What a prostate cancer diagnosis like Biden’s means for patients

Former President Joe Biden’s cancer diagnosis announced Sunday

is raising questions about how a cancer that is typically found early could be undiscovered so long in someone with the comprehensive medical care of a former President.

Biden has Stage 4 prostate cancer, meaning it’s spread to his bones and cannot be cured, his office announced.

Experts say the diagnosis is a clarion call for men to speak with their doctor about getting screened.

According to MultiCare Cancer Institute oncologist Dr. Brett Gourley, prostate cancer is common and occurs at least once in the lifetime in over 20% of men. But the disease is most often caught very early and is not as deadly as the cancer with which Biden was diagnosed.

“A lot of people hear about prostate cancer that is low grade. And sometimes people don’t even remove it because they think it is a cancer that can’t cause mortality. Unfortunately, we know that when it spreads, prostate cancer can be fatal,” Gourley said.

According to CDC data, 114.7 men out of 100,000 will develop prostate cancer in a given year, but only 18.7 men out of a 100,000 will die from the disease. But that number increases drastically among the 8.1% of prostate cancer patients whose disease has spread to other areas of the body. Only 36.2% of patients survived within five years if their cancer had spread beyond the prostate, according to CDC data between 2014 and 2020.

The prostate is a gland near the bladder and assists use of the penis in males. Early symptoms of prostate cancer typically include blood in the urine, pain while urinating or difficulty in getting urine out. These symptoms are typically noticeable and irritating enough that those with prostate cancer go to the doctor before the cancer spreads.

According to Gourley, screening should be considered sometime between the ages of 40 and 70 for those with low risk factors. Screenings can be considered early for those at high risk of developing prostate cancer, such as those with relatives with the disease, those who have certain gene mutations and men with African ancestry.

Gourley said he could not speak to Biden’s health specifically but noted late-stage prostate cancer is often diagnosed late because patients have ignored symptoms.

“I would imagine that the President of the United States probably gets excellent access to medical care, and it’s very possible former President Biden and his physician had a conversation about prostate cancer screening, and based on his risk factors he decided that wasn’t something that he wanted to do. It’s also possible that he just wasn’t having any symptoms that would necessitate a workup for possible prostate problems until now,” Gourley said.

Other doctors have noted it is unlikely Biden first developed cancer after his presidency.

“He did not develop it in the last 100 to 200 days,” Dr. Ezekiel J. Emanuel, an oncologist who served as an adviser on the coronavirus pandemic for the Biden administration, said on MSNBC’s “Morning Joe.” “He had it while he was president. He probably had it at the start of his presidency in 2021.”

Recent research shows men with stage four cancer can now live longer, even if it is not curable.

“Life is measured in years now, not months,” Dr. Daniel W. Lin, a prostate cancer specialist at the University of Washington, told the New York Times.

Dr. Judd Moul, a prostate cancer expert at Duke University, said that men whose prostate cancer has spread to their bones, “can live 5, 7, 10 or more years” with current treatments. A man like Biden, in his 80s, “could hopefully pass away from natural causes and not from prostate cancer,” he said.

Biden’s office said the former president had urinary symptoms, which led him to seek medical attention.

But, Lin said, “I highly doubt his symptoms were due to cancer.”

Instead, he said, the most likely scenario is that a doctor did an exam, noticed a nodule on Biden’s prostate and did a blood test, the prostate-specific antigen test. The PSA test looks for a protein released by cancer cells, and can be followed up by an MRI. The blood test and the MRI would have pointed to the cancer.

When caught early, prostate cancer can often be surgically removed, and the cancer is treated by reducing testosterone levels. These anti-androgen treatments often cause menopause-like symptoms such as hot flashes, fatigue, libido loss and muscle atrophy.

With reporting from Gina Kolata of the New York Times and Amanda Sullender of The Spokesman-Review.