Whether he’s singing Frank Sinatra at a club in Rio de Janeiro or doing handstand pushups at the Ridgedale YMCA, Andy Steinfeldt has a knack for getting people’s attention.
His performances on stage and in the gym would be impressive at any age, but the fact that Steinfeldt is 71 is what makes his active lifestyle so eye opening. It wasn’t always this way—a prostate cancer diagnosis in 2014 sparked a new zest for life. Other health complications in the years that followed strengthened his resolve to live better.
“I want to motivate people to do more than they’re doing physically,” Steinfeldt says. “But also everyone faces aging. I’m an example of someone with really high energy, doing everything I can to try to get better with age rather than let myself decline. And it didn’t happen really until I had all of these challenges.”
Steinfeldt, who lives in Minnetonka, has also taken up motivational speaking, and considers himself a crusader for healthier living and raising awareness of the common cancer that started his journey.
In the U.S., one in nine men will be diagnosed with prostate cancer in their lifetime, according to the American Cancer Society. It is the second leading cause of cancer death among men in the U.S., behind lung cancer. However, the U.S. Preventive Services Task Force (USPSTF) says the lifetime risk of dying from the disease is low—2.5 percent. And screening, the organization has found, can lead to physical and emotional harm in those who either don’t have prostate cancer, or have it but would never experience symptoms in their lifetime.
Because of a danger for false positive results, the potential for overdiagnosis and overtreatment, and possible complications, such as incontinence or erectile dysfunction, the USPSTF does not recommend screening for prostate cancer in men age 70 and older. In men age 55–69, screening is recommended only if men express a preference for it after being informed of and understanding the benefits and risks.
So what’s the best way to prevent health complications from both prostate cancer and the screening procedures used to detect it? The answer lies in individual decisions made after consulting with your doctor.
KNOW YOUR RISK
Prostate cancer begins in the prostate gland which sits at the base of the bladder, and for many patients, there are no symptoms for years—or ever, says Dr. Charles Ryan, a prostate cancer specialist at the University of Minnesota and director of the Division of Hematology, Oncology and Transplantation.
Risk increases with age, with nearly 60 percent of diagnoses occurring in men 65 and older. Another risk factor is having a father or brother with prostate cancer, which more than doubles an individual’s chance of developing the disease, according to the American Cancer Society. Inherited gene changes, like those common in breast cancer, can also raise prostate cancer risk.
Ethnicity is another factor, as prostate cancer occurs more commonly in African American men and less often in Asian American and Hispanic or Latino men.
Ryan says there might also be risk factors associated with high-fat diets. A “heart healthy” diet low in animal fats, cholesterol and sugar, and high in vegetables and nutrients is recommended. Exposure to certain chemicals, such as Agent Orange that was used in the Vietnam War, have been linked to increased prostate cancer risk as well.
SCOPE OF SCREENING
Prostate cancer screening involves a prostate- specific antigen (PSA) blood test. All men have PSA. It is a protein made in the prostate that, when prostate cancer is present, leaks out into the blood, increasing its level, Ryan says. The Prostate Cancer Foundation states that a normal PSA level for a man in his 60s is 4.5 nanograms per milliliter (ng/ml), and 6.5 ng/ml for a man in his 70s.
However, other conditions, such as an enlarged prostate or a urinary tract infection, can also increase PSA. Those false positives are part of what makes screening for prostate cancer tricky.
“One of the challenges with screening is that a positive screen generally leads to a biopsy and biopsies can lead to complications, and even the detection of cancer can lead to a therapy that may not be adapted to that patient’s risk of disease,” Ryan says.
Just hearing the word “cancer” can be difficult for patients and lead them to decisions that might not be in their best interest. That’s why one-on-one doctor consultation is so important, Ryan says.
Your doctor can take into consideration your whole health history and existing conditions, and help you decide whether screening is appropriate. And if a screen is performed, Ryan says, what’s most important is understanding the results and taking appropriate action.
“It can save lives,” Ryan says of screening. “But the decisions that are made after the screening need to be adapted to the risk that is found in the screen.”
TREATMENT OPTIONS
When a needle biopsy is performed, doctors assign a number to each of two areas that make up most of the tumor (if present). The first number represents what is most prevalent, the second shows a less prevalent part of the tumor. When added together, the numbers produce what is called a Gleason score.
A score of six is the lowest found on a prostate biopsy, and 10 is the maximum score. The score is used along with the PSA test, rectal exam and other factors to help doctors determine the best route for treatment.
When the cancer is contained in the prostate, which is the case in 95 percent of diagnoses, there are many options for a cure, Ryan says. Less aggressive cancers might require no treatment beyond active surveillance—patients can sometimes live for decades without any clinical intervention. Prostate removal through surgery is an option for more aggressive cancers, as is radiation and hormonal therapy.
If the disease is more advanced and has spread to the bone or other organs, hormonal therapy, which reduces the testosterone the cancer feeds on, is the foundation, Ryan says. Chemotherapy is used less frequently but can also be effective.
“Prostate cancer should not be treated as a single monolithic disease for which there is a uniform set of treatments,” Ryan says. “That’s the single most important factor.”
FINDING MOTIVATION
Steinfeldt was getting a routine physical in 2014 when his doctor, who had been recommending PSA testing, saw an unusual rise. A biopsy found an aggressive cancer that led to removing Steinfeldt’s prostate.
Within three years of the surgery, Steinfeldt also went through major arterial surgery in his leg following a severe clot, an appendectomy, hernia surgery, and radiation treatment for prostate cancer recurrence.
He sees all of the issues as motivators for accomplishing the unthinkable, such as a 38-minute plank he held on his 71st birthday. Planking is part of the trifecta of exercises he practices (handstand pushups and regular pushups are the other two). He also signed up for vocal lessons and started performing duets in multiple languages. He recently performed in Brazil, a favorite destination where he also spent weeks clearing his mind before prostate surgery.
“Maybe if I hadn’t had all of these challenges I wouldn’t live the way I do today,” Steinfeldt says. “It was a wakeup call. And if you don’t have something that knocks you over the head like I did, you still should recognize that life is short and do your best to maintain yourself.”