Is Warren Buffett’s Cancer Treatment Necessary
Billionaire’s choice not right for everyone, prostate cancer experts say.
What You Should Know About Prostate Cancer
Prostate cancer specialists worry that because the high-profile, 81-year-old billionaire has chosen two months of daily radiation treatments, other men automatically will “assume that must be the right treatment and it must be good for me,” said Dr. Peter Scardino, chairman of the surgery department at Memorial Sloan-Kettering Cancer Center in New York.
“Generally, in a person over 80 years old, you’d be very hesitant to treat a prostate cancer unless it’s clearly life-threatening,” Scardino said. “Doctors caution men at that age prostate cancer is very common. Most of the time it’s not dangerous to their life or health. It’s unusual, in our experience, to treat someone over 80, although I’ve done it.”
Of course, no doctor wants to second-guess Buffett’s decision, especially without at least two key pieces of information that he didn’t disclose when he announced his diagnosis Tuesday: his PSA score and his Gleason score, both of which help determine whether cancer is low-risk or high-risk, Scardino and other top prostate specialists said.
The PSA test measures levels of prostate specific antigen , a protein that increases in prostate cancer as well as in benign prostate enlargement.
The Gleason score measures how closely cancer cells resemble normal tissue: The higher the score, the more abnormal the tissue and the more likely it is to spread.
Questions To Ask Your Doctor Or Nurse
- What type of hormone therapy are you offering me and why?
- Are there other treatments I can have?
- What are the advantages and disadvantages of my treatment?
- What treatments and support are available to help manage side effects?
- Are there any lifestyle changes that might help me manage my cancer, symptoms, or side effects?
- How often will I have check-ups and what will this involve?
- How will we know if my cancer starts to grow again?
- What other treatments are available if that happens?
- Can I join any clinical trials?
- If I have any questions or get any new symptoms, who should I contact?
Treatments To Help Manage Symptoms
Advanced prostate cancer can cause symptoms, such as bone pain. Speak to your doctor or nurse if you have symptoms there are treatments available to help manage them. The treatments above may help to delay or relieve some symptoms. There are also specific treatments to help manage symptoms you may hear these called palliative treatments. They include:
This is the team of health professionals involved in your care. It is likely to include:
- a specialist nurse
- a chemotherapy nurse
- a urologist
- an oncologist
- a diagnostic radiographer
- a therapeutic radiographer
- a radiologist
- other health professionals, such as a dietitian or physiotherapist.
Your MDT will meet to discuss your diagnosis and treatment options. You might not meet all the health professionals straight away.
Your main point of contact might be called your key worker. This is usually your clinical nurse specialist , but might be someone else. The key worker will co-ordinate your care and help you get information and support. You may also have close contact with your GP and the practice nurses at your GP surgery.
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Faqs About Prostate Cancer That Has Spread To The Bones
Learn what this diagnosis means for your health and your future, and what you can do to feel strong and well supported.
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The prostate is a gland the size of a golf ball that sits below the bladder and in front of the rectum. Its responsible for making the fluid that forms semen. Many men develop cancer of the prostate gland its the second most common cancer among men in the United States. There are several stages of prostate cancer the earliest, when the cancer is still limited to the prostate gland itself, is the easiest to treat.
When the cancer has spread, or metastasized, beyond the prostate gland, its considered advanced, according to the American Cancer Society . When it spreads, its common for cancer cells to reach the bones first. Nine out of 10 men with advanced prostate cancer also have it in their bones.
At this advanced stage, the cancer cant be cured, says Scott T. Tagawa, MD, a medical oncologist at Weill Cornell Medicine and New York-Presbyterian Hospital in New York City. But with treatment, many men can live a long time. There are men Ive been treating for advanced prostate cancer for 10 or 20 years.
Arm yourself with the facts about what happens when prostate cancer spreads to the bones and what you can do to help manage it.
What Happens If My Cancer Starts To Grow Again
Your first treatment may help keep your cancer under control. But over time, the cancer may change and it may start to grow again.
You will usually stay on your first type of hormone therapy, even if its not working so well. This is because it will still help to keep the amount of testosterone in your body low. But there are other treatments that you can have alongside your usual treatment, to help control the cancer and manage any symptoms. Other treatments include:
Which treatments are suitable for me?
Which treatments are suitable for you will depend on many things, including your general health, how your cancer responds to treatment, and which treatments youve already had. Talk to your doctor or nurse about your own situation, or speak to our Specialist Nurses.
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Radiation Therapy And Radiopharmaceutical Therapy
External-beam radiation therapy
Candidates for definitive radiation therapy must have a confirmed pathologic diagnosis of cancer that is clinically confined to the prostate and/or surrounding tissues . Staging laparotomy and lymph node dissection are not required.
Radiation therapy may be a good option for patients who are considered poor medical candidates for radical prostatectomy. These patients can be treated with an acceptably low complication rate if care is given to the delivery technique.
Long-term results with radiation therapy are dependent on stage and are associated with dosimetry of the radiation.
Evidence :
Evidence :
Brachytherapy
Prostate Cancer Survival By Age
Five-year survival for prostate cancer shows an unusual pattern with age: survival gradually increases from 91% in men aged 15-49 and peaks at 94% in 60-69 year olds survival falls thereafter, reaching its lowest point of 66% in 80-99 year olds patients diagnosed with prostate cancer in England during 2009-2013. The higher survival in men in their sixties is likely to be associated with higher rates of PSA testing in this age group.
Prostate Cancer , Five-Year Net Survival by Age, Men, England, 2009-2013
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Surgically Removing The Prostate Gland
A radical prostatectomy is the surgical removal of your prostate gland. This treatment is an option for curing prostate cancer that has not spread beyond the prostate or has not spread very far.
Like any operation, this surgery carries some risks.
A recent trial showed possible long-term side effects of radical prostatectomy may include an inability to get an erection and urinary incontinence.
Before having any treatment, 67% of men said they could get erections firm enough for intercourse.
When the men who had a radical prostatectomy were asked again after 6 months, this had decreased to 12%. When asked again after 6 years, it had slightly improved to 17%.
For urinary incontinence, 1% of men said they used absorbent pads before having any treatment.
When the men who had a radical prostatectomy were asked again after 6 months, this had increased to 46%. After 6 years, this had improved to 17%.
Out of the men who were actively monitored instead, 4% were using absorbent pads at 6 months and 8% after 6 years.
In extremely rare cases, problems arising after surgery can be fatal.
It’s possible that prostate cancer can come back again after treatment. Your doctor should be able to explain the risk of your cancer coming back after treatment, based on things like your PSA level and the stage of your cancer.
After a radical prostatectomy, you’ll no longer ejaculate during sex. This means you will not be able to have a child through sexual intercourse.
Where Do These Numbers Come From
The American Cancer Society relies on information from the SEER database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.
The SEER database tracks 5-year relative survival rates for prostate cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead it groups cancers into localized, regional, and distant stages.
- Localized: There is no sign that the cancer has spread outside the prostate.
- Regional: The cancer has spread outside the prostate to nearby structures or lymph nodes.
- Distant: The cancer has spread to parts of the body farther from the prostate, such as the lungs, liver, or bones.
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For More Information See Prostate Cancer On The Ncci Website
The National Cancer Control Indicators are a set of indicators across the continuum of cancer care, from Prevention and Screening through to Diagnosis, Treatment, Psychosocial care, Research and Outcomes. The NCCI website allows users to see visual representations of data on each indicator through interactive charts.
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Hormonal Therapy For Recurring Disease
Continuous versus intermittent hormonal therapy
Most men who are treated for recurrence after initial local therapy are asymptomatic, and the recurrence is detected by a rising PSA. It is possible that intermittent androgen deprivation therapy can be used as an alternative to continuous ADT to improve QOL and decrease the amount of time during which the patient experiences the side effects of hormonal therapy, without decreasing the survival rate.
Hormonal approaches
Why Study Trichomonosis And Prostate Cancer
Trichomonosis, a sexually transmitted infection caused by the protist Trichomonas vaginalis, has significant public health relevance. The annual incidence is 8 million women in the United States and 170 million worldwide, with an equal number of infected male partners . Both men and women infected with T. vaginalis are at increased risk for human immunodeficiency virus infection . Recent evidence suggests this STI is associated with increased risk of prostate cancer, the most commonly diagnosed cancer and the second leading cause of cancer death among men in the United States . There is no immunity to T. vaginalis, and a hallmark of this STI agent is persistence. Most T. vaginalis infections in men are asymptomatic, and few are diagnosed and treated thus, infections persist. In older, pre-antibiotic era studies, T. vaginalis was frequently found in prostate fluid specimens from asymptomatic male partners of women with trichomonosis, leading to the belief that the prostate might serve as the reservoir for trichomonosis in men . Trichomonosis may cause chronic prostatitis, and researchers have identified trichomonads in the prostatic urethra, glandular lumina, submucosa, and stroma and, more recently, in benign hyperplastic prostatic tissue . They also observed foci of nonspecific acute and chronic inflammation, as well as intraepithelial vacuolization, near trichomonads, leading them to propose that trichomonosis might contribute to prostate carcinogenesis .
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Enhancing Healthcare Team Outcomes
Prostate cancer diagnosis and treatment can be complex and is often controversial. an interprofessional team of specialty-trained nurses, nurse practitioners, physician assistants, primary care providers, and urologists must work to manage:
These and many more issues continue to challenge clinicians who deal with prostate cancer patients and men at risk for this common, potentially lethal male malignancy.
The interprofessional team can optimize the treatment of these patients through communication and coordination of care. Primary care providers, urologists, oncologists, radiation oncologists, and nurse practitioners provide diagnoses and care plans. Specialty care urologic nurses should work with the team for coordination of care and are involved in patient education and monitor compliance. The interprofessional team can thus improve outcomes for patients with prostate cancer.
Men With Incurable Prostate Cancer Living For Twice As Long As Decade Ago
Patients with advanced prostate cancer treated with the latest therapies are living on average for more than twice as long as a decade ago, a striking new analysis reveals.It showed that patients with incurable prostate cancer treated at leading cancer hospital The Royal Marsden NHS Foundation Trust now live for about two extra years on average than they did just 10 years ago.The research, conducted by The Institute of Cancer Research, London, and The Royal Marsden, found the introduction of a range of new drugs has had such an impact that the system doctors use to predict how long patients will live now needs to be revised.The research is published in European Urology and was conducted by researchers who are funded by Prostate Cancer UK, Cancer Research UK, the Medical Research Council and the Prostate Cancer Foundation, US.The team studied data from 442 UK patients across 32 clinical trials and two extended access drug programmes at The Royal Marsden since 2003.Some 78% of patients received docetaxel-based chemotherapy, which was approved for use on the NHS in 2005.
Half received abiraterone, a targeted prostate cancer drug discovered at The Institute of Cancer Research and approved for use on the NHS last year.
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What Types Of Testing Should I Expect For Monitoring My Condition
Since metastatic prostate cancer isnt curable, your doctor will most likely set up regular visits to check the cancers location, and to manage any long-term side effects from the cancer or any medication youre taking.
And since treatments for advanced prostate cancer are changing so fast and need to be given in a certain sequence to be the most effective, youll probably have not only a prostate cancer doctor but other specialists taking care of you. Your care team should coordinate closely, say the authors of a major study of such teams published in August 2015 in the journal Annals of Oncology.
Along with regularly testing your prostate-specific antigen levels, your care team may request blood tests that measure such prostate cancer indicators as alkaline phosphatase and lactate dehydrogenase. Magnetic resonance imaging or PET scans of the spine or other bones can also help identify how your cancer responds to treatment.
If youve had radiation, youre at an increased risk for bladder and colorectal cancer and should get screened regularly for these as well.
The tests youll have and how often youll need them should be customized to you. Your care team will consider your overall health, medications that are safe for you to take, other health conditions you might have, and what stage your cancer was when you were diagnosed.
Comparison Of Curative Treatments
Active surveillance, radiation therapy, and surgery all have advantages and disadvantages .13,2427 A randomized controlled trial of 1,643 men in Great Britain compared active surveillance, radical prostatectomy, and external beam radiation therapy for treatment of clinically localized prostate cancer over a median of 10 years.24 There were 17 prostate cancerspecific deaths overall: eight in the active-surveillance group , five in the radical prostatectomy group , and four in the EBRT group . There were no significant differences among groups in prostate cancerspecific mortality or all-cause mortality. Surgery and radiation therapy were associated with lower incidences of disease progression than active surveillance. No trials have compared treatment outcomes by race or ethnicity.
Summary of Curative Treatment Options for Localized Prostate Cancer
Radical prostatectomy
EBRT = external beam radiation therapy.
Information from references 13, and 24 through 27.
Summary of Curative Treatment Options for Localized Prostate Cancer
Radical prostatectomy
EBRT = external beam radiation therapy.
Information from references 13, and 24 through 27.
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