There has been a recent uptick of elderly men in my primary care clinic asking about prostate cancer, perhaps because they heard of Warren Buffett’s recent prostate cancer diagnosis and his proposed treatment.
Patients are wondering if they should also be screened. Other patients who already have been diagnosed are wondering if they should receive radiation treatment for their prostate cancer, as Buffett is planning to do. It is very important to remember that what’s right for Buffett may not be right for everyone else.
According to Buffett’s letter to shareholders, his prostate-specific antigen (PSA) had been “regularly checked for many years.” A sudden jump in his PSA level led to a prostate biopsy and cancer diagnosis. But should an 81-year-old man even be screened for prostate cancer?
The evidence says no. The U.S. Preventive Services Task Force, an independent panel of non-government clinicians providing data-based practice guidelines, recommends against prostate cancer screening for healthy men. Studies over the years, which have included participation of more than 300,000 men of various ages, have failed to show prostate cancer screening saves lives.
“If there is significant benefit, it should have been apparent by now, and it is not,” said Virginia Moyer, chair of the task force.
The guidelines of other organizations, which are not as stringent as those suggested by the task force, also question Buffett’s routine prostate cancer screening. For instance, the American Cancer Society and American Urological Association both recommend that doctors discuss the pros and cons of prostate cancer screening with men whose additional life expectancy exceeds 10 years. Even by that measure, screening Buffett — who can expect to live another eight years, based on actuarial data from the Social Security Administration — is questionable.
According to his letter, Buffett was diagnosed with Stage 1 prostate cancer, meaning the cancer had not spread beyond the prostate. The prognosis is generally excellent for this early-stage cancer, and for many men, just monitoring the cancer to ensure it doesn’t spread is proper. More aggressive treatments are available, including surgery and radiation therapy, which Buffett plans to undergo. The problem with these options is that the treatment may be worse than the disease.
The fact is, 75% of men over the age of 80 have cancer cells in their prostate, but in elderly men cancer grows so slowly that the men are much more likely to die of something else.
Moreover, for all men, prostate tests are not sophisticated enough to determine which of these cancers are dangerous and which are not. Without knowing, most men opt for treatment. But for every 1,000 men treated for prostate cancer, five will die of complications from surgery. Side effects of both SURGERY and radiation can include impotence, incontinence and frequent urination — all for a disease that, at Stage 1, has less than a 1% chance of causing death in the next 10 years.
The annual cost of PSA testing contributes $3 billion annually to health care spending, much of it paid for by Medicare and the Veterans Administration, without significant health benefits. In fact, Richard J. Ablin, the scientist who discovered PSA, calls its widespread use a “public health disaster.” Buffett’s high profile cancer coverage should have been an opportunity to educate the country that, for many, more conservative options would not only save them from harmful, unnecessary treatments, but also potentially reduce health costs.
Instead, some may view Buffett’s decision to screen for prostate cancer and aggressively treat it as the right thing to do. I’m not second-guessing the approach taken by Buffett and his medical team. And I also understand that some men would rather know their prostate cancer status and accept the risks of too much testing. but we should realize that Buffett’s prostate cancer path isn’t necessarily the right road for every man.
Kevin Pho is co-author of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices. He is founder and editor of KevinMD.com, also on Facebook, Twitter, Google+, and LinkedIn.