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Editor's note: On October 24, 2021, James Michael Tyler died at age 59 following his battle with prostate cancer. We invite you to learn more about James' prostate cancer journey and the Prostate Cancer Foundation by going to https://www.pcf.org/james-michael-tyler.
James Michael Tyler’s Prostate Cancer Diagnosis
James Michael Tyler, who is best known for his role as the coffee shop manager, Gunther on the sitcom “Friends,” was diagnosed with prostate cancer in September of 2018. In an interview with NBC’s Today Show, James said that he was diagnosed with advanced prostate cancer before it spread to his bones. The illness was initially caught during an annual checkup.
James recalls, "I was 56 years old at the time, and they screen for PSA, which is prostate-specific antigen. That came back at an extraordinarily high number ... So, I knew immediately when I went online and I saw the results of my blood test and blood work that there was obviously something quite wrong there.”
Like many, James put off doctor’s office visits during the pandemic, noting, "I missed going in for a test, which was not a good thing. So the cancer decided to mutate at the time of the pandemic, and so it's progressed."
Currently, James Michael Tyler is undergoing chemotherapy treatments, and emphasizes the importance of how screening and early diagnosis can lead to better prognoses for others.
"There are other options available to men if they catch it before me," Tyler told NBC Today. "Next time you go in for just a basic exam or your yearly checkup, please ask your doctor for a PSA test. It's easily detectable."
What Exactly is Prostate Cancer?
Prostate cancer – the malignant growth of cells in the male prostate gland – affects approximately 11.6% of men during their lifetime.i It is one of the most common forms of cancer among men and is typically slow-growing. In the U.S., an estimated 248,530 new cases of prostate cancer are identified per yearii, with a 5-year survival rate of 97.5%. Survival rate decreases with aggressiveness of the disease.iii
Currently, there are about 3.1 million prostate cancer survivors in the United States.iv Early detection is key to survivability. The earlier prostate cancer is found and treated, the more probable a patient will remain free of the disease. Early detection can lead to better outcomes; however, for some men, one of the most common detection methods — prostate biopsy — may offer more risk than benefit.
PSA Testing and Biopsies
Prostate-specific antigen (PSA) testing is widely used as a screening tool for prostate cancer. There are some important things to note about PSA testing:
PSA is not a cancer-specific marker. As such, there are considerations regarding PSA testing:
- PSA concentrations are not definitive evidence for the presence or absence of prostate cancer
- Elevated PSA may not indicate cancer
- PSA is also present in non-cancerous conditions, such as benign prostatic hyperplasia
- PSA levels are affected by acute and chronic prostatitis, as well as by physical trauma and inflammation
PSA testing accuracy has been difficult because men with typical tPSA values will not undergo biopsy unless their digital rectal exam (DRE) is abnormal. The work-up bias tends to overestimate the sensitivity and underestimate the specificity of the test.v,vi
Typically, as PSA levels increase, so does the probability of detecting cancer.
| PSA (Hybritech Calibration) | PSA (WHO Calibration) | Probability of Cancer |
| 0-2 ng/mL | 0-1.6 ng/mL | 1% |
| 2-4 ng/mL | 1.6-3.1 ng/mL | 15% |
| 4-10 ng/mL | 3.1-7.8 ng/mL | 25% |
| > 10 ng/mL | > 7.8 ng/mL | > 50% |
However, only about 25% of patients whose PSA levels are between 4-10 ng/mL have a subsequent positive biopsy.vii,viii With biopsies being invasive procedures that may leave patients vulnerable to a number of risks, many healthcare professionals are focused on reducing biopsy-related compilations.
The Need for phi
Prostate Health Index (phi) is a simple blood test that provides better prostate cancer detection to reduce negative biopsies. The FDA-approved test is ordered under particular circumstances, such as when a patient’s PSA is in the 4-10 ng/mL range, and it combines PSA, free PSA and p2PSA tests.
Prostate Health Index results are based on a score that provides information on the probability of finding prostate cancer and providing confidence in biopsy decisions. Because phi analysis improves specificity for prostate cancer, it fills the diagnostic gap between PSA screening and a prostate biopsy.
Want to learn more about prostate cancer and phi?
