Former United States president Joe Biden, 82, has been diagnosed with an aggressive form of prostate cancer that has spread to his bones.
Biden sought medical attention last week after experiencing urinary symptoms, which led doctors to discover a nodule on his prostate, his office said in a statement on May 18. After further testing, an aggressive, high-grade cancer was found.
“While this represents a more aggressive form of the disease, the cancer appears to be hormone-sensitive which allows for effective management,” his office said.
“The president and his family are reviewing treatment options with his physicians.”
The prostate cancer was assigned a Gleason score of nine out of 10, indicating a highly aggressive form of the disease. The Gleason scoring system is the most common way to grade prostate cancer, with higher scores signifying more abnormal and rapidly growing cancer cells.
“It just really describes how the cells look compared to normal healthy cells,” explained Elizabeth Holmes, director of health policy at the Canadian Cancer Society.
“It gives an idea of how quickly the cancer might be growing and how likely it is to spread, and so it’s really one of the inputs that’s used for your health-care team in making suggestions for how to plan your treatment.”
Prostate cancer is the second most common cancer in men globally, with more than 1.4 million new cases diagnosed each year.
In Canada specifically, it’s the most frequently diagnosed cancer among men, with approximately 27,900 Canadian men diagnosed annually, representing about one in eight men during their lifetime.
The disease develops in the prostate, a small, walnut-shaped gland located below the bladder and in front of the rectum that produces seminal fluid.
While many prostate cancers grow slowly and may need minimal or no treatment, aggressive variants like Biden’s can spread quickly and require immediate intervention.
Cancers that have spread, or metastasized, are considered Stage 4, the most advanced.
Most prostate cancers are detected at an earlier stage as a result of screening, according to the American Cancer Society.
“This news is a reminder about the tragic impact of prostate cancer in the U.S., where about one in eight men will be diagnosed over their lifetime with prostate cancer. Although it is a highly survivable disease when caught in early stages, it is the second leading cause of cancer death in men. Early detection is key, and we are concerned given the 5% year-over-year increase in diagnosis of men with more advanced disease,” the American Cancer Society said in a statement on Sunday.
Prostate cancer risk factors
Certain factors can increase a man’s risk of developing prostate cancer, such as age, family history and ethnicity.
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“If you have a family history of prostate cancer, then it’s certainly really important to be aware that this increases your risk of developing prostate cancer,” Holmes said.
“We do know that prostate cancer occurs in Black men more often than in men of other ethnicities. So really important for Black men to be aware about their prostate cancer risk.”
The risk for prostate cancer also increases as men get older. The chance of being diagnosed with prostate cancer is greater after age 50 and is most often diagnosed in men in their 60s.
However, unlike some other cancers, prostate cancer has fewer modifiable risk factors (like diet and smoking) related to lifestyle.
“We do know that obesity increases the risk for advanced prostate cancers, but there’s not a lot of other modifiable risk factors,” Holmes explains. “So really [we’re] talking about age, family history and ethnicity when it comes to prostate cancer.”
Many men with early-stage prostate cancer don’t experience any symptoms, which is why regular screening is important, especially for those with risk factors, Holmes said.
Early detection through tests like the prostate-specific antigen (PSA) blood test can identify cancer before it spreads, significantly improving treatment outcomes.
“There may not be any signs and symptoms in its early stages,” Holmes cautioned.
“And because of the location of the prostate near the bladder and the rectum, some of the first symptoms might be changes in bladder habits.”
These urinary symptoms, like those that prompted Biden to seek medical attention, can include:
- Having to urinate more frequently, especially at night
- Strong or sudden urges to urinate
- Weak, slow, or interrupted urine flow
- Difficulty emptying the bladder completely
- Pain or burning during urination
- Blood in the urine or semen
Holmes added that there are also “non-bladder-having” symptoms that can develop, particularly as the disease advances, such as discomfort or pain when sitting, any pain with ejaculating or erection, or stiffness in your back, hips or pelvis.
She emphasized that these symptoms can also be caused by many other conditions and aren’t necessarily signs of cancer. However, they should prompt a medical evaluation, particularly for those in higher-risk categories.
Treatment and survival rates
Treatment options for prostate cancer depend on several factors, including the cancer’s stage and the patient’s overall health, according to the Canadian Cancer Society.
“There are lots of treatment options available for prostate cancer … depending on the stage,” says Holmes. “It might include active surveillance, surgery, radiation therapy, chemotherapy or hormone therapy. And essentially, a health-care team creates that treatment plan with you.”
Dr. Rob Rutledge, a radiologist based in Halifax, told Global News on May 19 that, “It’s not rare that men come in with a prostate cancer diagnosis that has already spread elsewhere in the body.”
He said he believes Biden would likely be treated with hormone therapy, which reduces the testosterone the disease feeds on, killing cancer cells.
The survival rates for prostate cancer are generally favourable, particularly when the disease is caught before it has spread beyond the prostate.
“On average, 91 per cent of people diagnosed with prostate cancer are expected to survive at least five years after their diagnosis. And survival is nearly 100 per cent if the cancer is detected before it has spread,” Holmes said.
However, the five-year survival rate drops significantly for advanced cases like Biden’s, where the cancer has spread to distant parts of the body.
According to the American Cancer Society, the five-year survival rate for late-stage prostate cancer is about 37 per cent.
“On average, men who have been diagnosed with prostate cancer that has already spread to the bone, right from the get-go, their life expectancy is measured in many years. … is that three years, five years, seven years, 10 years … It’s probably somewhere in that range,” Rutledge said.
— With files from Global News’ Heidi Petracek