A year ago, on his radio program, self-described cheapskate Clark Howard said he had prostate cancer.

Fortunately, he said, it was not an aggressive version and he is not getting worse. “I’m in great shape,” he said by phone today on his way to one of his Habitat for Humanity home  sites (and after a stop at McDonald’s for a Southern-style chicken sandwich. Not as good as Chick-Fil-A, he noted, but good enough.)

In fact, he has not had his prostate treated, which often involves surgery and radiation. Rather, he is using the European model of “watchful waiting.” He takes a test to check for prostate-specific antigen (PSA) count every 90 days.

From cancer.gov:

It is normal for men to have a low level of PSA in their blood; however, prostate cancer or benign (not cancerous) conditions can increase a man’s PSA level.

Clark, who is now 54 years old but looks ten years younger, said he had elevated PSA levels over the summer, enough that doctors thought his cancer had progressed. But he waited and those PSA numbers have gone back closer to normal since then.

“A lot of people have cancer that’s just not that dangerous,” he said. “It’s going to grow so ultra slowly, you’ll die of something else.” This is very different from American protocal, which he says is to “jump in with both feet. Or what we say in the military as, ‘Fire, ready, aim!’ instead of “Ready, aim, fire!’ ” (He is part of the Georgia State Defense Force.)

He will have it checked again in the spring in Los Angeles at the Prostate Cancer Research Institute, where he happens to have a cousin.  “One of the advantages of being Jewish,” he said. “My family is full of doctors and lawyers!” His cousin, he said, “is cutting edge. He was supportive of European protocol.”

Howard said he wants to avoid the potential complications of prostate cancer treatment, which is usually surgery and/or radiation. This can result in infertility or incontinence, not pleasant side effects.

In fact, he said he’s had more than a half-dozen men over the past year come to him in person and “burst into tears. They wish they had considered doing what I’m doing. They had a lot of post-treatment problems.” The biggest message he’s sent out is to get tested. (Black men should start getting tested at 40 and others, 50.)

Naturally, he said, if things really go bad, he will have treatment.

On a lighter note, he said his year-long HLN run so far has been a good fit. His ratings, while not spectacular, have been good enough and has improved when football isn’t on. “Football seems to be my biggest rival,” he noted. He’s also seen his biggest affiliate increases since before 9/11. (He’s been in syndication since 1998.)

Howard has more than 300 affiliates now who air his Monday-Friday show, up from around 200 in 2008. Many also air his “Clark Howard Minute” offerings in the morning and a few use his show on weekends. “I don’t know how much has to do with the economy and how much has to do with the TV show,” he said. Nonetheless, he considers himself “counterprogramming.”

HLN also runs his commentaries during the week so he is getting continuous exposure. It also has raised his profile nationwide. In the past, he could travel to places and go incognito outside of Atlanta. Now people recognize him all over. But he noticed that folks who only know him from TV don’t tend to approach him. Radio fans will talk to him as if he’s an old friend. “It envelops you in the car. They feel like you’re part of the family,” he noted. “TV has a certain remoteness.”

His Web site www.clarkhoward.com has also seen a massive increase in traffic. He said he actually earned more money from his Web site last year than his syndication radio deal, which also grew to record numbers.

My thoughts-

“Naturally, he said, if things really go bad, he will have treatment.”

I have no objection to surveillance, I give it as an option to every patient I diagnose with prostate cancer. But the above quote gave me pause. A 54-year-old man with probably 25 years  of life to live most probably will see his cancer advance. Certainly his diagnosis in a 70-year-old is different. This is where understanding the “years at risk” concept comes into play.

What is so striking about the quote, and I am sure he misspoke, is that it assumes the curable phase  has passed.  Obviously you don’t want to “have treatment” when things go really bad. You want to do treatment before things go really bad. Really bad in prostate cancer means out of the bag, too late for curative treatments.

What makes his decision dicey is his age and the fact that the favorable parameters of a biopsy don’t always mean what the actual situation in the whole prostate is. The surveillance mindset is trying to hold off on treatment untill it is clear that the disease is necessary. If you time it wrong, you lose. That’s the rub. I know. I have been right where he is now.

Be careful Mr. Howard.  Ps… we do surveillance in Georgia too.