Today, leading medical professionals expressed their views on the complexities surrounding Joe Biden’s unexpected cancer diagnosis, indicating that his advanced age and frailty may have hindered appropriate testing.
The former president’s office announced on Sunday that he had been diagnosed with late-stage cancer, which likely had been developing for several years, as it had already metastasized to his bones.
A simple blood test can detect approximately 90% of patients with this condition, leading many in the medical community to be astonished that the cancer remained undetected and questioning why he had not been evaluated during his presidency, given his access to the nation’s foremost medical experts.
Dr. Shawn Dason, a urologic oncologist at The Ohio State University Comprehensive Cancer Center, stated to the Daily Mail that it is commonly believed that men expected to live between 15 to 30 years stand to gain the most from prostate cancer screenings.
He noted that it is uncommon for individuals over the age of 80 to undergo such testing, which may explain why a certain individual was diagnosed at a later stage of the disease.
Furthermore, medical experts suggested that President Biden, who is 82, likely has not undergone prostate cancer screening since taking office in 2021 at the age of 78, indicating that the cancer may have been developing during this period.
Prostate cancer results in approximately 35,000 fatalities among American men annually, with over 300,000 diagnoses made each year, making it the most common cancer among men.
If detected while still localized in the prostate, it boasts an almost 100% survival rate and is considered highly treatable when identified early.
Medical professionals clarified to the Daily Mail that there is no conspiracy, as some have alleged, but rather that the diagnosis may have been overlooked by others.
The United States Preventive Services Task Force (USPSTF) recommends that men aged 55 to 69 should be screened for prostate cancer every two to three years, while those at higher risk, such as Black men or those with a family history, may need more frequent screenings.
Due to concerns such as the risk of over diagnosis and overtreatment, the potential for false positives, and the fact that prostate cancer often progresses slowly—resulting in many men living with the disease rather than dying from it—the FDA advises against screening men over the age of 70.
This suggests that the risks involved in cancer treatment outweigh the potential benefits. A prostate-specific antigen (PSA) test, which assesses the levels of proteins produced by the prostate gland, is utilized for prostate cancer screening.
To verify a cancer diagnosis, a prostate biopsy and imaging may be performed if PSA levels are found to be elevated. According to Dr. Todd M. Morgan, a urological surgeon and Chief of Urologic Oncology at the University of Michigan Health, President Biden likely stopped undergoing prostate cancer screenings at the age of 75, two years prior to his presidency.
Dr. Morgan informed the Daily Mail that ‘routine screening is not typically advised for a healthy man in his 80s.’ He further stated, ‘If President Biden adhered to the recommended guidelines, he would have likely ceased PSA testing several years ago.’
The 82-year-old’s cancer was categorized as ‘aggressive’ and rapidly progressing, with a Grade Group of five and a Gleason score of nine.
The Gleason grading system is employed by physicians to assign a score to prostate cancer based on the appearance of cancer cells under a microscope; generally, a higher score (ranging from 1 to 10) indicates a more aggressive cancer.
A score of six or lower signifies a slow-growing cancer, while a score of seven indicates an aggressive cancer with intermediate risk.
Grade Groups range from one, suggesting a slow-growing cancer, to five, indicating a likely rapid growth and spread.
Biden’s diagnosis occurred shortly after medical professionals identified a ‘small nodule’ on his prostate, a gland the size of a walnut that regulates urine flow and produces semen in men.
Physicians speculate that the presence of the nodule may suggest that he did not undergo regular PSA testing.
Other experts, however, indicated that cancer could have gone undetected even if the former president had undergone testing.
Dr. Daniel Petrylak, chief of genitourinary oncology at Yale Cancer Centre, informed the Daily Mail that aggressive prostate cancer can manifest even with low PSA levels.
He explained that higher-grade tumors typically produce less PSA per cancer cell compared to lower-grade tumors, which may result in such tumors being overlooked by PSA testing.
The standard measurement for PSA levels is nanograms per milliliter (ng/mL), with levels exceeding 4 ng/mL generally considered abnormal, prompting further testing.
However, some doctors may set a higher threshold, such as 5 ng/mL, for older men due to the natural increase in PSA levels with age.
Dr. Stuart Fischer, an internal medicine physician in New York, noted that individuals can have cancer with PSA levels of five or six, and for some unfortunate patients, it can metastasize within 10 months.
While this is a rare occurrence, it highlights the unique nature of this cancer. Conversely, for others, the disease may progress very slowly. President Biden’s medical records during his presidency indicated various health issues, including high cholesterol, irregular pulse, and sleep apnea, which may have taken priority in his healthcare management.
Dr. Tanya Dorff, a medical oncologist and section chief of the Genitourinary Disease Program at City of Hope in California, emphasized that physicians must balance cancer screening with the management of other health issues, such as cognitive changes or heart conditions, particularly in older patients.
She clarified that this does not imply that prostate cancer is neglected; rather, care is tailored to address the most pertinent aspects of the patient’s overall health.
The lack of symptoms may have played a role in the unnoticed transmission of the disease. While it can lead to difficulties in urination and the presence of blood in urine or semen, these signs are often mistaken for aging or less severe health issues.
Dr. Morgan stated, ‘In the absence of regular PSA screenings, even an aggressive form of prostate cancer can advance without manifesting symptoms.
Tumors typically do not produce urinary symptoms while they remain localized within the prostate,’ and noted that bone pain or unexplained weight loss could be the initial indicators.
‘Conversely, by the time the cancer begins to exhibit symptoms related to the prostate, it may have already metastasized.’ He remarked that discovering the cancer after it has spread is ‘not unexpected’ in such cases.
Experts informed the Daily Mail that older men diagnosed with metastatic prostate cancer often ‘respond favorably’ to treatments, which may include immunotherapy, ultrasonography, and medications that block testosterone, despite the serious nature of the diagnosis.
Dr. Pterylas mentioned, ‘Survival rates vary, ranging from three to seven years, with a small percentage of patients living up to ten years.’
Furthermore, Dr. Edmund Folefac, a medical oncologist at the Ohio State University Comprehensive Cancer Center, conveyed to the Daily Mail, ‘With contemporary treatment options, there is a strong likelihood of surviving for many years.
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