Former President Joe Biden, 82, has been diagnosed with an aggressive form of advanced prostate cancer that has spread to his bones and may be treatable, but not curable, several doctors say.
Several cancer specialists not involved in Biden’s care say that aggressive, advanced prostate cancer that has spread to the bones — like the type Biden has — can’t be cured.
“While it is treatable, it is not curable,” says Bilal Siddiqui, MD, an oncologist and a prostate cancer researcher at the University of Texas MD Anderson Cancer Center in Houston.
Because advanced cancers like the type Biden has aren’t curable, the main goal of treatment is to stall tumor growth, which can buy patients more time, says Tudor Borza, MD, an assistant professor of urology at the University of Michigan and the director of the Michigan Urological Surgery Improvement Collaborative (MUSIC) Prostate Program in Ann Arbor.
Here’s what else to know about the type of prostate cancer Biden has.
What Is a Prostate Cancer Gleason Score?
Lower scores indicate tumors aren’t expected to spread far or fast, and doctors don’t tend to intervene when patients have scores of 5 or less, says Douglas Dow, MD, a urological surgeon at Memorial Hermann Medical Group in Webster, Texas.
“A 9 out of 10 means it’s highly aggressive,” Dr. Dow says.
What’s Metastasis to the Bone?
Prostate cancer stages range from 1, when tumors are so small they may be undetectable with a physical exam or an ultrasound, to stage 4, when there is tumor growth outside the prostate, according to ACS.
When prostate cancer has spread into the bones it’s considered stage 4, the most advanced stage, says Dr. Borza. “In general, stage 4 cancers are not considered curable.”
What Treatments Are Possible?
The statement reported by CNN said that Biden’s type of cancer “appears to be hormone-sensitive, which allows for effective management.”
Prostate cancer is fueled by the male sex hormone testosterone, and all cases of prostate cancer start out as “hormone-sensitive,” meaning they can be treated with androgen deprivation that lowers testosterone levels, says Dr. Siddiqui.
“Prostate cancer feeds on testosterone, so if we remove the testosterone from the body — either what we call a chemical castration with shots of medicine and pills, or a surgical castration by removing the testicles — we remove the food for the cancer,” Dow says. “That means the cancer is hormone sensitive because you remove the hormones from the body.”
But at some point, even when testosterone is removed from the body, the cancer will still grow, Dow says.
Patients may also receive chemotherapy or radiation, Siddiqui says.
What’s the Prognosis for Advanced Prostate Cancer?
“The average life expectancy for metastatic prostate cancer is three to five years,” Siddiqui says. “But this can be shorter or longer, based on factors such as age, specific features of the cancer, and medical history.”
Is Prostate Cancer Preventable?
“Unfortunately there is no behavior that is proven definitively to prevent prostate cancer,” Dow says. “The biggest risk factor for prostate cancer is a known family history of prostate cancer, but the key to prostate cancer treatment is early detection.”
Detection is typically done with a combination of what’s known as a prostate specific antigen (PSA) blood test and a rectal exam, Dow says.
PSA screening isn’t recommended for men over 70, Siddiqui says. “This is because in many men, prostate cancer will be slow growing, and the harms of treatment may outweigh the benefits.”
How Common Is Advanced Prostate Cancer?
Prostate cancer is the most common cancer in American men, with about 1 in 8 men diagnosed in their lifetime, Borza says. Most cases are caught at less-advanced stages, but about 5 to 7 percent of men have metastatic cancer when they’re diagnosed, Borza adds.
It’s uncommon for men to have aggressive prostate cancer that has spread to the bones at the time of diagnosis if they’re getting routine PSA screenings, says Daniel Spratt, MD, the associate chief scientific officer at University Hospitals Cleveland Medical Center and a professor and the chair of radiation oncology at Case Western Reserve University.
“PSA screening could miss this, but that’s uncommon,” Dr. Spratt says.
But many men Biden’s age no longer get routine screening, Spratt adds. “It is more common that his PSA was not being routinely checked given his age or overall health status.”
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