Chad Rubel was more than a little surprised when he was diagnosed with prostate cancer. At 42, Rubel was decades away from the average diagnosis age of 66. He wasn’t experiencing any of the typical symptoms, and to his knowledge, he had no family history of the disease.
“At first, I thought the worst,” says Rubel, a West Hills resident. “This was the first time I even thought about prostate cancer, and I didn’t know anything about it.”
Rubel is one of about 268,000 men who will be diagnosed with prostate cancer this year. The disease is one of the most common cancers in men — second only to nonmelanoma skin cancer, according to the Centers for Disease Control and Prevention. It affects about one in eight men, primarily those older than 50.
The prostate gland sits below a man’s bladder and is part of the male reproductive system. Typical early-stage symptoms of prostate cancer may include difficulty starting urination, frequent urination, pain when urinating, blood in the urine or semen, and pain in the back, hips or pelvis that doesn’t abate.
Photo: Chad Rubel is one of about 268,000 men who will be diagnosed with prostate cancer this year. Early detection proved crucial for him. (Photo courtesy of Chad Rubel)
Call it a hunch
Rubel’s cancer may have gone undiagnosed for years had it not been for a “hunch” by his primary care physician, Robert Yamane, MD, at UCLA Health Motion Picture Television Fund (MPTF) Calabasas, whom Rubel visited in the spring for a routine checkup and a referral for a vasectomy. In addition to the normal bloodwork, Dr. Yamane ordered a PSA (prostate-specific antigen) test.
The blood test measures the level of PSA, a protein produced in the prostate gland. A high level may indicate the presence of prostate cancer, but the diagnosis must be made by a prostate biopsy, in which tissue samples are removed for examination under a microscope.
“I was lucky that my doctor just went with his instinct and decided to add the PSA test to my blood work,” says Rubel, who is married with two young sons, ages 8 and 10. “Maybe he saw something, but I wasn’t even aware of the PSA test.”
Diagnosis confirmed
Rubel was instructed to mention his PSA results when he went for his vasectomy consultation with Christopher Saigal, MD, MPH, professor and vice chair of urology at the David Geffen School of Medicine at UCLA and member of the UCLA Jonsson Comprehensive Cancer Center. Given Rubel’s young age, his elevated PSA level concerned Dr. Saigal. He ordered a second PSA test, with similar results.
“Essentially, we try to adjust the PSA results to the person’s age,” Dr. Saigal says, noting that as a person ages, his prostate gets bigger and makes more PSA, often for benign reasons, whereas a younger man makes less PSA.
“In lab results, Mr. Rubel’s level was under 4, which is normal. But given his age and prostate size, I realized something was up,” he says.
After undergoing an MRI, Rubel next had a prostate biopsy, and the results came back conclusive for prostate cancer.
Then the question became how to treat it.
Opted for surgery
Treatment for prostate cancer varies from active surveillance — closely monitoring the cancer with regular PSA testing and biopsies — to radiation therapy or surgical removal of the prostate. There also are experimental treatments, Dr. Saigal notes, such as cryotherapy and high-intensity focused, ultrasound that are under investigation.
The treatment choice depends on the patient’s goals and tolerance for risk, Dr. Saigal says. It is always shared decision-making between doctor and patient, he adds.
“I had a long discussion with Mr. Rubel about what’s important to him — sexual health, urinary health, his concerns about the importance of getting rid of the cancer, and if recovery time was a factor. They’re all basically tradeoffs.”
Rubel opted to undergo a robotically assisted radical prostatectomy in which the prostate, as well as the surrounding tissue, is removed.
”Because of my young age I think getting it out of my system was the best course of action,” Rubel says.
Typically, after surgery, patients spend a night in the hospital and then recover at home for the next few weeks, Dr. Saigal says. He notes it’s important to monitor urinary control and sexual health recovery.
"I was lucky that my doctor just went with his instinct and decided to add the PSA test to my blood work."
Chad Rubel
“He’s ahead of the curve,” Dr. Saigal says about Rubel. “The younger you are, the better those outcomes are. It can take months for those things to come back in older men.”
A little over a month post-surgery, Rubel is starting to resume his favorite activities, including playing with his two boys.
“I’m feeling good,” Rubel says. “I just had my four-week post-op checkup, and Dr. Saigal told me some people would dream to be in my position now. I think I’m on track for a very positive outcome.”
Early detection critical
Prostate cancer is one of the most curable cancers if caught early. In fact, many men with low-risk disease live symptom-free without requiring treatment. However, once the cancer spreads from the prostate to nearby organs or the lymph nodes, it’s difficult to treat, Dr. Saigal says.
“Mr. Rubel had a high volume of disease, and it’s quite possible in a few years’ time, at the typical age of screening, his disease would not be curable. I think he really had an intervention at the right time,” he says.
Currently, the U.S. Preventive Services Task Force recommends men age 55 to 69 make an individual decision about whether to be screened after a conversation with their clinician about the potential benefits and harms.
However, there are cases when men should be screened earlier.
“The key is shared decision-making with patients,” Dr. Saigal says. “For younger men, we’re more aggressive with using PSA testing if there is a clinical suspicion, along with men with a family history of prostate cancer and certain populations, like African American men.”
For men 70 and older, the potential benefits do not outweigh the expected harms, and these men should not be routinely screened for prostate cancer, he adds.
Dr. Saigal says physicians are trying to use testing in a more intelligent way and not overtreat the disease when it’s low risk.
For Rubel, early detection proved to be life-saving.
“I’m very lucky and very grateful,” he says. “I feel like I’ve gained 30 years to my life. If we discovered this at 50, this would be a much different story.”
Learn more about UCLA Health’s prostate cancer care.
Jennifer Karmarkar is the author of this article.
