Warren Buffett announced Tuesday that he has stage 1 prostate cancer and that doctors have begun treating it with radiation. Buffett is 81 and, at that age, it would be more surprising if he didn't have it. A full 80% of men older than 80 have some form of prostate cancer, according to the National Cancer Institute, but many or even most of them do not know it. Even if they do know, in many cases, the tumor is progressing so slowly that it doesn't need treatment. Instead, doctors simply monitor to make sure that it doesn't begin progressing too rapidly, a process known as watchful waiting or active surveillance.
Stage 1 is the earliest and mildest form of prostate cancer. Generally, tumors are so small that they are difficult to detect. They cannot be felt in a digital rectal exam and they do not show up on a typical imaging examination. The first sign that they are present is an above-normal score on a PSA (prostate-specific antigen) test. Their presence then can be confirmed by an ultrasound-guided biopsy; typically, the urologist will remove 12 samples. If only one or two show the presence of a tumor and the cancer cells are not particularly aggressive, the doctor typically will recommend active surveillance, according to Dr. Marc Botnick, a radiation oncologist and medical director of Vantage Oncology in Sherman Oaks. If the tumor is detected in three or more biopsy samples and is more aggressive -- and if the man is healthy and has a life expectancy of more than 10 years, doctors most often use radiotherapy. That can be either an external X-ray beam directed at the tumor or implantation of small radioactive seeds near the site of the tumor, a process known as brachytherapy.