Francis S. Collins, MD, PhD, a renowned physician-geneticist and former director of the NIH, revealed he has prostate cancer.

In a perspective piece published in the Washington Postopens in a new tab or window, Collins said he went public to “share lifesaving information, and I want all men to benefit from the medical research to which I’ve devoted my career and that is now guiding my care.”

Collins, 73, explained that 5 years ago his doctor had noted a slow rise in his prostate-specific antigen (PSA) level. A targeted biopsy then identified he had a slow-growing cancer and he was referred to active surveillance.

However, a month ago, his PSA level shot up to 22 ng/mL, well above the normal level of 5 ng/mL for an individual his age. An MRI showed that the tumor had significantly grown, and new biopsies showed that it had transformed into a much more aggressive cancer, with a Gleason score of 9.

Thus, a PET scan ordered to determine if the cancer had spread beyond the prostate “carried high significance,” he wrote. “Would a cure still be possible, or would it be time to get my affairs in order?”

He noted that the 5-year survival rate for prostate cancer that has metastasized to other parts of the body is just 34%.

Fortunately, the scan showed the cancer had not spread outside the primary tumor, and he is scheduled to undergo a radical prostatectomy, which his doctors said has a high likelihood of being curative.

Collins said that advances in research and technology — like high-resolution MRI that can detect the exact location of a tumor, or the robotic surgery he’ll be undergoing that is less invasive than previous surgical approaches — mean that prostate cancer can now be treated with “individualized precision and improved outcomes.”

“Having now received a diagnosis of aggressive prostate cancer and feeling grateful for all the ways I have benefitted from research advances, I feel compelled to tell this story openly,” he wrote. “I hope it helps someone. I don’t want to waste time.”

Early detection really matters, he added, and when combined with active surveillance, can identity those high-risk cancers like his, while leaving others alone.

However, he also observed that current screening guidelines can leave men and their physicians confused.

The U.S. Preventive Services Task Forceopens in a new tab or window (USPSTF) 2018 recommendations suggested that men ages 55 to 69 discuss PSA screening with their physicians, but advised against screening once men hit the age of 70. This was a change from the 2012 guidelineopens in a new tab or window in which the USPSTF recommended against PSA screening entirely — a policy that has been linked with a rise in the incidence of advanced prostate cancer in the U.S.opens in a new tab or window

On the other hand, the American Urological Association and Society for Urologic Oncologyopens in a new tab or window suggest that screening should begin earlier — especially for men like Collins with a family history of prostate cancer, and African-American men who have a higher prostate cancer risk.

Collins’ decision to disclose his diagnosis was met with praise by members of the healthcare community.

“Francis Collins’ bravery in revealing his prostate cancer diagnosis inspires us all,” said Ellen Sigal, PhD, chair and founder of Friends of Cancer Research, in a statement. “His dedication to health and medical research has touched countless lives, and I am confident that his strength and resilience will guide him through this journey. We, and millions of patients whose lives he has changed, stand with him in support and hope, ready to fight alongside him.”

HHS Secretary Xavier Becerra, said that “Dr. Collins has saved millions of lives and inspired generations of doctors and scientists in his career. For him, an obstacle is but an opportunity to teach. He has always sparked confidence in humankind’s ingenuity to defeat our Goliaths. Prostate cancer will soon learn that lesson, I’m sure.”

https://www.medpagetoday.com/hematologyoncology/prostatecancer/109646