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Summary
On episode 394 of 40+ Fitness, Coach Allan sits down with James Hill, author of Midpoint, a former content marketing professional who spent his career publishing clinical information for major hospital systems before he was diagnosed with stage three prostate cancer at 56.
Jim argues that PSA testing is caught in a decades-long controversy, and that the only way through it is for a man to own his own screening and treatment decisions instead of passively accepting whatever his doctor recommends.
The conversation walks through his actual diagnosis path: a clean rectal exam for years, a PSA that jumped from about 15 to almost 20 in six weeks, a biopsy that undersold his cancer, and the MRI that revealed he was really stage three. He and Allan cover the tradeoffs between surgery and radiation, and what recovery actually requires.
Links
- https://www.jamesahill.com
Key Takeaways
- PSA testing is controversial, but skipping the conversation is worse. Medical opinion on PSA testing has swung back and forth since the 1990s because an elevated PSA can come from BPH or prostatitis, not just cancer. Jim's position: whatever you decide, have the conversation with your doctor and own the decision instead of drifting into it.
- A digital rectal exam only reaches part of the prostate. Jim's tumor sat on the far side of the gland, out of reach of a DRE, which is why it wasn't caught until it had already grown to stage three.
- Push for an MRI before a biopsy. His first doctor called it unnecessary, and a standard 12-core biopsy found cancer in only 2 cores, understating his actual stage. Sloan Kettering later told him they would never biopsy without an MRI first, since a biopsy causes bleeding that obscures the prostate on any MRI taken afterward.
- It is fine to fire a doctor who does not respect you as a patient. Jim switched physicians when his first doctor responded to his questions with sarcasm instead of collaboration. His point: competence is not the same as being a good partner in your care.
- Surgery and radiation carry similar cure rates, so the decision comes down to your specific case. Radiation avoids removing the prostate and has fewer continence issues, but tissue changed by radiation is much harder to operate on afterward. Jim chose surgery first because his doctors gave him roughly even odds of needing radiation as a follow-up treatment.
- Recovery from a prostatectomy is a program, not a rest period. Kegel exercises before and after surgery help rebuild continence, and Sloan Kettering's injection therapy keeps tissue stretched and oxygenated while the nerves recover from what can be one to two years of dormancy after surgery.
- Fitness going into surgery changes the outcome. A prostatectomy takes four to six hours and is one of the more complicated cancer surgeries performed. Jim argues that being lean, strong, and well-conditioned beforehand speeds healing and circulation afterward, including getting you walking hospital hallways within hours of the operation.
- Cancer treatment carries a psychological cost that men tend to ignore. Jim points to shifts in identity, sexuality, and relationships as part of recovery that deserve as much attention as the physical side, and he credits leaning on his wife and a support system for getting through it.
- James's three strategies to get and stay well: lead a genuinely fit lifestyle built on eating right, exercise, and managing stress as an everyday approach rather than a reaction to stress; be a model patient by following your doctors' guidance completely and asking questions rather than resisting it; and prepare for the psychological shifts that come with treatment by surrounding yourself with people who can support you through them.
“Cancer cells are the terrorists of the human body, the weaponized bundles of angry, twisted cellular matter that have come unmoored in their restraints.”
James Hill
