Aug 1, 2022
It’s a tale often told in the media.
A beloved figure, a basketball or baseball coach, a popular community leader, a political figure, or a celebrity, is diagnosed with prostate cancer.
The articles typically say the cancer was detected early, and a radiation oncologist or urologist saved the day with radiation therapy or radical prostatectomy.
When Hollywood legend Robert De Niro was diagnosed in 2003, his publicist issued a statement: “The condition [prostate cancer] was detected at an early stage because of regular check-ups, a result of his proactive personal healthcare program.”
(Robert De Niro)
The press agent gave the diagnosis a positive spin: De Niro was watching his health, found a problem, and took care of it.
Active surveillance, close monitoring of low-grade prostate cancer rather than a rush to treatment, was virtually unheard of then.
De Niro underwent a prostatectomy. That was that.
The coverage, such as on ABC, built the actor up as a hero and devoted the coverage to how many Oscars the “tough-guy” actor had won. Not much education. The press agent steered the media coverage away from the details.
Typical media coverage of prostate cancer—and probably other cancers,.
(I’m not saying there is anything special about news reporting on prostate cancer. But his newsletter is about AS for prostate cancer so that is the lens through which I am looking. Plus, I am a rare career medical journalist so I have skin, make that prostate, in that t issue.)
Sports reporters like entertainment and political reporters, along with media reporters and general assignment reporters, in my view as a veteran reporter and patient, do a poor job of covering prostate cancer stories involving high-profile individuals. Oddly, medical reporters typically don’t appear to be assigned often to cover stories on these patients.
Padres and media muff coverage
In May of this year, TheActiveSurveillor.com reported on the story of the San Diego Padres’ new skipper Bob Melvin who told baseball reporters in a dugout briefing that he was undergoing “prostate surgery” the next day.
Like a pitcher trying to brush a batter off the plate, while briefing reporters, Melvin attempted to simultaneously raise and avoid his personal health issue: “Real quickly, let’s minimize this. I’m going to have surgery tomorrow. It’s’ going to be prostate surgery,” he said.
He then plunged into details on who was going to fill in for him and how long he was going to be gone.
Caught off guard, reporters didn’t have any hardball questions.
One reporter said he wasn’t sure what he was hearing and asked: “Bob, just so we’re reporting it accurately. You say prostate … is it cancer? Or is it something else?”
Melvin downplayed the prostate cancer angle and responded: “I don’t think so but they won’t know until they get in there.”
Huh? That’s when things started to not add up for me as a veteran medical reporter and as a patient on active surveillance for low-risk prostate cancer for the past 12 years. My panel of urology experts couldn’t figure out why Melvin would undergo “exploratory surgery” for prostate cancer. Never heard of such a thing.
My impression is that prostate surgery is planned after the presence of cancer is verified in pathology. Prostate surgery wouldn’t be performed because of a suspicion of cancer.
The experts told me my instincts were correct.
Whatever the doctors in San San Diego were looking for, they apparently didn’t find anything.
Then, the Padres and Melvin just as quickly tried to make the story go away. Local media dropped the ball, led by the nose by the team’s PR operatives.
Prostate cancer is the most common form of non-skin cancer found in men, making it a true public health concern. You’d never know it from this coverage.
A Padres spokesman told me, “Bob’s medical information is private and confidential, so we won’t be able to provide any additional information. We won’t be commenting any further.”
The manager, the team, and the media booted an opportunity to inform the public about a serious public health matter.
Feel good sports coverage strikes out again
The New York Post “broke the story” in July 2022 of New York Mets first-base coach Wayne Kirby undergoing prostate surgery. These articles contained no details other than Kirby sailed through surgery.
“By all accounts, the beloved coach is indeed doing well. All-Stars Manny Machado, a player in Baltimore when Kirby coached there, and Pete Alonso paid tribute to Kirby during the moving Stand Up To Cancer moment at the All-Star Game Tuesday night here by holding up a placard with Kirby’s name on it,” the Post reported.
A touching moment no doubt.
But the articles on Kirby contained no enlightening details, such as explaining that Black men like Kirby are at increased risk for diagnosis of and death from prostate cancer. He might have qualified for active surveillance but we don’t know because key details were missing other than Kirby was “feeling good” and would be ready to rejoin the team in a few days.
“Pretty awesome surgery,” Kirby texted from the hospital. “I’m walking the halls of the hospital and feeling good.”
I know that reporters generally don’t consider themselves educators, though, in my opinion, they should be. As a reporter, I knew that I had “teaching moments” in my stories, opportunities where the right information could improve or even save my readers’ lives.
Colin Powell’s prostate cancer
In 2003, Secretary of State Gen. Colin Powell was diagnosed with prostate cancer. The New York Times Larry Altman, MD, a medical doctor who worked as a daily newspaper, and political reporter Christopher Marquis provided a good account of Powell’s surgery. They interviewed Powell’s famed surgeon Peter Scardino, MD, of Memorial Sloan Kettering.
A State Department spokesman gave the typical statement about Powell’s cancer: “They got it at its early stage.”
The cancer was localized and confined to the prostate. This was 2003 so active surveillance really wasn’t a blip yet. But Altman, a friend of mine, provided significant details, often missing in reporting these days.
(Gen. Colin Powell)
But the reporters missed an opportunity to explain that Powell’s family came from the Carribean, where prostate cancer is considered an epidemic from a population that has its roots in West Africa.
Could Agent Orange have played a role in this cancer?
Less than inquiring minds: Al Roker’s prostate cancer
We really don’t know what NBC weatherman Al Roker’s real story is. Mark Lichty and I wrote about his diagnosis in 2020 in an article entitled Al Roker’s Forecast: Rising PSA, Radical Prostatectomy On Horizon.
This time media reporters were on duty. Maybe Roker wanted to keep his story mostly private.
He said his cancer was “caught early.” We hear this over and over. But what does that mean?
What was his Gleason score? Did he get a second opinion? He said his cancer was a “little aggressive”? What does that mean? Could Roker have gone on active surveillance? Maybe not. Did anyone ask?
Lichty and I wrote: “We know when such news is reported that the public will seek help in large numbers. In this case, many men, especially Black men, will be undergoing PSA (prostate-specific antigen) tests to see if they have signs of prostate cancer. You don’t have to be a weatherman to know that many men likely will be diagnosed with prostate cancer. We want to be sure they know that radical surgery isn’t their only choice.”
Dr. Vincent Laudone, Roker’s surgeon, said the weatherman’s cancer “appears somewhat limited or confined to the prostate,” but given that it’s aggressive, the decision was made to remove the prostate.
Questions for perplexed reporters
Reporters may ask but don’t report on the crucial details that might explain what doctors did do or didn’t do.
I hope some reporter looking for background reads this and asks these basic questions when they’re slammed with an assignment on prostate cancer:
—What is PSA and what was the patient’s PSA? Was it rising rapidly? Read more.
—What were the results from his multiparametric MRI?
—What was his Gleason score? Read more.
—How aggressive is the cancer? Did the patient undergo genomic testing? What did the test find? Cancers have their own DNA information that can add some information to help patients and doctors decide on a course of care.
—Did the subject of the story get a second or third opinion? Read this.
These are the basics you need. Download the Prostate Cancer Foundation’s free booklet for more background.
Reporters should ask and report the answers.
They can encounter obstacles. Patients may not understand the details of their own case and so may not be reliable sources. Sorry, but it’s true.
Reporters should try to talk to their subjects’ doctors if they can. Most physicians consider themselves teachers and want to share their knowledge. A least, that’s what I have found after many years on the beat. Get other opinions if you can.
Celebs mum on AS
I’ve also found that few celebrities are open about going on active surveillance.
I can count them on two fingers, and one of them hid the diagnosis for years. Bill Duke was forthcoming in sharing his story in a video at the Prostate Cancer Research Institute.
BTW, I loved Duke in “Predator” with Arnold Schwarzenegger. What do you think?
Sir Ian McKellen came out of the closet as a gay man but did his best to conceal his prostate cancer diagnosis and the fact he was on AS. He eventually confirmed his diagnosis.
We in the Reluctant Brotherhood could use the help of McKellan, who played Gandalf, the head of the Fellowship of the Ring in the film version of J. R. R. Tolkien’s novels The Hobbit and The Lord of the Rings. But don’t hold your breath.
I found out firsthand, Gandalf won’t lend a hand to the prostate brotherhood. He’s entitled of course. There must be other celebs who could help the AS movement?
(Sir Ian McKellen)
To preserve their images of youth and vitality and to protect their contractual obligations, it turns out to be easier for many celebs to undergo treatment than to go on AS.
FYI, celebrities and public figures don’t necessarily get the best prostate cancer care. Check out my article on celebrity medicine: https://www.medpagetoday.com/special-reports/apatientsjourney/82226
Media coverage often shoddy
But what I want to talk about today is how the media covers prostate cancer.
I know that the editors tend to think any reporter cover any story. I believe that’s true–with proper preparation for an assignment. But these days, with short staff, reporters may not have the time to prepare.
General assignment reporters plunge into their stories at internet speed and may not know what questions to ask. The same is true for the entertainment, media and sports reporters who cover diagnoses and deaths of celebs with prostate cancer. Likewise, the political reporters who cover cases of pols diagnosed with prostate cancer.
Medical reporters have to do their homework as well.
It’s tough. I know the pressures of making deadlines. As we say, journalists do it daily–or even more frequently. There can be a tendency to take shortcuts. This is rue throughout the journalism enterprise.
The local story
Reporting isn’t just shoddy in the case of famous politicians or actors. It can be really bad in local media, especially in small towns, where prostate cancer treatment may not be up to the standards of clinical centers of excellence.
I read local stories on this topic regularly. There usually is not enough information to determine if the patient is being offered the best treatment or all of his options. I sense that in many towns and rural areas, active surveillance may not be on the table.
I read over and over again about how cancers were detected and treated early, The stories virtually never mention active surveillance.
If these cancers really were detected early, I wonder if the patient in question might have been a candidate for active surveillance?
Take a recent report on a local hero, a boy’s basketball coach in small-town Idaho.
The article suggests that Clem (not his real name) might have been saved with radiation therapy. He had a hard time with his treatments. But he hit the links to play through the rough of radiation.
The reporter notes: “The urologist checked [Clem] for signs of cancer and didn’t notice anything amiss. Plus, [Clem] hadn’t yet experienced any of the symptoms of prostate cancer.”
Symptoms? What symptoms?
I assume the doctor gave Clem a digital rectal exam. But did the doctor find bumps, soft or hard spots, or other abnormal areas suggesting the presence of prostate cancer? Are these the aforementioned symptoms?
Most of us diagnosed with prostate cancer these days don’t have any symptoms. Most cases are found with PSA (prostate-specific antigen), a blood test that looks for the molecule associated with prostate cancer rising, followed by MRIs and biopsies before any palpable irregularities are present. So I am not sure what the reporter is saying.
Of course, the reporter is reliant on what the patient or his doctor told him. This reporter did not appear to have spoken with Clem’s doctor. The reporter should have interviewed the doctor to confirm the patient’s details.
That’s Journalism 101.
Unlike many articles, this one mentions PSA.
(I know you guys know this, or should. I am writing on the off chance that a diligent general assignment reporter is looking for background on prostate cancer.)
Generally, PSAs below 4 ng/mL are considered OK–though prostate cancer can be found in patients with very low or very high PSAs. Not a great test for screening,
Clem was at the high end of the grey zone of 4-10.
Clem’s PSA was 10 ng/ml.
TheActiveSurveillor.com readers know that a PSA of 10 is not necessarily the time to push the panic button.
Urological oncologist Todd Morgan, MD, of UMichigan, said patients should ask if their labs are following the World Health Organization calibration standards for PSA. If not, their PSAs may be higher–like by 25%–than it appears.
Morgan also said patients are more focused on PSA numbers of 10 than urologists like him who monitor these patients. He usually doesn’t get worried about PSAs until they hit around 15.
Why did Clem’s urologist suggest a biopsy? It seems aggressive. Maybe because Clem and his family were “scared to death” by the PSA? Was his PSA rapidly rising? We don’t know.
Did Clem undergo a multiparametric MRI? This is considered the first step these days, rather than a biopsy. Is an MRI available in the small town or somewhere nearby? Probably. But we don’t know if Clem had a scan.
What was Clem’s Gleason score? Most reporters probably wouldn’t ask. If this one asked, we don’t know.
(Pathologists view cores of prostate tissue under the microscope to see how normal prostate cancer cells look and how likely the cancer is to advance and spread.)
Was Clem’s Gleason 3+3=6 or Gleason Grade 1? Or favorable 3+4=7 or Gleason Grade 2? If so, Clem could have been a candidate for active surveillance. If higher, he would have been a candidate for radiation or radical surgery.
Not all coverage sucks
There is some hope. Some reporters do an excellent job—ask the right questions and provide context and balance even in brief TV reports.
Back in April, I found myself on the other side of things as a subject rather than a reporter. I co-authored an article with my former urologist in the Journal of Clinical Oncology on why we thought Gleason 6 lesions should not be considered a cancer. The journal piece was widely covered.
I was impressed with the professionalism and accuracy of reports in the Chicago Tribune and NBC News and also Fox. Read all about my 15 seconds of fame here:
(NBC crew came out to my house for an interview.)
(Cimone the cat watches me being interviewed by Lauren Petty on Channel 5 NBC)
The public: Read everything, including this article, with a skeptical eye.
Reporters, of all kinds, you have a mission to inform the public about an important public health matter. Take your responsibilities seriously. Do your homework.
Howard Wolinsky is the editor and founder of TheActiveSurveillor.com. He has been on AS for low-risk prostate cancer for 12 years years.
He has worked as a newspaperman, mainly a medical reporter, for more than 50 years. He’s still on the medical beat at Medscape Medical News and MedPageToday.com, where he does a blog mainly about AS. He is the founder and editor of his newsletter.
The Chicago Sun-Times nominated him twice for the Pulitzer Prize for exposes on financial and ethical scandals at the American Medical Association. The National Press Club, the Association of Health Care Journalists, the American Public Health Association, the Chicago Newspaper Guild, the National Cancer Institute, the America Bar Association, and a long list of other organizations, have recognized his writing.
He also taught medical writer wannabes in the graduate school at Northwestern University’s storied Medill School of Journalism.
Earlier this year, Wolinsky had a cancer reporting fellowship at the National Cancer Institute.
Active surveillance is often used interchangeably with “watchful waiting,” but there’s a big difference. Although both involve forgoing immediate therapy, watchful waiting is generally more passive, with the treatment given when cancer symptoms worsen. In contrast, in active surveillance, patients withhold medical treatment until (or if) PSA or follow-up prostate biopsy indicates disease progression. Active surveillance (AS) is primarily an option for those with cancer that is not likely to progress, such as cancers confined to the prostate and with a low Gleason score, PSA level, and clinical stage. However, some evidence suggests that it also might be suitable for certain men with intermediate-risk prostate cancer.
The biggest drawback to active surveillance is psychological—the ongoing stress and even panic that you have cancer and are not doing anything about it. Many men can handle the passive approach of taking no action and have a tough time following this option. The good news is that AS is not a psychological burden for many, like Howard Wolinsky, who writes in his blog, TheActiveSurveillor.com, about his experience of being on AS for over 12 years. (You should check out his blog)
Who is a Candidate for Active Surveillance in Prostate Cancer?
The research indicates that not only those diagnosed with low-risk prostate cancer (Gleason 6, Grade Group 1) can be on AS but only low intermediate-risk patients with Gleason 7 (3+4) or Grade Group 2 (GG2) can as well. If intolerable anxiety by the patient is not an issue, then GG1 and GG2 prostate cancer patients can undergo AS according to research.
Pro-Active Surveillance vs. Active Surveillance
Lifestyle medicine can help with the problem of “doing nothing” since you are proactively doing something as you change your eating habits, improve fitness, and create an unfavorable body to cancer. Even if you are not currently undergoing traditional medical treatments, you are still treating your prostate cancer with a powerful form of medicine, Lifestyle medicine.
The goal is to create an inhospitable cancer microenvironment by lowering chronic inflammation, reducing excess oxidative stress, maintaining a robust immune system, and assuring optimal detoxification pathways. Diet, physical exercise, sleep, and targeted nutraceuticals seem to significantly help men on Active Surveillance for prostate cancer. In my clinical experience, patients express that lifestyle medicine, like diet and dietary supplements, help to regain a sense of control and address feelings of anxiety during active surveillance or increasing PSA. With Lifestyle medicine, you are not “just sitting there,” you are back in charge of your body with non-toxic interventions.
Diet while on Pro-Active Surveillance for Prostate Cancer
A Mediterranean / Plant-based diet is what I recommend most for men with prostate cancer. Such a diet, which I refer to as the XY Wellness diet, focuses on the consumption of vegetables, low-glycemic fruits, fish, primarily salmon, nuts and seeds, and whole, unrefined foods that help best for prostate cancer. Also, it’s been my experience that too often, people are hyper-focused on what they eat and not on how much they eat. Eating clean is important but abstaining from overeating is equally important. For example, if you are eating six meals a day, you are still overeating even if those meals consist of nuts, broccoli, fish, and whole, unrefined foods in six meals a day. Practice intermittent fasting and don’t ever eat with guilt.
Physical Exercise while on Pro-Active Surveillance for Prostate Cancer
The prescriptive form of exercise for men on Pro-Active Surveillance is about four a week with moderate to high intensity, including anything from brisk walking to jogging and some weight resistance exercise. In addition, high-Intensity Interval Training (HIIT) has shown benefits in men with prostate cancer on AS. A good explanation of exercise for prostate cancer is found here.
Nutraceuticals and Dietary Supplements while on Pro-Active Surveillance for Prostate Cancer
I’ve noticed much confusion on what dietary supplements people take compared to what they should take while on active surveillance for prostate cancer. So often, the desperate man seeking to cure his conditions reads something online or hears about a “new magic cure” from a friend on this supplement or another and they take it. While the chances of those toxic nutrients being toxic are minimal, the major problem is that they are overspending on too many bottles that don’t work. Instead, dietary supplements for men on AS should be targeted to reduce chronic inflammation, optimize immunity, and support overall prostate health.
Through XY Wellness, I have formulated specialized nutraceuticals that seem to work very well for patients I’ve seen on AS. I have even seen regression upon follow-up biopsies. While it is important to note that the whole program, including diet and exercise, is essential, and no one component is more important than others, the Active Surveillance supplements seem to contribute positively.
Regimen 01 / Active Surveillance packets continue to impress as men are experiencing a drop in PSA and prostate cancer regression after biopsy. As importantly, urinary problems of urgency and frequency also seem to improve.
Regimen 01 ingredients:
- Botanicals: Curcumin, Ginger extract, Rye Pollen extract (Graminex), Cranberry fruit extract, Quercetin, Chinese Skullcap root extract (Scutellaria), Reishi Mushroom, Green tea extract, Grape seed extract, Andrographis, Magnolia bark, Milk thistle, Broccoli seed extract, Boswellia gum extract, Pomegranate extract
- Vitamins and Minerals: Vitamin C, Vitamin D, Vitamin E (High gamma-mixed tocopherol), zinc, Alpha Lipoic Acid, Omega-3 fatty Acid, L-Glutathione
Benefits of Regimen 01:
- Anti-inflammatory – Ginger extract, Rye Pollen extract (Graminex), Cranberry fruit extract, Quercetin, Omega-3 fatty acid
- Immune system support – Reishi mushroom, Agaricus mushroom, Andrographis, Magnolia bark
- Antioxidant & Protect against Oxidative stress – Grape seed extract, vitamin C, E, Alpha Lipoic Acid, zinc, vitamin C, vitamin D, selenium (from selenized yeast), vitamin E (High gamma-mixed tocopherol)
- Prostate health – Rye Pollen extract (Graminex), Reishi mushroom, Curcumin, Quercetin
- Urinary Support – Cranberry extract, Rye Pollen extract
- Relaxes nerves and muscles – Chinese Skullcap (Scutellaria)
- Liver & Detoxification support – Milk Thistle, Schizandra, vitamin C, E, Alpha Lipoic Acid, zinc, vitamin C, vitamin D, selenium (from selenized yeast), vitamin E (High gamma-mixed tocopherol), Broccoli extract, Glutathione, Quercetin
The nutraceutical ingredients in Regimen 01 aim to provide targeted nutrients to lower the risk of prostate cancer development and progression, improve prostate health and support optimal urinary function.
Instructions for taking Regimen 01:
Take one packet of Regimen 01 in the morning and one in the evening, with or without food, 8 to 12 hours apart
Lastly, prostate cancer can be a new beginning for most where it provides an opportunity to live healthier and better despite such diagnosis. Don’t squander this opportunity to improve your prognosis and live with better, more robust health moving forward.
– naturopathic functional medicine doctor
– prostate and male health specialist
– NYU Langone Health – Clinical Assistant Professor, Urology
– Institute for Functional Medicine – faculty, educator