Joe Biden Diagnosed with Aggressive Prostate Cancer
Former U.S. President Joe Biden has been diagnosed with an aggressive form of prostate cancer, according to reports from his office. The Prostate Cancer Foundation of Australia (PCFA) has indicated that despite the seriousness of the diagnosis, recent medical advances offer him strong chances of survival.
Biden, aged 82, has a Gleason score of nine — also described as grade group five — with cancer that has spread to his bones.
Understanding the Gleason Score
The Gleason Score is used to assess how aggressive prostate cancer is, helping to determine how quickly it might progress. While still widely used, the newer ISUP grading system (referred to as “grade group”) is now considered more straightforward and accurate by medical professionals, including the PCFA.
These scores are determined by analyzing prostate tissue samples, and they are separate from cancer staging. According to the American Cancer Society, the grade reflects how abnormal the cancer cells appear under a microscope — more abnormal cells typically indicate a faster-growing cancer.
The Gleason system assigns scores to the two most common patterns seen in the tissue, each ranging from one to five. However, scores of one and two are rarely used today, meaning the lowest practical score begins at three.
A patient’s final Gleason score, ranging from two to ten, is the sum of those two pattern scores. For example, if one pattern is rated three and the other four, the combined score is seven. Higher scores suggest a more aggressive cancer.
What Does a Gleason Score of Nine Indicate?
A score of nine, like Biden’s, is classified as highly aggressive. Former White House physician Dr. Jeffrey Kuhlman described it as “the score you do not want to have.” Typically, scores between six and ten confirm a prostate cancer diagnosis, with grade group five representing the highest level of risk.
What’s Biden’s Outlook?
While his office did not give a detailed prognosis, it noted that the cancer is hormone-sensitive, allowing for effective management. PCFA CEO Anne Savage said, “We would expect him to outlive his disease,” adding that prompt and effective treatment greatly improves survival chances.
Dr. Kuhlman, however, cautioned that only around one-third of men with metastatic prostate cancer survive beyond five years. Nevertheless, new drug classes are showing promise in prolonging life and managing the disease, according to Ms. Savage.
The Cancer Council NSW notes that prostate cancer generally has a high survival rate, especially when caught early, and even aggressive types often progress more slowly than many other cancers.
What Does ‘Metastasis to the Bone’ Mean?
When cancer spreads to the bone, it’s classified as advanced or stage 4. This occurs when cancer cells travel through the blood or lymphatic system. Though secondary bone cancer is not curable, treatments can relieve symptoms and improve quality of life for years.
Dr. Kuhlman remarked that it’s uncommon for prostate cancer to be metastatic at diagnosis, noting this occurs in only about 10% of cases — typically among patients with limited healthcare access.
Prostate Cancer Treatment Options
Treatment varies based on the cancer’s stage and the patient’s health. Options include:
- Androgen deprivation therapy (testosterone suppression)
- Additional hormone therapy
- Chemotherapy
- Radiation therapy
- Surgery (radical prostatectomy)
Biden’s office confirmed he is still considering treatment options and highlighted the hormone-sensitive nature of his cancer. Hormone therapy, available via tablets or injections, works by blocking or reducing hormone levels to slow cancer growth.
Ms. Savage also noted that Biden might pursue a combination of therapies, including newer nuclear medicine treatments. One such method, PSMA therapy, uses radioactive molecules to target cancer cells and has shown encouraging results in clinical trials — though it’s not yet approved for general use in Australia.
Symptoms of Prostate Cancer
Early-stage prostate cancer typically shows no symptoms. In advanced cases, symptoms may include:
- Frequent urination
- Painful urination
- Blood in urine or semen
- Weak urine stream
- Back or pelvic pain
- Leg or foot weakness
- Fatigue or unexplained weight loss
How is Prostate Cancer Diagnosed?
The most common diagnostic tool is the PSA (prostate-specific antigen) blood test. If elevated levels are found, a biopsy may follow, where tissue samples are examined using ultrasound guidance.
Digital rectal exams (DREs) are no longer routinely recommended for men without symptoms, according to PCFA guidelines.
When and How Often Should Men Be Tested?
PCFA recommends men start testing from age 40 — earlier than current guidelines, which begin at 50. Testing frequency depends on age, family history, and overall health. Annual testing is suggested for those at high risk, such as men with a family history of prostate, breast, or ovarian cancer or those with BRCA1 or BRCA2 gene mutations.
Ms. Savage urges men not to delay testing, emphasizing that prostate cancer is often symptomless in its early stages.
