Former President Biden's Cancer Treatment Options

Yahoo

19-05-2025

Former U.S. President Joe Biden speaks at a conference hosted by the Advocates, Counselors, and Representatives for the Disabled on April 15, 2025 in Chicago. Credit -In a statement from his personal office on May 18, former President Joe Biden revealed he has an aggressive form of prostate cancer that has spread to his bones. '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 in a statement. 'The President and his family are reviewing treatment options with his physicians.'
Recent studies show that survival for men with prostate cancer that has spread to the bone is just under two years. But this form of cancer, though aggressive, can sometimes be controlled. Here's what oncologists who treat prostate cancer say are the most common strategies for treating a cancer like Biden's, and some of the challenges.
'The good news is this: we have now entered an era of different treatments that I call therapy intensification where we are trying to attack cancer with a multi-modality approach,' says Dr. Maha Hussain, deputy director of the Robert H. Lurie Comprehensive Cancer Center at Northwestern University Feinberg School of Medicine. 'We can come up with a significant prolongation of life by comparison to when I entered the field." She has seen patients with prostate cancer that has spread survive and "live many, many years.'
Most prostate cancer is fueled by the male hormone testosterone, so the most effective strategies to control it starve the cancer by cutting off its supply, say experts. Historically, doctors have removed the testes—the main source of the hormone—but today, pills and injections can suppress testosterone not just in the testes but in other organs that produce small amounts, such as the adrenal glands, as well. Doctors also now add chemotherapy to hormone-suppression to better control cancer growth.
Exactly which combinations of treatments are right for Biden will depend on whether his cancer is new or if it was previously diagnosed and recently re-emerged. Either scenario is possible, say experts.
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With respect to having prostate cancer initially diagnosed at such an aggressive state, after it has already spread, 'I don't think there is any reason to think this could not be the natural history of prostate cancer in an older person,' says Dr. Robert Figlin, cancer center director at Cedars-Sinai Cancer Center. 'And this would not [indicate] something that was missed or mismanaged in past years. This is certainly something that can occur in the course of a male's life—it's not unusual to present in this way.' Many older men are diagnosed with aggressive disease, with studies showing that about 20% of prostate cancer cases are diagnosed in men 75 years and older, and that men 70 and older tended to have higher Gleason scores, an indicator of the cancer's aggressiveness, at diagnosis. (Biden's Gleason score is 9, his office said in the statement, indicating a more aggressive cancer.) 'Prostate cancer can sit dormant for years and suddenly decide to wake up,' says Hussain. 'I've seen all kinds of cases—all shades of grey.'
Treatment options also depend on a patient's overall health. Other conditions a person might have can affect their ability to tolerate the therapies and side effects. 'We have to take into account other diseases a man may have, other medical conditions that may be life-limiting, goals that man has in terms of longevity and quality of life, and other medications he may be taking,' says Dr. Michael Morris, prostate cancer section head at Memorial Sloan Kettering Cancer Center.
Immunotherapy—an exciting new treatment that harnesses the immune system to fight certain cancer types—is so far not effective against prostate cancer. While it has been successful in slowing melanoma, breast, lung, kidney and bladder cancers, and lymphoma, prostate cancer remains relatively hidden from the immune system, making it what doctors call a 'cold' cancer. 'I'd rather call it a sneaky cancer,' says Hussain. 'Prostate cancer cells literally sit inside the bone marrow next to the white blood cells," which are immune cells. "The white blood cells can't see it, so unlike other cancers, prostate cancer has still not been responsive to immunotherapies.'
Read More: A New Immune Treatment May Work Against Several Cancer Types
However, while current immunotherapy strategies may not be as effective against prostate cancer, new immune-based interventions are being explored, says Morris. 'For now, for a patient who presents today with prostate cancer, there is no real role for immunotherapy,' he says. 'But there are many ways of manipulating the immune system to activate against prostate cancer. If you ask me in another couple of years, we will have a quite a different message.'
Doctors are also exploring whether introducing chemotherapy earlier, along with hormone-suppressing treatments could improve their chances of controlling the cancer and preventing it from spreading and becoming more aggressive. 'One of the most important questions for patients with newly diagnosed metastatic disease would need to answer is whether they need docetaxel chemotherapy in addition to [hormone suppressing] therapy,' says Dr. Timothy Daskivich, associate professor of urology at Cedars-Sinai. "Data suggests that patients with higher volume metastases benefit the most from docetaxel. If these patients don't get it up front, it could be a missed opportunity."
Prostate cancer screening—done with a blood test for prostate specific antigen (PSA), a marker of cancer cells—has helped to lower deaths from the disease. But the screening has been controversial, since prostate cancer generally grows slowly and the test can pick up signs of benign prostate growth, which also occurs as men age.
However, the American Cancer Society currently recommends that men with average risk of prostate cancer get screened beginning at age 50, if they are expected to live at least 10 more years, and that men with higher risk, including African-American men and those with a father or brother diagnosed with the disease, start earlier, at age 45. The U.S. Preventive Services Task Force recommends that most men stop screening at age 70, since at that time, men may be more likely to die of causes other than prostate cancer, and the risks of over-treating slow-growing cancers may outweigh the benefits.
As vice president under President Barack Obama, Biden led the Cancer Moonshot to spur research into new treatments. As president in 2022, he set a nationwide goal of reducing cancer death rates by 50% over 25 years. The quest was personal for Biden, whose son Beau died in 2015 of brain cancer at age 46.
'Cancer touches us all,' he wrote in an Instagram post on May 19. "Like so many of you, Jill and I have learned that we are strongest in the broken places. Thank you for lifting us up with love and support."
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