Al Roker Diagnosis: Prostate Cancer Most Common Type for Men in U.S.

• Al Roker announced last week he has prostate cancer.
• About 1 in 9 men in the United States will receive a prostate cancer diagnosis in their lifetimes.
• Roker will undergo robotic-assisted surgery to treat the cancer.

Al Roker, the “Today” show’s popular weatherperson since the 1990s, has announced he’s battling prostate cancer and will undergo surgery to have his prostate removed.

“It’s a good news, bad news kind of thing,” Roker said on the Nov. 6 broadcast. “Good news is we caught it early. Not great news is that it’s a little aggressive, so I’m going to be taking some time off to take care of this.”

According to Roker, this began with a routine physical that found he had elevated prostate specific antigen (PSA) in his blood. This was followed by an MRI and biopsy. His diagnosis was confirmed at the end of September.

Prostate cancer is the most common cancer in men in the United States. About 1 in 9 men will get a prostate cancer diagnosis in their lifetimes.

Dr. Vincent Laudone of Memorial Sloan Kettering Cancer Center will perform the robotic-assisted surgery for Roker sometime next week.

“Fortunately, his cancer appears somewhat limited or confined to the prostate,” Laudone said on “Today.” “But because it’s more aggressive, we wanted to treat it, and after discussion regarding all of the different options — surgery, radiation, focal therapy — we settled on removing the prostate.”

Roker is at higher risk due to age and race

“African American men tend to get cancer at an earlier age, have more aggressive prostate cancer at an earlier age,” said Dr. Brian Norouzi, a urologist with St. Joseph Hospital in Orange County, California. “That, however, shouldn’t bring any extra challenges to the treatment, but not knowing the specifics of Mr. Roker’s cancer, could lead to potentially lower cure rate.”

According to the Prostate Cancer Foundation (PCF), African American men have a greater risk for developing prostate cancer and aggressive disease. More research is needed, but the PCF says this is possibly due to socioeconomic or genetic factors.

The PCF recommends African American men begin to speak with healthcare providers about the risk by 40 years of age.

What type of prostate cancer does Al Roker have?

Dr. Louis Potters, deputy physician-in-chief at Northwell Health Cancer Institute in New York, explained that one option for men with a diagnosis of prostate cancer is active surveillance, a form of observing and seeing what happens with the disease over time.

He said this means between 60 and 65 percent of men never need to be treated for prostate cancer.

“We don’t know what type Mr. Roker was diagnosed with,” Potters said. “But we have clues, which I believe they addressed on air.”

Since Roker made a comment that his disease wasn’t eligible for active surveillance, Potters is inclined to say that he has a high-risk type of the disease.

“We do know that the incidence of disease is higher in African Americans as a whole, but that overall the prognosis in an African American is worse,” Potters said.

Potters explained that, while all surgeries present a level of risk, Roker’s surgery is actually routine and the risk is quite small.

“He is going to undergo a robotic-assisted radical prostatectomy,” Potters said, “which is a surgical procedure to remove the prostate and seminal vesicles as well as the surrounding lymph nodes. It’s the complete physical removal of the prostate.”

He noted the surgery usually has minimal recovery.

Further treatment depends on what doctors find out

“The need for what we would refer to as adjuvant or salvage treatment after surgery is something that we would determine based on two factors,” Potters said.

One of those factors is the discovery of the cancer in the pathology report that’s obtained by examining the prostate after it’s been removed. This will provide additional information about the stage, grade, and risk of recurrence that could need secondary treatment.

“And what we’ve learned most recently is that in general men don’t need to rush into a second or adjuvant type of treatment until there’s a sort of proof that the disease is still a little bit active,” Potters said.

The other factor is the results of further PSA tests after surgery.

“PSA is used after surgery, whether PSA should go to zero and stay there, and if it’s not, then there is some disease that may warrant adjuvant treatment that could include radiation, hormone therapy, or a combination,” Potters said.

Surgery not the only option

According to Norouzi, many cancer centers use a set of guidelines called the National Comprehensive Cancer Network (NCCN) guidelines.

Those guidelines list two types of treatments: One is surgical removal of the prostate, and the other is a form of radiation therapy.

“Now there are many forms of radiation therapy, but there are also other forms of treatment that aren’t listed on those guidelines,” Norouzi said.

“Like cryosurgery or freezing of the prostate and HIFU, which is an acronym for high-intensity focused ultrasound, and that is a minimally invasive treatment that’s used to treat prostate cancer but has not yet been [FDA] approved for prostate cancer,” he said.

Radiation or surgery: Both carry risks

Norouzi explained there are reasons why someone might choose one or the other, but that the cure rates are “fairly equivalent to radiation therapy and surgical removal of the prostate.”

However, “each treatment has their own set of unique risks.”

Norouzi said for prostate cancer treatment, these include problems holding urine and the inability to maintain an erection.

On the other hand, radiation treatments “tend to cause problems, such as diarrhea that doesn’t go away, bowel obstruction, and sometimes some bleeding from the intestines and urinary tract.”

Radiation therapy also presents another, far more serious long-term risk.

“Radiation can have a long-term side effect of causing other types of cancer, like intestinal cancer, and bladder cancers,” Norouzi said.

“So, the younger a man is, the more likely they are to choose a treatment like surgery so they’re not subjected to that long-term risk of secondary cancers,” he said.

The bottom line

Al Roker, well-known co-host and weatherperson on the “Today” show, has announced he has prostate cancer.

Experts say Roker’s age and race place him at greater risk for the disease and a poorer outcome after diagnosis.

However, Roker said it was caught early, and he will soon undergo surgery to remove his prostate, so his outlook should be good.

Experts add that Roker had a choice of either surgery or radiation therapy, both of which carry their own unique risks, but his age likely influenced the decision to go ahead with surgery.

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