Men who were exposed to Agent Orange chemicals used during the Vietnam War are at higher risk for life-threatening prostate cancer than unexposed veterans, researchers have found.

What's more, those who served where the herbicide was used were diagnosed with cancer about five years earlier than other men, on average, in the new study.

"This is a very, very strong predictor of lethal cancer," said urologist Dr. Mark Garzotto, who worked on the study at the Portland Veterans Affairs Medical Center in Oregon.

"If you're a person who's otherwise healthy and you've been exposed to Agent Orange, that has important implications for whether you should be screened or not screened," he said.

But one researcher not involved in the new study said it's hard to take much away from it, given the imprecise way it measured exposure.

Agent Orange - named after the giant orange drums in which the chemicals were stored - was used by the U.S. military to destroy foliage, mainly in southern Vietnam. The herbicide was often contaminated with a type of dioxin, a potently carcinogenic chemical.

The Vietnam Red Cross Society has estimated that up to one million Vietnamese suffered disabilities or health problems as a result of Agent Orange, including children born with birth defects years after their parents were exposed.

Past research has also suggested that U.S. veterans who served where Agent Orange was used are at an increased risk of lymphoma and certain other cancers, including prostate cancer.

For the new study, researchers wanted to see whether exposure was more closely linked to slow-growing prostate cancers or aggressive tumors.

They analyzed medical records belonging to 2,720 veterans who were referred to the Portland VA for a prostate biopsy. About one in 13 of those men had been exposed to Agent Orange during the Vietnam War, according to their VA intake interviews.

One third of all men in the study were diagnosed with prostate cancer, about half of which were high-grade cancers - the more aggressive and fast-growing type.

When the researchers took men's age, race, weight and family history of cancer into account, they found those with Agent Orange exposure were 52 percent more likely than unexposed men to have any form of prostate cancer.

Separating out different types of tumors showed the herbicide was not linked to an increased risk of slower-growing, low-grade cancer. But it was tied to a 75 percent higher risk of being diagnosed with aggressive prostate cancer, the study team reported Monday in the journal Cancer.

"The increase in the rate of cancers was almost exclusively driven by the potentially lethal cancers," said Garzotto, who’s also associated with Oregon Health & Science University.

More research is needed to figure out exactly why that is, he said. In the meantime, Garzotto said veterans who were exposed to Agent Orange should discuss that with their doctors.

But Dr. Arnold Schecter, from the University of Texas School of Public Health's Environmental and Occupational Health Sciences Program in Dallas, said there's a "big problem" with just asking veterans if they were exposed to Agent Orange or served in an area where it was sprayed.

"Of those most heavily exposed in the military as best we know, only a relatively small percentage of them had elevated dioxin from Agent Orange in their blood when tested by (the U.S. Centers for Disease Control and Prevention)," he told Reuters Health.

Schecter said that in Vietnam, people who have high levels of that type of dioxin in their blood live in places where the chemical has become integrated into the food supply - or were sprayed directly with Agent Orange.

Another researcher who has studied the effects of Agent Orange agreed that not having blood dioxin levels is a drawback, but said the findings are consistent with past research and general thinking about the chemical.

"Almost all studies have implicated that men with Agent Orange (exposure) either have higher-grade prostate cancer or a more aggressive clinical course," said Dr. Gregory Merrick, head of Wheeling Hospital's Schiffler Cancer Center in West Virginia, who also wasn't involved in the new research.

But, he added, as long as men are getting into the VA system and getting regular evaluations and treatment for cancer, Agent Orange exposure "is not a death sentence by any means."

Related:

• US begins Agent Orange cleanup, decades later
• US, Vietnam team up to clean up Agent Orange
• New test may help guide prostate cancer treatment

Urologists fell in line with other doctor groups on Friday in recommending careful consideration and discussion when it comes to screening for prostate cancer, rather than a gung-ho approach.

At its annual meeting in San Diego, California, the American Urological Association (AUA) recommended against screening average-risk men under age 55 or any man over 70 using prostate-specific antigen, or PSA, blood tests.

At in-between ages, the group said each man should weigh the benefits and harms of screening and treatment and decide with his doctor what approach best fits his values.

For those who do choose screening, it added, an interval of every two years may be better than annual tests.

"I look upon this guideline… as the beginning of a targeted-based screening," said Dr. H. Ballentine Carter, chair of the panel that developed the guidelines and a urologist and oncologist at Johns Hopkins Hospital in Baltimore.

"Instead of a one-size-fits-all approach, we're trying to emphasize that there is a group of men between age 55 and 69 that are much more likely to benefit," he told Reuters Health.

A year ago, the U.S. Preventive Services Task Force, a government-backed panel, created controversy by recommending against prostate cancer screening for average-risk men of all ages.

Since then, other professional organizations have taken a skeptical but less decisive view toward PSA testing.

Last month, for example, the American College of Physicians said that for men in their 50s and 60s, doctors should base screening decisions on the patient's risk for prostate cancer, his general health and preferences and on a discussion of screening's potential benefits and harms (see Reuters Health story of April 8, 2013 here: http://reut.rs/12C8KfH).

About 239,000 men are expected to be diagnosed with prostate cancer in the U.S. in 2013 and about 30,000 will die of the disease, according to the American Cancer Society.

Evidence suggests that screening with PSA tests is tied to a small reduction in deaths - about one per 1,000 men screened over a decade, the AUA reported. But some results are also false-positives and spur unnecessary further testing and treatment, which can leave men impotent and incontinent.

In evaluating the data, Carter said, "The evidence for the benefits of prostate cancer screening was moderate, but the quality of evidence on the harms was high."

He said it's important to have shared decision-making between patients and doctors when it comes to PSA tests, as men may weigh the pluses and minuses of screening differently.

"I think men need this information, they deserve to have this information and when they get it, some men will take the same information and decide they want to get screened" and others won't, he said.

Dr. Richard Greenberg, head of urologic oncology at Fox Chase Cancer Center in Philadelphia, agreed with the new guidelines but is still concerned about whether they will reach men and their primary care doctors.

"If you don't get people to buy into the guidelines and understand and read the guidelines, it doesn't really help us very much," said Greenberg, who wasn't part of AUA's guideline writing team.

He said the PSA test is "not a great test," but that it has made it rare for oncologists to see advanced prostate cancer.

"To just say, ‘You shouldn't do screening because there's no benefit,' is I think the wrong message," Greenberg told Reuters Health.

Rather, he agreed with Carter that men should understand everything that comes with screening - both the pluses and minuses - and discuss it with their doctor.

Men who are overweight are more likely to have precancerous lesions detected in a benign prostate biopsy and are at a greater risk for subsequently developing prostate cancer, a new study shows.

“It is absolutely clear that obesity increases a man’s risk of dying from prostate cancer,” said Dr. Andrew Rundle, associate professor of epidemiology at Columbia University’s Mailman School of Public Health in New York City, who conducted the study.

But, he told NBCNews.com, “We don’t know if obesity causes it (prostate cancer) or makes it harder to treat.” Rundle’s study was published on Tuesday in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.

He noted that being overweight is known to cause five cancers -- post-menopausal breast, colon, kidney, endometrial (uterus) and esophageal. Cancer of the prostate -- the gland that releases the male hormone, testosterone, into the body -- is the leading diagnosed cancer in men and the second leading cancer killer of men behind lung cancer.

According to the American Cancer Society, 28,000 men died of it last year in the United States and over 238,000 new cases will be detected in the country this year.

"Studies conducted in the past have attempted to determine if there are subpopulations of men diagnosed with benign conditions that may be at a greater risk for developing prostate cancer,” Rundle said. “This is one of the first studies to assess the association between obesity and precancerous abnormalities."

Rundle and his colleagues studied obesity and future prostate cancer incidence in 6,692 men at the Henry Ford Health System who were followed for 14 years after a biopsy or transurethral resection of the prostate with benign findings. To determine obesity, he used the standard Body Mass Index, which factors in weight and height combined. Taking an average BMI of 30, Rundle said about one-third of the U.S population is considered obese.

The researchers conducted a case-control study among 494 of these patients and 494 matched controls; they found precancerous abnormalities in 11 percent of the patients' benign specimens. These abnormalities were significantly associated with obesity at the time of the procedure, according to Rundle.

After accounting for variables, including family history of prostate cancer, prostate-specific antigen (PSA) levels in the blood, and the number of PSA tests and digital rectal exams during follow-up, the researchers found that obesity at the time of the initial procedure was associated with a 57 percent increased incidence of prostate cancer during follow-up.

Generally, a biopsy will be performed after a high PSA level, or if a doctor can detect a hardening of the prostate during a digital rectal examination. The biopsy takes minute slivers of tissue from the gland to test for cancerous cells. But it can be inaccurate, depending on where the tissues are taken from, and can miss cancerous cells.

“It is possible that the tumors missed by initial biopsy grew and were detected in a follow-up biopsy," Rundle said.

Helena Furberg, associate attending epidemiologist at Memorial Sloane-Kettering Cancer Center in New York City, said Rundle's findings represented "a significant research study" at a time of controversy over whether obesity is associated with the risk of prostate cancer.

“Now, future studies should look at the question: does losing weight decrease the risk of prostate cancer?” she said in an interview with NBCNews.com.

Furberg also noted the study shows how the accuracy of a biopsy can be affected and fail to detect pre-cancerous lesions in obese patients who have a larger prostate. “In future, clinicians should take into consideration the size of the patients,” she said.

Dr. Marcus Quek, associate professor of urology at Loyola University Medical Center outside Chicago, said previous studies have come to conflicting conclusions about how obesity and prostate cancer may be related.

“This study tells us more work needs to be done on the link between obesity and cancer,” he said. “And if we find they are related, whether we can modify the risk.”

Quek noted Dr. Rundle’s study had found lesions during follow-ups, indicating that they had been missed in the initial biopsy.

“Biopsies are only so accurate,” Quek said. ”People have looked at ways to improve prostate biopsies, with MRI and other imaging technology.”

“But right now, they are only as accurate as where they put the needles.”

A batch of new gene discoveries nearly doubles the number of genes known to cause three of the most common cancers – breast cancer, prostate cancer and ovarian cancer. While each gene alone affects only a small number of people, taken together they help explain one-third of cases of these cancers, researchers reported on Wednesday.

It took a giant study to find all the genes – nearly 200,000 people took part at 160 institutions. The findings can not only help doctors decide who needs more frequent screening for cancer, but may eventually help target treatments that will work better for particular patients, the researchers said.

People with several of the genetic changes linked with cancer will have a much higher-than-average risk of the cancers, the researchers said. They published their findings in a series of 13 papers in several medical journals, including Nature Genetics and Nature Communications.

“By looking for people who carry most of these variations we will be able to identify those who are at the greatest risk of getting these cancers and then targeting screening tests to these individuals,” said Douglas Easton of Britain’s University of Cambridge, who led some of the studies.

“We now have 76 common genetic variants which are associated with breast cancer risk,” Easton told a news conference. Combined with other research, including the well-known breast cancer genes BRCA1 and BRCA2, genetic susceptibility explains 40 percent of breast cancer cases, he said.

“Any one of those (variants) is so tiny they don’t affect much,” Dr. Fergus Couch of the Mayo Clinic in Rochester, Minn., who worked on the project, told NBC News. “But when we put them together into a complex model … It’s the power of everything together that can make a difference.”

The researchers found 23 new genes linked with prostate cancer and three more for ovarian cancer. Now researchers know about 78 different genes associated with higher prostate cancer risk, and 16 of them are associated with aggressive disease.

The three cancers affect 2.5 million people globally, killing about a third of them. They all are driven by hormones.

“The most immediate practical application is probably going to be for women already at high risk of (breast cancer),” Easton said. A woman with a BRCA1 or BRCA2 mutation already has a very high chance of breast cancer. If she also has one or more of these other alterations, she’s at even higher risk.

Women who have a BRCA1 mutation along with most of the other, newly discovered mutations have an 80 percent chance of developing breast cancer by age 80, the researchers found.

“The 1 percent of people who have lots of these alterations could see their risk of developing prostate cancer increase by nearly 50 percent and breast cancer by 30 percent,” Easton said.

People may soon be able to take a genetic test to see what their risk is. They could then opt for early screening to watch for the disease. “This will be ready for prime time in a little more than a year,” Couch predicted.

Right now, guidelines vary on when women should get mammograms, for instance. Some guidelines call for annual screening starting at age 50; others say women only need them every two years.

A woman with a high genetic risk might opt to start having mammograms at age 30 or younger. There’s also confusion around testing for prostate cancer. U.S. experts say men shouldn’t be routinely screened using a blood test called a PSA test, because it causes too many “false positives” – when men are initially told they may have cancer but it turns out they don’t.

But men with a high genetic risk might opt to have frequent PSA tests.

“These results are the single biggest leap forward in finding the genetic causes of prostate cancer yet made,” said Rosalind Eeles  of Britain’s Institute of Cancer Research.

“They allow us, for the first time, to identify men who have a very high risk of developing prostate cancer during their lifetime,” she added.

The genes play a variety of roles in cancer. Some are supposed to stop the out-of-control growth that marks a tumor; some help cancer cells spread.

Related:

• New gene clues found for 4 types of breast cancer
• Cancer prevention through gene testing
• "Pap" test possible for ovarian cancer

New research strongly reinforces the notion that prostate cancer is vastly overtreated with often dire results.

A study out Wednesday in the New England Journal of Medicine focused on treatment side effects, following a group of 3,533 men for 15 years after they got either surgery (called prostatectomy) or radiation for cancer that had not spread beyond the prostate. Radiation produced fewer side effects -- especially in the first years after treatments-- but both groups experienced huge impacts.

“This paper tells you that if you get treatment there are a lot of side effects regardless of the therapy you chose,” the senior author Dr. David Penson, professor of urologic surgery at Vanderbilt University Medical Center, said in an interview.

Most men were in their sixties when they were first treated. Two years after treatment 60.8 percent of the men who had undergone radiation had erectile dysfunction, compared to 78.8 percent of those who chose surgery. By 15 years, the numbers became 87 percent and 93.9 percent. Many men also suffered urinary and bowel problems and those, too, grew worse with time.

A rational argument is that such side effects are acceptable if the treatment is saving lives. But the paper raises serious doubts.

“So many of these men have low-risk disease that probably doesn't need to be treated,” Penson said.

Men typically undergo needle biopsies because they have elevated levels of the blood test called prostate-specific antigen (PSA). If the needle finds cancer cells, a pathologist measures their severity, resulting in what is called a combined Gleason score that ranges from 1-- the least severe-- to 10. Most prostate cancers score between 6-7. Several top urologists at university medical centers agreed that prostate cancer below a score of 6 should be watched, but not treated. Yet in this latest study, which is a reliable cross-section of how medicine is actually practiced, about 60 percent of the men who underwent treatment had scores of 2 to 4.

The findings prove that “a staggering percentage of men with totally inconsequential prostate cancer got treated and suffered the consequences,” says oncologist Dr. Marc Garnick of Beth Israel Deaconess Medical Center and Harvard Medical School, who was not involved the study.

Undoubtedly, prostate cancer can be deadly. Estimates are that it will kill almost 30,000 men in the United States this year, second only to lung disease as the major cause of cancer deaths in men. But the problem is, there are at least two kinds of prostate cancer.

The common form appears in the majority of men over age 50, grows slowly, and never presents a health threat. The other form spreads rapidly and can lead to a horribly painful death, usually from malignant cells invading the bones. Doctors cannot tell the difference between the dangerous and harmless cancers. Researchers are looking for genetic markers that would make the critical distinction, but they have yet to find them.

Meanwhile, increasing numbers of prostate cancer specialists argue that the sensible path is for men with lower combined Gleason scores to undergo active surveillance (formerly called watchful waiting), come back for future tests and forgo treatment until it is indicated. Often they will never need treatment.

That doesn’t happen, however. Penson said recent surveys show that fewer than one in four men who are candidates gets active surveillance. The majority get surgery or radiation.

One reason for the intervention is “incentives for the facility and for the providers” -- in other words, money for hospitals and doctors. “Also,” he adds, “patients don't like to hear 'I have cancer and I'm just going to watch it.’” But patients should demand and doctors should educate that “just watching it” is perfectly safe in many cases. 

Learning that lesson could spare an enormous amount of misery and money.

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Shorter penis alarms some men after prostate treatment
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By Karen Rowan
MyHealthNewsDaily 

Men with prostate cancer often experience erectile dysfunction as a side effect of their treatment, and many find this to be upsetting to the point where it undermines their wellbeing. Moreover, men's distress about ED often does not improve over time — in some men, it worsens.

A new study sheds light on the causes of this prolonged distress. While some researchers have thought that the severity of a man's ED is linked with how distressed he feels, the new findings show that regardless of men's ED severity, they are much more likely to be distressed when they feel they've lost their masculinity as a result of treatment.

Not all men experience this feeling of lost masculinity, said study researcher Talia Zaider, a clinical psychologist at Memorial Sloan-Kettering Cancer Center in New York City. But those who do are most at risk of feeling deeply troubled, embarrassed or ashamed about their ED.

A feeling of lost masculinity is an aspect of prostate cancer treatment that's not often talked about, Zaider said. "Gender norms work against men," and can keep them from discussing it, she said.

In the study, about one-third of men who had been treated for prostate cancer in the last year reported feeling their masculinity was diminished, and that they had lost a vital part of their identity, Zaider said.

A better understanding of how men respond to their sense of a change in their identity could help researchers find better ways to help men recover, the researchers wrote in their study, published online Sept. 18 in the Journal of Sexual Medicine.

About 242,000 men in the U.S. will be diagnosed with prostate cancer in 2012, and 28,000 will die of the disease this year, according to estimates from the National Cancer Institute. More than 9 in 10 prostate cancers are diagnosed in early stages, and these men are likely to live for a long time after treatment.

This optimistic outlook on survival means that researchers are looking closely at factors affecting men's quality of life after the treatment, Zaider said.

Treatments can affect men's sexual, urinary and bowel functioning, but i mpaired sexual functioning is the most common long-term complaint of men after treatment, according to the study.

Zaider and colleagues interviewed 75 men, whose average age was 60, who had received prostate cancer treatment in the previous year.

The men answered questions about their level of erectile function, how happy they were with their sex lives, the degree to which they felt a loss of masculinity, and the amount of "marital affection" they felt in their relationship (all men in the study were living with a spouse or partner). The men's spouses were also interviewed.

"Men who felt they'd lost their masculine identity were very likely to be stressed by their ED. The two seemed to go closely together," Zaider said. "That link was there whether they had severe or mild ED."

The researchers also found that among men who felt a lost of their masculinity, those in relationships with a high degree of affection were less likely to feel distress over their ED.

But women don't always understand their husbands' feelings. "I've worked with couples, and when the man talks about how upset he is about his loss of erectile function, the wife says, 'but you're alive, and we're OK,'" Zaider said. "For men, it's not just about their function — it signifies a loss of who they are. There are feelings of incompleteness."

The findings make a case for involving men's partners in interventions aimed at helping men cope with their distress, she said. The researchers have begun a trial to test the effectiveness of such an intervention.

"Perhaps in the context of a strong, affectionate and communicative relationship, men can revise their ideas about what makes them a man and, in turn, adjust better to ED," Zaider said.

More from MyHealthNewsDaily:

• 7 Surprising Reasons for Erectile Dysfunction
• 5 Ways Relationships Are Good for Your Health
• 5 Things You Should Know About Prostate Cancer 

For men diagnosed with prostate cancer, the decision about how to treat it -- or even whether to treat it -- can be agonizing. Surgery, radiation, or some  combination of both may lead to miserable side effects such incontinence, impotence and rectal damage. Doctors usually can’t predict whether a man will suffer all or none of those side effects. While some risk factors are well-known -- including age, diabetes and poor cardiovascular health -- whether a man suffers harsh side-effects is often chalked up to random luck.

So what if it were possible to know before treatment which men might be more likely to suffer complications?

New research, published Thursday in the International Journal of Radiation Oncology, discovered a set of genetic markers that appear to indicate a significantly greater risk of collateral damage from radiation treatment for prostate cancer. Knowing a man’s susceptibility to fallout from radiation may steer a doctor toward surgery instead of other potentially damaging therapy.

“More often than not, it’s not clear-cut which way to go,” explained Barry Rosenstein, professor of radiation oncology at Mt. Sinai School of Medicine in New York City. “If you see a surgeon, he’s likely to say surgery is best. If you see a radiation oncologist he’ll say oncology.”

Determining what type of treatment a man should receive is only part of the dilemma of prostate cancer. The debate whether to even test for it is ongoing. This early-stage study represents a big step toward doctors and their patients making that decision.

The researchers started with a pool of 841 men treated with radiation for prostate cancer. Patients were assessed every three to six months for signs of sexual dysfunction for up to five years. The number of men studied was eventually winnowed down to 260 patients with erectile dysfunction and 205 controls.

The scientists then performed DNA analyses on the men, looking for genetic variations called single nucleotide polymorphisms, or SNPs (pronounced snips), slight differences in the “spelling” of our DNA.  After sifting through hundreds of thousands of SNPs, they settled on 12 suspect genetic variations.

It turned out that when the SNPs were combined to create a score that could be used to measure individual risk of treatment complications, having just one of the 12 SNPs more than doubled the risk. The more of the 12 a man had, the greater his chances of radiation therapy complications.

“It is cumulative,” Rosenstein explained. “If a man has five or six, it increases his chances quite a bit.”

The research is still in the early stages, so doctors aren’t likely to be using the genetic markers to determine treatment any time soon. “This is still not nearly good enough, yet” he said.

But he’s part of an international consortium that is trying to make that very scenario a practical reality. The next step, he said, is for group members to validate the predictive power of the markers his team found.

If they can, then doctors really will be “able to assign patients to treatments and see if we maintain the same level of control of cancer and lower the incidence of complications,” he said. “And if we can do that, then there’ll be enough confidence to put it into use in the clinic.”

Even better, he suggested, it may one day be possible to use drugs to target the SNiPs, or the biological processes they influence, as a way to prevent damage from therapy.

That hope is evident to other researchers, such as Dr. Ithaar Derweesh, a urologic oncologist and associate professor of surgery at the University of California San Diego Moores Cancer Center.

"This is a study that in certain ways is groundbreaking and also elegantly performed," Derweesh said.

While Derweesh agreed with Rosenstein that such a technique will take time to validate, and be used to steer patients toward a particular therapy -- something he called the "holy grail" -- he suggested that in the nearer term, such markers might be used as a trigger to pre-emptively begin erectile rehabilitation or to take measures that might lessen the potential damage.     

This kind of work is important not just for prostate cancer, but all cancers. While there has been greater success in treating cancer, survivors may live many years with side effects after treatment. If Rosenstein’s hopes are fulfilled, it may one day be possible to prevent some of the damage before it’s done, and still effectively treat the cancer.       

Brian Alexander (www.BrianRAlexander.com) is co-author, with Larry Young Ph.D., of "The Chemistry Between Us: Love, Sex and the Science of Attraction," (www.TheChemistryBetweenUs.com), now on sale.

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The news that financier Warren Buffett, in the public eye lately thanks to the politics of the so-called proposed “Buffett Rule” that would raise taxes on the very wealthy, has been diagnosed with Stage 1 prostate cancer may be noteworthy, but it’s not surprising.

Buffett will be 82 on August 30. It’s a truism among urologists that just about every man who lives long enough will get prostate cancer, but that most men will die with, not of, the disease. In 2011, 240,890 men were diagnosed with prostate cancer, according to the American Cancer Society, and 33,720 men died of it.

As those numbers suggest, most men survive prostate cancer. Stage 1, the phase of disease Buffet announced he has, is the earliest, and least deadly stage. At Stage 1, the cancer is limited to one-half or less of one lobe of the prostate. Buffett's cancer was discovered after routine blood tests showed his PSA level had jumped.

"I feel great — as if I were in my normal excellent health," Buffett said. "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."

Buffett said he was diagnosed April 11 and has received tests including a CAT scan, a bone scan and an MRI. He said the tests showed no indication of cancer elsewhere in his body.

Buffett has chosen radiation treatment — five days a week for six weeks. During radiation treatment, people feel tired and have some risk of urinary and bowel problems but usually can work and live normally, said Dr. Sean Collins, a radiation oncologist at Georgetown's Lombardi Comprehensive Cancer Center.

In general, treatments for Stage 1 prostate cancer can range from simple watchful waiting to treatments like surgically removing the prostate or implanting radioactive “seeds” to kill the tumor. Doctors in the UK recently announced in the journal Lancet Oncology that a new technique using ultrasound beams treated the cancer in test subjects without some of the serious side-effects like incontinence and impotence most men worry about.

Buffett's case is likely to renew controversy over PSA blood tests. A leading government task force warns against them for men older than 75 because prostate cancer usually grows so slowly in older men that it rarely proves fatal. That means many men are treated and suffer side effects unnecessarily. The American Cancer Society says only men in good health with a life expectancy of at least 10 years should consider a PSA test.

"Mr. Buffett made a decision to get it, but that may not be the right decision for every man in that age group," said Dr. Len Lichtenfeld, the cancer society's deputy chief medical officer.

Likewise for treating the disease. Any man at that age should have "a careful conversation with his physician about the pros and cons of treatment," let alone which type is best, Lichtenfeld said. "We're becoming increasingly aware that not every man needs to be treated."

In a letter to shareholders, Buffett said, "The good news is that I've been told by my doctors that my condition is not remotely life-threatening or even debilitating in any meaningful way," he wrote in the letter.

Dr. Christopher Kane, chief of Urology at the University of California San Diego School of Medicine, told msnbc.com that for patients who are Buffett's age, if the cancer is determined to be slow growing (based on analysis of prostate specific antigen, or PSA), watchful waiting is a common tactic. If it’s more aggressive, then surgery or radiation using seeds or a focused beam may be considered.

Since the cancer is Stage 1, he said, “that implies the cancer is confined to the prostate, or that there is a low risk for metastases to other parts of the body.” Given that, Buffett’s prognosis would be good. 

Related: Warren Buffett tells investors he has cancer 

The Associated Press contributed to this report.

Vitamin D does not protect men from getting prostate cancer, but it may lessen their chances of dying of it.

In a new study, men with the highest levels of vitamin D in their blood were 57 percent less likely than men with the lowest levels to succumb to prostate cancer.

However, no link was found between vitamin D levels and having prostate cancer, the researchers said.

"Prostate cancer is a very heterogeneous disease," said study researcher Irene Shui, an epidemiologist at the Harvard School of Public Health. Some tumors progress quickly, spreading to other sites in the body and causing death, while others stay within the prostate for years and never affect a man's health or life.

It remains unclear exactly why vitamin D would lower men's risk of dying from prostate cancer if it has no influence at all on the risk of developing the cancer, Shui said. It may be that vitamin D specifically influences the cancer cells' abilities to progress to later stages of the disease and spread through the body, but not the actual initiation of the cancer, she said.

Still, the study was observational, and it does not show a cause-and-effect link between vitamin D and prevention of deadly prostate cancer.

The new findings were published in online April 12 in the Journal of the National Cancer Institute.

Vitamin D and prostate cancer
"There is abundant laboratory evidence that vitamin D may have anticancer properties," Shui said. But while studies conducted on prostate cancer cells growing in lab dishes have shown that vitamin D may thwart cancer's progression, studies in people have shown that high levels of the vitamin don't lower a man's risk of getting cancer of the prostate, the gland surrounding a man's urethra.

For their study, the researchers gathered data from men who had provided blood samples between 1993 and 1995 as part an ongoing study at Harvard University. The researchers looked at 1,260 men who had developed prostate cancer by 2004, and 1,331 men who were the same age but didn't develop the disease.

By March 2011, when the study ended, 114 of the men with prostate cancer had died. When the researchers looked at these men's levels of vitamin D, they found that 31 of them were among the men with the lowest levels of vitamin D in the study, whereas only 19 of them were among the men with the highest levels of vitamin D in the study.

However, vitamin D levels made no difference in terms of developing any prostate cancer — 310 of the men with the cancer were in the group with the lowest vitamin D levels, and 333 of the men with cancer were among those with the highest levels.

So should men try to get more vitamin D?
While the results of this study need to be replicated in future research, Shui said, vitamin D has been shown to have numerous effects on health. "Men who are concerned that they may be deficient in vitamin D should speak with their physicians about taking supplements or eating more foods rich in vitamin D," she said.

The vitamin is also produced naturally by the skin when exposed to the sun. Getting about 30 minutes of sun exposure between 10 a.m. and 3 p.m. twice a week usually leads to sufficient vitamin D synthesis, according to the National Institutes of Health. 

The study was limited in that most of the participants were white. "As vitamin D deficiency is even more prevalent in men of African descent, and this population also has a higher prostate cancer risk, studies conducted in men of other ethnicities would be helpful to see of our results are generalizable to those populations," Shui said.

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• Balding at Age 20 May Signal Higher Risk of Prostate Cancer

Men who got regular PSA blood tests were 21 percent less likely to die of prostate cancer, according to a European study published in the New England Journal of Medicine Wednesday. The new research probably won’t change the current screening guidelines for American men, but the findings could reopen the controversy -- and confusion -- over prostate cancer screening.

“What am I am supposed to do?” my physician lamented during my most recent physical exam.  “All my male patients are refusing PSA tests.  How do I check for their prostate cancer risk?”

It has become a common concern. Ever since the Food and Drug Administration approved it in 1987, the Prostate-Specific Antigen blood test has been controversial. Many experts condemned it as unnecessary, or even dangerous, for most men. Many medical organizations including the American Cancer Society, the American Medical Association and, most recently, the U.S. Preventive Services Task Force have not recommended it. General practitioners often ordered the test, usually without a discussion of the implications, to most men who came into the office.

Finally, however, many patients have gotten the message and are saying no on their own.

This trend will likely continue despite results from the European Randomized Study of Screening for Prostate Cancer that followed 182,000 men for 11 years. More fundamentally, it renews the question: How can a cheap and painless blood test for a potentially deadly cancer be unnecessary -- or even dangerous?

Prostate cancer differs substantially from most other cancers.  Still, many doctors and patients insist on putting it into their mental box called “cancer” where the response is always “find it early and cut it out.”

Make no mistake, it can be a killer. At least 28,000 men in the U.S. will die from prostate cancer this year.  But 241,000 men in this country will be diagnosed with the disease and most of them  -- whether they are treated or not -- will likely survive to die of something else. 

Prostate cancer comes in at least two forms. One is the killer; the other is a slow-growing type of cell most men get if they live long enough. Studies of men who died of other causes found that 30 percent of those 50 and older and 70 percent of those over 80 have prostate cancer and never know it.  Medical science cannot distinguish between the killer form and the far more common one that can be left alone.

That is where the PSA test comes in. It is not a test for cancer, but for normal prostate tissue, which can be enlarged for several reasons. If the PSA is elevated, the doctor will order a needle biopsy. Because prostate cancer is so ubiquitous, the biopsy will often find some.

Then the patient and his doctor face a dilemma. Whether the treatment is surgery, radiation, hormones or a combination, it often comes with serious side effects including impotence, incontinence and bowel problems. Often men who need no treatment follow this path and end up with the side effects. Millions of American men have. It is difficult to find men who will admit suffering embarrassing side effects that may not even be necessary. In fact, most often they will call themselves lucky to be “a cancer survivor” -- even if it is from a cancer that may never have hurt them.

The latest European study found that to prevent one prostate cancer death, 1,055 men had to be screened and 37 men were diagnosed. That means that 36 men were eligible for treatment that may not have been necessary and may have left the men with distressing side effects.

In addition, a similar study of U.S. men has found no survival advantage from routine screening.  An editorial in the current New England Journal of Medicine where the study appears concludes current guidelines should not change.

As for my physician’s question, he still has the old digital rectal exam to find lumpy spots, which was how prostate cancer was found before PSA.  And scientists are looking hard for some genetic marker that will distinguish the truly dangerous prostate cancer.

Until there is better diagnosis, any man would be advised to have a serious discussion with his physician about whether he wants his blood to be tested for PSA. The test could easily start him down a path he does not want to follow.

More from Robert Bazell:  

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Robert Bazell is NBC's chief science and medical correspondent. Follow him on Facebook and on Twitter @RobertBazellNBC

By Joseph Brownstein
MyHealthNewsDaily

Men who are circumcised may have a lower risk of developing prostate cancer, a new study finds.

Researchers at the University of Washington surveyed 1,754 men with prostate cancer, and 1,645 similar men who did not have the disease.

They found that those who had been circumcised before they first had sexual intercourse were 15 percent less likely to have prostate cancer.

"These data suggest a biologically plausible mechanism through which circumcision may decrease the risk of prostate cancer," said study researcher Dr. Jonathan Wright, an assistant professor of urology at the University of Washington School of Medicine. He noted that the study was observational; it did not show a cause-and-effect link.

Still, the reason for the findings might be that men who are uncircumcised are more likely to contract sexually transmitted infections. The inflammation caused by those infections may in turn be involved in the development of prostate cancer, the researchers said.

The study appears today (March 12) in the journal Cancer.

Circumcision & cancer

Because the results were based on men with prostate cancer at a single point in time, and not the result of following patients forward in time, from circumcision through developing prostate cancer, other experts expressed concerns the results might be skewed for unknown reasons.

"It certainly is an interesting and thought-provoking report," said Dr. Durado Brooks, director of prostate and colorectal cancers for the American Cancer Society, which publishes the journal.

But the findings would need to be replicated in other groups of people, Brooks said.

"I don't believe it's anything that will alter clinical practice, either for adults or children," Brooks said.

For parents wanting to know the benefits from circumcision, the possibility of lowering the risk of infections "would be a more convincing and better documented concern…than the possibility of prostate cancer 50 years down the line," he told MyHealthNewsDaily.

Medical organizations have noted small benefits potentially arising from circumcision, but have not advocated for circumcision as a matter of routine, largely because the procedure can have complications.

"At the end of the day, we feel there's risks and benefits, and it's up to the parents to decide what is in the best interests of their child," said Dr. Andrew Freedman, a pediatric urologist and a member of the circumcision task force at the American Academy of Pediatrics.

The AAP is now revisiting its position on circumcision, which was last reaffirmed in 2005. A new statement is due to be released this year.

Circumcision in adulthood

One concern Freedman expressed about the new study was that the highest rates of prostate cancer were found in men who were circumcised as adults.

While this was the smallest group of men in the study, and therefore most likely to have the results skewed by chance, he said that the inclusion of these men with others who were not circumcised may have made the benefit of circumcision seem larger than it actually is.

Men getting circumcised later in life might be doing so because of increased infections, Freedman said.

"Circumcision after sexual debut means the male may have already acquired a STI, and might already have inflammatory damage to the penis," said Brian Morris, a professor at the University of Sydney.

Morris said he is more in favor of circumcision than most in the mainstream medical community, having published research that indicates cost savings from circumcision in infancy, in the form of reduced infections later in life.

Noting a higher rate of urinary tract infections among uncircumcised men, Morris said, "I'd like to see more research done to see whether there is a connection between these and prostate cancer."

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