WASHINGTON (TNND) — Former President Joe Biden’s diagnosis of aggressive prostate cancer that has developed beyond a curable stage was a surprise to many after years of scrutiny about his health as the oldest person to hold the Oval Office did not lead to any indications he had developed cancer.
Biden was diagnosed on Friday with an aggressive, late-stage prostate cancer that has spread to his bones, according to his office. The diagnosis means the 82-year-old former president will have to fight the disease for the remainder of his life, though doctors have noted that it is still treatable and he could still live for years.
The late-stage diagnosis was a surprise to many for a person in Biden’s position as a longtime lawmaker who served as vice president and president with access to world-class medical care. His annual physical exams gave no indications he was dealing with prostate cancer and generally described a patient dealing with typical problems of a man entering and in his 80s like arthritic changes to his spine that affected his gait.
In his last physical exam in office, his physician said there were no signs of other issues like stroke, multiple sclerosis, Parkinson’s or other similar conditions. Biden had used a continuous positive airway pressure, or CPAP, machine at night to help with sleep apnea.
Dr. Ezekiel Emanuel, an oncologist that worked with Biden’s transition team, told MSNBC that the former president likely had prostate cancer well before the public announcement of the diagnosis.
“Oh, he’s had this for many years, maybe even a decade, growing there and spreading. That’s right,” Emanuel said. “It’s a little surprising. I looked back at the records and there’s no evidence that when he got his health status and the medical records were released, that he had a prostate specific antigen.”
Doctors use what’s called a Gleason score to grade the aggressiveness of prostate cancer with scores ranging from 6 to 10. Scores on the higher end of the range are more aggressive. Biden’s office said his score on the scale was 9, which indicates his cancer is behaving aggressively.
“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.”
While Biden’s cancer is advanced, oncologists said the former president could still live for years with treatments and pass away from natural causes rather than the disease. He is likely to receive hormone therapy in drugs that stop the production of testosterone or block it from binding to other parts of the body.
Biden’s office said his cancer was caught after he developed urinary symptoms that led him to seek medical attention, which doctors said likely prompted other screenings that detected it. Prostate cancer often develops without symptoms until it reaches advanced stages when people can have difficulty urinating, blood in their urine or bone pain.
“Unfortunately, prostate cancer is one of these cancers that until its late stages is without symptoms, and that actually highlights the importance of screening,” said Dr. Mohummad Minhaj Siddiqui, director of Urologic Oncology and Robotic Surgery at the University of Maryland Greenebaum Comprehensive Cancer Center at the University of Maryland Medical Center. “In an 82-year-old, I don’t think any of us would ever recommend routine screening, but for younger people, screening is the only way to catch prostate cancer early.”
Prostate cancer is one of the most commonly diagnosed cancers in the United States and ranks highly on causes of cancer-related deaths. It is the most frequently diagnosed cancer in dozens of countries and a leading cause of cancer death.
But it can also go undetected in older men once prostate-specific antigen exams stop being a routine part of check-ups. It is unclear whether Biden had received PCA tests while in the White House and some doctors recommend not doing the exam after the age of 70.
Some medical groups recommend against screening older men because the PCA tests can lead to false positives or overtreatment of a slow-growing cancer. It is also possible Biden could have opted out of receiving it after consulting with his medical team.
“If someone’s been screened for prostate cancer through this time period, and they have not developed prostate cancer by the time they hit 75, at that point, the medical community has generally guidelines recommended to ease off on the screening for prostate cancer,” Siddiqui said. “What happens is that most of the time, even if the person does develop a cancer after the age of 75, this is such a slow-growing cancer that from going from developing a new cancer to it becoming aggressive, spreading and causing death is typically a 15-year timeline.”
