Buffett Diagnosed W/Prostate Cancer

Kongo said:

IMRT
One of the news reports I read indicated that he was having daily radiation treatments for two months starting in July so I assumed it was IMRT. At 81 with an early detected Stage 1 cancer you have to wonder why they didn't just recommend that he do AS but I suspect it has something to do with giving the appearance to stockholders that he is DOING SOMETHING to address the cancer. We all get treatment for different reasons.

Hope he does well.

K

I'm thinking
that your premise is possible.It is also possible that if he is having radiation at 81, his diagnosis is more than the garden variety..

Anyway WB "can save some money", post here with his information, so we can share our experiences with him, in order to help him come up with a best decision.

mrspjd said:

Buffett
A smart savvy businessman like Mr Buffett who is as well connected as he is did not get where he is in the world today without knowing ALL his options and studying them carefully before making critical decisions. Cancer is an emotional word, yes, but at age 81, Mr Buffett is still a rational man. Buffett will be informed and aware (or made aware) of ALL possible PCa tx options (whether appropriate txs or not for his age & PCa), including all forms of RT (IG/IMRT, HDRB, LDRB, and SBRT/CK), RP, and Active Surveillance (AS).

No doubt Buffett and his entourage will fully investigate all options, side effects, rates of BCR, solid evidence of findings/results from clinical studies, etc. and evaluate all choices carefully before arriving at a critical decision appropriate for him and his risk level.

If news media reports are accurate, according to the Washington Post, Buffett’s PCa is T1, low risk, and he “…will begin a two-month treatment of daily radiation in July.” As of this date, apparently his tx choice is IG/IMRT. Hypothetically he may have a higher risk PCa & could be receiving neo adjv ADT. We'll probably never really know for sure.

Let’s hope Buffett becomes a benefactor for PCa research, creates a new PCa charitable foundation, or teams up with an existing one.

At least I think I know why
At least I think I know why he probably wasn't recommended on the Proton beam therapy based on this recent population-based study in JAMA 2012;307(15):1611-1620

http://jama.ama-assn.org/content/307/15/1611.abstract

Swingshiftworker said:

Not Just A Business Decision
FWIW, we don't know the details but I don't think that Buffett necessarily knew and/or considered ALL of the options available to him before he decided to go ahead w/radiation (presumably IMRT) treatment.

More than likely, his urologist decided that he wasn't a suitable candidate for surgery because of his age and referred him to a radiation oncologist who did IMRT (and maybe LDR BT) but probably not CK, PBT, HDR BT or HiFU. The RO probably recommended that Buffett undergo the treatment s/he normally performs by reassuring him that the treatment had limited side effects and had a good probability of killing all of the cancer which (as far as they know) is still contained w/in the prostate.

I doubt that he got a 2nd opinion on the biopsy (few do) or that he consulted other urologists or ROs and instead relied on the advice of his physicians (which most men are prone to do) rather than fully investigate all of the options available to him.

While IMRT is fairly accurate, there is still room for error that can cause significant tissue damage if the radiation is not properly focused or if there is significant body or organ movement. These problems can be better avoided w/CK and PBT and, if Buffett knew about the additional risks of IMRT and the greater precision of CK, PBT and even HDR BT, I think he would have chosen one of them instead.

Of course, this is just a guess on my part but process of deciding how to treat PCa in your body is not a purely analytical business decision and I don't think Buffett is any different than any other man when it comes to making this kind of decision.

Apples and Oranges
Do not confuse IMRT with IG/IMRT (IMAGE GUIDED/intensity modulated). Modern up to date IG/IMRT delivery systems have real time tracking technology that can make radiation therapy more accurate and cause less damage to healthy tissue.

Clinical studies have found that in patients treated with newer forms of radiation, specifically IG/IMRT, they had less severe tx side effects compared to patients treated with non-IGRT. Other similar study findings conclude: >”High-dose radiotherapy for prostate cancer using IMRT and IGRT resulted in low rates of acute toxicity and preliminary results of late toxicity are promising;” > “IG-IMRT, using daily target localization with fiducial markers, permits the use of smaller margins and correspondingly lower doses to the organs at risk, such as the rectum and bladder. These tangible gains appear to translate into lower clinically significant toxicities.”

ALL PCa txs have a range of risks. Successful outcome with RT (any form), including SBRT (aka “CyberKnife”) and IG/IMRT, is not based solely upon “proper focus or body movement.” It's a little more complicated and there are a multitude of factors that may contribute to risk and “room for error.” Some variables may include: the accuracy of pre-tx clinical PCa tumor staging, the expertise & skill of the radiation/medical team (such as the radiation oncologist, the dosimetrist/physicist, the RT technician), and the use of up to date modern RT delivery systems, etc.

Last year, the American Society for Radiation Oncology (ASTRO) released a white paper titled “Quality and Safety Considerations in Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)” In regard to patient safety, the paper addressed certain risk factors. An excerpt from the paper states: “Given that very high-dose fractions of radiation are delivered, the margin of error for SRS and SBRT is significantly smaller than that of conventional radiotherapy and therefore special attention and diligence is required. A small error in target localization for any 1 fraction risks under treatment of portions of the tumor by 20% or more, and inadvertent over dosage of adjacent normal tissues could escalate the risk of serious injury to a much greater degree than an equivalent treatment error in a course of radiotherapy where a substantially lower dose per fraction is used.”

The bottom line is that each PCa patient is his own best advocate. After doing the homework, only he can decide which PCa tx modality or plan of action is best for him, only him, and no one else.

M (mrs pjd)

dcirrotti said:

New guy
I am looking into MRI Image Guided Therapy for my Prostate Cancer as another way to treat prostate cancer. They use a laser to direct extreme heat to a small area of the prostate. The heat destroys tumor cells but does not affect healthy tissue. Doctors want to see if magnetic resonance imaging (MRI) can be used to improve this treatment. MRI will be used to help locate tumor cells and guide the laser during surgery. However, MRI-guided laser therapy has not been used to treat many people with prostate cancer. More studies are needed to see whether it can destroy tumor cells permanently. This is a trial study, What do you guys think of this. I am new to this, just been told the bad news of a Gleason 6 a few days ago and I need some help. dcirrotti@hotmail.com

dcirrotti
You have come to a good place to for advice from informed lay people.

I suggest that you start a new thread, include more information about your case so we can better respond. How many cores were taken in your biopsy, how many cores were positive, what was the involvement of each positive core (percent of the core that was cancerous), what is the stage of your cancer, what promted you to get a biopsy. What does the dre show, what is your psa history, any other diagnostic tests? Your age and general health.

Looking forward to your response

dcirrotti said:

new thread
Most of this is correct, have not had that talk with the Doc.
12 cores, how many cores were positive, I think one @ 50%
percent of the core that was cancerous, don't know will ask
what is the stage of your cancer = Gleason 6 (3+3)
what promted you to get a biopsy = PSA doubling twice in 3 years year 1= .80 2= 2.2
year 3 = 4.2 retested @ 3.5 same period.
What does the dre show, don't know, will ask
age 70 and general health is excellent, and in a great loving relationship with a lovely lady.

Help

First relax a little, we are here to Help.
First, you need to have written copies of all tests and information available. You are entitled to this information it is the law. Simply contact the office secretary.

A GLeason 3+3=6 is considered a less aggressive cancer, so that is a good thing,,,,have you done any research to understand what these Gleason numbers mean?

Now if you have a low volume cancer of 3+3=6, that is less than 2 of 12 cores with less than 50 percent involvement in each of these cores, it is possible that you may have indolent cancer, that is not likely to spread, and you can be treated with "active surveillance with delayed treatment" by a medical professional prefably by one who specializes in active surveillance. This is what I am doing since my Gleason is also a 3+3=6. You can click my name for details. With this treatment choice if you have a sexual relationship this will continue exactly as it is, there will be no ill effects of any active treatment specifically incontinence, ed, bowel problems, and other physical effects from treatments.

The biopsy is the main piece of information, and you want to make sure that it is correct, so you will not be under or over treated. Since determining a Gleason score is subjective you want your slides to be sent to a world class pathologist who specializes in prostate cancer, there are only about 10 of these in the united states. You can contact the doctors office and ask they they be sent.....one specialist is david grignon of michigan 313-745-2520

Anyway, others will make comments, we will all agree that the main things that you need to is research, read books, internet research, attend face to face support groups.

The first 2 or 3 months we all go thru an emotional roller coaster, but you will do fine.....be with positive people, enjoy the moments.

hopeful and optimistic said:

First relax a little, we are here to Help.
First, you need to have written copies of all tests and information available. You are entitled to this information it is the law. Simply contact the office secretary.

A GLeason 3+3=6 is considered a less aggressive cancer, so that is a good thing,,,,have you done any research to understand what these Gleason numbers mean?

Now if you have a low volume cancer of 3+3=6, that is less than 2 of 12 cores with less than 50 percent involvement in each of these cores, it is possible that you may have indolent cancer, that is not likely to spread, and you can be treated with "active surveillance with delayed treatment" by a medical professional prefably by one who specializes in active surveillance. This is what I am doing since my Gleason is also a 3+3=6. You can click my name for details. With this treatment choice if you have a sexual relationship this will continue exactly as it is, there will be no ill effects of any active treatment specifically incontinence, ed, bowel problems, and other physical effects from treatments.

The biopsy is the main piece of information, and you want to make sure that it is correct, so you will not be under or over treated. Since determining a Gleason score is subjective you want your slides to be sent to a world class pathologist who specializes in prostate cancer, there are only about 10 of these in the united states. You can contact the doctors office and ask they they be sent.....one specialist is david grignon of michigan 313-745-2520

Anyway, others will make comments, we will all agree that the main things that you need to is research, read books, internet research, attend face to face support groups.

The first 2 or 3 months we all go thru an emotional roller coaster, but you will do fine.....be with positive people, enjoy the moments.

Thank you
Great advise for the second opinion, what do you think of the study in my first post??? I am worried that my PSA will just continue to rise and something will have to happen soon and trying to get my act together now. I will start with active surveillance, but the way this thing is increasing I don't think it will last very long.

Samsungtech1 said:

Pca at 81
I think if younget diagnosed at this age why worry? Clearly 81 is onmthe downhill side. I like the man personally, but why worry? Probably not agressive or he would be in treatment. Most of us are younger. I am 66 and feel that I have lived the best part of my life. I do not want to get to the point where I am sitting at a table and a nurse is pouring food down my throat. Pretty sure that is not a problem for me, but if you have ever treated a family member for alhizmers then you know what hell is. Should I ever get that , on top of wverything else, the shotgun is coming out. I would never put anyone I loved through that trauma. It is a killer for all concerned.
Not trying to put a damper on things, but life is a matter of living it all. When it starts retreating then things have to be re-prioritized.

Mike

Increased PSA
dcirrotti

What was the reason to take you for a biopsy, was it the high PSA?
Do you have any symptoms or a positive DRE?
What was the advice you got from your urologist?

The Gleason grade and score is low and the PSA is consistent for a man of your age. You could follow Active Surveillance (WW) or try a radical treatment with intent at cure but you need to be prepared for the risks and side effects from treatments. Your active love life will be affected.
Remember that the PSA increases if sex or any possible manipulation of the gland (riding a bike, etc) existed the day before drawing blood.

Hormonal therapy is also a valid option to control the advancement of the bandit. It is palliative and you can stop it at any time to follow other treatments.
I would recommend you to research the net and read some books on the matter;

A “Guide to Surviving Prostate Cancer” by Dr. Patrick Walsh (third edition); which may help you understanding options between surgery and radiation.
“Beating Prostate Cancer: Hormonal Therapy & Diet” by Dr. Charles “Snuffy” Myers; which informs on diagnosis and treatments with hormonal manipulations.

Welcome to the board.
Wishing you luck in your journey.

VG

hopeful and optimistic said:

First relax a little, we are here to Help.
First, you need to have written copies of all tests and information available. You are entitled to this information it is the law. Simply contact the office secretary.

A GLeason 3+3=6 is considered a less aggressive cancer, so that is a good thing,,,,have you done any research to understand what these Gleason numbers mean?

Now if you have a low volume cancer of 3+3=6, that is less than 2 of 12 cores with less than 50 percent involvement in each of these cores, it is possible that you may have indolent cancer, that is not likely to spread, and you can be treated with "active surveillance with delayed treatment" by a medical professional prefably by one who specializes in active surveillance. This is what I am doing since my Gleason is also a 3+3=6. You can click my name for details. With this treatment choice if you have a sexual relationship this will continue exactly as it is, there will be no ill effects of any active treatment specifically incontinence, ed, bowel problems, and other physical effects from treatments.

The biopsy is the main piece of information, and you want to make sure that it is correct, so you will not be under or over treated. Since determining a Gleason score is subjective you want your slides to be sent to a world class pathologist who specializes in prostate cancer, there are only about 10 of these in the united states. You can contact the doctors office and ask they they be sent.....one specialist is david grignon of michigan 313-745-2520

Anyway, others will make comments, we will all agree that the main things that you need to is research, read books, internet research, attend face to face support groups.

The first 2 or 3 months we all go thru an emotional roller coaster, but you will do fine.....be with positive people, enjoy the moments.

I have written copies of all tests and information now.
Guys, thanks for all your input but I need more. Just got my report today and 11 of the 12 cores showed benign or with glandular atrophy or fibromuscular tissue. the 6th LEFT MEDIA~ APEX:
ADENOCARCINOMA, GLEASON'S GRADE 3 + 3 (SCORE 6) INVOLVES THE SINGLE EVALUATED CORE BIOPSY (MAXIMUM LINEAR MEASUREMENT 0.2 CM, APPROXIMATELY 15% OF TOTAL CORE BIOPSY SAMPLE) WITHOUT PERINEURAL INVASION.

Give me your best take on what is going on.

Kongo said:

Low Risk
Your biopsy shows a very low risk prostate cancer. It is not going to kill you, something else will. At age 58 with a similar diagnosis I chose to be treated with CyberKnife radiation and have had no side effects or impact on my quality of life. Had I been your age at the time of diagnosis I would probably have chosen active surveillance under a doctor's supervision.

I still recommend getting second opinions on your biopsy sample and meeting with other doctors to get their take.

Good luck to you.

Go on with your life
Enjoy the moments

You appear to be a perfect candidate for "Active Surveillance with delayed treatment if necessary"

Yes to Kongo's recommendation...second opinion on the biopsy samples

Of course, you require a competent doctor to manage your case so you can receive treatment in a timely manner if appropriate. It would be a good thing if this doctor specialized in Active Surveillance, and was associated with a center of excellence such as Johns Hopkins, etc.

A good idea to become knowledgeable about the various treatment options that are available with the potential side effects. In case you will require treatment in the future you will be prepared.

You can continue to read and post here, attend a support group in the area where you live. By the way where do you live? read books, research.

One thing that some of us have done is improve our dietary habits. This will be heart healthy at the least( you are more likely to die from heart disease than prostate cancer). There is a dvd FORKSoverKnives . Or better yet read the book "The China Study" by T. Colin Campbell

Keep on posting, keep us informed, hopefully as you acquire information you will help others.