In his message to Berkshire Hathaway shareholders earlier this week, Warren Buffett wrote, "My doctors and I have decided on a two-month treatment of daily radiation" for his just-diagnosed stage I prostate cancer.
While the rest of the world does not know all the specific details about Mr. Buffett's health and the considerations that contributed to that decision, it is highlighting a debate over whether someone in Mr. Buffett's position should be treated at all.
Radiation treatments for prostate cancer can have significant, negative long-term side effects. Tara Parker-Pope writes in the New York Times "Well" blog that they include "erectile dysfunction, frequent urination, bleeding and incontinence."
On the other hand, she writes, for older men "the cancer is typically so slow-growing that it will never cause harm, and the man will die of another cause."
As a result, some patients are at "greater risk for harm from the treatment than from the cancer itself."
ABC News quotes Dr. Peter Scardino at New York's Memorial Sloan-Kettering Cancer Center as saying, "Generally, in a person over 80 years old, you'd be very hesitant to treat a prostate cancer unless it's clearly life-threatening. Doctors caution men [that] at that age prostate cancer is very common. Most of the time it's not dangerous to their life or health."
He hopes that Buffett's high-profile decision doesn't encourage other men to "assume that must be the right treatment and it must be good for me."
Dr. Scardino acknowledges that he can't make judgments about Mr. Buffett's own situation, especially without knowing some key data like his PSA level and Gleason score, which measures how likely it is that an abnormal tissue will spread.
Still, he says, "the burden would be on the physician to show why immediate treatment is needed for a stage I cancer in an 81-year-old man."
The main alternative is a "watchful waiting" strategy in which men with early-stage prostate cancer are closely monitored but do not start treatment unless there is evidence the cancer is growing.
The debate over treatment also extends to whether men should even be routinely screened for prostate cancer.
Mr. Buffett wrote that his condition was discovered after a regular test showed his PSA level "jumped beyond its normal elevation." That led to a biopsy, CAT and bone scans, and an MRI.
Concerns about the risks of treatment have prompted a government health panel, the United States Preventative Services Task Force, to recommend that men above 75 should not routinely receive a PSA blood test.
That recommendation is controversial, facing opposition from some doctors, and from groups representing prostate cancer survivors. It is also criticized by some in the political realm as a subtle form of health care "rationing."
For one expert quoted by the Boston Globe, age shouldn't be a cut-off point for screening or treatment.
Dr. Anthony D’Amico, chief of genitourinary radiation oncology at Brigham and Women's Hospital in Boston, tells the Globe that if a man is in excellent health and has a good chance of living another 15 or 20 years, "it's not unreasonable to consider treatment that's definitive" as a cure for his cancer. "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."
Dr. Howard Sandler, chairman of radiation oncology at Cedars-Sinai Medical Center in Los Angeles, tells ABC that for men with stage I disease who expect to live another 10 years, choosing radiation therapy is "perfectly fine."
A patient's emotional response to knowing he has prostate cancer can also play a role in the decision to treat or not treat. ABC's story quotes Dr. Otis Brawley, chief medical officer of the American Cancer Society as saying, "I've had so many patients who say, 'Goddamn it. I'm an American. I have cancer. I want to be treated."
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