diagnosed with cancer because of elevated PSA levels have cancers that of the slow-growing variety that would not cause symptoms.
One might say, isn’t it better to catch a cancer early than risk it becoming a problem later? In most cancers that is definitely the case. However, because of the slow-growing benign course of some kinds of prostate cancer, “treatment” of those tumors would only be exposing men to surgery and or radiation treatment they do not need. These treatments can also result in problems with impotence, urinary incontinence or bowel problems. A number of recent studies have shown that PSA testing on large populations of men may increase the detection of prostate cancer, but does not lower the risk of death from prostate cancer (see e-book below).
SO where does this put us? The decision whether to do a PSA test should be individually decided between physician and patient. If a man is of higher risk, i.e. African American men and men who have a first-degree relative (father,brother, or son) diagnosed with prostate cancer at an age younger than 65, then PSA testing may be appropriate. PSA levels may also be appropriate for those men who have been treated for prostate cancer as a way to look for recurrence. Most organizations (American Cancer Society, American Urological Association, National Cancer Institute, etc.) are not recommending routine, general screening using PSA tests at this time. They do, however, recommend DRE – Digital Rectal Examination – insertion of a gloved,lubricated finger into the rectum to feel for any bumps or hard areas on the prostate – for men at age 50, age 45 for those at higher risk.
It should be known that studies are being done to find other tests that will better detect prostate cancer.
Click here to read an article from the Prostate Cancer Foundation outlining some of these new studies.
Free E-Book on PSA Testing: