Long Island doctors weigh in on Biden's diagnosis, discuss how to reduce the odds of getting prostate cancer
Former President Joe Biden has been diagnosed with an aggressive form of prostate cancer that has spread to his bones, according to a statement released by his office. Here are some answers to questions about the most common cancer for men in the United States after non-melanoma skin cancer, and Biden's prognosis.
What is the prostate, and what's the related-cancer rate in the U.S.?
The prostate, a gland, is part of the male reproductive system. Cancer of the prostate is the most common cancer among men in the United States after non-melanoma skin cancer, according to the Centers for Disease Control and Prevention.
The American Cancer Society estimates 313,780 new prostate cancer cases will be diagnosed in the United States, and 35,770 men will die of the disease in 2025. The incidence is almost 70% higher in Black men than in white men.
What are the former president's treatment options?
Because the prostate cancer has metastasized into Biden's bones, it cannot be cured.
"There are treatment options for him that can help control the cancer and maintain his quality of life," said Dr. Reza Ghavamian, eastern region chair of urology for New Hyde Park-based Northwell Health.
With the increase in prostate screenings and tools, most cases are detected in the early stages of the disease. "It is very rare nowadays to find patients who would show up with bony metastasis at diagnosis," Ghavamian said. "That constitutes less than 5% of prostate cancer diagnosis."
Ghavamian wasn’t aware of the type of preventive screenings Biden had undergone over the years, but noted there are some situations where an aggressive prostate cancer may not be reflected in high numbers from a prostate-specific antigen (PSA) test, one tool used in detecting the disease.
When is the right time to get a PSA test?
The American Cancer Society recommends that men undergo blood tests to check their PSA levels starting at age 50 if they are at average risk. Those who are at higher risk, including having a family history of prostate cancer, should start at age 40 or 45, but have a discussion with their doctors first. Doctors can also test for prostate cancer through a physical examination.
"We look for an abnormality in the PSA and if the patient wants to proceed with further testing, there are various molecular markers we can look for in the blood or the urine," said Dr. Howard Adler, medical director of the Prostate Care Program at Stony Brook Medicine. "We also do an MRI and based on those results, we discuss the options of doing a prostate biopsy."
In Biden's case, the statement from his office said the 82-year-old former president had urinary symptoms. During an exam, doctors found what was described as a "small nodule" on his prostate.
How are early forms of prostate cancer treated?
Adler said many prostate cancers are slow-growing and can be managed. In some cases, the cancer can be treated with radiation therapy or a short course of hormone therapy. Surgical removal of the prostate is another option, but it can cause urinary incontinence and sexual side effects.
How are more aggressive forms treated, such as Biden’s?
"A lot of the treatments are hormone-based therapies," said Dr. Christopher Atalla, associate chief of urology and director of men's health at Good Samaritan University Hospital. "Prostate cancer thrives on testosterone, so the treatments suppress testosterone in the body."
He said that while radiation is generally used to cure prostate cancer, it can also be used with patients whose cancer has spread to the bones. "They call it palliative radiation," he said. "You can sometimes radiate the bones in areas where we're having pain or trouble walking to alleviate some of those symptoms."
Chemotherapy can also be used in treatment, but surgery is usually not.
"There's no benefit to taking the prostate out after it's already in the bones," Atalla said.
Adler pointed out that there are no sweeping recommendations for every person who has prostate cancer.
"Like all cancers, we can talk about it in generalities," he said. "But ultimately we have one human being in front of us and then we need to individualize therapy."
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