Past MSSNY President and Past BOT Chair Art Fougner, MD Shares His Personal Journey with Cancer
My Men’s Health Story
By Arthur Fougner, MD
June is Men’s Health Month. I realize that many different awareness months are significant for various people, but this June is especially significant for one man – me. For those who don’t know, I was recently diagnosed with prostate cancer. My surgery is scheduled for next week.
Prostate cancer is the second most common cause of cancer death for men. Some have called it “man’s breast cancer” because its incidence is about the same as breast cancer. While prostate cancer does not get the press breast cancer receives, it is no less problematic for those afflicted. The controversy surrounding screening may actually be more pronounced than for breast cancer. Prostate cancer tends to hit older folks and usually is slow growing. But sometimes, it’s not.
As with breast cancer, there are some who are genetically predisposed. BRCA 2 conveys around a 20% to 40% lifetime risk of developing prostate cancer. Just my luck, I have a BRCA2 mutation. African American men also have an increased risk of developing prostate cancer as well as an increased risk of dying from prostate cancer. These cancers may actually present earlier and behave more aggressively.
Being well off is no protection as prostate cancer has taken the lives of Roone Arledge, Dennis Hopper, Gary Cooper, Merv Griffin, and Frank Zappa. Lou Costello’s straight man Bud Abbott (Hey Abbott!) also succumbed to prostate cancer.
Screening and Diagnosis
Screening is simple enough. A simple serum Prostate Specific Antigen (PSA) seems straightforward enough. Whom to screen becomes a more difficult conversation but most recommend that conversation start around age 50. The United States Preventative Services Task Force (USPSTF) does not recommend screening over the age of 70. One of my colleagues has dubbed this group the “US Prevention of Services Task Force.” Several long-term studies have not shown a significant long-term benefit of screening of men between 55 – 69 years old. I have noticed, however, that Frank Zappa was unavailable for comment.
Diagnosis is made by ultrasound directed needle biopsy. Specimens are given a score to assist in determining aggressiveness to assist in treatment. Treatment then becomes the next question. Many cancers can be followed in a regimen termed “Active Surveillance.” Definitive treatment involves either surgery or radiation.
One Physician’s Personal Story
So what’s my story? Well, when I learned I had a BRCA2 mutation, I considered myself at high risk. Periodic blood tests were fine until about 8 years ago when my level of PSA was more than twice what it had been running. Resulting biopsy revealed Atypical Small Acinar Proliferation or ASAP. Great – not cancer but not normal. MRI done had technical difficulties rendering it impossible to interpret. So, the following year brought a second set of biopsies with more samples than the standard. Again, the result was ASAP.
At this point, because PSA was now back to what it had been running, I decided to forgo more biopsies unless the PSA rose significantly again. This essentially became my version of Active Surveillance which, as I’m sure with many, was rendered somewhat more inactive with the COVID19 pandemic. In 2022, PSA was still low but in December 2023, it had jumped again – not markedly elevated but (at least to me) significantly higher than baseline. So this year brought first, an MRI and then, when MRI suggested one area of concern, another set of biopsies. This time, two samples revealed cancer with one very small area suggestive of more aggressive tumor. PET scan was then done and found no disease outside the prostate. Because the one higher risk sample was so small, my case was actually presented at tumor board where the pathologist suggested this was a tumor to treat, not to follow, I had thought the same as disease had progressed. For me, surgery seems the better option.
While awaiting surgery, I’m identifying more and more with patients’ concerns and fears.
Although I do have more than a little anxiety, I’m confident that I will be joining the ranks of cancer survivors. Guys, June is Men’s Health Month. Have that conversation with your physician. Don’t back down.
Arthur Fougner, MD is a past MSSNY President and a past BOT Chair. He currently serves as a member on MSSNY’s BOT. Board certified in Obstetrics and Gynecology, Dr. Fougner is Chief of Gynecologic Ultrasound at Northwell Health.
