Desmond Tutu and Prostate Cancer: A Voice for Awareness

What Desmond Tutu made public

Desmond Tutu was diagnosed with prostate cancer in 1997. It came midway through South Africa's Truth and Reconciliation process. NPR reported that he was treated successfully at the time. He disclosed a recurrence in 2005. NPR noted it did not visibly slow his schedule until he retired.

He was in and out of hospital in 2015 and again in 2016 for minor surgery. The aim was to clear a persistent infection linked to his cancer. He died in Cape Town on December 26, 2021, at 90. Al Jazeera reported the death as following a long period with prostate cancer and infections.

That is the record. His medical decisions were his own, and this article does not judge them. His 24 years with the diagnosis do point at something unusual about this cancer. It is often a condition men live with for a very long time. And the hardest questions about it are not about treatment. They are about testing.

What the prostate is, and what usually grows there

The prostate is a gland that sits below the bladder and wraps around the urethra, the tube urine passes through. That position explains most of the symptoms.

The National Cancer Institute states that more than 95% of primary prostate cancers are adenocarcinomas. That means they start in gland cells. NCI also notes these tumors are often multifocal, with several separate spots in the same prostate. They are heterogeneous too, so different areas can look different under the microscope.

When to get checked

NCI lists these as signs to raise with a doctor:

• Trouble starting the flow of urine.
• Frequent urination, especially at night.
• Trouble emptying the bladder completely.
• A weak or interrupted, stop-and-go stream.

For advanced disease, NCI adds lasting pain in the back, hips, or pelvis. It also adds signs of anemia: breathlessness, fatigue, fast heartbeat, dizziness, or pale skin.

There is a large catch. As men age, NCI notes, the prostate often enlarges and presses on the urethra. That condition is called benign prostatic hyperplasia, or BPH. BPH is not cancer, but its symptoms look much like prostate cancer's. That overlap is why symptoms alone cannot settle the question.

Practical guidance:

• New or worsening urinary symptoms after age 50 are worth an appointment, mainly to sort BPH from anything else.
• Bone pain in the back, hips, or pelvis lasting weeks, in a man with a prostate cancer history, should be reported promptly.
• Blood in the urine or semen always needs a check.

The screening question, stated honestly

Most prostate cancers in the United States are found by testing, not by symptoms. NCI says so, and adds that screening is controversial.

The tests are a prostate-specific antigen blood test and, less often, a digital rectal exam. PSA is a protein made by the prostate. NCI notes that infection, inflammation, or BPH can also raise it. A high result is not a diagnosis.

NCI's summary of the evidence is blunt. Randomized trials have produced conflicting results. Systematic reviews and meta-analyses report no clear evidence that screening lowers the risk of dying from prostate cancer, or that the benefits outweigh the harms.

The U.S. Preventive Services Task Force split the question by age in its recommendation of May 8, 2018. For men aged 55 to 69 it is a grade C. The decision to have periodic PSA screening should be an individual one, made after discussing benefits and harms with a clinician. For men 70 and older it is a grade D, meaning USPSTF recommends against PSA screening.

The listed harms are concrete. False positives lead to more testing and possibly a biopsy. Overdiagnosis and overtreatment happen. Treatment complications include incontinence and erectile dysfunction.

The overdiagnosis problem, in one number

Here is the fact that makes prostate cancer different from almost every other cancer.

NCI reports that clinically indolent tumors, meaning tumors that would never cause harm, are estimated at 30% to 70% in men older than 60. That estimate comes from autopsy studies. Men who died of something else were found to have prostate cancer nobody knew about.

NCI states the consequence plainly. Many patients, especially those with localized tumors, may die of other illnesses without ever being disabled by prostate cancer. That holds even when the cancer is managed conservatively, with no attempt at cure.

This is why active surveillance is a real option, not a polite word for doing nothing. It means monitoring with PSA tests, examinations, imaging, and repeat biopsies. Treatment starts only if the disease shows signs of progressing.

How the grade is decided

If a biopsy finds cancer, the pathologist assigns a Gleason score. NCI describes the system: patterns are graded from 1, well differentiated and closest to normal, to 5, very poorly differentiated. The classical score adds the two most common patterns, giving a total from 2 to 10.

The order of the two numbers matters. NCI notes scores are often reported as separate components, so a Gleason 3 + 4 = 7 is not the same as a 4 + 3 = 7. In the second, the more aggressive pattern is the dominant one.

NCI also flags a wrinkle worth knowing. Over time, pathologists have tended to give higher Gleason scores to the same tissue patterns. That is called grade inflation. When slides from men diagnosed between 1990 and 1992 were re-read a decade later, the newer scores averaged 0.85 points higher.

What the numbers describe

These are group statistics. They do not describe any individual man.

SEER's page carries an American Cancer Society projection of 333,830 new prostate cancers in the United States in 2026, about 15.8% of all new cancer diagnoses, with 36,320 deaths. Five-year relative survival across all stages is 98.2% for men diagnosed from 2016 to 2022. Prostate cancer is most often diagnosed between ages 65 and 74, and NCI puts the median age at diagnosis at 68.

Stage drives the difference. SEER records five-year relative survival of 100.0% for localized disease and 100.0% for regional disease, falling to 40.1% for distant disease. About 69% of cases are found localized and 9% are distant at diagnosis.

NCI also notes that the rate of tumor growth varies from very slow to moderately rapid, and that some men live a long time even after the cancer has spread to distant sites such as bone. Tutu lived with the diagnosis for 24 years.

That last sentence is a fact about one man, not a forecast for anyone else. The transferable part is smaller. With prostate cancer, the first real decision is usually whether to test at all. That decision belongs to a conversation, not a reflex.

Sources

• NCI: Prostate Cancer Treatment (PDQ) — Health Professional Version
• NCI: Prostate Cancer Treatment (PDQ) — Patient Version
• SEER Cancer Stat Facts: Prostate Cancer
• USPSTF: Prostate Cancer Screening, final recommendation, May 8, 2018
• NPR: Desmond Tutu dies
• Al Jazeera: Obituary — Desmond Tutu, South Africa's 'moral compass'
• American Cancer Society: Cancer Facts & Statistics