When the 'Doctor' Becomes the Prostate Cancer Patient
- “Grey’s Anatomy” star James Pickens Jr., 71, was diagnosed with early-stage prostate cancer during a routine checkup—thanks to decades of proactive screening rooted in his family’s history with the disease.
- Pickens began prostate-specific antigen (PSA) testing – which screens for signs of prostate cancer – in his early 40s, knowing his father and uncles had faced prostate cancer; his vigilance allowed doctors to catch a rare variant before symptoms appeared.
- He opted for robotic radical prostatectomy, a minimally invasive surgery that offers precision and potential benefits for continence and nerve preservation in localized prostate cancer cases.
- “The robot has really revolutionized our ability to operate in that small space, to be able to apply fine dissection, tremor, less movements of the hands to dissect these nerves off of the prostate, and at the same time, suture the bladder back to the urethra after the prostate is removed,” Dr. Randall Lee, a urologist at Fox Chase Cancer Center in Philadelphia, tells SurvivorNet.
- A longtime health advocate, Pickens continues to encourage men, especially Black men, to prioritize health screenings, while acknowledging the medical mistrust among Black patients rooted in historical injustices like the Syphilis Study and Henrietta Lacks’ story.
- Research published in the New England Journal of Medicine shows prostate cancer develops earlier and more aggressively in Black men; experts recommend Black men begin PSA screening starting at ages 40–45 to reduce mortality by up to 30%.
- Men at average risk are recommended to begin screening between 50 and 55. Men with a family history of prostate cancer should consider screening at 40.
“It was rare enough that they wanted to make sure that they were crossing all the T’s and dotting all their I’s. But they hadn’t seen one that was detected as early as mine,” Pickens explained to Black Health Matters.
WATCH: What Happens If My PSA Test Is Elevated?
Prostate cancer screening may often involve a digital rectal exam and prostate-specific antigen test. This test measures the level of PSA in the blood, and higher levels can indicate cancer. Most cancer diagnoses are caught with screening.
“I started getting my annual physical 34 years ago. And I started my PSA testing when I was 41,” Pickens said.
Last year, during a routine check-up, Pickens says his doctor noticed those subtle increases in his PSA levels, which prompted more tests.
“My primary said, ‘Yeah, you know what? It’s ticked up some more. I want to send you back to the urologist.” Pickens said.
A biopsy and PET scan helped discover prostate cancer, but it was isolated to one quadrant of the prostate.
Not wasting any time, Pickens chose to undergo a robotic radical prostatectomy.
Prostate cancer surgery is a highly effective treatment for many men with localized disease. The goal is to remove the prostate gland and surrounding tissues (such as seminal vesicles) to eliminate cancer. This procedure is called a radical prostatectomy.
“The robot has really revolutionized our ability to operate in that small space, to be able to apply fine dissection, tremor, less movements of the hands to dissect these nerves off of the prostate, and at the same time, suture the bladder back to the urethra after the prostate is removed,” Dr. Randall Lee, a urologist at Fox Chase Cancer Center in Philadelphia, tells SurvivorNet.
“Historically, with open surgery … one of the big risks of that was leakage of urine at that connection site. Nowadays, that is less of a concern with the ability to visualize that area in the pelvis.”
Choosing the right surgical approach involves a detailed conversation with your urologist or oncologic surgeon, something similar to what Pickens had with his care team before settling on robotic radical prostatectomy over radiotherapy.
“We caught it really early, and so they thought that would be the best route to take. I do have a rare variant that you don’t see very often. They wanted to err on the side of caution and keep an eye on it,” Pickens said.
Pickens told ABC News that his latest scans found “no detectable” signs of cancer.
WATCH: Robotic Surgery Vs. Open Prostate Surgery For Prostate Cancer
More on Robotic Prostatectomy
A robotic-assisted laparoscopic prostatectomy (RALP) is a minimally invasive procedure that uses a robotic surgical system, such as the da Vinci Surgical System. The surgeon operates from a console, controlling robotic arms that hold surgical instruments and a high-definition 3D camera.
Tiny incisions (usually 5-6) are made in the lower abdomen to insert the instruments. The robotic system translates the surgeon’s hand movements into precise actions inside the patient’s body. The camera provides magnified views that help in identifying nerves and structures crucial to continence (bladder and bowel control) and sexual function.
Both types of prostate cancer surgeries [robotic and open surgery] carry the same general risks, including bleeding, infection, and complications related to anesthesia. However, functional outcomes, particularly urinary continence and erectile function, are of major concern for most patients.
Most men experience some degree of incontinence initially. Robotic surgery may lead to a quicker return to continence due to better precision in preserving structures around the urethra. Long-term incontinence rates are similar between both methods with experienced surgeons.
Nerve-sparing techniques can help preserve erectile function in eligible patients. Robotic surgery may offer a better chance at nerve preservation, though outcomes depend largely on the patient’s preoperative function and cancer location. Full recovery of sexual function can take months or more than a year.
Pickens Has a History of Medical Advocacy
Pickens has dedicated years to urging men—especially Black men—to take charge of their health. He acknowledges the deep-rooted mistrust many in the Black community feel toward the medical system, shaped by a legacy of racism that includes the Syphilis Study and the unauthorized use of Henrietta Lacks’ cells, among other injustices.
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“One in eight men will be diagnosed with prostate cancer in their lifetime, and among Black men, that risk is even higher,” Pickens said in a PSA promoting prostate cancer awareness.
Research published in the medical journal “Cancer” states, “Black men are disproportionally affected by prostate cancer; they have the highest prostate cancer incidence in the United States (183.4 new cases per 100,000).”
Last year, the Prostate Cancer Foundation (PCF) released recommended screening guidelines for Black men in the United States and says, “Among Black men who elect screening, baseline PSA testing should occur between ages 40-45. Depending on the PSA value and health status, annual screening should be strongly considered.”
The New England Journal of Medicine highlights that Black men are at a higher risk of getting prostate cancer. Researchers, consisting of primary care, urology, medical and radiation oncology, translational science, and patient advocates, reviewed 287 studies using systematic review protocols to develop prostate cancer screening guidelines specific to Black men.
They determined, for Black men (higher-risk):
- Prostate cancer tends to develop 3–9 years earlier in Black men.
- Early discussions about PSA screening should begin in the early 40s.
- Baseline PSA testing between the ages of 40 and 45 is recommended.
- Continued screening until age 70, adjusted for PSA levels and health status, could reduce mortality by roughly 30% without a major overdiagnosis risk.
Expert Resources for Prostate Cancer Awareness
- ‘A Profound Effect’: Treating Advanced Prostate Cancer With Hormone Therapy
- ‘A Relationship Disease’ — SurvivorNetTV Presents: The Power of Emotional Support For Men Handling Prostate Cancer
- ‘Early Detection Can Be the Key’: National Guard Vet & Prostate Cancer Survivor Urges Others to Get Screened
- ‘Men Beating The Odds’: A Groundbreaking Film Series That Celebrates Resilience After Prostate Cancer
- Balancing Treatment and Quality of Life: What Men Should Know About Prostate Cancer Care
- Chemotherapy for Prostate Cancer: Adding Power To Your Treatment Plan
- How Doctors Use Risk Assessing System To Determine Best Prostate Cancer Treatment Approach
Prostate Cancer Screening and Warning Signs
When you do get screened for prostate cancer, your doctor will run a few tests.
One of the tests is the PSA test, a simple blood test that screens for prostate cancer. It looks for more significant amounts of protein-specific antigen (PSA) in the blood. An elevated PSA test does not always mean you have prostate cancer. It could also reflect that your prostate is enlarged, which is common, or it could signal an infection or inflammation.
Your doctor may also conduct a digital rectal exam (DRE) to check your prostate for lumps.
Depending on the results of these tests, imaging scans and a biopsy may be ordered.
WATCH: How Gleason Grade Determines Treatment
Prostate cancer does not always behave the same in every man it impacts. The cancer can be considered “low-risk” and can be slow-growing, and treatment might not be necessary. In other men, the cancer may grow faster or more aggressively, requiring more immediate treatment. Because of this, there is some debate about screening.
The United States Preventive Services Task Force recommends that men at average risk between the ages of 55 and 69 years talk with their doctor about the pros and cons of prostate cancer screening.
The American Cancer Society recommends that men at age 50 who are at average risk should begin screening. Men who are at high risk of prostate cancer should begin screening at age 40. Men with a close relative diagnosed with prostate cancer should consider annual screenings in their 30s.
SurvivorNet experts suggested that men consider factors like their family history, genes, and age when deciding whether and when to screen.
Symptoms of prostate cancer may include:
- Urinating more often
- Waking up in the middle of the night to pee
- Blood in your urine
- Trouble getting an erection
- Pain or burning when you urinate
- Pain in your back, hips, thighs, or other bones
- Unexplained weight loss
- Fatigue
If You’re Diagnosed With Prostate Cancer, What to Expect for Treatment?
After testing and establishing your risk, your doctor will discuss possible treatment options. These may range from active surveillance to more aggressive options, including surgery and radiation therapy.
WATCH: Coping emotionally after a prostate cancer diagnosis
Surgery is an option for men with any risk group of prostate cancer that hasn’t spread outside of the prostate gland. The type of surgery most often used is called a radical prostatectomy.
During the procedure, the surgeon removes the entire prostate, along with some tissue around it, including the seminal vesicles that release fluid into the semen. Your doctor can perform this through a traditional open procedure with one large or several small incisions, called laparoscopic surgery.
WATCH: Sexual Function Recovery After Prostate Cancer Surgery
Surgery side effects may include erectile dysfunction and urinary incontinence. Fortunately, the side effects are usually temporary, and there are ways to help you manage them.
“Erectile function is so sensitive when we’re dealing with prostate cancer because the nerves that are critical for this function wrap around the prostate; they’re just so intimately connected to the prostate that they can be damaged from a surgical removal of the prostate or through radiation treatment,” Dr. Isla Garraway, a staff urologist in the Veterans Administration (VA) Greater Los Angeles Healthcare System, told SurvivorNet.
Doctors often recommend sexual counseling after prostate cancer treatment to help improve sexual function. This approach actively addresses the psychological, emotional, and relationship impacts on sexual health.
Radiation therapy is often done when prostate cancer is caught early and confined to the prostate gland.
Questions for Your Doctor
If you have experienced symptoms associated with prostate cancer or have a screening coming up, here are some questions you may ask your doctor:
- If I had elevated PSA levels, what could be causing that besides cancer?
- How long will it take to learn if my PSA levels warrant further testing?
- What are the treatment options that are best suited for me based on my risk level?
- What financial resources exist to help me with the costs associated with treatment?
- How long will my potential treatment prevent me from working or continuing normal activities?
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