Prostate Cancer: The Second Most Common Cancer in Men Can Spread Without Symptoms, But Screening Can Save Lives

Chris French’s prostate cancer diagnosis stemmed from a pain in his knee. A remodeling contractor and competitive equestrian, French had suffered for years from joint problems related to an old martial arts injury. He was set to undergo knee replacement surgery last March, but after doing the pre-surgery bloodwork, he got surprising news from his surgeon.

“The surgeon said, ‘When we finish your knee surgery, we need to get you to a urologist. Your PSA numbers are really high,’” recalls French, now 68. PSA stands for prostate-specific antigen, a substance made by the prostate, which can appear at higher levels in men who have prostate cancer. According to the American Cancer Society, there’s no specific PSA level that indicates cancer, but a score below 4 nanograms per milliliter generally indicates a low risk, while numbers between 4 and 10 are considered borderline. French’s was 17.

French had none of the symptoms that can sometimes accompany prostate cancer, including painful urination, frequent urination or an inability to urinate. Then again, other warning signs can include pain in the upper thighs, hips or lower back — and he had those anyway from participating in cattle sorting competitions throughout the year, including at the Houston Livestock Show and Rodeo. Even when he’s not competing, he’s riding his horse, Sadie, five days a week. “I’ve got aches and pains in all those places,” he says. “If I get off the horse and I’m walking a little funny, well, that’s just because I was sitting in a saddle for too long.”

French, who lives in Pecan Grove, went to see Memorial Hermann urologist Ramesh Krishnan. Dr. Krishnan ordered a blood test that can better identify the risk of aggressive prostate cancer. When that number was also elevated, he ordered an MRI, then a biopsy. The results were worrisome: several spots that were “really not good,” French recalls. “He said, ‘I don’t even think radiation or chemo is an option at this point. I think it needs to come out.’ ”

Dr. Krishnan removed French’s entire prostate, along with some nearby lymph nodes, and sent them to a lab to make sure the cancer had been entirely removed. It had, but just in time. “It was just getting ready to spread, so we were lucky we got it right when we did,” French says. “He told me, ‘If you had come in a year later, I’m not sure what we could have done for you.’ ”

Prostate cancer is second only to skin cancer as the most common cancer affecting American men, according to the American Cancer Society, which anticipates nearly 270,000 new cases and about 34,500 deaths from prostate cancer this year. The American Cancer Society recommends PSA blood tests for men over 50 who are at average risk of prostate cancer, or as early as age 40 for men who are at high risk, especially for those with more than one close relative who developed prostate cancer at an early age.

In recent years, however, some medical organizations have advocated for less rigorous screening, partly out of concern that men were being treated unnecessarily for slow-growing forms of prostate cancer that would never have caused symptoms. The U.S. Centers for Disease Control and Prevention does not recommend screening for men over 70, for example, because they could suffer complications from cancer treatments that offer little or no benefit during their lifetime.

But for men with more aggressive forms of the disease, the benefits of screening and treatment far outweigh the risks, says Memorial Hermann urological surgeon Paul Smith.

“The recommendation for less screening has been controversial, and now I think the pendulum is swinging back the other way,” says Dr. Smith. “I think a better checkpoint is not in the screening stage, but once we get the data, it’s asking, ‘How aggressive do we need to be?’ For prostate cancer that doesn’t need to be treated, we’ll just watch it and make sure there’s no major change. I have a lot of men in my practice that I’m watching, but I also have a lot that I’ve operated on or recommended radiation for, because that’s what they needed.”

One reason to be conservative in screening and treatment is that prostate surgery and radiation have caused serious side effects in the past, including incontinence and impotence. But more targeted forms of radiation and more sophisticated surgical methods have significantly reduced those risks, Dr. Smith says. For the past year or so, he’s been using a surgical procedure called a retzius-sparing prostatectomy.

“I do the surgery totally differently from how I was taught 10 or 12 years ago. I’m coming at it from a completely different angle, so I end up not cutting a lot of structures that are important for urine control,” he says. In the past, patients would leak urine for months after a prostatectomy, and sometimes for the rest of their lives. With the new procedure, patients have complete urine control almost immediately.

“It’s made a huge difference from a urine standpoint,” Dr. Smith says. “And it’s helped with nerve sparing, too, which is how we retain erectile functioning.”

French was worried about side effects from his surgery, but didn’t feel like he had much choice given how aggressive his cancer was. He was grateful to discover that everything worked like it should after a couple months and some physical therapy. “Dr. Krishnan said he thought he’d be able to save the nerves, but he couldn’t promise anything. But he did it,” said French. “I’m just lucky and blessed.”

About 10 weeks after his surgery, French was back in the saddle.

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Ali Vise