Joe Biden has been diagnosed with an aggressive form of prostate cancer, the former president’s office announced on Sunday. Here’s an explainer about the disease:
What is prostate cancer?
The prostate is a small, walnut-sized gland in the male reproductive system located just below the bladder. It creates fluid that mixes with sperm to form semen. Cancers of the prostate begin with a growth of cells inside the gland that, if left untreated, can spread to other parts of the body and become metastatic, or advanced prostate cancer.
What is ‘aggressive’ prostate cancer?
Prostate cancers are given a scaled Gleason score, ranging from six to 10, depending on how the cancerous cells look compared with normal cells. A Gleason score of six or seven is considered less aggressive, with cells appearing to be healthy (well differentiated) or somewhat healthy (moderately differentiated). These cancers may spread more slowly.
A Gleason score of eight or above indicates a higher degree of aggressiveness. The cells are poorly differentiated or undifferentiated from healthy cells. Biden’s office said his score was nine, suggesting his cancer is among the most aggressive.
What are the symptoms?
All forms of prostate cancer, including the most aggressive forms, might not exhibit symptoms until the tumor has grown large. When this happens, symptoms can include blood in the urine and semen, a need to urinate more frequently, especially at night, and difficulty beginning to urinate.
Symptoms of advanced prostate cancer can include urinary incontinence, back pain, bone pain, erectile dysfunction, fatigue, weight loss and weakness in the arms and legs.
What are the causes?
While advancing age, obesity, racial background and a family history of the disease are considered risk factors, the exact causes have not been determined. The cancer starts when cells in the prostate develop changes in their DNA that causes them to grow and multiply too quickly.
How is prostate cancer detected?
Blood tests that measure levels of PSA (prostate-specific antigens), and digital rectal examinations are common screening tests. More invasive diagnostic tests include biopsy of a section of the prostate, ultrasound examination and magnetic resonance imaging (MRI).
Other tests can be used, especially in suspected more advanced or aggressive cases, including bone scans, computed tomography scan (CT) scans of the prostate or other organs, and urine analysis.
What are the treatments?
Treatments vary depending on the severity of the cancer, and depend on a patient’s needs and preferences. In early, small, slow spreading prostate cancers, surveillance might be sufficient. Developed cancers might require surgery to remove the prostate, radiotherapy and chemotherapy, targeted drugs such as PSMA (prostate-specific membrane antigen) proteins, and immunotherapy.
Metastasized cancer is much harder to treat than localized cancer because it can be hard for drugs to reach all the tumors and completely root out cancerous cells.
What is the survival rate?
Many factors determine the survival rate, including the stage of the cancer, the patient’s age, and overall health. According to the American Cancer Society (ACS), there are almost 36,000 deaths a year from prostate cancer.
The five-year survival rate for men diagnosed under 65 is about 98%, compared to 85% for men over 80. If the cancer has metastasized to other parts of the body, the survival rate drops substantially, to 30-40% after five years.
Prostate cancer is usually found early and it often grows slowly. Most people with prostate cancer are cured.
How common is prostate cancer?
Prostate cancer is one of the most common types of cancer, with an estimated one in eight men receiving a diagnosis in their lifetime. In 2021, the Centers for Disease Control and Prevention (CDC) reported 236,659 new cases in the US, while the ACS estimates that 313,780 new cases of prostate cancer will be diagnosed in 2025.
While rates are increasing, earlier and better screening leads to more successful outcomes, with the ACS reporting that 3.3 million men in the US who have been diagnosed with prostate cancer are still alive.
Sources: The Mayo Clinic, Centers for Disease Control, and Prevention, National Institutes for Health, the American Cancer Society.
