What Al Roker's Openness Can Help Us Understand About Prostate Cancer

Said on air, in his own words

On November 6, 2020, Al Roker told TODAY viewers he had prostate cancer. He was 66. "It's a good news-bad news kind of thing," he said. "Good news is we caught it early. Not great news is that it's a little aggressive."

His surgeon, Dr. Vincent Laudone at Memorial Sloan Kettering, explained the reasoning on air. The cancer appeared limited to the prostate, but because it was more aggressive they wanted to treat it, and after weighing surgery, radiation, and focal therapy they settled on removing the prostate.

The operation took place on November 9, took five hours, and was done with a robot. It removed the prostate along with some surrounding tissue and lymph nodes. A week later TODAY reported that the pathology found no evidence of cancer beyond the prostate. Roker said he would have a PSA blood test in January, then every six months for five years.

He said he went public to make a point about who gets this disease, citing figures that 1 in 9 men overall, and 1 in 7 African American men, will be diagnosed in their lifetime. Everything below is about the disease, not the man.

What the PSA test is, and is not

Prostate-specific antigen is a protein made by both normal and cancerous prostate cells. The test measures how much is in the blood.

NCI is clear that there is no single cutoff separating normal from abnormal. Higher levels make cancer likelier, but no level proves it. In general a PSA above 4.0 ng/mL is treated as abnormal and may lead to a biopsy. Because levels rise with age, some doctors use a higher cutoff such as 5 ng/mL for older men and a lower one such as 2.5 ng/mL for younger men. Drugs for an enlarged prostate, finasteride and dutasteride, lower PSA, so a lower cutoff is used for men taking them.

Plenty of harmless things raise it. Prostate infection or inflammation, or a recent biopsy, can keep it high for a month or two. Hard exercise such as cycling, and ejaculation, raise it briefly; NCI advises avoiding both for two days before a test. Our page on an elevated PSA walks through what usually happens next.

If a screening PSA comes back high, NCI describes repeating it in six to eight weeks. If it stays up, the options are repeat tests with digital rectal exams, further blood or urine tests, MRI or micro-ultrasound, or a biopsy taking several tissue cores.

Who is advised to have the conversation

The US Preventive Services Task Force gives PSA screening a grade C for men aged 55 to 69. That means the decision should be individual, made after discussing benefits and harms with a clinician. For men 70 and older it gives a grade D: do not screen.

NCI notes that some organizations advise routine PSA testing from age 40 or 45 for men at higher risk. That group includes Black men, men with inherited changes in BRCA2 and to a lesser extent BRCA1, and men whose father or brother had prostate cancer. Medicare covers an annual PSA test for eligible people over 50.

NCI summarizes the evidence honestly: a meta-analysis of randomized trials found PSA screening leads to a small reduction in prostate cancer deaths over ten years. Against that sit false positives, biopsies, overdiagnosis, and treatment side effects including urinary leakage, bowel changes, and erectile problems. Our page on the benefits and possible harms of PSA screening lays both sides out.

How aggressiveness is measured

"Aggressive" is not a mood. Pathologists score the pattern of the cancer cells using the Gleason system, which AJCC translates into five Grade Groups.

Grade Group 1 is a Gleason score of 6 or less. Group 2 is Gleason 7 written as 3+4. Group 3 is Gleason 7 written as 4+3. Group 4 is Gleason 8. Group 5 is Gleason 9 or 10. The two numbers describe the most common and the next most common pattern, so 3+4 and 4+3 are not the same thing.

That number, the PSA level, and the extent of the tumor together decide whether a cancer is watched or treated. Our page on Gleason scores and grade groups explains how it reads on a report.

The numbers

For 2026 the American Cancer Society projects 333,830 new US cases of prostate cancer and 36,320 deaths. Five-year relative survival across all stages, for cases diagnosed in 2016 through 2022, is 98.2%. The median age at diagnosis is 68.

Stage at diagnosis matters enormously. About 69% are found still confined to the prostate and 14% in nearby lymph nodes; five-year relative survival for both groups is 100.0%. For the 9% found after spread to distant organs it is 40.1%. The stage tables track the same 2016 through 2022 cases.

These are group figures from men treated in past years. They describe a population and not any one man, and they are shaped by the fact that screening finds many slow cancers.

When to get checked

Screening is a discussion to have while you feel fine. These symptoms are a reason to book an appointment now:

• Trouble starting or stopping urination, or a weak stream
• Needing to urinate often, especially at night
• Blood in the urine or semen
• Pain or burning while urinating
• Persistent pain in the back, hips, or pelvis

Two age markers are worth knowing. Age 55 is where the Task Force's individual-decision range begins. Ages 40 to 45 are where several organizations suggest higher-risk men start the conversation.

What this does not mean

• One man's PSA result, grade, and outcome say nothing about another's. The same word "aggressive" covers a wide range.
• A PSA above 4.0 ng/mL is not a diagnosis. Infection, an enlarged prostate, a recent bike ride, or a recent biopsy can all raise it.
• The 98.2% five-year figure is an all-stage average across the whole US population, heavily weighted by screen-detected disease.
• Surgery is one option among several. NCI and the surgeon quoted here both describe radiation and focal therapy as real alternatives.
• Screening prevents some deaths and causes some harm. That trade-off is why the Task Force calls it an individual decision rather than a rule.

Sources

• NBC News, Al Roker reveals prostate cancer diagnosis (November 6, 2020) — https://www.nbcnews.com/health/health-news/al-roker-reveals-prostate-cancer-diagnosis-n1246751
• TODAY, Al Roker gives positive update after prostate cancer surgery — https://www.today.com/health/al-roker-gives-positive-update-after-prostate-cancer-surgery-t199377
• Memorial Sloan Kettering, NBC's Al Roker Shares Important Message About Prostate Cancer Screening — https://www.mskcc.org/news/nbc-s-al-roker-shares-important-message-about-prostate-cancer-screening
• NCI, Prostate-Specific Antigen (PSA) Test — https://www.cancer.gov/types/prostate/psa-fact-sheet
• NCI PDQ, Prostate Cancer Treatment (Health Professional Version) — https://www.cancer.gov/types/prostate/hp/prostate-treatment-pdq
• USPSTF, Final Recommendation Statement: Prostate Cancer: Screening — https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening
• SEER Cancer Stat Facts, Prostate Cancer — https://seer.cancer.gov/statfacts/html/prost.html

How this article was prepared

An AI-assisted editorial system helped prepare this page. No named medical reviewer has reviewed it unless one is listed.

The National Cancer Information Foundation publishes Cancer Explained. This page is for learning. It is not medical advice and does not suggest a test or treatment.

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