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Medscape
27-05-2025
- General
- Medscape
Biden's Prostate Cancer Diagnosis: Debunking Misconceptions
This transcript has been edited for clarity. Hello, everyone. This is Dr Bishal Gyawali, from Queens University, Kingston, Canada. I'm a medical oncologist. I was saddened to hear the recent news of Joe Biden's diagnosis of prostate cancer. At the same time, I also saw misinformation and several misconceptions circulating on social media and some mainstream media as well.I wanted to clarify these, as a medical oncologist and a cancer researcher. First, let's talk about the stage of the disease. There were some posts about it being stage V or stage IX. The stages of cancer always go from I to IV. There is no such thing as stage V, VI, VII, VIII, or IX cancers. Stage IV is what we refer to as metastatic or advanced disease; when the cancer from one location goes to a different location, then that becomes stage IV. Joe Biden's cancer is stage IV cancer. I think part of the confusion came from the Gleason score. For prostate cancerspecifically, we look at something called the Gleason score. This is something you examine with the biopsy sample under the microscope, and you give a score that can go up to 10, where 10 is the most aggressive. Anything over 8 is what we consider aggressive prostate prostate cancer had a Gleason score of 9, so it is an aggressive cancer. From the press release, we also know that it is a hormone-sensitive cancer. Prostate cancers, usually at the initial diagnosis, are often hormone means if you can reduce testosterone — and there are different ways of doing that — then the cancer will likely respond to that. By reducing the level of testosterone in the body, we can control prostate cancer. Those are some of the misconceptions related to his diagnosis. Then there was some talk about what treatment he might likely get.I think we would be speculating at this point because we don't know many of the other factors that are needed to make a proper treatment decision. I hate to speculate about treatment options, but I'll mention a couple of general points. The first thing to know is what we consider high-volume disease. Is his disease a high-volume disease?What do we mean by that? We know that it has metastasized to the bone, but is it only bone or has it metastasized to any other organ? If it has involved any other visceral organ, then that would be considered a high-volume, high-risk disease. Even the metastasis to the bone — at this point, I'm not sure whether it's one bone or it involves multiple bones. If it involves four or more bones, then again, that would be considered a high-volume disease. Why we want to know that is because if it is a high-volume disease, then we want to offer a treatment that involves not only suppression of androgen or testosterone, what we referred to earlier as the hormone-sensitive disease; so, not just the suppression of hormone using androgen-deprivation therapy, but also treatment with a newer-generation agent such as abiraterone or darolutamide, plus even chemotherapy like docetaxel. If it's not high-volume disease, then we don't necessarily need to use chemotherapy upfront. There might also be a role of using radiation to the are all speculations. We don't know exactly what the situation is, and we also don't know what the comorbidities are. Does he also have some heart disease or some other comorbid conditions that preclude one or more of these treatments? The broader point I wanted to make here is that I saw some posts from top people, his well-wishers, former presidents who are saying, 'Biden is a fighter, Joe is a fighter. We know that he's going to fight this and he is going to win this.' I have a distaste for this metaphor of thinking of cancer as a war and patients as fighters. I have seen that this metaphor has harmed many of my you think of this as a fight, then giving up is not an option. You feel like it's a war that you can win, when in fact, in many metastatic cancers, especially in stage IV cancers, the disease progresses. Even in stage II and stage III cancers, sometimes the cancer relapses. Does the cancer progressing or relapsing mean that the person was not a good fighter? Absolutely not. It's not in anyone's capacity to prevent that from happening. It's just bad luck. That does not mean that the person was not a good fighter. The other harm of this is that when you think of this as a fight, you are also very prone to getting overtreated,and you're getting treated with things that may not even benefit you. Sometimes you get treated until the very end of life. Even in this example, we talked about if it is a high-volume disease, we can use androgen-deprivation therapy plus abiraterone plus docetaxel. If someone wants to prioritize their quality of life — and Joe Biden is 82 years old — then not doing chemo is a perfectly fine could just do hormone therapy. There are so many nuances to this, and all patients are different. That's why we have to individualize treatment to the patient. If we keep using this metaphor of cancer being a war or a fight and the patient being a fighter, then it takes all the nuances away and it makes the patientfeel like he or she has to always do everything that is possible, because not doing so, or prioritizing quality of life, or prioritizing treatment options based on other preferences, is considered 'losing the fight.' That is absolutely untrue, especially for patients who progress despite getting all the treatment, or who die despite getting all the treatment, and for those with early-stage disease who relapse despite doing everything that they makes them feel like they lost the war or they could not fight well, which is absolutely untrue. I think as a community, we should get away from this metaphor of patients being fighters. One final point about this is that many people are commenting about why this cancer was diagnosed so late at stage IV: 'Why was it not detected earlier? He was a president. A president should have all the facilities in the world. He was a US president. It is embarrassing that a former US president was not diagnosed early and was diagnosed with stage IV, an aggressive stage of disease.' That, again, is a fundamental misconception about how cancer screening prostate cancer has a screening test called the PSA test. It is a blood-based test where you detect the levels of prostate-specific antigen, or PSA, but it's a very lousy screening test because it gives many false positives. What do I mean by that? For many patients who get PSA testing done and the PSA is high, saying that they have a high risk of having prostate cancer,it turns out not to be prostate cancer. It's a false positive. It's a false alarm. In many of these cases, when you do a biopsy or a surgery, it turns out to be a very benign form of prostate cancer. It is something that would not have caused death and would not have even progressed to stage IV during the lifetime of that is a problem. The other problem with screening tests in general — and this is not even about PSA alone but for any screening test — is that there can always be these aggressive cancers that are missed by the screening test. It's not a 100% reliable test. People talk as ifone should undergo every screening test every month because anything can happen. This time, we talked about prostate cancer. Maybe there is some colon cancer. Maybe there can be lung cancer. That does not mean you get screened every single month for every single disease out there. Especially for prostate cancer, for the PSA test, the USPSTF guidelines, the US Preventive Services Task Force guidelines, are supposed to be the gold standard, especially for our medical practice. It specifically says that the PSA screening test is not recommendedfor people over the age of 70. It specifically says not to do this screening test if the person's age is more than 70 years because the harms outweigh the benefits. Joe Biden is 82. Even based on the USPSTF standard guidelines, he would not have been recommended for this screening testbecause that's the recommendation for anyone over the age of 70. His not getting a PSA screening test is the standard practice. It's not malpractice and there is nothing nefarious going on that he was not screened for prostate cancer. At his age, the risks outweigh the benefits, and the recommendation from the guidelines is not to be screened, for all these reasons that we have discussed. Also, treatment choices and screening choices will vary from person to person, and also will depend on the expected life expectancy remaining, comorbidities, benefits and risks, judgement calls, and each individual's tolerance with the levels of risks and benefits. As I said, we should not think of a screening test as a 100% foolproof test because no test is 100% foolproof. I don't know whether he underwent a screening test or not. I don't know whether he underwent a PSA test and the PSA did not detect this, or if he did not undergo a PSA test. At his age, PSA screening is not even indicated. These are a few misconceptions about Joe Biden's diagnosis of prostate cancer that I wanted to clarify today through this video. I wish him all the best and I wish him a speedy recovery. Thank you.
Irish Times
26-05-2025
- Health
- Irish Times
Prostate cancer: ‘When you hear ‘inoperable', your world falls apart. But soon I realised that didn't mean terminal'
Tallaght man Phelim Warren knows all about Gleason scores, the measure which tells you how prostate cancerous cells look compared with normal cells. Former US president Joe Biden (82) was given a Gleason score of nine when his office announced a week ago that his diagnosis of prostate cancer was deemed to be an aggressive type, having already spread to the bone. When prostate cancer spreads to other parts of the body, it often spreads to the bones. Metastasised cancer is much harder to treat than localised cancer because it can be hard for drugs to reach all the tumours and completely root out the disease. However, when prostate cancers need hormones to grow, as in Biden's case, they can be susceptible to treatment that deprives the tumours of hormones. 'Joe is a fighter – and I know he will face this challenge with the same strength, resilience and optimism that have always defined his life and leadership,' said the former US vice-president Kamala Harris following news of his diagnosis. Biden's health was a dominant concern among voters during his time as president. READ MORE [ New prostate cancer imaging shows 'extremely encouraging' results in trials Opens in new window ] In Tallaght, Warren was also given a Gleason score of nine following a biopsy in August 2023, which confirmed earlier suspicions – a high score on a Prostate-Specific Antigen (PSA) test and lesions near his prostate seen on an MRI scan- that he might have prostate cancer. The Gleason score will usually be described using a number from six to 10, with nine and 10 considered high-grade and often associated with more aggressive cancer. 'I was diagnosed six days after my 57th birthday. I had no symptoms whatsoever: no pain, no bladder or bowel issues,' says Warren, who had taken early retirement from the civil service in 2022 to look after his wife, Louise. She has reduced mobility, and is affected by fibromyalgia and functional neurological disorder (FND). Warren says that the initial diagnosis terrified him – particularly at his relatively young age – but when he discovered that his cancer was treatable, his view changed. 'When you hear 'inoperable' – as my cancer was because, it had spread to the lymph nodes in the pelvis – your world falls apart. But, soon I realised inoperable didn't mean terminal,' he says. Warren feels sympathy for Biden and finds some negative social media comments following the former US president's diagnosis highly distasteful. 'People celebrating Biden's seriously bad cancer diagnosis or thinking he deserves it, is shameful, abhorrent, disgusting and unforgivable,' he says. Biden's prostate cancer was diagnosed following urinary symptoms and the discovery of a prostate nodule. However, his office said his cancer was deemed to be hormone-sensitive, which allows for effective management. Joe Biden and his wife Dr Jill Biden in a post to X last week, when he said: 'Cancer touches us all' In 2022 Biden made a 'cancer moon shot' one of his administration's priorities, with the goal of halving the cancer death rate over the next 25 years. The initiative was a continuation of his work as vice-president to address a disease that had killed his eldest son, Beau, who died of brain cancer in 2015. Prostate cancer is the most common form of cancer affecting men in Ireland, with about 4,000 men diagnosed with it each year. Dr Lynda Corrigan, medical oncologist at Tallaght University Hospital, says: 'The difficulty about prostate cancer is that the narrative in the community is that 'You won't die from it, you'll die with it'. This is unhelpful for men who are diagnosed with advanced-stage prostate cancer.' [ 'Prostate cancer is not necessarily an old man's disease' Opens in new window ] About 10 per cent of men with prostate cancer in Ireland are diagnosed when the cancer is at an advanced stage, in that it has moved beyond the prostate gland, often to the bone. 'Prostate cancer is a life-changing diagnosis and this narrative minimises their condition and can affect the support men with advanced stage disease get,' says Dr Corrigan. Superior detection with more refined diagnostic equipment, and an ageing population, means that there is a growing incidence of prostate diagnosis in Ireland. The fact that GPs can refer patients to rapid-access prostate clinics in all the main cancer-treating hospitals following high levels of PSA means that there is a clear pathway for diagnosis and treatment. However, urologist Louise McLoughlin in St James's Hospital, Dublin, says that 'bottlenecks' in getting MRI scans can delay diagnosis. 'Men can wait up to six months for an MRI scan, which is key to finding out if the cancer is early-stage disease confined to the prostate or later-stage disease,' she says. Surgery to remove the prostate gland or radiotherapy (external beam radiotherapy or brachytherapy, in which radioactive beads are implanted in the prostate) is the standard treatment for early stage prostate cancer. Those whose cancer is already more advanced are treated with hormone therapies to stop the disease from progressing. You can feel perfectly healthy and have advanced-stage prostate cancer — Louise McLoughlin Warren, positive by nature, took on board that although surgery was not an option for him because he had advanced prostate cancer, there was an effective treatment regime he could undergo. In October 2023 he received the first of four annual hormone therapy injections. These slow-release drugs stop the production of testosterone in the testicles, preventing the cancer from progressing further. He was also prescribed daily hormone tablets to supplement the work of the injections. 'The tablets can have quite severe side effects and cause issues with liver, heart and blood pressure, but thankfully this didn't happen to me,' says Warren, who writes a blog to document his cancer journey. When he shared his story on social media and on his blog, Warren was overwhelmed by the messages of support he received. 'People were incredible, and I know that at least 15-20 people have said to me that because of reading about my situation, they took it upon themselves to have their bloods done. In more than a few cases, they discovered that they did have issues, so sharing my story has been very effective in that regard.' He has found speaking to others with a cancer diagnosis helpful, and is also trying to maintain a positive attitude. 'Your positive mental attitude is key in this and I'm a firm believer in that,' he says. He says that the main side effect he has experienced is fatigue. 'I mind my energy levels and I don't let cancer stop what I enjoy doing. I look after my wife, I do my music, my football, walk the dog and mind the grandchildren and if I feel tired in the evening, I'll go to bed,' he says. [ Prostate cancer: can regular physical activity reduce the risk? Opens in new window ] Other common side effects of hormone therapy are hot flushes, erectile dysfunction, weight gain, low mood and reduced bone density, leading to osteoporosis. In April, Warren got the good news that his PSA levels were not detectable, meaning the cancer had effectively been stopped in its tracks. 'I won't need any further scans once the PSA levels remain low. I now feel joy, elation, relief and gratitude,' he says. He is passionate about encouraging all men over 50 to have annual blood tests to check their PSA levels. Warren cites the example of British Olympic cycling champion Chris Hoy (49), who was diagnosed with terminal prostate cancer in September 2023, as a wake-up call to other men. Hoy told reporters that he had first attributed the pain in his shoulder to working out in the gym. 'I assumed it was going to be tendonitis or something, and it was just going to be lay off weights or lay off cycling for a wee while and get some treatment and it'll be fine,' Hoy told BBC Sport. Hoy's openness resulted in a near eight-fold increase in NHS searches for prostate cancer symptoms over the following days. New, persistent or worsening urinary symptoms (needing to go the toilet urgently or more often), unexpected weight loss or bone pain are symptoms that men should get check out with your GP. Warren says: 'A lot of men refuse to the go the doctor even when they don't feel well. We bring our cars for NCTs every year. Do it for your body too. Having your blood tested is a way into knowing more about your health.' The problem is that although prostate cancer is now more like a treatable chronic disease, the lack of symptoms means it can go undetected for a long time. Dr McLoughlin says: 'We still see people presenting with advanced disease. You can feel perfectly healthy and have advanced-stage prostate cancer.' Ireland is one of the countries involved in the EU prostate cancer screening pilot study. The research project, PRAISE-U is looking at whether organised screening programmes could be a feasible and cost-effective way to increase the early detection of prostate cancer across Europe. Prof Ray McDermott, National Cancer Control lead for prostate cancer in Ireland, says that screening for prostate cancer should only be introduced if there is a reliable test that picks up most cancers early and doesn't miss others. 'This test is a few years away yet and it won't be PSA,' he adds.
Yahoo
21-05-2025
- Health
- Yahoo
Biden family misled public, concealed details on son Beau's cancer diagnosis, new book says
Former President Joe Biden and his late son actively chose to conceal details and misled the public regarding Beau Biden's cancer diagnosis while he served as attorney general of Delaware, a new book claims. The book, "Original Sin: President Biden's Decline, Its Cover-up, and His Disastrous Choice to Run Again," said that the Biden family wanted to keep Beau Biden's cancer diagnosis a secret and misled the media about his condition. The nonfiction book, authored by journalists Jake Tapper of CNN and Alex Thompson of Axios, was released Tuesday. The revelation comes just after former President Biden announced Sunday he had been diagnosed with an "aggressive form" of prostate cancer. The former president's office later said Tuesday he had never received a prostate cancer diagnosis. Gleason Score For Prostate Cancer: What To Know About Biden's Diagnosis "Beau's cancer treatment also demonstrated the Biden's capacity for denial and the lengths they would go to to avoid transparency about health issues, even when the person in question is an elected official, in this case the sitting attorney general of Delaware," the book alleges. Fox News Digital has written extensively dating back to the 2020 presidential campaign about former President Joe Biden's cognitive decline and his inner circle's role in covering it up. Read On The Fox News App The book details how Beau Biden collapsed in the summer of 2013 during a family vacation and that he subsequently faced surgery to remove a brain tumor. By the fall, Beau Biden started to reduce his public appearances and media interviews. "In September, Biden and Beau's team internally debated how much to disclose about Beau — the vice president's son and a state's top law enforcement officer — but ultimately said nothing," the book said. "In November, Beau told a local reporter he had been given a 'clean bill of health.'" Months later, in February 2014, a neurologist revealed that a "small lesion" was removed from Beau Biden's brain — even though the former president later shared the tumor was larger than a golf ball. Joe Biden Diagnosed With 'Aggressive Form' Of Prostate Cancer With Metastasis To The Bone Beau Biden continued to serve as attorney general of Delaware as he received treatments all over the country. He would enter hospitals using the name George Lincoln, according to the book. The book details that Beau's wife, Hallie, told others she remained confused regarding why Beau Biden's declining health was kept under wraps, since the public would have likely provided support. However, Joe Biden and Beau Biden remained against sharing details with the public, the book said. Hallie Biden did not immediately respond to Fox News Digita's request for comment. Additionally, the book said that the then-vice president ordered his staffers to "mislead" the media regarding his whereabouts as vice president. While his team would say he was departing Washington and going to Delaware on weekends, the vice president would also travel to Houston to be with Beau Biden, who was receiving treatment there. "Publicly acknowledging Beau's illness would make it a reality," the book said. "It was them against the world." A spokesperson for the former president did not immediately respond to a request for comment from Fox News Digital. Beau Biden died of a glioblastoma brain tumor in May 2015 at the age of 46. "Original Sin" details the 2024 election cycle and how former President Joe Biden's team allegedly orchestrated a cover-up to hide just how severely his mental faculties had suffered. The book is one of several that detail Joe Biden's decision to run in 2024 and assert the dramatic decline of his cognitive article source: Biden family misled public, concealed details on son Beau's cancer diagnosis, new book says
Al Jazeera
21-05-2025
- Health
- Al Jazeera
Biden camp denies cancer was diagnosed earlier amid cover-up claims
Former United States President Joe Biden was not diagnosed with prostate cancer before last week, and received his 'last known' blood test for the disease more than a decade ago, his office has said. The Biden camp's statement on Tuesday came as critics, including current President Donald Trump, stoked scepticism over the timing of the diagnosis, which has reanimated questions about whether the former president misled the public about his health while in office. 'President Biden's last known PSA was in 2014,' Biden's office said in the brief statement, referring to the prostate-specific antigen test used to detect prostate cancer. 'Prior to Friday, President Biden had never been diagnosed with prostate cancer.' On Monday, Trump said he was 'surprised' that the public had not been notified about Biden's diagnosis 'a long time ago'. 'Why did it take so long? This takes a long time. It can take years to get this level of danger,' Trump told reporters at the White House, referring to the advanced nature of Biden's cancer. 'Somebody is not telling the facts, and that's a big problem,' Trump said. Biden's office said on Sunday that the former president had, two days earlier, been diagnosed with prostate cancer that had spread to his bones. Biden's office said his cancer had score of 9 under the Gleason classification system, which grades prostate cancer from 6 to 10, indicating it is among the most aggressive kinds. While some doctors have expressed doubt that Biden, 82, was not diagnosed earlier given his access to the best medical care, others have noted that screening is generally not recommended for men of his age and that some cancers do not show up in tests. The US Centers for Disease Control and Prevention and other medical bodies do not recommend regular screening for prostate cancer for men over 70 due to the quality of life issues that can result from unnecessary treatment. 'It is entirely reasonable, albeit sad, that even a person of President Biden's position may present with a new diagnosis of prostate cancer that is metastatic at his age,' Adam Weiner, an urologic surgeon at Cedars-Sinai Medical Center in Los Angeles, told Al Jazeera. 'Since President Biden is now 82, it is entirely possible he was screened for prostate cancer up to the recommended age and his newly diagnosed prostate cancer first occurred sometime since then,' Weiner said. Nick James, an expert in prostate cancer at The Institute of Cancer Research in London, said the Biden camp's account of the diagnosis was 'plausible even if a bit unusual', as certain cancers with a low PSA production can be missed in blood tests. 'It's one of the drawbacks of PSA testing is that it can miss such tumours. Likewise, prostate MRI, the other test he might have had, also has a false negative rate,' James told Al Jazeera. Biden's age and health were major concerns for voters during his presidency and re-election campaign, which the former president abandoned following a disastrous debate performance against Trump in June. Critics have accused Biden and his team of covering up the extent of his mental and physical decline while in office. On Tuesday, CNN anchor Jake Tapper and Axios correspondent Alex Thompson released a new book, Original Sin, detailing the Biden camp's alleged efforts to conceal his deterioration. The book includes numerous accounts of Biden's alleged decline, including an incident in which the then-president was said to have not been able to recognise Hollywood actor George Clooney at a 2024 fundraiser.
Fox News
20-05-2025
- Health
- Fox News
Biden's 'last known' prostate cancer screening was over a decade ago, as questions mount over diagnosis
President Joe Biden's last known prostate-specific antigen (PSA) test was in 2014, as questions rise about how much his cancer has spread and why it wasn't caught earlier. "President Biden's last known PSA was in 2014. Prior to Friday, President Biden had never been diagnosed with prostate cancer," a Biden spokesperson told Fox News. The PSA test is a blood test used primarily to screen for prostate cancer. The test measures the amount of prostate-specific antigen (PSA) in the blood, according to the Mayo Clinic. PSA is a protein produced by both cancerous and noncancerous tissue in the prostate, a small gland that sits below the bladder in males. The former president's prostate cancer has been characterized by a Gleason score of 9 (grade group 5) with "metastasis to the bone." This story is breaking. Please check back for updates.
