What are the treatment options for prostate cancer patients like Joe Biden?
The news that former
US
president
Joe Biden
, aged 82,
has been diagnosed with cancer
has put a focus on prostate
cancer
. The diagnosis was reportedly made after he sought medical help for worsening urinary symptoms.
According to a statement from his office, Biden is battling an 'aggressive' form of prostate cancer. The statement added that his condition is characterised by a 'Gleason score of nine'. His office also said Biden's diagnosis included metastasis to the bone, but that the cancer was 'hormone sensitive'.
Prostate cancer is the most common cancer in men in Ireland if skin cancer is excluded. Each year, about 4,000 men are diagnosed with prostate cancer in this country. One in six men will get prostate cancer at some point in their lives. The chances of getting prostate cancer increase as you get older. Age at diagnosis also affects life expectancy: the five-year survival rate for men diagnosed under 65 is about 98 per cent, compared with 85 per cent for men over 80.
The prostate is a gland about the size of a walnut and is located in front of the rectum around the urethra – the tube that runs from the bladder to the penis. Its function is to manufacture substances in the fluid that makes up semen.
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The discovery of a small nodule on Biden's prostate led to further investigation, revealing a high-grade cancer. If the cancer has spread to bone, as his has, the survival rate is approximately 30-40 per cent after five years.
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While many prostate cancers grow slowly and may never cause serious harm, some, like Biden's, are more dangerous, and are capable of spreading quickly – often before symptoms are noticed.
What is meant by the statement that the former president has a Gleason score of nine?
A Gleason score is a system for grading the aggressiveness of prostate cancer, meaning how quickly it could spread. It is different from the cancer staging score. If prostate cancer is found in a biopsy sample, the pathologist will assign it a grade, which is based on how abnormal the cancer looks under the microscope.
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The Gleason score system works by identifying the two most common patterns of cells. Those patterns are assigned a score from one to five – one is non-cancerous and five is the most aggressive. The two scores are added together to give an overall Gleason score.
An overall score of nine means Biden's cancer is quite aggressive.
Because his cancer has already spread beyond the prostate, it places the former president in stage four − the most advanced stage of prostate cancer. It means his cancer is not curable at this point, but it is still treatable and can be managed with a combination of therapies.
A significant detail in Biden's diagnosis is that the cancer is hormone sensitive. Prostate cancer cells typically rely on male hormones such as testosterone to grow. Hormone-sensitive cancers can respond well to treatments that block or lower these hormone levels.
What are the overall treatment options for prostate cancer?
They range from surgery – the main type being a radical prostatectomy, which removes the prostate, part of the urethra and the seminal vesicles, to radiotherapy and chemotherapy. Androgen deprivation therapy, which blocks testosterone, is a cornerstone of treatment for hormone-sensitive tumours as well as additional forms of hormone therapy. The final choice depends on the grade of prostate cancer, the patient's age and overall health.
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Early prostate cancer often has no symptoms. More advanced prostate cancer symptoms can include: frequent urination, especially at night; pain while urinating; blood in the urine or semen; a weak stream and pain in the back or pelvis.
If the cancer has spread, it may also cause unexplained weight loss and fatigue.
Meanwhile, US cancer experts are optimistic about Biden's prognosis. Dr Judd Moul told The New York Times a man like him, in his 80s, 'could hopefully pass away from natural causes and not from prostate cancer'.
mhouston@irishtimes.com
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