Gandalf the Wizard’s Prostate Cancer

Even the “the greatest spirit and the wisest” wizard sometimes has to deal with health issues.

Sir Ian McKellen, 73, who has played the wizard Gandalf in the Lord of the Rings Trilogy as well as the upcoming Hobbit series, told the UK’s Daily Mail that he has had prostate cancer for 6 or 7 years.

When you have got it you monitor it and you have to be careful it doesn’t spread. But if it is contained in the prostate it’s no big deal.

Many, many men die from it but it’s one of the cancers that is totally treatable so I have ‘waitful watching’. I am examined regularly and it’s just contained, it’s not spreading. I’ve not had any treatment.

Sir Ian’s decision to forgo surgery or radiation treatment for his prostate cancer is one option many men don’t realize they may have. According to the Prostate Cancer Foundation, “current estimates indicate that many more men are aggressively treated for prostate cancer than is necessary to save a life from the disease.”

Technically called active surveillance, it means closely watching for any sign that the cancer may be growing or changing.  During active surveillance, a patient makes frequent doctor visits (typically every 3 to 6 months, at first) along with a  digital rectal exams and  a blood test called PSA (prostate specific antigen). After about a year,  another prostate biopsy is done to check the cancer. If these tests show that the cancer is growing or changing in any way, radiation therapy or surgery is offered to treat the cancer.

Whether active surveillance is a reasonable option for a particular patient is dependent on several factors:

  1. Their age, symptoms, and general health
  2. The stage of the tumor– based on the size and location of a tumor and whether it has spread or not
  3. The Gleason score (grade) of the tumor- based on a scale of 2 to 10. This score tells how different the prostate cancer tissue (taken by a biopsy) looks from normal prostate tissue and how likely it is that the cancer will grow or spread. Most men with early-stage prostate cancer have a Gleason score of 6 or 7.

Based on these factors, a physician can determine the degree of risk for a particular cancer:

  • Low-risk prostate cancer is not likely to grow or spread for many years.
  • Medium-risk prostate cancer is not likely to grow or spread for a few years.
  • High-risk prostate cancer may grow or spread within a few years.
  • PSA levels (or changes in levels)

The ideal candidates for active surveillance have a low grade (Gleason 6 or less), low-risk prostate cancer that is small in size, especially if they have concerns about treatment affecting their potency or causing urinary symptoms. It may also be a good choice for older men with limited life expectancy, or for those dealing with other serious health conditions.

As always, this decision should be made between a patient and his physician after all the options are discussed. A second opinion is also valuable.  Consulting with the three types of physicians who treat prostate cancer- a urologist, a radiation oncologist, and a medical oncologist— can give the most comprehensive assessment of the available treatments and expected outcomes.

I’m pleased that McKellen has been so open about his cancer. As e-patients know- knowledge is power!

And besides- we need Gandalf around for many more Hobbit adventures!

 

 

 

Michele R. Berman, M.D. was Clinical Director of The Pediatric Center, a private practice on Capitol Hill in Washington, D.C. from 1988-2000, and was named Outstanding Washington Physician by Washingtonian Magazine in 1999. She was a medical internet pioneer having established one of the first medical practice websites in 1997. Dr. Berman also authored a monthly column for Washington Parent Magazine.

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