Biden’s Diagnosis Shines Light on Aggressive Prostate Cancer

When we think about prostate cancer, we tend to focus on the slow-growing nature of the disease. The cancer usually progresses at such a modest pace that the American Cancer Society suggests men with less than a 10-year life expectancy don’t even need to be screened for signs of the disease.

Yet when former president Joe Biden, 82, revealed that he has been diagnosed with an aggressive form of the disease, it served as a reminder that not all variants of prostate cancer are so docile. In Biden’s case, the disease has spread to his bones, complicating his treatment options.

Most Common Cancer in Men

Each year, it is estimated that there are nearly 315,000 new cases of prostate cancer in the U.S., making it the most common cancer for men. It is also the second-leading cause of cancer death for men, trailing only lung cancer.

You can essentially divide prostate cancer into two categories. The first is completely treatable. As long as the cancer is detected before it can spread and become serious, you can receive treatment and then move on with your life. In fact, most men who are diagnosed with prostate cancer will die from some other cause.

But there is a second category of higher risk prostate cancers that are aggressive and have the potential to end life early by spreading to other parts of the body. The Biden announcement revealed that his prostate cancer is an aggressive form of the disease with a Gleason score of 9.

Grading Prostate Cancer

Prostate cancer is typically diagnosed in a number of ways. It may be detected during a digital rectal examination, where your doctor runs a finger over your prostate to look for lumps or irregularities. Blood tests are also used to look for elevated levels of the PSA protein (prostate-specific antigen), which can indicate prostate cancer. If that number is high, your doctor may suggest a biopsy to collect tissue for a closer examination.

Medical pathologists – the scientists who help diagnose disease by studying tissues and fluids –use a grading system to rate the aggressiveness of your prostate cancer. After examining cells from your prostate under a microscope, the pathologist will assign a Gleason score of one to 10.

This scale, however, is not particularly intuitive. A score of anything less than six, for example, is not considered to be prostate cancer. So, the cancer scoring system only deals with ratings 6 through 10. Here’s what those scores tell us:

• Gleason 6: This is the mildest form of prostate cancer, with the lowest risk for growth. Treatments available include surgery ablation and HIFU focal ablation. It is not uncommon for the initial treatment recommendation to be nothing more than observation and surveillance.
• Gleason 7: These cancers have moderate risk of spreading. Your doctor is likely to suggest some form of treatment.
• Gleason 8, 9 and 10: These are high-risk cancers that are usually treated aggressively. There will be more options if the cancer is caught before it has a chance to spread to bones or other organs.

In the case of high Gleason scores, additional testing, including bone scans, can reveal whether the cancer has spread beyond the prostate.

Treating Advanced Prostate Cancer

When caught early, there are several treatment options available, including surgery, radiation therapy, hormone therapy, immunotherapy and chemotherapy. But once the disease has spread to bones or other tissues, the options are more limited – with the disease past the point of being cured.

If the disease has metastasized, the primary treatment is hormone therapy, also called androgen deprivation therapy. The treatment deprives the body of male hormones (including testosterone) that fuel the growth of cancer cells. This often inhibits prostate cancer, though some variants (known as hormone unresponsive) learn to grow even without this fuel. There are, however, new treatments being developed to help combat these aggressive cancers.

The outlook for patients with advanced forms of prostate cancer is significantly impacted by whether or not the disease has spread. If the cancer has not spread and his response to hormone treatment, life expectancy could be well beyond 10 years. On the other hand, if the cancer has spread and is not responsive to hormone therapy, the timeline could be more in the five-year range.