Know Your Risk. Be Your Own Advocate
Matt Fish, a 47-year-old Veteran, has an important message for younger men. Know your history and risk factors for prostate cancer: if you’re over age 50, if you’re Black, or have a family history of cancer. Matt adds to that: if you’ve served in the military. And if you’re concerned, talk to your doctor about getting a PSA test. Don’t wait until you’re 50. Be your own advocate.
Matt should know. He was diagnosed with Stage 4 prostate cancer at age 45…..and he’d been getting his PSA checked since age 35. He’s convinced that if he hadn’t had those early tests, he wouldn’t be here today.
A Decade to Diagnosis
As a young man, Matt served in the Marines at Camp Lejeune, NC. Veterans who served at Camp Lejeune from 1953 through 1987 were potentially exposed to water contaminated with dangerous chemicals. Although Matt was there in 1995, outside this window, the VA has been covering his prostate cancer care. Starting at age 35, his VA doctor started checking his PSA annually. Matt didn’t know why, but he figured it was just part of the process. His PSA was high, and “a roller coaster,” bouncing between 5 and 8. (Most men under age 50 have a PSA less than 1.) His digital rectal exam results, and even an ultrasound, were normal. It was chalked up to prostatitis. Matt didn’t want a biopsy, but he made a deal with himself: if his PSA went over 10, he’d do it. A PSA test later came back as 12.
The biopsy showed cancer, Gleason score 7. Looking back, Matt recalls that he had very few symptoms: occasional severe back pain, and, just before the biopsy, problems with ejaculation. That’s why prostate cancer is sometimes called the “silent killer” – men have no symptoms until the disease is advanced.
On Treatment, Life as Normal as Possible
He had surgery to remove his prostate. Further testing of the tissue revealed that the cancer was more aggressive, with a Gleason score of 9. His lymph nodes appeared cancer-free. However, at Matt’s first PSA check after surgery, instead of being undetectable, it was 16. A scan showed one small spot of cancer in his hip: Stage 4. He started medications to lower his testosterone. The treatment is working: his PSA is checked monthly, and it remains virtually zero. The plan is for him to stay on these medicines for a year and have another PET scan. If the spot of cancer on his hip is still there, radiation to that area is a treatment option.
Today, Matt is doing well. His lives with his wife, Penny, and their two children. He stays busy with a full-time job, playing golf, and doing outdoor activities with his family. He prefers to keep his life as normal as possible. He’s got a few side effects from the hormone therapy: brain fog, fatigue, muscle aches – all manageable. The hot flashes are the worst; he keeps a fan nearby.
Stay Busy, Stay Positive
How did Matt cope with all of this? By staying busy. “Working has really helped me,” he says. Just being at home would have destroyed me. I need sense of purpose.” He stays positive, and has a strong support system with family and friends. His wife helps out by reading articles and dealing with paperwork. Matt doesn’t think of it so much as denial, but “I just don’t want it in my face.”
Cancer is a Family Issue
Matt didn’t have prostate cancer in his family, but there were other cancers on his father’s side, as well as an aunt on his mother’s side who died of breast cancer. Genes (the “instruction manual” of cells) for cancer can run in families. We now know that men may also be at increased risk of prostate cancer if they have a strong family history of other cancers, such as breast, ovarian, colon or pancreatic cancer. And a diagnosis of aggressive prostate cancer at a young age may signal increased risk of other cancers in both male and female family members. Matt has talked with family members about getting genetic testing for inherited cancer risk. (Information from this type of testing can help create a family health plan for prevention and earlier detection.)
Matt’s doctors are also planning to perform biomarker testing on his tumor tissue. These tests of the tumor’s genetic material and proteins may provide information about Matt’s specific type of prostate cancer and guide treatment in the future.
In the meantime, Matt is working to get the message out and raise awareness among men—especially younger men—to get their PSA checked. We’ll be following his story in the coming months.
One-Year Update: A Beacon of Hope for Others
More than a year ago, Matt Fish kindly shared his remarkable story with PCF. A Veteran, Matt was diagnosed with prostate cancer at age 45. After a prostatectomy, his PSA remained high, and a PET scan showed that the cancer had spread to his hip. The cancer was advanced: Gleason 9, Stage 4. He started medications to lower his testosterone: a daily oral novel hormonal therapy, abiraterone, along with Lupron shots every three months. Matt experienced side effects, but coped by keeping life as normal as possible and staying busy with work, family, and outdoor activities.
Two and a half years after his initial diagnosis, Matt has wonderful news to share. Now off hormone therapy, his energy levels are improving and he’s feeling more like himself. His PSA remains undetectable. Most recently, a PSMA PET scan showed no spots of cancer, and he is in remission!
Matt and his wife, Penny, enjoy outdoor adventures and travel.
Matt is thankful for the new developments in prostate cancer care. He describes the medication as a “game changer – my doctors kept telling me how well I was responding.” The initial PET scan he received wasn’t specific for prostate cancer, so his doctors couldn’t be as certain which spots indicated metastatic disease. Today, PSMA PET scans target a protein called prostate specific membrane antigen (PSMA) on the surface of prostate cancer cells, and can show smaller amounts of prostate cancer, with greater clarity.
Also important, Matt says, is attitude. “Sometimes, I wanted to be treated like a cancer patient. I wouldn’t be feeling well, and I wanted the sympathy. But that was rare. Mostly, I wanted to get on with my life and my daily routine—working every day, playing sports, doing yard work.” While the side effects of hormone therapy were rough at times, he recognizes that “I had it easy, compared to some other men.”
Matt has a strong follow-up plan with his doctors. He’ll continue getting his PSA checked every 3 months, tracking his PSA doubling time. If needed, he can go back on hormone therapy, or consider other options. “They’re coming out with new discoveries all the time.”
He’s feeling optimistic about the future, with good reason: having just celebrated his 20th wedding anniversary, he’s embarking on an Alaskan cruise this summer. “I want to be a beacon of hope for others and help other men know they can get through this, too. I was Stage 4, Gleason 9 – and I am doing OK.”
