Joe Biden's prostate cancer: Risks, symptoms, treatment options explained

Joe Biden's metastatic or stage 4 prostate cancer diagnosis highlights common symptoms, risk factors, and treatment options men should know about

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Former US President Joe Biden has been diagnosed with aggressive prostate cancer at the age of 82. His office confirmed that the disease has metastasised to his bones, making it a serious but manageable condition through ongoing hormone therapy.

 

The diagnosis came after Biden experienced urinary symptoms and underwent a physical exam that revealed a suspicious prostate nodule. A biopsy confirmed a high Gleason score of 9, a sign of fast-growing cancer. Doctors say that while the disease is not curable at this stage, hormone therapy can slow its progression and extend life expectancy.

 

This isn’t Biden’s first encounter with cancer. Earlier in February 2023, President Biden had a basal cell carcinoma, a common type of skin cancer, removed from his chest. Before that, in November 2021, doctors removed a polyp from his colon, which was benign but had the potential to become cancerous. Before the presidency, he underwent treatments for multiple non-melanoma skin cancers, including Mohs surgery, due to sun exposure earlier in life.  According to Biden’s office, he and his family are reviewing treatment options with his physicians. When prostate cancer spreads beyond the prostate, it most commonly spreads to the bones. Metastatic cancer is more difficult to treat than cancer that remains localised, as it becomes challenging for medications to reach and eliminate all cancerous cells throughout the body.

 

However, in cases like Biden’s, where the cancer relies on hormones to grow, treatments that block or reduce hormone levels can be effective in slowing or controlling the disease. 

What is prostate cancer and how does it develop?

Prostate cancer develops in the prostate gland, a small organ in men that produces seminal fluid. It’s one of the most common types of cancer in men and often grows slowly. However, some forms are aggressive and can spread quickly, as in Biden’s case.

How is prostate cancer aggressiveness measured?

The aggressiveness of prostate cancer is assessed using the Gleason score on how abnormal the cancer cells look under a microscope. It helps doctors predict how quickly the cancer is likely to grow and spread. The score ranges from 2 to 10. Higher scores, particularly 8, 9, or 10, indicate a more aggressive form of the disease. According to a statement from President Biden’s office, his score was 9, pointing to a highly aggressive cancer.

 

According to Cleveland Clinic, a nonprofit academic medical centre based in Cleveland, Ohio, US, pathologists analyse tissue from a prostate biopsy and grade each area of cancer on a scale from 1 to 5, where 1 indicates well-differentiated cells that closely resemble normal tissue, and 5 indicates poorly differentiated cells that look very abnormal. The two most common grades are then added to calculate the Gleason score.

 

What the scores mean:

• 6 or less: Low-grade cancer, less aggressive
• 7: Intermediate-grade
• 8 to 10: High-grade cancer, more aggressive and likely to spread 

What are the key risk factors for prostate cancer?

Risk factors for prostate cancer include:

• Age: Risk increases significantly after age 50
• Family history: Having a father or brother with prostate cancer doubles the risk
• Diet: A diet high in red meat and high-fat dairy products may increase risk
• Race: Men of Black or African ancestry are more likely to develop prostate cancers (even before age 50) that are more likely to spread
• Genetics: Men with Lynch syndrome or mutations in BRCA1 or BRCA2 genes are at high risk 

What are the early warning signs of prostate cancer?

Prostate cancer in its early stages may not show any symptoms. However, when symptoms do occur, they may include:

• Frequent or painful urination
• Weak urine flow
• Blood in urine or semen
• Erectile dysfunction
• Bone pain (in advanced stages)

How common is prostate cancer globally and in India?

According to GLOBOCAN, prostate cancer is the second most commonly diagnosed cancer in men with over 1.4 million new cases and 397,430 deaths reported in 2022.

 

In India, prostate cancer ranks among the top 10 cancers in men, with increasing incidence in urban areas. In 2022, 37,948 new cases and 18,386 deaths were reported in India, according to GLOBOCAN data.

How is prostate cancer diagnosed?

 

Doctors usually begin with:

• PSA test (Prostate-Specific Antigen): Measures PSA levels in blood. Higher levels may indicate cancer.
• Digital rectal exam (DRE): A physical check for abnormalities in the prostate.
• Biopsy: Tissue samples from the prostate are analysed for cancer cells.
• MRI/bone scan: To check if the cancer has spread.

What are the treatment options for prostate cancer?

• Treatment depends on how aggressive the cancer is and whether it has spread: 
• Active surveillance (for low-risk cases)
• Surgery (prostatectomy)
• Radiation therapy
• Hormone therapy (as in Biden’s case)
• Chemotherapy (in advanced cases)
• Immunotherapy and targeted therapy (for resistant or metastatic cancers) 

How much does prostate cancer treatment cost in India?

Treatment costs vary by city and hospital. Here are average estimates:

• Hormone therapy: ₹1,00,000 to ₹3,00,000 
• Radiation therapy: ₹3,00,000 to ₹5,00,000 
• Surgery: ₹3,00,000 to ₹5,00,000 
• Chemotherapy: ₹2,00,000 to ₹4,00,000 
• Immunotherapy: ₹5,00,000 and above 

Can prostate cancer be prevented or reduced?

You can’t control age or genetics, but the following can help reduce your risk: 

• Eat a diet rich in fruits, vegetables, and whole grains 
• Avoid red meat and processed foods 
• Maintain a healthy weight
• Exercise regularly 
• Get routine screenings, especially after age 50 or earlier if you have a family history

It is important to understand that early detection is key for any cancer, especially for those at high risk. Thus, one should never take the symptoms lightly and consult their doctor early.  For more health updates and wellness insights, follow #HealthWithBS