Angelina Jolie and me -- a family history of cancer

I didn’t realize until now that Angelina Jolie and I have something in common: cancer. Or at least risk factors for it.

Jolie, of course, has made worldwide headlines with her dramatic op-ed Tuesday in the New York Times describing her decision to undergo a double mastectomy. And clearly, family history played a big role in her choice:

“My mother fought cancer for almost a decade and died at 56,” Jolie writes. “She held out long enough to meet the first of her grandchildren and to hold them in her arms. But my other children will never have the chance to know her and experience how loving and gracious she was.”

Jolie, who’s only 37, carries the BRCA1 gene; doctors told her she had an 87% chance of getting breast cancer herself.

As a man, I’m not so concerned about breast cancer. But that family history cloud is hard to ignore.

You see, my mother had cervical cancer in her 40s, then lung cancer (and no, she wasn’t a smoker) in her 50s. Amazingly, she “survived” both, living into her 80s, a testament, I suppose, to some good fortune and the toughness that many from the Greatest Generation possess.

My dad was diagnosed with prostate cancer in his early 70s. What the Germans couldn’t do, cancer did, but he also lived into his 80s.

My brother was diagnosed with prostate cancer at about my age. After treatment, he’s doing OK. Sadly for him, his wife died young after her own battle with breast cancer.

So I’m not a famous actor, but I know something about dreading cancer.

Interestingly, my dad was a kind of an “Angelina Jolie of prostate cancer.” Given the range of treatment options when he was diagnosed, he opted for -- gulp -- castration.

I’ll never forget the phone conversation when he told me. A young man at the time, my mind reeled at the thought of taking that drastic step. But Dad was matter of fact about it. He thought it gave him the best option for a full life. (Having taken up golf in retirement, he even joked with his playing partners that he was now entitled to use the ladies’ tees.)

And yes, I suppose you can say it worked -- until it didn’t; until the scan a few years later showed cancer in his bones. It was not an easy death.

I wish Dad were here now so we could talk about Jolie’s case; I’ll bet he would applaud her decision.

But, like Jolie, now I also wonder: What are my risk factors? What choices should I make?

I’ve had regular PSA tests for years; the one last year showed elevated levels. My doctor suggested I see a urologist. But I haven’t.

Why? Partly because of new studies showing that PSA tests are unreliable indicators. Partly because of my brother’s experience, who, though opting for aggressive treatment, now says he’s not sure he made the right choice.

Here’s what I have to go on, from the American Urological Assn.’s latest recommendations:

Men between the ages of 55 and 69 are most likely to benefit from PSA testing, but these men should weigh the benefits and harms of the test in consultation with their doctors. The association notes that 1,000 men must be screened over 10 years -- and incur the risks involved with biopsies and treatment -- in order to prevent a single death from prostate cancer.

Jolie chose to be aggressive about her breast cancer risk. Many men, faced with possible prostate cancer, will do the same. Are they wrong? Doctors’ opinions and studies are one thing; facing a condition that may kill you is, well, personal.

Me? I’ve chosen to be, OK, not complacent but practical. I’ll still have my annual physical, including a prostate exam. I’ll probably have another PSA test.

And if the levels are elevated again? I’m not really sure what I’ll do.

Although I do know one thing: Sorry, Dad, it won’t be castration.

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