By Joel Achenbach — Former president Joe Biden has been diagnosed with an aggressive form of prostate cancer that has spread to his bones.
Prostate cancer is one of the most common types of cancer among men, especially older men. It usually grows slowly and initially remains confined to the prostate gland where it may not cause serious harm. But some types of prostate cancer can be aggressive and spread quickly to other parts of the body, including the bones.
Here’s what to know.
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What has Biden said about his diagnosis?
Biden’s office said Sunday that the cancer is subject to “effective management” and that Biden and his family are reviewing treatment options with his physicians.
“Last week, President Joe Biden was seen for a new finding of a prostate nodule after experiencing increasing urinary symptoms,” said a statement from Biden’s personal office. “On Friday, he was diagnosed with prostate cancer, characterized by a Gleason score of 9 (Grade Group 5) with metastasis to the bone.”
The diagnosis “represents a more aggressive form of the disease.” But the statement said “the cancer appears to be hormone-sensitive, which allows for effective management.”
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What is a Gleason score?
The pathology report gave Biden’s cancer a Gleason Score of 9 – in which 10 is the highest number possible – according to the statement from his office. A Gleason Score reflects the appearance of cells under a microscope. A high score indicates that many look malignant and not like normal prostate cells, said William Dahut, the chief scientific officer for the American Cancer Society. Dahut, who is not one of Biden’s doctors, worked until 2022 at the National Cancer Institute and ran the prostate cancer program.
The high Gleason Score means the cancer is aggressive but does not by itself show that it is metastatic, said Otis Brawley, a medical oncologist at Johns Hopkins University who treats patients with metastatic prostate cancer.
“If I have a Gleason Score of 6, it is almost never metastatic. If I have a 7, 8, 9 or 10, it can be metastatic. As the number goes up, the likelihood of it being metastatic goes up,” he said.
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How was Biden’s metastatic cancer detected?
Brawley said Biden probably had a Positron Emission Tomography (PET) scan that showed the spread of the cancer. He said it’s not surprising if previous prostate exams or screening while Biden was president failed to turn up indications of cancer. Brawley said “this happens all the time.”
“It is not a very good screening test, and we need a better test,” he said.
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What do treatment and prognosis look like?
“Once it spreads to the bones, in general we no longer consider this a curable cancer, although there are therapies that are very effective at treating the cancer,” Dahut said.
Typically a patient is treated with a hormone therapy that blocks the production of testosterone, Dahut said. That would shrink the prostate tissue itself, as well as the cancer.
“He could definitely live many years with this. There’s a wide range of how long people can live with metastatic prostate cancer,” Dahut said. “In the most aggressive cases, under a year, but there are reports of people living 15 or 20 years, too.”
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How long do patients like Biden survive?
“Many men are going to live for years with metastatic prostate cancer, especially with the new treatments available today,” said Jason Efstathiou, a prostate radiation oncologist at Mass General Brigham.
“Speaking generally, for all comers with bone metastatic prostate cancer at diagnosis, the median survival is on the order of about three to five years. Some patients live much longer.”
He said a longer survival is “especially dependent upon if they have a favorable response to treatment and access to modern therapies.”
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How common is prostate cancer?
In 2020, prostate cancer was the second-most commonly diagnosed cancer and the fifth-leading cause of cancer-related deathsin the U.S., according to the National Cancer Institute. According to 2020 data published in the journal Frontiers in Public Health, there were approximately 1,414,000 new cases globally, and 375,304 deaths.
It is the most frequently diagnosed cancer in 112 countries and the leading cause of cancer death in 48 of those countries.
Some types of prostate cancer can be aggressive and spread quickly to other parts of the body, including the bones. PSA testing in combination with a physical examare the best way to catch early aggressive prostate cancer.
Symptoms can include pain or difficulty urinating, more frequent urination, and blood in urine or semen. But by the time symptoms appear, the cancer has usually progressed to a more advanced stage that can be harder to treat.
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Sabrina Malhi contributed to this report.
