Former President Joe Biden has recently been diagnosed with an aggressive form of prostate cancer that has spread to his bones. This announcement has reignited the conversation surrounding who should undergo annual screenings for this serious disease. Prostate cancer is the second leading cause of cancer-related deaths among men, claiming approximately 35,000 lives each year in the United States.
Following Biden's diagnosis, speculation arose online suggesting that he may have been aware of his condition prior to the announcement. Critics pointed out that his medical records while in office do not clarify whether he underwent testing for prostate-specific antigen (PSA), a marker that can indicate a heightened risk for prostate cancer when elevated. Experts consulted by The Washington Post noted that it is not uncommon for men of Biden's age to forgo such screenings.
Michael Morris, head of the prostate cancer section at Memorial Sloan Kettering Cancer Center, explained that for most cancer screenings, there comes an age when screening is deemed unnecessary. He emphasized that the majority of prostate cancers diagnosed are not aggressive and pose little threat to longevity. According to the U.S. Preventive Services Task Force, routine screening is not recommended for men aged 70 and older. For men between 55 and 69, the decision to screen should be made on an individual basis.
The guidelines from the U.S. Preventive Services Task Force caution that many men may experience potential harms from screening, such as false-positive results, overdiagnosis, and treatment complications, including incontinence and erectile dysfunction.
The American Cancer Society does not endorse routine prostate cancer testing for men of any age. They suggest that men should consult with their healthcare provider about screening starting at age 40 if they have a family history of prostate cancer, at age 45 for those at high risk (including African American men), and at age 50 for men at average risk. The ACS warns that because prostate cancer often grows slowly, asymptomatic men should not be screened as they are unlikely to benefit from such interventions.
On the other hand, the American Urological Association takes a more proactive approach, advocating for screening to begin at age 40 for high-risk men and recommending regular screenings every two to four years for men aged 50 to 69. Notably, the guidelines do not address recommendations for men aged 70 and older.
Phillip Koo, chief medical officer at the Prostate Cancer Foundation, indicated that the risk-benefit analysis for screening has evolved. The foundation now recommends increased screening due to the availability of numerous treatment options. Koo highlighted that the primary treatment for early prostate cancer—tumor removal—is increasingly performed via laparoscopic or minimally invasive surgery, which typically involves small incisions and can often be done on an outpatient basis.
"The take-home message is that patients can be their own best advocates, and early detection and treatment can significantly impact their lives," Koo remarked.
According to Biden's office, doctors discovered a nodule on his prostate, and subsequent microscopic analysis confirmed the presence of cancerous cells. His cancer received a Gleason score of 9 out of 10, indicating its aggressive nature, and further investigation revealed that it had metastasized to his bones.
In contrast, former President Barack Obama had his PSA levels checked during his tenure, consistent with screening guidelines that recommend early screening for high-risk groups. Obama was 47 at the start of his presidency. Former President Donald Trump also had his PSA checked earlier this year, with normal results.
As Biden, now 82, navigates his cancer treatment, he is likely to undergo hormone therapy to inhibit testosterone production, which fuels prostate cancer, similar to how estrogen is linked to breast cancer. Peter Nelson, a prostate cancer researcher, described this therapy as a means to reduce testosterone levels significantly, thereby prolonging survival.
While hormone therapy can extend the lives of cancer patients, it often brings significant side effects, including fatigue, hot flashes, cognitive challenges, weight gain, and decreased libido. Morris emphasized that the dangers associated with untreated metastatic disease far outweigh the side effects of hormonal therapy.
Otis Brawley, a medical oncologist at Johns Hopkins University, noted that hormone therapy can be psychologically challenging for patients, with many reluctant to accept treatment due to the associated side effects. However, he pointed out that older patients may find the transition to lower androgen levels less disruptive.
Experts, including William Dahut from the American Cancer Society, estimate that the average life expectancy at diagnosis for patients with metastatic prostate cancer that has spread to the bone is approximately three to five years, although some may live significantly longer. Dahut highlighted that Biden’s prognosis may vary based on numerous factors, including the extent of bone metastasis and the cancer's response to initial hormonal therapy.
As the dialogue around prostate cancer screening continues, Biden's case serves as a critical reminder of the importance of early detection and treatment for this prevalent disease.
