Over the weekend, you may have heard that former President Joe Biden has been diagnosed with an aggressive form of prostate cancer that has metastasized or spread to his bones. This diagnosis – a Gleason score of 9 (Grade Group 5) – shows a high-grade cancer with a real potential for rapid progression without treatment.
What Does a Gleason Score of 9 Mean?
The Gleason scoring system uses biopsies of the prostate to grade the aggressiveness of prostate cancer based on examination of the retrieved prostate tissue. Scores range from 6 to 10, with higher numbers indicating more aggressiveness. A score of 9 tells us that the cancer cells are likely to grow and spread quickly.
What Is Bone Metastasis?
The spread of prostate cancer to the bones is an indicator of an advanced stage of the disease. While serious, bone metastasis is still treatable. That said, bone involvement can lead to complications such as pain, fractures, and other skeletal issues, impacting quality of life.
Treatment Options: Hormone Therapy and Beyond
Biden’s cancer is reported to be hormone-sensitive, meaning it relies on androgens like testosterone to grow. Androgen deprivation therapy (ADT) reduces or blocks these hormones and slows the cancer. Traditional medications lower testosterone levels, and newer options inhibit androgen production or block androgen receptors.
In cases where the cancer has metastasized to the bones, other treatments may also be considered:
Targeted radiation can alleviate bone pain and control localized tumor growth.
Chemotherapy drugs like docetaxel may be suitable, especially if the cancer develops resistance to hormone therapy.
Medications such as bisphosphonates or denosumab can strengthen bones and reduce the risk of fractures.
Surgical removal of the prostate, known as a radical prostatectomy, is typically not offered in these cases due to the widespread nature of the disease.
Prognosis and Survival
While metastatic prostate cancer is not curable, advancements in treatment have improved survival rates. Patients with hormone-sensitive metastatic prostate cancer can live several years with appropriate therapy.
Importance of Early Detection
President Biden’s diagnosis highlights the need for early detection of prostate cancer. Routine screenings, including prostate-specific antigen (PSA) tests and digital rectal exams, can find cancer before symptoms ever show. Early-stage prostate cancer has a significantly higher survival rate, so regular check-ups, especially for men over 50 or those with risk factors, are critical.
If you’re wondering why this cancer wasn’t caught sooner, the United States Preventive Services Task Force (USPSTF) recommends against routine prostate cancer screening for men 70 years and older. It’s possible that the former president hasn’t had a prostate exam in over a decade. However, President Biden’s diagnosis highlights both the importance of shared decision-making in deciding when to discontinue prostate cancer screening as well as the risks of discontinuing testing.
Of course, all of us at Georgia Urology wish President Biden the very best in his fight against the disease.
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