Warren Buffett announced Tuesday that he has stage 1 prostate cancer and that doctors have begun treating it with radiation. Buffett is 81 and, at that age, it would be more surprising if he didn’t have it. A full 80% of men older than 80 have some form of prostate cancer, according to the National Cancer Institute, but many or even most of them do not know it. Even if they do know, in many cases, the tumor is progressing so slowly that it doesn’t need treatment. Instead, doctors simply monitor to make sure that it doesn’t begin progressing too rapidly, a process known as watchful waiting or active surveillance.
Stage 1 is the earliest and mildest form of prostate cancer. Generally, tumors are so small that they are difficult to detect. They cannot be felt in a digital rectal exam and they do not show up on a typical imaging examination. The first sign that they are present is an above-normal score on a PSA (prostate-specific antigen) test. Their presence then can be confirmed by an ultrasound-guided biopsy; typically, the urologist will remove 12 samples. If only one or two show the presence of a tumor and the cancer cells are not particularly aggressive, the doctor typically will recommend active surveillance, according to Dr. Marc Botnick, a radiation oncologist and medical director of Vantage Oncology in Sherman Oaks. If the tumor is detected in three or more biopsy samples and is more aggressive -- and if the man is healthy and has a life expectancy of more than 10 years, doctors most often use radiotherapy. That can be either an external X-ray beam directed at the tumor or implantation of small radioactive seeds near the site of the tumor, a process known as brachytherapy.
Radiation therapy is typically in the form of what is known as intensity modulated radiation therapy, or IMRT. A relative new technique, IMRT involves use of a tightly focused radiation beam that is directed at the prostate from a variety of angles. The idea is to bathe the entire prostate in radiation to kill all the tumor cells, while sparing the nearby bladder, rectum and small intestine. This allows a much higher dose of radiation than could have been used two decades ago, Botnick said. Typical side effects include fatigue during therapy, irritation to urination and slower urination. Other side effects can include rectal irritation and bleeding, impotence and a very low risk of incontinence. The frequency of side effects is only a few percent, whereas if the same dose of radiation were given 20 years ago, the frequency would have been 20% to 30%.
The 5- to 10-year cure rate for radiation therapy is 85% to 92%.
Actor Ryan O’Neal recently announced that he has stage 2 prostate cancer, which is a slightly more advanced form of the disease. It may be detected by a digital rectal exam, but not always. The surest sign is an elevated PSA level -- higher than for a stage 1 tumor.
Treatments for stage 2 tumors are virtually the same as for stage 1, but in younger men with the disease, oncologists often will remove the entire prostate. The 5- to 10-year cure rate for radiation therapy of stage 2 prostate cancer is usually 75% to 80%.