Biden's Cancer Has A High Gleason Score. Doctors Explain What That Means.
'On Friday he was diagnosed with prostate cancer, characterized by a Gleason score of 9 (Grade Group 5) with metastasis to the bone,' the official statement read.
The statement also categorized his diagnosis as 'a more aggressive form of the disease' and noted that there are certain hormone-based treatments available.
Biden's diagnosis sent shockwaves throughout the country and the world, along with people who have faced this diagnosis themselves.
One in eight people are diagnosed with prostate cancer in the United States, making it the most common type of cancer in men. There are treatments available, whether it's caught early or in later stages, like Biden's.
Below, doctors explain what Biden's diagnosis means and what you should know about early detection.
A Gleason score applies exclusively to prostate cancer, and is used by doctors to measure how advanced it is.
'The Gleason score is one of the first measures that describes the appearance of the cancer under the microscope. And that's a very strong indicator of how aggressive the prostate cancer is,' said Dr. Michael Leapman, clinical program leader of the prostate and urologic cancers program at Yale Cancer Center in Connecticut.
In the official statement, Biden's office said he has a Gleason score of 9 and Grade Group of 5. Grade Group refers to the new way doctors measure one's Gleason score, and Grade Group 5 is 'the highest grade that we assign to prostate cancer,' Leapman said.
In the old Gleason system, which goes from 6 to 10, Biden's Gleason score is a 9, which is 'among the most aggressive types [of prostate cancer],' said Dr. Jason Efstathiou, a radiation oncologist at Mass General Brigham in Boston.
'And what does that mean? It means that it can grow quickly and it is more likely to spread,' Efstathiou explained.
'When prostate cancer has spread beyond the prostate, the most common sites are the lymph nodes and/or the bone, and when it's spread in that manner, it's called metastatic prostate cancer, and that makes it more serious and certainly harder to cure,' Efstathiou said. In Biden's case, it has spread to the bones, according to the official statement.
Roughly 5-10% of prostate cancers are diagnosed after they have spread, Efstathiou noted. 'Gleason 9 cancers are more likely than lower grade cancers to be metastatic at diagnosis or to spread later on,' Efstathiou said.
'Unfortunately, prostate cancer that has left the bones is not currently curable. We don't have any cures for prostate cancer that has metastasized,' said Leapman.
While there isn't currently a cure, there are other options to extend someone's lifespan. 'We do, fortunately, have very good treatments that can control and shrink prostate cancer that has metastasized for many, many years,' Leapman added.
Cancer research has grown in recent decades to allow for therapies and treatments for patients, said Dr. Nitim Yerram, the co-director of urologic oncology at the John Theurer Cancer Center at Hackensack University Medical Center in New Jersey.
The official statement from Biden's office said that 'the President and his family are reviewing treatment options with his physicians.'
And while no one other than Biden's own care team knows his current treatment options, experts said there are a few common treatment routes for metastatic prostate cancer.
'Talking about patients that are initially diagnosed with prostate cancer that has spread beyond the prostate with metastatic prostate cancer, treatment typically includes a combination of therapies, but by far and away, the backbone is what's called hormone therapy,' said Efstathiou.
'And what does hormone therapy do? It reduces testosterone and testosterone production, and can also block the action of testosterone — and testosterone is actually the fuel for prostate cancer, and so what these hormone therapies are doing are cutting off the fuel supply and starving the prostate cancer cells,' he explained.
Hormone therapy is usually combined with other therapies, he added. 'So, while the backbone is hormonal therapy, in recent years, research and trials have shown that adding on other targeted therapies can improve survival and outcomes even further.'
Radiation therapy, chemotherapy and immunotherapy are examples of other targeted therapies that can help control symptoms and the disease, added Efstathiou.
'If you or a loved one is diagnosed with these more advanced prostate cancers ... it's important for them to know that they're not alone, that there are many effective treatments, that research has been moving fast. In just the past two decades, there are well over a dozen new drug therapies specifically for metastatic prostate cancer,' he said.
'So while it's serious, there is hope, and there certainly is progress as well.'
'We know that the the best thing we can do to reduce any man's risk of dying from prostate cancer or developing metastatic prostate cancer is to find it early,' said Leapman.
The best way to do this is through PSA screening, which measures 'a blood marker called PSA, which stands for prostate specific antigen, and if that level is elevated, that can be an indicator that there is prostate cancer,' Leapman noted.
The official guidelines recommend PSA screenings for men ages 55 to 69, but you should talk to your primary care doctor to see if PSA screening is right for you and at what age.
'Some of the guidelines would start that at at age 50, and some guidelines even recommend a baseline PSA level drawn between ages 45 to 49,' said Efstathiou.
As mentioned above, some folks are at higher risk of prostate cancer — Black men, those with a familial history and those with certain genetic mutations. For those people, PSA screening should 'certainly be considered,' said Efstathiou.
In the official statement about Biden's diagnosis, 'increasing urinary symptoms' were mentioned. But it is often a symptomless cancer, said Yerram.
'Most men who are diagnosed with prostate cancer do not have symptoms because we're catching things early,' said Leapman.
This is particularly true in its early stages, added Efstathiou.
This doesn't mean there are never signs, though. 'When [symptoms] do occur, it could manifest as urinary difficulties, like difficulty starting or stopping the urinary stream, more frequent urination, a weak stream,' Efstathiou said.
It may also present as blood in the urine or semen, he added.
When it comes to more advanced prostate cancer, sometimes — but not often — it could present with bone pain, weight loss or fatigue, said Efstathiou.
If you have any of these concerning symptoms, it's important to talk to your doctor, Efstathiou said.
'Prostate cancer is not the one that typically spreads quickly, ' said Yeram. 'So, [Biden] has had this for some amount of time, and I'm sure it was undiagnosed prior to what they recently recently released,' said Yerram.
Typically, routine PSA screening is not recommended for people over the age of 70, he added. 'I suspect, given the president's age, he may not have gotten routine PSA screening — I can't speak to his care specifically, but I would say the chance of having aggressive prostate cancer while you're getting routinely screened with a blood test of the PSA is extremely low,' Yeeram said. (This is why doctors typically recommend PSA screening, Yeeram added.)
'The time from cancer development to symptom onset can vary widely. Even aggressive prostate cancer can go quietly for months or even years before symptoms appear ... in some cases, by the time symptoms develop, the disease has already spread. That's why regular screening and early evaluation are essential, especially in men at higher risk,' Efstathiou said.
Higher-risk men include those with certain genetic mutations, Black men and those with a family history of the disease, added Efstathiou.
'It's even possible for some advanced prostate cancers to present with low PSA and to develop very quickly,' noted Efstathiou.
'Certainly, Gleason 9 prostate cancers can grow more quickly, and have a greater ability and likelihood to spread and that can happen quickly — even though that timeline can vary quite a bit,' Efstathiou said.
'The one thing I really want to emphasize in the current climate, and this is the most important thing, is with federal funding being slashed for research, and the NIH being gutted, and all the other support that the government is slowly taking away, this is years in the making to be able to provide new therapies to help patients,' said Yerram. 'And I'm sure [Biden] will be one to benefit from all that,' he said.
'I think it should make us all rethink what's happening on an everyday basis in our country and really emphasize that it's really the government that helps with the advancement of new therapies, and we should really, really advocate for such funding,' noted Yerram.
Biden Shares Selfie, Message Of Gratitude After Shock Cancer Diagnosis
Biden Has Been Diagnosed With Aggressive Prostate Cancer
The Age You Should Get A Mammogram Just Got Lowered
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
USA Today
2 days ago
- USA Today
New EPA data show more towns have PFAS in their water. Is yours one?
Shane Pepe knows exactly how his town's drinking water came to be polluted with the "forever chemicals" it recently reported to the U.S. Environmental Protection Agency. The borough manager in Emmaus, Pennsylvania, points to a firefighter training facility as the source of contamination that averaged 32 times the federal limit over the past year. For decades, fire-extinguishing foams containing PFAS seeped into the local aquifer during training exercises. "While our firefighters are practicing to save your life, they had no idea that at the same time the water system was getting poisoned," he said. Emmaus was among 839 water systems whose yearly average exceeded EPA limits for two types of forever chemicals, according to a USA TODAY analysis of new test results the EPA released last week. Together, these utilities serve 46 million Americans. These PFAS, or per- and polyfluoroalkyl substances, are part of a family of chemicals engineered to repel liquids and heat, making them nearly indestructible. They can build up in nature and in human bodies, increasing the risk of certain types of cancer and other health problems. The EPA is nearing the end of the largest PFAS testing initiative it's undertaken – a three-year effort that requires most public drinking water systems serving at least 3,300 customers to sample and report measurements for several types of forever chemicals. Places that have found contamination now need to find other sources of drinking water or install filtration systems that can remove the PFAS within the next few years. That deadline was originally set for 2029, but in May, the EPA announced plans for an extension. The agency also rescinded limits on four other types of PFAS set under the Biden administration in 2024. MAP: Where water systems reported PFAS contamination Click on a system in the map below to review its PFAS measurements. You may also enter an address in the search box to locate the nearest water systems. Don't see a map? Click here. USA TODAY's analysis shows larger water utilities more frequently fail to meet the EPA's standards for the two chemicals it still plans to limit: PFOA and PFOS. Nearly a quarter of systems serving over 100,000 people had average results exceeding the limit, compared to about 8% of those with fewer than 10,000 customers. But in the latest data release, it's some of the smaller communities that have reported the most eye-popping concentrations of forever chemicals in their drinking water. Nashville, North Carolina, a town of 6,000 east of Raleigh, reported one well that measured PFOS at 490 parts per trillion (ppt) last fall and then at 200 ppt in March. The EPA limit is 4 ppt, which puts the average of those samples 86 times over the limit. The city's director of public works did not return USA TODAY's calls requesting comment. The borough of Emmaus, which is home to about 12,000 people just outside Allentown, Pennsylvania, reported several wells over EPA limits – most notably at its waterworks building, where PFOS averaged 32 times over the limit. PFOA also measured high, averaging about five times above the limit. 'These firefighting foam companies knew what was in the water and never notified anybody,' Pepe said. He added that Emmaus declined a $4 million settlement from a class-action lawsuit against PFAS manufacturers and is instead pursuing its own lawsuit to recover damages. A spokesperson from the 3M Co. didn't respond directly to Pepe's allegation, but said they've committed $12 billion to public water suppliers as part of the settlement Emmaus declined. The company plans to stop manufacturing PFAS by the end of 2025. Spokesman Dan Turner of the DuPont Co., another manufacturer that Emmaus named in its lawsuit, declined to comment since the litigation is ongoing. Emmaus discovered the contamination through state-mandated testing in late-2021, Pepe said. The utility immediately shut down one well and studied how to remedy another well. Residents of Emmaus made it clear they wanted to fix Emmaus' water, Pepe said, rather than becoming dependent by buying water from elsewhere. Earlier this year, the town won over $9 million in grant funding and a nearly $2-million loan from the state to install four enormous treatment tanks filled with granular-activated carbon able to filter out PFAS. Pepe said construction should finish by June 2026. Emmaus will need to raise water rates slightly to pay for ongoing maintenance to the new tanks, Pepe said, since it costs about $100,000 per year to replace the carbon filters. But, he's thankful the Pennsylvania Infrastructure Investment Authority's grant will bear the brunt of costs. 'Had we not gotten the grant,' Pepe said, 'instantly our folks would have been paying four times what they pay today. Instantly. And that would have been for the next 20 to 30 years.' Hundreds of other small water systems face Emmaus' predicament, where local budgets may not suffice to cover the cost to remove PFAS without raising water rates. Several water utility officials have told USA TODAY it's not fair to pass these costs on their customers rather than the manufacturers and processors that created the PFAS contamination. Because of this, industry groups representing water utilities sued the EPA last year, claiming the agency did not follow proper procedures when approving the new PFAS limits. The lawsuit has been on hold since shortly after President Donald Trump took office, to allow the new administration time to review the limits. After the EPA announced plans to rescind some PFAS limits in May, a federal judge said the agency now has until Sept. 10 to clarify its position in the lawsuit, according to the latest court filing. Regardless of the lawsuit's outcome, Pepe said his customers' lives and safety must come first. 'We are being told by environmental agencies that these chemicals in the water are bad and have the potential to cause cancer and other illnesses,' Pepe said. 'We have a duty to mitigate this as quickly as possible, and so that's exactly what we're doing.'
Wall Street Journal
2 days ago
- Wall Street Journal
Drug Approvals Hit an FDA Wall
Does Food and Drug Administration Commissioner Marty Makary want to accelerate life-saving drugs as he claims? The agency's recent torpedoing of an immunotherapy shot for advanced melanoma and slow-rolling a treatment for a rare disease raise big questions. The FDA's approval of new drugs has notably slowed this year. Annual novel drug approvals averaged 52 in the first Trump Presidency and 48 under Joe Biden, but there have been only 22 in the first seven months of this year. On current trend that would make 38 for the year.
The Intercept
2 days ago
- The Intercept
Veterans Are 'Guinea Pigs' in Trump's First National Abortion Ban Experiment
Ash Wallis knows she likely wouldn't survive another pregnancy. Doctors said as much years earlier after she suffered a pulmonary embolism following a miscarriage, and got a second blood clot. Getting pregnant again isn't a risk she is willing or able to take. 'I have two sons,' said Wallis. 'I don't want to leave them motherless.' Wallis, 40, begged her health care provider to give her an IUD — her best chance at preventing another pregnancy and protecting her life. But her provider, the Department of Veterans Affairs, refused to cover the procedure. Despite three years of service in the Army, Wallis was forced to pay out of pocket at a local clinic. 'The risks of me getting pregnant and there being a significant health issue were too much risk for me to gamble on,' she said. Access to reproductive care and abortion has long been a problem for those who rely on VA care. But a policy change by the Trump administration stands to make reproductive health for service members and veterans even worse. Last week, the administration posted a proposed rule for VA facilities that would severely narrow access to abortion — eliminating exceptions for health, rape, and incest, and only allowing the procedure in situations deemed to threaten the life of the mother. The rule would also ban any counseling for abortion through the VA. The proposed policy now enters a mandatory 30-day comment period, after which it can go into effect. Experts told The Intercept that the rule change will have devastating consequences for the millions of service members and veterans reliant on health care through the VA, as well as their families. 'It's the worst-case scenario,' said Rachel Fey, vice president of policy and strategic partnerships at Power to Decide, a nonprofit focused on reproductive and sexual health. The Department of Veterans Affairs has long excluded abortion care and abortion counseling from its medical benefits package, with a narrow exception for the 'life of the mother.' That changed in 2022 when the Biden administration, recognizing the danger posed to veterans and service members by the Supreme Court's Dobbs v. Jackson Women's Health Organization decision, instituted a new rule allowing for abortion counseling and abortion care in an expanded list of circumstances. It's this Biden-era change that is under attack by the Trump administration. The administration describes the proposed policy shift as a return to form. 'Prior to the Biden Administration's politically motivated change in 2022, federal law and longstanding precedent across Democrat and Republican administrations prevented VA from providing abortions and abortion counseling,' wrote Gary Kunich, a Veterans Affairs spokesperson, in a statement to the Intercept. Fey and other reproductive health experts had anticipated the Trump administration would institute an abortion ban at the VA. But they told The Intercept that this version is particularly draconian considering the dramatic fall-off in abortion access following the Dobbs decision. 'This new policy would be one of the strictest abortion bans in the country, and for veterans living in the 12 states that ban abortion, it would further close off what may be their only opportunity to access urgently needed abortion care,' said Liz McCaman Taylor, senior federal policy counsel at the Center for Reproductive Rights, in a statement. 'For veterans living in these states, they may now be forced to carry pregnancies to term even if they were raped or the pregnancy puts their health in jeopardy.' The proposed rule would 'reinstate the full exclusion on abortions and abortion counseling.' Unlike under the Biden rule, which allowed for abortion counseling and abortion care to protect the health of the mother or in cases of rape and incest, the new proposed rule only includes a vague, narrow exception for 'life of the mother.' 'For the avoidance of doubt, the proposed rule would make clear that the exclusion for abortion does not apply 'when a physician certifies that the life of the mother would be endangered if the fetus were carried to term,'' wrote the administration in a summary of the draft proposal. However, in a potentially complicating line, the administration wrote: 'Taken together, claims in the prior administration's rule that abortions throughout pregnancy are needed to save the lives of pregnant women are incorrect.' Jaclyn Dean, director of congressional relations, reproductive health, at the National Partnership for Women & Families, said that the lack of medical clarity around when doctors are allowed to intervene is going to cost lives. 'If I'm a doctor for the VA,' said Dean, 'I'm very confused about what I'm legally allowed to do.' Fey said her organization, Power to Decide, was 'not aware of any circumstances' where the VA covered abortion care under the life exception in place before the Biden rule. 'There was always sort of supposed to be this very, very narrow life exception, but similar to what's happening now in the post-Dobbs world, we're seeing that those life exceptions don't work in practice,' she said. Lindsay Church, executive director of Minority Veterans of America, said the counseling ban adds another layer of risk because providers are prevented from even discussing the option of abortion until it may be too late. 'Good luck if you get to a place where you're dying,' said Church, 'because you can't get abortion counseling before that. And that, to me, is insulting. Not only that, but it could have deadly consequences.' Read Our Complete Coverage The counseling ban also means veterans or active-duty service members referred to the Veterans Affairs administration for care after being sexually assaulted can't discuss abortion as an option with their provider. 'We already know that women veterans experience Military Sexual Trauma at alarming rates, and many of us continue to fight battles long after our service ends,' said Stephanie Gattas, founder of the Pink Berets, which offers support for women veterans struggling with PTSD, military sexual assault, and other mental health issues. Over 8,000 service members, who can also be referred to the VA for care, reported being sexually assaulted last year. And nearly 500 people reported being sexually assaulted while on a VA campus last year, according to Church. Both numbers are likely a severe undercount. 'The military community is wrought with sexual violence,' said Church. 'Now, if you get raped and become pregnant … because of assault at the Department of Veterans Affairs, they won't help you.' Sylvia Andersh, a former service member who worked at Veterans Affairs hospitals as a nurse, called the lack of exceptions for rape 'cruel.' 'My faith in humanity has been quite tested with the fact that they're willing to blatantly hurt women,' said Andersh. For Wallis, who was sexually assaulted while serving in the military, the lack of rape exceptions is especially troubling. 'It feels like being spit in my face,' she said. 'I wrote a check up to and including my life for this country, and I'm not provided equal access to care,' Wallis said. Wallis also worries that this new policy could increase suicidal ideation among service members. 'An unexpected pregnancy, whether it's due to rape, incest, or contraceptive failure, doesn't matter what the cause is,' she said, 'it increases suicidal ideation, and in the lack of access to care, you add that in, and that risk increases further.' The biggest impact is going to fall on veterans and service members living in states with abortion bans, experts told The Intercept. The Department of Veterans Affairs is the largest integrated health care system in the United States, serving 2 million women veterans, over 400,000 of whom live in states with abortion bans. 'We were living in a much different world the last time this total ban was in effect.' Though the Trump administration insists the policy change would be a return to standard VA practice, Taylor, of Center for Reproductive Rights, points out that the landscape has changed following the Supreme Court's Dobbs decision. 'We were living in a much different world the last time this total ban was in effect. This is the first time there has been a total abortion ban in VA health care facilities since Roe v. Wade was overturned,' said Taylor. 'Before Roe fell, if a veteran couldn't get an abortion at a VA health care facility, they could seek one elsewhere in their state. Now, abortion is banned in many states, and over 100 clinics have closed, meaning veterans living in those states will be totally out of options.' Wallis said she feels as if the administration is testing how far it can restrict access to care, pointing to the abortion ban and new restrictions on gender-affirming care at the VA. 'We're the guinea pigs they want to test what they're able to do to the general public,' she said. 'I truly feel like they're testing what they want to do with the rest of the country on us, and it's scary to me.'
