How long could Biden have left? Experts reveal bleak prognosis for men with advanced prostate cancer - yet there is hope
Former US president Joe Biden could have less than five years left to live because his prostate cancer is aggressive, has spread and was caught late, data suggests.
The 82-year-old's diagnosis was announced on Sunday, and revealed the disease had been given a Gleason score of nine and had already spread to his bones.
A Gleason score is a system which medics use to grade prostate cancer using samples taken from a biopsy that assess its aggressiveness, how likely it is to grow and spread.
The scale goes up to 10 meaning Biden has received the second-highest potential score.
A result of nine means the cancer looks like it will likely grow and spread at a 'moderately quick rate', according to Prostate Cancer UK.
Studies conducted on thousands of men with the disease show only about one in three of those diagnosed with a Gleason score of 9–10 were alive at the end of a 10-year follow-up.
Of the remainder, almost half had died from the disease, and nearly one in four from other causes like advanced age.
But Biden's cancer has already spread to his bones, implying it is at stage 4.
This is the later stages where the disease has spread to other parts of the body, also known as metastatic cancer.
While Biden's disease has been described as 'stage 5', this typically references a very advanced stage 4.
Data from Cancer Research UK show that only 50 per cent of men diagnosed with stage four prostate cancer are alive five years after their diagnosis.
However, there are overall statistics covering men of all ages who are diagnosed at this stage.
Biden, being in his 80s, will face additional challenges relating to his age.
Of all prostate cancer deaths recorded in the UK of all stages the vast majority (75 per cent) are among men aged 75 and over.
Ben Lamb, a consultant urological surgeon, Barts Health and University College London Hospitals NHS Foundation Trusts said cases of prostate cancer like Biden's account for the minority of cases.
'Most prostate cancer, around four fifths, in the UK is diagnosed before it is metastatic, with one fifth diagnosed with metastatic disease,' he said.
He added that most cases of late diagnosis are linked to 'deprivation, ethnicity and older men'.
Mr Lamb added that in cases like Biden's the go-to option for treatment is typically hormone therapy to stop the spread of the cancer.
'Prostate cancer depends on testosterone to grow, and by blocking testosterone production and action, the cancer can be effectively treated but not cured.
'Additional modern hormone drugs (known as ARTA's) are given in addition, and these are known to prolong survival. Chemotherapy can also be given.'
He added that, for most men the first symptom they notice is problems urinating, but this in the early stages.
Biden had recently reported urinary problems, a known red flag for the disease.
As the disease advances, patients like Biden will face additional problems caused by their growing cancer, Mr Lamb added.
'In later stage disease, some men may have symptoms from metastatic disease, such as fatigue, bone pain or weight loss,' he said.
'Lymph node spread can cause blockage of the kidneys with renal failure and leg swelling.
'If the prostate tumour is large, it can cause bladder symptoms, though in most men in general, these are from benign enlargement of the prostate as men age.'
Several medics have questioned how Mr Biden's cancer could have been caught so late, given his age means he is at advanced risk of the disease and it can be screened for by routine blood tests.
'It is inconceivable that this was not being followed before he left the Presidency,' wrote Dr Howie Forman, a professor of radiology and biomedical imaging, public health management and economics at Yale.
He noted that the test for prostate-specific antigen would have shown he had cancer 'for some time before this diagnosis', given how aggressive it is.
About 55,000 British men and more than 300,000 in the US are diagnosed with prostate cancer each year.
Survival from the disease has vastly improved over time thanks to screening, increased awareness of symptoms and better treatments.
In the 70s only a quarter of men were expected to survive a year after their diagnosis.
However, this has now increased to around 80 per cent.
Generally, cancer is easiest to treat if caught in the earlier stages and patients tend to have better outcomes.
Due to the prostate's location—the gland is situated below the bladder, and wraps around the urethra—it most commonly causes urinary symptoms.
If a man notices these, it;s important to speak to a GP and discuss whether something called a PSA test might be warranted.
PSA stands for prostate specific antigen, a hormone that's produced by the prostate in higher amounts if there is a problem with the gland.
One of the most common signs something is wrong with the prostate is a change in urinary frequency.
While the amount people urinate can vary widely—anything between four and ten or so times can be seen as normal—it's a noticeable increase that experts say men need to be aware of.
Sudden urges—needing to rush to the loo—may also be a sign of a problem.
This could be coupled with difficulty in starting to pee, known medically as hesitancy.
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