When billionaire investor Warren Buffett announced on Tuesday that he had early stage prostate cancer, my fellow health journalists took to Twitter to speculate on his prognosis. National Public Radio contributor Nancy Shute tweeted, “Wouldn’t you be surprised if Warren Buffett didn’t have prostate cancer, at age 81?”
In fact, about half of men Buffett’s age have some evidence of prostate cancer -- yet only a small percentage die from it. For this reason, many men his age often aren’t treated for their cancers but are instead routinely monitored to make sure their tumor hasn’t grown, according to Dr. Philip Kantoff, head of the prostate cancer program at Dana-Farber Cancer Institute.
A government task force recommends against screening men over age 75 with the prostate specific antigen (PSA) blood test because it leads to more harms from overtreatment than lifesaving benefits. Radiation or surgery to treat prostate cancer often cause permanent erectile dysfunction and urinary incontinence.
Thus, I was surprised to hear how Buffett’s cancer was diagnosed. As he wrote in this letter to shareholders of his company, “I discovered the cancer because my PSA level (an indicator my doctors had regularly checked for many years) recently jumped beyond its normal elevation and a biopsy seemed warranted.”
He also revealed that he had a bone scan, CT scan, and MRI imaging -- all of which showed no signs that the cancer had spread -- and that he would be starting a two-month course of daily radiation treatments in July to treat his Stage 1 cancer that is “not remotely life threatening.”
Kantoff told me it’s unusual for an 81-year-old man to get regular PSA screening, and -- for those that do -- to get a biopsy if the PSA is elevated, and to undergo treatment if they’re diagnosed with an early stage cancer. Scans to look for spread aren't done routinely for non-aggressive cancers, he added, since their likelihood of finding a false positive result is higher than finding a true metastasis.
“Even if [Buffett] had high-grade, aggressive prostate cancer, his prognosis would still be excellent,” Kantoff said. Those who have stage 1 cancers have less than a 5 percent risk of dying of prostate cancer within five years of diagnosis if they get no treatment and have about a 10 to 20 percent risk of dying within 10 years, also without any treatment.
On the other hand, Buffett may be in excellent health and have a good chance of living another 15 or 20 years free of heart disease, diabetes, and other life threatening health problems. If that's the case, "it's not unreasonable to consider treatment that’s definitive" as a cure for his cancer, said Dr. Anthony D’Amico, chief of genitourinary radiation oncology at Brigham and Women's Hospital.
Age, he added, should not be used as a cut-off for screening or treatment of prostate cancer since it doesn't necessarily correlate with longevity. Rather, doctors should take the time to determine a patient's life expectancy based on his overall state of health. New tools like the Adult Comorbidity Evaluation-27 were recently developed to help oncologists take into account various health conditions like heart failure or dementia when determining a course of cancer treatment.
"If a man is 50 and not in good health, I don't think he should get PSA screening or treatment for prostate cancer," said D'Amico. "If he's 80 and in good health, however, I think he should. I don’t know Mr. Buffett’s health profile, but if his doctors made the decision to treat him, he's probably in good overall health."