BY MARK SCHOLZ, MD
This announcement reveals the lack of progress in general public understanding of the unique nature of prostate cancer. People still have not learned that when the condition is newly-diagnosed it almost always means that even in the worst case scenario, cancer mortality will be postponed for at least 10 years, if not indefinitely.
Other news releases have indicated the Mr. Buffett is planning to undergo radiation, probably IMRT. IMRT cure rates range between 80 to 100% depending on specific individual factors such as Gleason score, PSA and how many biopsy cores contain cancer, details that have not, in Mr. Buffett’s case, been made available.
The real question is: Considering that Mr. Buffett is 81, does he require radiation? Getting cured sounds like a no brainer until you realize that his chance of dying is incredibly small even if he skips radiation altogether. And even with modern radiation there is a risk of permanent damage to sexual, urinary and rectal function.
Why is his risk of dying so small? Prostate cancer has a unique Achilles heel. It needs a continuous supply of the male hormone testosterone to survive, without it prostate cancer shrivels and dies.
Pharmaceutical agents that block testosterone constitute an amazing safety net. With this safety net in place, an 81-year-old man has the option of monitoring his status rather than feeling obligated to rush to immediate curative treatment, as would be the case with other types of cancer.
If, while monitoring the situation, it appears that the disease is growing quickly, radiation can be administered at that juncture. After all, even if the very worst scenario ensues and the disease metastasizes—jumps to another part of the body—testosterone inactivating pharmaceuticals can suppress the disease for an average of more than ten years.
Mr. Buffett has become famous for his wise capacity to make successful long-term investment decisions. Rather than relying on the expertise of others he should apply some of his energy and talent toward researching his medical situation further. He might conclude that the risk of spending his twilight years with radiation-induced urinary or rectal damage is far greater than the risk of early mortality from prostate cancer.