Is the Prostate Cancer Plot on 'And Just Like That' Realistic?

Time​ Magazine

9 hours ago

On this season of And Just Like That…, Harry Goldenblatt couldn't help but wonder if his health had taken a turn. On the June 26 episode of the show, Charlotte's affable husband goes from wetting his pants in a nightclub to joining a club he'd rather not be part of—even though, as he points out, it also includes Robert De Niro, Warren Buffett, and Nelson Mandela.
During an evening walk past the Guggenheim Museum, Harry tells Charlotte there's a reason he asked her to go for a stroll. 'To get away from the kids? Me too,' she quips. Not exactly: Because of a couple strange symptoms he'd been experiencing, Harry decided to go to the doctor for a check-up. 'What do you know? I got prostate cancer,' he tells his wife, who immediately dissolves into panicky fear. 'Everything is going to be fine,' he reassures her. 'We caught it early.'
Charlotte might not be happy about Harry's news, but some experts are pleased with the development. 'I'm ecstatic about this plotline, because the awareness and discussion around prostate cancer is often hidden,' says Dr. Phillip Koo, chief medical officer at the Prostate Cancer Foundation. 'Men don't like talking about it—I think we often put up that tough shell on the outside, especially when it involves the sort of organs that men define their masculinity based on. I think it's wonderful we're raising awareness.'
Still, that doesn't necessarily mean the show's depiction is accurate. We asked experts how realistic Harry's experience is—and what they want men to know about prostate cancer.
Creative liberties
Harry went to the doctor after experiencing two symptoms (played for cringey laughs from viewers). Earlier in the season, he hits the clubs with Charlotte, who's trying to finagle an art sale for the gallery she manages. As the group plots their move to an after-party, Harry makes a pit-stop at the bathroom, where he finds, much to his horror, that he can't undo his fancy jeans quickly enough. 'Oh boy, oh boy,' he mutters. 'These buttons! Why so many?' And just like that, Harry pees in his pants. 'It's a good thing these babies are so dark,' he says to Charlotte when he meets up with her again. 'You can't tell they're soaked.'
Then, in the next episode, Harry has trouble performing in the bedroom with Charlotte. As he wonders in exasperation what is—or, he clarifies, isn't—"going on down there,' he bemoans how out-of-character this is for him. 'Is this it? The beginning of the end?' he spirals. 'Knock knock, who's there? Old age!'
Read More: Why Some Men Keep Their Prostate Cancer a Secret
Cut to the latest episode, and Harry has been diagnosed with prostate cancer based on those symptoms. 'There's definitely some creative liberties the show has taken,' says Dr. Julia Willingham, a urologist who treats prostate cancer patients at Texas Oncology. 'It makes sense—it helps drive the plot forward—but most early-stage prostate cancer has no symptoms at all.' That's why some people call the disease—which will affect more than 313,000 men in the U.S. in 2025—a silent killer. It's almost always detected via a routine prostate-specific antigen (PSA) test, a screening blood test that most men undergo every couple of years or so starting around age 50 for those with average risk. (Exact screening frequency depends on a person's age and risk factors.)
When a man's PSA level is high, doctors typically do a biopsy and, potentially, tests like a CT scan or bone scan to confirm the diagnosis. 'Sometimes men say, 'Oh my gosh, I feel great,'' Willingham says. ''There's no way I can have prostate cancer. I have no symptoms.' And then they do.'
A more likely path to diagnosis
Before the PSA test was approved as a diagnostic tool in 1994, men were more likely to figure out something was wrong because they were experiencing urinary retention, rather than Harry's incontinence. That can mean difficulty starting to pee, a weak stream, trouble fully emptying the bladder, or sometimes, an inability to pee at all. 'The prostate is in a very busy neighborhood,' says Dr. Mark Pomerantz, clinical director of the Lank Center for Genitourinary Oncology at Dana-Farber Cancer Institute. 'It sits right under the bladder and the urethra—and if there's a large prostate tumor, in theory it could press against that tube and cause urinary retention.'
Other times, men were diagnosed because their prostate cancer spread, leading to symptoms that affected other parts of the body. 'Prostate cancer loves to go to bone,' Pomerantz says. 'It was not uncommon, prior to PSA testing, for people to show up in the emergency room with terrible back pain.' There, they'd get an X-ray that ultimately led to a diagnosis of metastatic prostate cancer that had spread to the bones in their back. 'We don't see that nearly as much anymore now that we have a test that can catch the cancer early,' Pomerantz says. 'When it does cause symptoms, typically the disease is pretty far along.'
That means, if Harry were a real-life patient, there'd be reason to believe his disease was advanced. 'It could still be local'—which means it hasn't yet spread beyond the prostate—'but it would take a tumor that's pretty far along to get to the point where it would cause those symptoms.'
Read More: The Race to Explain Why More Young Adults Are Getting Cancer
Overall, Harry's path to diagnosis is 'possible, but certainly not typical,' Pomerantz says. That said, he understands why the show's creators probably chose to highlight urinary incontinence and erectile dysfunction. 'Those side effects are famously common consequences of prostate cancer treatment, but are rarely the symptoms that lead to diagnosis.'
Sometimes, doctors recommend active surveillance, or watchful waiting. But if a man's cancer is aggressive, doctors typically take the prostate out, and that's when side effects enter the picture. 'The way the surgery works is the whole prostate has to come out, and when you remove the prostate, you must remove the part of the urethra that runs right through the middle of the prostate,' Pomerantz says. 'The surgeon takes the remaining urethra that's still in the body and drags it up and sews it into the bottom of the bladder to make a new connection. That connection can be a little fragile.' Urine might have an easier time getting through, for example, which can lead to leakage. Plus, there are critical nerves that run alongside the prostate and are in charge of the sphincter muscle, which closes the bladder and keeps urine contained. 'If those nerves get damaged in surgery, then you can have the side effects that were depicted in the show,' he says.
A natural reaction
Throughout the episode, Charlotte—who promised Harry she wouldn't tell their kids about his diagnosis—struggles to contain her emotions. During a pre-planned glamping trip, she repeatedly snaps at her kids about the importance of savoring every moment together, and appears on the verge of an emotional breakdown. That's a natural reaction, experts say.
'Everyone always talks about the C word,' Koo says. 'I think your mind automatically jumps to the worst scenario, and the impact it will have on your life expectancy.' Many men worry about how they'll continue working—and the impact their disease will have on their family's finances. 'Someone like Harry, who has young kids, might wonder: 'How am I going to support them?''' he says. 'It's devastating,' no matter how optimistic the prognosis.
A welcome spotlight
Experts hope Harry's diagnosis encourages more men to get screened. 'Men should not be afraid of prostate cancer screening,' says Dr. Jamin Brahmbhatt, a urologist at Orlando Health. 'It's a simple blood test, just like you're getting your cholesterol checked.'
Prostate cancer is one of the most common diagnoses among men, he adds, and it's also very treatable, especially when caught early. More men die with the disease than of it. 'It's not like some of those other rare cancers,' he says. 'The more we get screened, the healthier we can get people.'
Read More: Why Are So Many Young People Getting Cancer? It's Complicated
Willingham has seen an increasing number of men come in proactively for screening, and she believes knowledge is power. That's why she applauds Harry's new storyline. 'If anything, we should take this as encouragement to get those annual checks in, to take care of ourselves, and to know what's going on,' she says. 'Cancer aside, if you're having urinary or sexual symptoms, go talk to your doctor, because these are things that we can handle and take care of—you don't have to suffer with these symptoms.'