It's hard to apply a one-size-fits-all rule to cancer screening and treatment. Oncologists and surgeons combine results of physical exams, biopsies, PSA and Gleason scores, along with family history of longevity and the patient's own level of concern in helping their patients make decisions about whether to treat prostate cancer or monitor it.
"I believe that active surveillance is an ideal form of treatment for men with low-risk disease who have a lifespan less than 20 years, but there are older men who are healthy who develop aggressive disease for whom treatment may be necessary," Walsh said.
For men with stage 1 disease who expect to live another decade, a choice like Buffett's to undergo radiation therapy is a "perfectly fine," said Dr. Howard Sandler, chairman of radiation oncology at Cedars-Sinai Medical Center in Los Angeles. He said guidelines issued by the National Comprehensive Cancer Network of cancer centers list active surveillance, radiation therapy and radical prostatectomy as viable options for such patients.
"Radiotherapy is more likely to maintain normal urinary function and normal sexual function compared with surgery," Sandler said.
Unlike surgery, which becomes riskier with age, "radiation you can give at any age," Scardino said.
In the last five years, especially, cancer specialists and urologists have tried to convey to the American public that over-testing and over-treating have a cost and that although prostate cancer can be lethal, "it is often not," Scardino said. "That's a message we've all been trying to get out very heavily the last few years, without scaring away people who have dangerous cancers that should be treated."
A National Institutes of Health consensus statement released in December said that optimal treatment for men with early-stage prostate cancer and low Gleason scores is observation "because the majority of these men will never need to be treated," said Dr. Otis Brawley, chief medical officer for the American Cancer Society in Atlanta. "That's the basis for which many of us think that Mr. Buffett likely has a very good prognosis."
However, Brawley said, many cancer patients aren't comfortable with the idea of leaving their disease untreated.
"I've had so many patients who say, 'Goddamn it. I'm an American. I have cancer. I want to be treated," Brawley said.
"Most men will elect to get treatment. Most men under 70 will elect to get radical prostatectomy. And most men over 70 will elect to get radiation therapy. That's well documented in the United States," Brawley said. For men who have thought through their options, "I think that is a very reasonable thing."