What Ben Stiller's Story Can Help Us Understand About Prostate Cancer

What he disclosed

Variety reported in November 2016 that Ben Stiller had been diagnosed with prostate cancer in June 2014. He appeared on Today with his surgeon and said he was cancer-free.

The Hollywood Reporter, covering his first public account of it that October, reported that he was 48 at diagnosis and that the cancer was described to him as "intermediately aggressive."

The details he gave are the useful part. He had no symptoms. He had no family history of the disease. The cancer was found because he had a PSA blood test as a precaution. "It's a whole new world, so you need to educate yourself," he said. "For me, it was learning what the options were." He chose to have his prostate removed.

He also talked about what that cost him. Asked about side effects, he said he had decided to get rid of the cancer and see what happened. His surgeon told Variety that men can have trouble with urination and with sexual function after treatment, and that this is not limited to surgery.

That is the whole public record used here. Nothing below describes his care.

PSA is a number, not a diagnosis

PSA stands for prostate-specific antigen. It is a protein the prostate makes, and a blood test measures how much of it is circulating.

NCI is clear that there is no single line between normal and abnormal. A level above 4.0 nanograms per milliliter is generally treated as raised, but some doctors use a lower cutoff, around 2.5, for younger men, and a higher one, around 5, for older men. The reason is that PSA drifts up with age on its own.

Plenty of things that are not cancer move the number. NCI lists prostate infection or inflammation, and a recent prostate biopsy, as causes that can keep it raised for a month or two. Hard exercise, cycling in particular, and ejaculation raise it briefly. NCI's own advice is to avoid those for two days before a test. The drugs finasteride and dutasteride, used for an enlarged prostate, push PSA down, so a "normal" result on those drugs means something different.

At 48, Stiller was young for this diagnosis. SEER data show 5.7% of US prostate cancer diagnoses are in men aged 45 to 54. The median age at diagnosis is 68.

What actually happens after a high reading

Nobody goes from one blood test to surgery. NCI describes the sequence.

A raised PSA is usually repeated in six to eight weeks, because a single reading can be a fluke. If it stays up, the next step may simply be watching: repeat PSA tests over time, plus a digital rectal exam, to see whether the number is climbing and how fast.

If it keeps rising, or the rectal exam finds a lump, more tests follow. These can be other blood or urine tests, or imaging such as MRI or high-resolution micro-ultrasound. Only then does a biopsy usually come up.

A prostate biopsy takes several tissue samples through hollow needles, guided by ultrasound. The needles go either through the wall of the rectum or through the perineum, the skin between the scrotum and the anus. A pathologist then reads the samples and assigns a grade. Our explainer on PSA screening benefits and possible harms covers what can go wrong at each of these steps.

The trade the treatment asks for

Stiller's surgeon made the point that matters most. Treatment can affect urination and sexual function, and that is true of radiation as well as of surgery.

This is why prostate cancer is argued about more than almost any other cancer. Many prostate cancers grow so slowly they would never have caused a symptom. Treating one of those cannot help the man, but it can still leave him with incontinence or erectile dysfunction. Finding a cancer that would have killed him is a different story entirely, and from the outside the two can look the same at diagnosis.

That is the reason active surveillance exists: monitoring a low-risk cancer with tests, and treating only if it changes. Our pages on active surveillance versus treatment and prostate surgery versus radiation lay out the choices.

Who is told to start the conversation earlier

The USPSTF position, which NCI summarizes, is narrow. For men aged 55 to 69, whether to have periodic PSA screening is an individual decision to be made after discussing benefits and harms with a clinician. For men 70 and older, the USPSTF does not recommend PSA screening.

Some organizations advise routine testing from 40 or 45 for men at higher risk. NCI names three groups: Black men, men with inherited variants in BRCA2 and to a lesser extent BRCA1, and men whose father or brother had prostate cancer.

When to get checked

Prostate cancer found by screening usually causes nothing at all, which is the point of screening. Symptoms are worth raising anyway:

• Trouble starting to urinate, or a weak or stop-start stream
• Needing to urinate often, especially at night
• Blood in the urine or semen
• Pain in the back, hips or pelvis that has lasted more than three weeks
• A PSA result you have never had explained to you

An enlarged prostate, which is not cancer, causes most urinary symptoms in older men. Book the appointment anyway.

What this does not mean

• One man's PSA test finding a cancer does not show that screening helps men on average. Both statements can be true at once.
• A PSA above 4.0 is not a diagnosis.
• A normal PSA does not rule prostate cancer out.
• Having no symptoms and no family history, as Stiller described, does not lower anyone else's risk.
• Nothing here says what any reader should do. The point of the USPSTF wording is that this is a decision to be made with a clinician.

Sources

• Variety, Ben Stiller Opens Up About His Prostate Cancer Diagnosis — https://variety.com/2016/biz/news/ben-stiller-opens-up-about-prostate-cancer-diagnosis-1201924879/
• The Hollywood Reporter, Ben Stiller Reveals Battle With Prostate Cancer — https://www.hollywoodreporter.com/lifestyle/lifestyle-news/ben-stiller-prostate-cancer-diagnosis-934883/
• NCI, Prostate-Specific Antigen (PSA) Test — https://www.cancer.gov/types/prostate/psa-fact-sheet
• U.S. Preventive Services Task Force, Prostate Cancer: Screening — https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening
• NCI PDQ, Prostate Cancer Treatment (Health Professional Version) — https://www.cancer.gov/types/prostate/hp/prostate-treatment-pdq
• SEER Cancer Stat Facts, Prostate Cancer — https://seer.cancer.gov/statfacts/html/prost.html

How this article was prepared

An AI-assisted editorial system helped prepare this page. No named medical reviewer has reviewed it unless one is listed.

The National Cancer Information Foundation publishes Cancer Explained. This page is for learning. It is not medical advice and does not suggest a test or treatment.

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