In December, after more than four years of medical monitoring while keeping his early-stage prostate cancer secret from his family, Michael Nutter had the walnut-size organ removed.
Now, fully recovered — fully, he stressed — the former Philadelphia mayor is advocating that men undergo regular screening for prostate cancer with the PSA blood test.
“Get screened!” he said during an interview on Thursday at the Center City offices of public relations executive Jay Devine. “All you have to do is give a little blood. See where you are. It’s not like they’re drilling a hole in your head.”
Nutter, 63, is aware that prostate specific antigen (PSA) screening is far more controversial than when he began doing it at age 50 in 2008. Back then, his doctor (who is also his best friend from high school) recommended checking his PSA level, so Nutter did it.
Fast forward to today. All the expert groups that issue guidelines, including the American Urological Association, acknowledge a dilemma. Studies show automatic, one-size fits all screening saves very few lives, and leads to diagnosis and treatment of many cancers that would never cause harm if left undetected. Treatment may cause permanent urinary or sexual problems, or both. The guidelines say men should be informed of the risks, as well as the benefits, before deciding what to do.
Nonetheless, Nutter believes he has an “obligation” to encourage PSA screening because of his race. Black men are about 60% more likely to develop prostate cancer during their lives, and twice as likely to die of it than white men. In terms of individual risk, 1 in 6 Black men and 1 in 8 white men are diagnosed; 1 in 23 Black men and 1 in 42 white men die of the disease.
The reasons are not totally clear, but studies have found socioeconomic status and suboptimal treatment can account for most, if not all, of the racial disparity in death rates.
“There continues to be a skepticism, a reluctance, on the part of Black people toward the medical establishment,” Nutter said. “I do want to reach out to men, but I’m hypersensitive to the disparities in communities of color. COVID-19 has, tragically, reminded us of that again. As a Black man, I have an obligation to talk about this.”
‘I didn’t want to worry them’
In 2007, Nutter won a come-from-behind victory in a field of political heavyweights by promising to clean up City Hall and avoid the ethical scandals of his predecessor and nemesis, John F. Street. Nutter led with a data-focused (some called it nerdy) approach to city management. He had an oftentimes icy relationship with City Council and labor throughout his eight years, which included the recession, the spotlight of the 2015 papal visit, and planning for the Democratic National Convention.
Since leaving office in 2016, he has been involved in education, media, public policy, political campaigns, consulting, and more.
It was in 2016 that Nutter’s PSA level, which had been under the threshold for concern, rose enough that his primary care doctor, Chris Hannum, sent him to urologist Laurence Belkoff in Bala Cynwyd. Belkoff is a managing partner of the MidLantic Urology group and on the faculty at Philadelphia College of Osteopathic Medicine and Drexel University College of Medicine.
Nutter underwent a biopsy, an ultrasound, a CAT scan, and a bone scan, then Belkoff gave him the bottom line: He had a tiny, relatively nonaggressive cancer confined to his prostate. The options, Belkoff said, were surgery or radiation. Or, they could monitor the cancer closely with frequent PSA tests and follow-up biopsies — so-called active surveillance.
“I’m working and traveling and teaching,” Nutter recalled. “I said ‘I’d like to do active surveillance.’ ”
To be sure, Nutter was leery of the potential side effects of treatment. But mostly, he couldn’t imagine taking four to six weeks off to recover from surgery, the preferred option for youngish, otherwise healthy men.
In 2018, his PSA level rose again. Nutter opted to continue active surveillance, and Belkoff concurred.
He also wasn’t ready to tell his wife, Lisa, and their grown daughter, Olivia.
“I didn’t want to worry them,” he said.
‘A good game plan’
Many experts think the race-based prostate cancer mortality disparity is a social phenomenon, not a genetic one. Still, the National Cancer Institute and Prostate Cancer Foundation are conducting a five-year study of Black men with prostate cancer to explore the roles of genetics, tumor markers, and “social stress.”
The U.S. Preventive Services Task Force, a federal advisory panel that influences health insurance coverage, says there isn’t enough evidence to make a separate, specific screening recommendation for Black men.
“The USPSTF believes that a reasonable approach for clinicians is to inform African American men about their increased risk of developing and dying of prostate cancer, as well as the potential benefits and harms of screening, so they can make an informed, personal decision about whether to be screened,” the panel wrote in its 2018 guideline update.
Nutter, who has no family history of prostate cancer, felt fortunate that his cancer was detected through screening, but he procrastinated about treatment and confiding in his family. While he attributes this to being busy (with Zoom calls since life was largely locked down) and solicitous of his family, he was also flirting with denial.
That changed last fall.
In September, feeling achy and feverish, Nutter went to the emergency room of the Hospital of the University of Pennsylvania for a COVID-19 test. It was negative. But he was indeed sick. He wound up having an emergency appendectomy — his first hospital admission since his tonsils were removed at age 17.
“I believe in signs,” he said. “I was laying there after the appendectomy. I was thinking, ‘You have this other thing that’s significant. It’s time to come to grips with it.’ ”
In October, the results of another PSA test and biopsy clinched his decision. Lab analysis showed his cancer had become more aggressive. Belkoff referred Nutter to David McGinnis, a urological surgeon who specializes in robotic prostatectomy — prostate removal surgery.
Telling his family “was the final acknowledgment that this is real,” Nutter said. “They said, ‘Well, we have a good game plan.’ Their reaction washed away any anxiety I had.”
Nutter had the prostatectomy in December. His recovery was smooth and rapid. He was back to riding his stationary bike in a month, and his PSA was so low it was unmeasurable by March.
Now, he is open to working with prostate cancer patient groups, or just talking one-on-one.
“I’m not looking to become an evangelist,” he said. “‘Hey, I survived prostate cancer’ is not going to be my opening line. But if somebody heard something about me, I’m happy to talk to them about it.”
Staff writer Julia Terruso contributed to this article.