Editor’s Note: Dr. Jamin Brahmbhatt is a urologist and robotic surgeon with Orlando Health and an assistant professor at the University of Central Florida School of Medicine.
President Joe Biden’s diagnosis of metastatic prostate cancer naturally raised concerns and questions.
As a urologist, I regularly diagnose my patients with prostate cancer and whenever I share the diagnosis with them and their families, it’s never easy. Over time I learned the importance of keeping conversations simple and straightforward. They use data, statistics and personal experiences to avoid sugar coatings and instead help patients begin their cancer journey.
When his publications turn attention to this type of cancer, it is a reminder to regularly check your own health. Here are some things you need to know about metastatic prostate cancer: How it is detected, how the treatment looks, and why early screening remains essential for men’s health.
The former president’s diagnosis began after he experienced “an increase in urinary symptoms,” his office says, and the prostate nodules were discovered.
The detection of prostate nodules may have occurred during digital rectal examination (DRE). During the DRE, the doctor gently inserts a finger into the rectum to examine the prostate gland, which is located directly in front of the rectal wall. A healthy prostate usually feels smooth and symmetrical. However, the prostate nodules feel firm, raised and irregular.
Not all prostate nodules indicate cancer. Many are benign and are associated with prostate enlargement (BPH) or prostate stones (calcification). However, in Biden’s case, further testing that could include prostate-specific antigen (PSA) blood tests, imaging and biopsies confirmed prostate cancer. Additional scans revealed that his cancer had spread to his bones, classifying it as a high-risk, aggressive metastatic prostate cancer.
“Metastasis” means that cancer cells spread beyond their original location (prostate glands) to other regions, most commonly bones and lymph nodes. Biden’s cancer especially spread to his bones, and he placed him between 5% and 7% of US prostate cancer cases that have spread in early diagnosis. This percentage appears to be small, but it represents a considerable number given that over 300,000 men in the US and around 1.5 million people worldwide are diagnosed with prostate cancer each year.
Early stage prostate cancer has an excellent prognosis with a survival rate of nearly five years. However, if prostate cancer is metastatic at the time of diagnosis, the 5-year survival rate drops sharply to about 37%. Importantly, these survival rates are statistical averages, with individual outcomes vary widely depending on overall health, age, cancer aggression, and how well a patient responds to treatment.
For Biden, and all prostate cancer patients, this diagnosis marks the beginning of a highly personalized journey. It is now impossible to answer the question “How long will it last?” accurately. Of course, this is a question that everyone wants to answer.
Prostate cancer severity is graded using a Gleason score ranging from 6 to 10. Scores (6-7) indicate slower growth and less aggressive cancer cells, whereas higher scores (8-10) represent aggressive cancers that are likely to spread quickly.
Biden’s Gleason score of 9 means highly aggressive prostate cancer that usually requires immediate and comprehensive treatment.
In my clinic, the moment of diagnosis of advanced prostate cancer is always difficult, evoking fear, uncertainty and many questions. At that moment, I ask the patient to take a deep breath and work with them as they build their care team.
This interdisciplinary team may include experts in urology, medical oncology, radiation oncology, radiology, and supportive care services. Each expert contributes to a unique perspective and helps in creating treatment plans that will give you the greatest interest in your patients and your life goals.
Local prostate cancer can often be cured with treatments such as robot-assisted prostate removal (prostatectomy) and radiation therapy. However, metastatic prostate cancer treatment moves from treatment to symptom management, control disease progression, and maintain quality of life. Common treatments for metastatic prostate cancer include:
-
Hormonal therapy (androgen ablation therapy, ADT): Blocks testosterone, which is essential for the growth of prostate cancer cells.
-
Chemotherapy: Drugs that slow the growth of cancer, especially when hormone therapy alone is not enough.
-
Radiation therapy: Reduces target metastatic lesions, especially bone pain and symptoms.
-
Immunotherapy and Precision Medicine: A treatment that leverages the immune system to attack cancer cells or treatments that target specific genetic markers.
-
Supportive care: Relieve symptoms and improve quality of life.
Advanced treatments effectively control metastatic prostate cancer, but often have side effects that affect daily life. Common side effects include fatigue, changes in sexual function, hot flashes, mood swings, and loss of muscle mass.
Treatment of metastatic prostate cancer depends on several factors, including the patient’s overall health, age, other medical conditions, and personal preferences. President Biden’s medical team carefully personalizes his treatment and closely aligns with his unique health situation and quality of life goals.
A common question revealed by Biden’s diagnosis is whether his cancer was detected earlier, or whether it affected him during his presidency. The US president receives excellent medical care and the truth is that we may never know.
Instead of staying with these unanswered questions, we recommend refocusing on what we have control over: our health. Biden’s diagnosis is a powerful reminder of our opportunities to actively manage our responsibilities and health.
As a urologist, I experience just how unpredictable prostate cancer is every day. Some patients show clear signs of illness, while others surprise me or even me with aggressive or unexpected cases. Cancer does not discriminate, and its trajectory is uncertain. But one factor that we all can control is our approach to prevention and early detection.
Symptoms to be aware of are urine or semen blood. You need to urinate more frequently, such as waking up at night and urinating. And it’s difficult to start when you urinate. Signs of more advanced disease include accidental leaks, back and bone pain, fatigue, weight loss and weakness.
Former President Biden’s experience is a call for action for us. Schedule regular health checks, discuss prostate screening with your health care provider, pay attention to physical signals, and prioritize overall health.
By shifting the conversation from speculation about other people’s journeys, you are investing in the most valuable and valuable assets you have: your health.