Last Update: Wednesday, August 27, 2014

LIFELONG HEALTH- PSAs Ill-Advised in Men of Warren Buffett's Age PDF Print E-mail
Written by Dr. David Lipschitz, Creative Syndicate   
Thursday, 17 May 2012 01:46

Warren Buffett's recent disclosure that he has been diagnosed with stage 1 prostate cancer made front-page news in virtually every newspaper and business website in the nation.

The billionaire investor is 81, and questions have long been raised about who would be his successor as chief executive of Berkshire Hathaway Inc.

At his age, Buffett has an average life expectancy of 8-10 years and fortunately, the chances that prostate cancer will shorten his life are very small. The biopsies to diagnose the cancer and the adverse effects of any form of surgery, radiotherapy or chemotherapy pose a far greater risk.

Should his doctors have screened him for prostate cancer? Most experts believe that no tests should be done unless symptoms are present that suggest a problem. Buffett had an elevated prostate-specific antigen test, or PSA that suggests the presence of prostate cancer. However, the use of the PSA has come under intense fire.

In 2008, the United States Preventive Services Task Force recommended against using the test in men over 75. Their rationale was its notorious unreliability as well as the fact that PSA levels are frequently elevated in older men for other reasons. Furthermore, while prostate cancer is more common in this age group, the chances of the disease causing symptoms and shortening life expectancy are small.

Recently, the task force recommended that the PSA not be tested in healthy men of any age. While this has created some debate, virtually every expert on prostate cancer agrees that measuring the PSA level in men over the age of 65 is of no value and does not prolong life; even for younger men, the benefits are small.

The thinking now is that PSA tests should be limited to men at a high risk of developing prostate cancer, including those with a strong family history of the cancer, blacks and anyone with symptoms suggesting prostate cancer (blood in the urine, for example).

Based upon all the available evidence, there is little chance the cancer will cause Buffett to experience symptoms or lead to his death. On the other hand, the diagnostic tests and treatment may cause serious problems. Buffett has had multiple biopsies, which can cause severe bleeding and a chance of a serious infection that, on occasion, is difficult to treat. Buffett was 1 of 1 million U.S. men estimated to have had a prostate biopsy in the past year. Of those, 3 out of 12 had a cancer, but for the majority, treatment was unnecessary.

Buffett is being treated with radiation. Not only is there no evidence that his life will be prolonged or symptoms prevented, the side effects are significant. Radiotherapy can lead to incontinence, persistent blood in the urine, chronic irritation of the bowel and bladder, and a higher risk of infection and impotence.

These side effects are not rare. The Preventive Services Task Force has found that of the more than 1 million U.S. men treated by either surgery or radiotherapy or both from 1986 through 2005, about 5,000 died soon after treatment, up to 70,000 had serious complications, 500,000 men had persistent blood in the semen and about 250,000 were impotent, incontinent or both.

Only Buffett and his physician know the true extent of his disease and any decision about treatment must be jointly decided by the physician and a fullyinformed patient. For every physician who believes that screening should not be done, there are others who believe just as strongly that not doing the test or ignoring possible cancer may lead to the spread of the disease throughout the body and a painful death. While this may occur in only a very small or even a tiny fraction of patients, there are those who believe that saving a single life is worth it, no matter what.

The message is clear. Be empowered and involved in your care. Warren Buffett studies every minor detail of a company before he considers an investment. The same amount of study and understanding is needed in making a decision about a treatment that remains so disputed.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging."