Warren Buffett’s Choices
U.S. billionaire investor Warren Buffett, 81, says he has prostate cancer and expects to begin two months of daily radiation treatment in mid-July. Treatment for his Stage 1 prostate cancer will restrict his travel, “but will not otherwise change my daily routine,” Buffett said. He joins more than 200,000 other men who will be diagnosed with prostate cancer this year.
I wonder about over-treatment in men like Buffett with early-stage prostate cancer, particularly in light of a recent study published in Health Affairs, which found that men whose prostate cancer was considered low risk were nonetheless as likely to receive IMRT as men at high risk.
I emailed radiation oncologist Dale Fuller and asked him if overtreatment for men with low-risk prostate cancer is a problem.
“Possibly,” Dr. Fuller answered, “but the problem with watchful waiting is that a man with a curable cancer can in some instances morph into a man who can’t be cured, because his watched cancer transformed into a more aggressive cancer in between the watchings, and picked up the pace of growth and metastasized elsewhere.”
Dr. Fuller gives the example of a former Texas governor who had always had a “normal” PSA, and in accordance with the strategy of the watching school, his physician stopped doing PSAs when the man was in his late seventies. “He was in his eighties when he presented with a PSA in the 400s and bone pain,” wrote Fuller. “He exemplifies the possibility I am talking about. He died.”
Men like Buffett with early-stage prostate cancer have many treatment options, access to outcomes data, and well-established educational tools and decision aids, including treatment planning guides.
Although a variety of educational products and decision aids have been developed for early-stage prostate disease, the impact of decision aids on patients with metastatic or advanced prostate cancer remains unclear. In ACCC’s new educational project, “Prostate Cancer Programs: Developing Tools and Measuring Effectiveness in the Community,” ACCC is working to develop outcomes measures and tools for this patient population and to measure their effectiveness in improving patient outcomes and satisfaction. Nine cancer programs from across the country are participating in the project for 8 to 12 months. After a baseline is established, participants will implement the tools, and changes in results will be measured against the outcomes criteria.
No doubt, Buffett sought out high-quality care in a high-quality cancer program. For patients with early-stage or with advanced prostate cancer, a quality program emphasizes the patients’ access to a team of providers who effectively collaborate and inform, according to ACCC’s Center for Provider Education’s “Prostate Cancer Best Practices Project.”
“Armed with information about all available options, patients can personally manage their healthcare and make their own educated treatment decisions. Patients want choice and believe that the best programs and physicians are those that provide all the information they need to make informed decisions,” explains ACCC’s “Guide to Best Practices in a Comprehensive Prostate Cancer Program.”
The bottom line: Comprehensive education is at the core of a model prostate cancer program and should drive whatever treatment choices Mr. Buffett makes.
Check out ACCC’s resource list of articles, videos, and an annotated bibliography, designed to help you help your patients with advanced prostate cancer.