Prostate cancer patients need to be fully aware of their options, because their options are good

Ten years after

My friend Don was one of the lucky ones.

In 2001, his doctor noticed that Don had an enlarged prostate. A blood test revealed a higher than normal PSA. With many doctors, Don would have gone under the knife. In fact, back then, surgery, followed by radiation or chemo (or both!) would have been common.

But he and his doctor agreed to hold off on treatment and monitor his condition.

Today, Don appears to be cancer-free. And in light of recent PSA research, Don’s doctor recently decided to discontinue their yearly PSA monitoring.

All men should be so lucky. But far too many are not.

Changing the standard of care

One of the unlucky ones is Warren Buffett. I’ve been thinking about him. Wondering how he’s doing.

Three months ago, the famous multi-billionaire announced that he had localized prostate cancer. That is, his cancer had not spread beyond the prostate. At age 81, his prognosis is very good, even without treatment.

And yet, Buffett agreed to begin extensive radiation treatments in mid-July. I hope he changed his mind. All the evidence shows that, left untreated, there’s very little chance his cancer will end or even disrupt his life.

With any luck, he saw my personal advice back in April, and called off the radiation. I expect it’s more likely that he might have heard about a recent New England Journal of Medicine study. If he did, I can’t imagine he would opt for treatment.

The new study enrolled more than 730 men with localized prostate cancer. Their average age was about 15 years younger than Buffett.

In half of the men, surgeons removed their prostates. Men in the other half were “observed.” They weren’t treated. Doctors screened their PSA levels.

After 10 years, there was very little difference in death rates between the two groups. The difference was so small that it landed within the possible margin of error.

Meanwhile, more than 20 percent in the surgery group suffered complications from their surgery, including one death.

Let’s make this as simple as possible. Most men with localized prostate cancer should not be treated. And this is especially true for men in their 70s and beyond.

Men? Doctors? Are you getting all this? It could hardly be more important! Let’s not wait years for the standard of care to change. We wish Warren Buffett all the best, of course. But nobody with his circumstances should take the aggressive course of action he’s on right now.

Please share this e-mail with the men in your life. For each man who knows about this and passes it on, there’s a huge potential to reduce the heartache and misery that too often comes with unnecessary treatment.

“Radical Prostatectomy versus Observation for Localized Prostate Cancer” New England Journal of Medicine, Vol. 367, No. 3, 7/19/12,

“Prostate cancer surgery fails to cut deaths in study” Gene Emery, Reuters Health, 7/18/12,

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