Market Timing Chart of BRKB below UPDATED 10:22 am on 4-24-2012
Warren Buffett’s diagnosis is not at all threatening over the short term of 5 years, or even over the next decade. The survival rate of treated low stage prostate cancer is over 99% over the first 5 years. Mr. Buffett has stage I (“stage one”) cancer, confined to the prostate. Over 10 years, the National Cancer Institute says survival is 86%. Others claim that number to be over 97%. The 15 year survival rate may be greater than 90% according to some, although the NCI quotes it as 56%. At 81 years of age, Warren Buffett is highly likely to live at least a decade, which should give him plenty of time to do many more of his big deals and transition to his new leadership that he has already chosen. Given that, the stock is likely to hold up fine (BRKA, BRKB). I continue to hold it from the market lows in August 2011. I expect that this event will not of itself give rise to market timing sell signals. The general market will likely have much more influence on the stock.
What does his public statement say?
“I feel great – as if I were in my normal excellent health – and my energy level is 100 percent. I discovered the cancer because my PSA level (an indicator my doctors had regularly checked for many years) recently jumped beyond its normal elevation and a biopsy seemed warranted.”
He feels great because prostate cancer is almost always asymptomatic unless it blocks urine flow, which is unusual, or if it has gone to bone, which can cause pain.
We can tell from this statement that he is having some form of external beam radiation treatment. That is clear because seed implants alone take just a day to place. External beam radiation where radiation is directed at the prostate from the outside takes about 2 months, which fits his statement.
Second, and this may be over-interpretation, he says his PSA went up from its “normal elevation.” This could either be his quaint way of saying that it went up from “normal” for him, which it does in nearly all men with age to some degree OR it could mean that he had already had some “BPH” which is the non-scientific term for benign prostate enlargement (“benign prostatic hypertrophy” which is actually a benign hyperplasia more precisely where the prostate grows larger often obstructing urine flow on the basis of being chronically stimulated by male hormones). In any case, his prostate specific antigen serum level went up higher and faster than it had before, so Mr. Buffett had a biopsy that showed he had prostate cancer, which stated as such is “adenocarcinoma” of the prostate. Adenocarcinoma is derived from the glands of the prostate, not other components. It is a very common cancer as you know. Over 241,000 men will be diagnosed with prostatic adenocarcinoma this year alone.
So it’s a big club Mr. Buffett has joined. Depending on a few critical parameters, his medical advisors have told him to be treated as opposed to just watching it. Why he and they chose external beam treatment over radiation seed implants may have to do with the size of his prostate, the grade of the tumor (how “bad” the tumor looks under the microscope), his PSA level, and possibly with the volume of his disease (biopsies are done in 10 or more locations by many urologists and a map of the tumor can be guessed at and therefore the size of the tumor can be estimated). Or it may have been his personal choice.
As an expert in urologic cancer (especially prostate and bladder) I can tell you and those you know to think about a few things prior to treatment and even before diagnosis:
1. Have a “second look” done. I do “second look consultations” because I’ve found that prostate cancers are both under and overdiagnosed. Why undergo treatment for something that is not there? If a man is both diagnosed and treated at the same hospital, he may never learn of an inaccurate diagnosis. Get a second opinion on the pathology.
2. It is now a controversy whether a man should be screened using the PSA blood test or not. This is becoming a personal decision for men. Warren Buffett said in his statement that his PSA had been followed for years. That was his personal choice.
3. Depending on the patient’s age and how “bad” the tumor looks (the Gleason grade, which is the pattern seen under the microscope), and the stage of the tumor, for many men it is possible to “watch and wait.” Some men may not want to wait and that is fine.
It may be that Mr. Buffett’s tumor was a “Gleason Score 7” or higher (“higher grade” tumors give the tumor a high “Score”) or the tumor may have been large and that is why they have gone to external beam treatment as the initial approach vs. radiation seed implants (where small metallic radioactive “seeds” are placed within the prostate under radiologic guidance).
4. Be treated by someone who “does a lot of them.” Whatever the procedure is, make sure your doctor has experience and that is true of both radiation oncologists and urologic surgeons. The latter are getting out of practice these days in many areas of the country, because so few prostatectomies are done as compared to the numbers 10-15 years ago. Surgeons well trained in true nerve sparing prostatectomies that help prevent nerve damage that may result in both impotence and incontinence are even fewer in number. This may seem unfair to young doctors, but it’s your body and it is called “the practice of medicine” for a reason.
Please retweet this article to or share it with those you know. If you or someone you know needs guidance on making these decisions and I can be of help, please let me know and I’d be happy to consult. My contact information for “Second Look” consultations is here:
Standard Disclaimer: Please realize that a patient’s individual clinical findings and his personal preferences need to be considered carefully to come to a decision about prostate cancer treatment.
I wish you the best if you are facing prostate cancer and of course wish Warren Buffett the best as well.
Copyright © 2012 By Wall Street Sun and Storm Report, LLC All rights reserved.