Former US president Joe Biden, 82, has been diagnosed with an “aggressive form” of prostate cancer, and it has spread to his bones. His personal office said Sunday (May 18) the cancer appeared to be “hormone-sensitive”, though, and could be hence effectively managed.
“Last week, President Joe Biden was seen for a new finding of a prostate nodule after experiencing increasing urinary symptoms. On Friday, he was diagnosed with prostate cancer, characterized by a Gleason score of 9 (Grade Group 5) with metastasis to the bone,” the statement said.
A Gleason score of 9 means “it’s the most aggressive form of prostate cancer”, CNN quoted Dr Benjamin Davies, a professor of urologic oncology at the University of Pittsburgh Medical Center, as saying.
Biden’s diagnosis has prompted others to speak out — including Dilbert creator Scott Adams, who revealed a day later that he too was battling metastatic prostate cancer. The 67-year-old cartoonist, known for his controversial views, shared the news during a YouTube livestream, saying the former president’s public health update encouraged him to come forward.
“I have the same cancer that Joe Biden has. I also have prostate cancer that has also spread to my bones… I expect to be checking out from this domain sometime this summer,” he said.
While deeply personal, such disclosures by public figures have the potential to raise awareness and prompt timely screening among those at risk.
“Prostate cancer is very common… As we get older, most men are going to have little cancer cells in them,” Dr Jamin Brahmbhatt, urologist and robotic surgeon with Orlando Health and assistant professor at the University of Central Florida’s College of Medicine, told CNN.
Are you shocked by the sudden emergence of so many cases of prostate cancer?
Well, Lancet journal had warned of this impending calamity in a 2024 report that was headlined as “planning for the surge in cases”.
According to the Lancet Commission, global prostate cancer cases are expected to double from 1.4 million in 2020 to 2.9 million by 2040 — a crisis that cannot be prevented by lifestyle changes alone.
Experts advise regular screening for men over 50, or earlier, for those with a family history or higher risk profile. Early detection can still be life-saving.
Understanding Prostate Cancer
Speaking to ABP Live, Dr Manav Suryavanshi, Senior Consultant & Head – Urology, Program Head – Uro-Oncology & Robotic Surgery, Amrita Hospital, Faridabad, explained the tools, trends, and future of prostate cancer detection and treatment in India.
About are the current systems of diagnosis deployed to detect prostate cancer, he said diagnosis of prostate cancer is multifaceted and typically involves a combination of clinical evaluations, imaging, and tissue sampling:
PSA Blood Test (Prostate-Specific Antigen): PSA is a protein produced by both normal and malignant prostate cells. Elevated levels can indicate cancer, although benign conditions like prostatitis or benign prostatic hyperplasia (BPH) can also raise PSA levels. It’s a useful screening tool but not diagnostic on its own.
Digital Rectal Examination (DRE): A simple yet effective physical exam where the urologist checks for abnormalities in size, shape, and texture of the prostate.
Multiparametric MRI (mpMRI): mpMRI has become a gold standard for non-invasive visualization of suspicious areas in the prostate, enhancing the accuracy of subsequent biopsies. AI integration in MRI interpretation is already improving detection of clinically significant cancers.
MRI/Ultrasound Fusion-Guided Biopsy: Combining MRI with real-time ultrasound allows for targeted biopsies, improving accuracy over traditional random sampling.
Histopathology & Gleason Grading: After biopsy, the tissue is graded using the Gleason system, which predicts the tumor’s aggressiveness.
Genomic Testing (in select cases): Tests like Homologous Recombination Repair (HRR) gene testing (including BRCA1/2, ATM, CHEK2, etc.) are used to identify patients who may benefit from targeted therapies, which also have implications for familial cancer risk and genetic counseling. These high-end tests are available at the Molecular Biology laboratory, Amrita Hospital, Faridabad.
What Are The Early Signs Of Prostate Cancer?
According to Dr Suryavanshi, prostate cancer often presents without symptoms in its early stages, which is why routine screening is essential. However, when symptoms do appear, they may include:
1. Urinary difficulties
- Increased frequency (especially at night)
- Weak or interrupted urine stream
- Difficulty initiating urination
2. Pain or burning during urination (less common)
3. Hematuria or Hematospermia
- Blood in the urine or semen can be a red flag, though not always cancer-related
4. Erectile dysfunction or painful ejaculation
5. Bone pain
- In advanced cases, cancer spreads to bones, especially hips and spine
- It’s critical to differentiate these symptoms from benign prostatic conditions, hence the thorough diagnostics is important.
What Are The Treatment Options For Prostate Cancer?
Treatment is personalised based on the stage, Gleason score, PSA level, patient age, comorbidities, and patient preference. According to Dr Suryavanshi, key modalities include:
Active Surveillance: For low-risk or indolent tumours. Patients are monitored with periodic PSA tests, MRIs, and biopsies without immediate intervention.
Surgical Options: Radical Prostatectomy (open, laparoscopic, or robotic-assisted), which constitutes complete removal of the prostate gland. Robotic-assisted surgery is another option, which offers more precision and quicker recovery.
Radiation Therapy: External Beam Radiation Therapy (EBRT) or Brachytherapy (internal radiation).
Hormone Therapy (Androgen Deprivation Therapy): Prostate cancer cells rely on testosterone. Drugs like leuprolide and degarelix suppress testosterone production.
Chemotherapy: Used in advanced or castration-resistant prostate cancers. Drugs include docetaxel or cabazitaxel.
Immunotherapy & Targeted Therapy: Trials are ongoing with immune checkpoint inhibitors and PARP inhibitors like olaparib for specific genetic mutations (BRCA1/2).
Bone-Targeted Therapies (if metastasised): Bisphosphonates or radiopharmaceuticals like Radium-223 to manage bone metastases.
AI Being Used To Diagnose Prostate Cancer
Dr Suryavanshi said AI is actively being integrated into diagnostic workflows, especially in developed countries, and India is slowly adopting these innovations.
AI in MRI interpretation: AI algorithms, such as those developed by Google Health and other med-tech startups, assist radiologists in identifying high-risk lesions on mpMRI scans. These tools help reduce variability in reporting and can flag suspicious areas that may be missed by the human eye.
AI in pathology: AI now supports pathologists in grading biopsies and identifying malignant cell patterns. Studies have shown that AI matches or exceeds human pathologist performance in some scenarios. It also offers predictive analytics for recurrence risk based on the digitised slide images.
Predictive Models: Machine learning models now integrate clinical data (age, PSA level, biopsy results) with genomic data to forecast treatment response or risk of metastasis. However, while promising, AI systems must be seen as assistive rather than autonomous tools. The final interpretation still rests with the clinician.
“Prostate cancer is increasingly affecting younger and seemingly healthy men. We are entering a new era of personalised care. AI, robotic surgery, and early screening are the way forward,” Dr Suryavanshi said.
Kirti Pandey is a senior independent journalist.
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