IRA FLATOW, HOST:
This is SCIENCE FRIDAY. I am Ira Flatow. When billionaire investor Warren Buffett revealed that he had been diagnosed with stage one prostate cancer, the announcement reignited an old debate, and that was, why was an 81-year-old man screened for the disease? After all, it was just four years ago that a federal task force had recommended against the routine use of a notoriously unreliable PSA testing in men over 75. But Warren Buffett also disclosed that he will seek radiation treatments in July, which is another controversial move, since experts say the long-term side effects of the treatment could be much worse than the cancer itself.
And like many others, Laura Newman, author of the blog Patient POV and a medical journalist who has covered prostate cancer for 15 years, Lauran Newman was concerned that other men might follow Warren Buffett's example. So she was so bugged that on her blog she listed 10 reasons why one of the world's richest men was making a poor medical decision. And Ms. Newman is here now in our New York studios to help us talk about that. Welcome to SCIENCE FRIDAY.
LAURA NEWMAN: Thank you.
FLATOW: What was so terrible about what he did?
NEWMAN: Well, first I want to qualify that I don't know the specifics of his case. I only know what hit the papers. And in general, there has been a movement away from treating particularly older men who really have little to gain in terms of longevity. The PLCO trial, which was a National Institutes of Health trial, showed that, you know, screening older men did not extend their lives at all. The treatments have some well-known problems, so my concern is that, you know, he can pay for this himself. He's got all the money that anyone would want, but people pay attention to icons.
FLATOW: Right. But doesn't Medicare still pay for that, the screening test, even when you get older?
NEWMAN: Yes, they do. It's going to take a...
FLATOW: Do you think that's a bad idea?
NEWMAN: Well, I think that this is a loaded topic. It's as loaded as it gets. You've got urologists who have been practicing treating prostate cancer and all things related to prostate cancer for, you know, BPH and other things for decades. If you go to the annual meetings, they're focused on prostate. So in a sense, their careers, you know, have something at stake unless perhaps they get involved in urology that can really help people.
FLATOW: 1-800-989-8255 if you'd like to talk about Warren Buffett's decisions, and Laura Newman, who's here, of Patient POV, point of view. But as I mentioned before, it isn't just the screening that's controversial here, is it? It's the seeking the treatment at his age that you have (unintelligible)...
NEWMAN: Right. Right. I think some of the urologists are fighting back. Some of them claim that patients are demanding it, which I feel like the way the message is conveyed to patients has a lot to do with their choice and...
FLATOW: And what do you mean by that? Like...
NEWMAN: Well, you know...
FLATOW: ...if you don't get - if you don't have the screening and you don't have the operation, you're a dead man.
NEWMAN: Yes, that could - that's one way of putting it. But if you make your living doing surgery or doing radiation therapy, you are vested in that and in a sense you may not get the best information, the most unbiased information.
FLATOW: I've heard commercials that basically say that. I remember listening to the radio here in New York and hear, you know, doctors advertising for that kind of situation. They say you want this thing out immediately, you know, that sort of hype on the commercial.
NEWMAN: I think that it's pretty well accepted now that most men will have prostate cancer cells seen on autopsy. There is an abundance of information that's come out in peer-reviewed journals in the past few years showing that the PSA test seems to be over-detecting and...
FLATOW: Especially in older people, you're saying?
NEWMAN: Right.
FLATOW: So what about younger people, people younger than Warren Buffett?
NEWMAN: Well, I think that younger, there are lots of question marks as well. There are, you know, many people who think that the PSA test in men who have no symptoms should be abandoned. But, you know, I wanted to backtrack to the treatment side, which you asked me about earlier, and that is that radiation, whatever kind it is, radical prostatectomy, often have sequelae that are not great. I mean, man have bowel problems. They can become impotent. They can become incontinent. You know, it took years for urologists to - who really handle prostate cancer - to begin to even look at these quality of life issues. And I think that came from some promising - some from younger urologists who really felt like this was very important.
FLATOW: Sure. But shouldn't I be given that option to take that risk if I want to?
NEWMAN: You mean to take - have a surgery or...
FLATOW: Have a surgery if I...
NEWMAN: Well, here's...
FLATOW: ... I'm facing the choice - why shouldn't I be given that option?
NEWMAN: Well, you know, we live in a culture that actually treasures choice, but I feel that we're dealing with a health care system that is collapsing. And there are choices and there are choices, and why not put our limited health care dollars into health problems that could be managed well where people will actually feel better and live longer?
FLATOW: Let's go to the phones, to Bob in St. Louis. Hi, Bob.
BOB: Hi. Yes, I'm a physician. I think maybe she's painting the picture with too broad a brush. I think there's, you know, we've got to really zero in on individual cases. I just was listening and I thought of a gentleman who was a close friend of mine. He was about 80 years old. I found a nodular cancer on his prostate on exam, sent him to a urologist. The urologist said something that I detest - detestable. Well, don't worry about it. Something else will kill you before that does. And two and a half years later, the gentleman had metastases all through his skeleton. And then they did procedures to try to keep his collapsed vertebrae from crunching his spinal cord and all that kind of stuff.
You know, every case is individual. Now, I know I heard - oh, I heard something on NPR about some new ultrasonic destruction-type technique in Europe, I think, that they're going to try here in the States. But, you know, each case is a little different.
FLATOW: Laura, what's wrong with Bob...
BOB: If I had it - go ahead.
FLATOW: No. Go ahead. If you had it, you'd want it done. You'd wanted everything done if possible.
BOB: You know, if I had it - you know, if I had it, I probably would opt, just like women with breast masses. A lot of them will opt for a total mastectomy even though the - even though the statistics say if you get a lumpectomy and radiation or something like that, you'll probably do just as well. But, you know, doctors' wives have the mastectomies.
FLATOW: What would you do if you had the same thing you detected in yourself?
BOB: I probably - I'd want to hunt around. I'd get about three or four opinions, and I would probably opt for something active.
FLATOW: Laura?
NEWMAN: I think that it's very hard for people to think about not getting treatment because the entire health care system is built around treatment. And, you know, I've heard from men who have tried to join support groups and who have been - have chosen active surveillance. And they basically tell me they kind of feel like they're not really welcome and they're like a fly on the wall because a lot of the support groups are talking about side effects of treatments, coping, coping with incontinence. These are things that if you're on active surveillance...
FLATOW: Is that the old watchful waiting...
NEWMAN: Yes, it is.
FLATOW: Yeah, watchful waiting. They (unintelligible)...
BOB: I've seen a lot of complications. I was an internist/gastroenterologist. I've seen radiation bowel disease, things of that sort. I've also seen a bunch of people that I thought probably lived longer because they had active treatment. You know, it's, you know, and I know you said that at autopsy - I think, oh, in med school 100 years ago...
NEWMAN: I think you have to be...
BOB: ...they used to say that at autopsy 85 year - 80-year-olds or 90-year-olds or whatever, something like 90 percent of them had cells, had malignant cells (unintelligible) determined to be malignant cells microscopically.
FLATOW: All right. Thanks for calling, Bob. Let's go to the phones, to Rich in - let's go to Rich in Minneapolis. Hi, Rich.
RICH: Hi. How are you, Ira?
FLATOW: Hi. How are you?
RICH: I'm doing well. I'm a 75-year-old who got into a discussion with my urologist at the VA because he wanted me to undergo a biopsy where I'm borderline normal on my PSA and I don't have BHP. And he got very, very upset when I told him I would have nothing to do with undergoing a biopsy due to the sequelae. It was very interesting.
FLATOW: So you're not fearful then? You don't want to have everything that could be done possible for you?
RICH: I'm 75 years old and I'm on no medications whatsoever, Ira.
FLATOW: Mm-hmm. Well, this is the point, I think, Laura, you're making - I don't want to put words in your mouth - that at a certain age, you don't believe the literature and the advisement of the researchers, that don't have things done after a certain age, correct?
NEWMAN: Right.
RICH: Well, the other factor in my behalf is the fact I'm a retired chiropractic physician and I read the research.
FLATOW: So you have a little...
RICH: Don't(ph) pay attention.
FLATOW: Yeah. All right. Well, good luck to you. We wish you well.
RICH: Well, thank you.
FLATOW: Thanks for...
RICH: Thanks for having me.
FLATOW: Thank you, Rich. So it's your - your criticism, Laura, is not that people have the biopsy or they have the PSA test or they have the operation, but that there are certain age limits, and Warren Buffett represents a certain age group where most people say not to have that kind of stuff done. Is that right?
NEWMAN: Right, right. I mean, that is really strong. Now, I do think that people who treat prostate cancer, you know, they're kind of not in a great position now because the data is getting stronger and stronger. But you know, if you look back in history, I mean I remember when every woman was getting radical mastectomies and then a landmark clinic trial came out and everything shifted to lumpectomies. Now, I imagine - I don't have the data in front of me, but I imagine there was plenty of resistance. You know, you women are going to kill yourselves, et cetera, et cetera. So...
FLATOW: Right, right. Well, thank you taking time to be with us today. Laura Newman, who is a medical journalist, written about the subject, what, 15 years or more?
NEWMAN: Yes.
FLATOW: Seen all kinds of stuff. She's author of the blog Patient POV. Thank for taking time to be with us today.
NEWMAN: Thank you.
FLATOW: I'm Ira Flatow. This is SCIENCE FRIDAY from NPR. Transcript provided by NPR, Copyright NPR.