I have been asked multiple times today about Warren Buffet’s diagnosis and treatment of prostate cancer. The questions include: Why was Mr. Buffet even screened for prostate cancer? and Why would Mr. Buffet be treated for prostate cancer with radiation therapy.
Mr. Buffett has disclosed that he will undergo radiation treatment for the cancer, but he is at greater risk for harm from the treatment than from the cancer itself. Long-term side effects of radiation treatment include erectile dysfunction, frequent urination, bleeding and rarely urinary incontinence.
Let’s look at the facts: The risks of screening are greater for an 80-year-old than a 60-year-old. If a healthy 82-year-old has a life expectancy to 94, and he is informed of the potential risks and benefits, then screening might be appropriate.
The longer a man lives, the more likely it is that he will develop prostate cancer. Autopsy studies among men in their 50s (who died of unrelated causes) showed that 10 percent had prostate cancer but didn’t know it. By the time men reach their 80s, autopsies show that nearly all of men will have prostate cancer. Thus older men are likely to die with prostate cancer and not from prostate cancer.
And in older men, even when cancer is found as a result of a P.S.A. test, the cancer typically is so slow-growing that it will never cause harm, and the man will die of another cause. There is no evidence that P.S.A. testing of men 75 or older saves lives, but the test increases the risk of harm from invasive biopsies and treatments that can cause pain, impotence and loss of urine.
So what to do? If you are over age 75, have no urinary symptoms, have multiple co-morbid conditions such as heart disease, diabetes, or hypertension, you may discuss the situation with your doctor and decide not to have the PSA test. Also, if you find out that you have prostate cancer but would not undergo treatment such as surgery or radiation, then you probably don’t need to do a PSA test.
Bottom Line: This is a situation where a discussion with your doctor is important. A thought out decision is really the best decision. For more information, please go to my website, http://www.neilbaum.com