CHENNAI: Former US President Joe Biden has been reportedly diagnosed with an aggressive form of prostate cancer that has spread to his bones. While this type of diagnosis is rare, doctors believe it could still respond well to treatment.
The diagnosis showed that a nodule was found on Biden's prostate, which led to further tests and the cancer was confirmed. The current status shows that the cancerous cells have spread (metastasized) to his bones.
While the doctors are optimistic that treatment will be effective, especially hormone therapy, in Biden’s case, the nature of prostate cancer is quite rare.
Rarity of Biden’s Case
Most prostate cancers are found early during routine screenings. Only about 8% of prostate cancers are already advanced by the time they are diagnosed. Doctors believe Biden may have had undiagnosed prostate cancer for many years.
Prostate cancer is usually detected through blood tests (PSA tests) or rectal exams. However, screening is not routinely done for men in their 70s or 80s, since many older men die from other causes before prostate cancer becomes a serious issue. From 2012 to 2018, national guidelines in the US discouraged screening, which caused a decline in early detection and an increase in advanced cases.
But as people live longer, some doctors now support screening older, healthy men. Hence the US screening guidelines are now undergoing some changes.
In the past, more men were screened, leading to many low-risk cancers being treated unnecessarily. Screening is becoming more common again as doctors improve at identifying which cancers need treatment.
In the case of Biden, his 2024 physical exam did not mention a prostate cancer screening, which isn't unusual for his age. His 2019 exam noted an enlarged prostate, but no cancer was diagnosed at that time.
Types of Prostate Cancer
Prostate cancer develops in the prostate gland, primarily affecting older men. The main types include:
Adenocarcinoma (Acinar Type): This type of of prostate cancer is most common, say also almost 95% of cases. This type of cancer develops in the gland cells that produce prostate fluid.
Ductal Adenocarcinoma: These are more aggressive, and originates in the ducts of the prostate gland.
Transitional Cell Carcinoma: Rare in nature, this type starts in the urethra and can spread to the prostate.
Small Cell Prostate Cancer: This is a form of neuroendocrine cancer; aggressive and less responsive to hormone therapy.
Squamous Cell Carcinoma: Very rare and aggressive, develops in flat cells covering the prostate.
Global Prevalence
As of 2024, there are over 1.4 million new cases annually worldwide. Prostate is the 2nd most common cancer in men globally. Approximately 375,000 deaths per year. Mortality is highest in sub-Saharan Africa and the Caribbean, often due to late detection.
However, survival rates are comparatively high in high-income countries. For instance in the US a 5-year survival rate is about 98%. This mainly due to early detection and treatment.
Advanced Diagnostic Methods
The diagnostics have advanced much in this area of cancer. Prostate-Specific Antigen (PSA) Testing is typically the common screening tool, though it is not cancer-specific but useful for monitoring. However, tests like multiparametric MRI (mpMRI) provides detailed imaging, helps in identifying clinically significant tumors. While, MRI-Targeted Biopsy is more accurate than traditional biopsy; guided by mpMRI results.
There is also genomic testing, which identifies genetic mutations that helps assess aggressiveness and tailor made therapy. PET scans are also highly sensitive in detecting metastatic prostate cancer.
Global Treatment Options
The current treatment regime for localised prostate cancer is active Surveillance, though this is mostly followed for low-risk cases. However the more specific treatment advised for confirmed and aggressive cases includes Surgery -- radical prostatectomy, and Radiation therapy using external beam or brachytherapy.
But, there are a host of new generation treatments currently available at modern settings for advanced or metastatic cancer. These options include Hormone Therapy (ADT), a first-line treatment for advanced disease, Androgen Receptor Inhibitors, Chemotherapy using drugs like Docetaxel, and Cabazitaxel.
The new generation treatments include targeted Therapy, Immunotherapy ( approved only in some countries), and Radioligand Therapy, which are promising for metastatic castration-resistant prostate cancer (mCRPC).
According to a senior professor at US's MD Anderson Cancer Centre, who spoke to The New Indian Express seeking confidentiality, the diagnoses like Biden’s diagnosis is serious, but not hopeless.
"While his case is unusual due to his age and the cancer’s spread, modern treatments often work well—especially if the cancer responds to hormone therapy. The case also highlights the ongoing debate about who should get screened for prostate cancer and when," he said.
Biden is exploring multiple treatment options, including hormone therapy, which reduces testosterone (a hormone that fuels the cancer.
Most patients with advanced prostate cancer respond well to initial treatments, sometimes for several years. In some cases, chemotherapy or radiation is added.
About 37% of patients with advanced prostate cancer live at least five years after diagnosis.
Prostate cancer remains a major global health concern, especially in aging populations. Advances in imaging, genomic testing, and personalised treatments have significantly improved outcomes.
However, Biden's case brings back the importance of screening and early detection.
Some doctors say it’s unusual for someone under regular medical care to be diagnosed at such an advanced stage. However, aggressive cancers can grow and spread quickly in rare cases. Early detection and equitable access to advanced diagnostics and therapies are critical to reducing global disparities in care.