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'Bachelorette' Lead, 34, Posts Heartbreaking Update Amid Stage 4 Cancer Diagnosis
'Bachelorette' Lead, 34, Posts Heartbreaking Update Amid Stage 4 Cancer Diagnosis

Yahoo

time6 days ago

  • Entertainment
  • Yahoo

'Bachelorette' Lead, 34, Posts Heartbreaking Update Amid Stage 4 Cancer Diagnosis

'Bachelorette' Lead, 34, Posts Heartbreaking Update Amid Stage 4 Cancer Diagnosis originally appeared on Parade. Bachelorette lead Katie Thurston has shared an update as she continues receiving treatment for Stage 4 breast cancer. "I wanted to do weekly check-ins that are just like uncut, raw emotions of whatever comes to my mind. I just finished my second month of treatment and if you're asking how long treatment is, technically forever. I am optimistic about medical advancements in the future. Fingers crossed as a stage 4 girly," the 34-year-old said on her Instagram Stories on June 1. "But right now, after finishing two months of my medication, my hair is coming out in an unnatural amount of clumps. Working on that. I'm losing my memory. That's great. Going through customs and them being like, 'Where are you coming from?' And I looked at him and I was like, 'I don't remember. I don't remember,'" she revealed her cancer diagnosis in a vulnerable post on social media back in February. After undergoing some additional tests, the former reality star was told that her cancer was Stage 4 as it had metastasized to her liver. Thurston was given some positive news in April when she learned that her cancer is her2 negative, which meant she doesn't need chemotherapy — at least not right away. Over the past couple of months, Thurston has been undergoing different treatments, one of which would cause her to go into early menopause. However, she got a period, indicating the medication didn't work. In her June 1 update, Thurston shared that her doctors were switching her to Lupron, but if that medication doesn't work, she may need to have her ovaries removed. Thurston was on Season 25 of The Bachelor before being offered a lead role on Season 17 of The Bachelorette. She ended up getting engaged to Blake Moynes, but the two split shortly after the show aired. Now, Thurston is happily married to someone that she met outside of the franchise. She and Jeff Arcuri tied the knot in March. 'Bachelorette' Lead, 34, Posts Heartbreaking Update Amid Stage 4 Cancer Diagnosis first appeared on Parade on Jun 2, 2025 This story was originally reported by Parade on Jun 2, 2025, where it first appeared.

Bunnie Xo describes IVF journey as 'hellacious'
Bunnie Xo describes IVF journey as 'hellacious'

Yahoo

time6 days ago

  • Entertainment
  • Yahoo

Bunnie Xo describes IVF journey as 'hellacious'

Bunnie Xo is rethinking IVF after a punishing second round attempt. The wife of country music star Jelly Roll has revealed that her latest round of in vitro fertilization (IVF) treatments has brought some of the most debilitating side effects yet, and says she's thought about reconsidering this path to parenthood. "Maybe having a baby isn't in our cards. I don't know," she shared. In a new instalment of her Dumb Blonde podcast, she described this go-around as more painful than ever. "I'm in medical menopause and it's f**king hellacious," she says in one clip from the podcast. "It has been the worst thing I've ever been through in my life." She describes symptoms like nausea, cold sweats, blood sugar crashes and pain, explaining that her estrogen levels have plummeted due to a new protocol for this round of IVF. This treatment plan includes taking Lupron, a drug that Bunnie encountered when her father Bill was battling cancer. "I saw how my dad felt on Lupron, and now that I have actually gone through it, I feel so bad that I was not more understanding with my dad," she admits. "I have almost gone to the hospital probably 10 times in the past 48 hours." Jelly Roll and Bunnie have been open about their hopes to have a baby together. Bunnie has spoken out about their journey as a way to bring awareness to those struggling with infertility.

Fact Check: RFK Jr. said HHS researcher without medical license wasn't hired for autism study
Fact Check: RFK Jr. said HHS researcher without medical license wasn't hired for autism study

Yahoo

time26-05-2025

  • Health
  • Yahoo

Fact Check: RFK Jr. said HHS researcher without medical license wasn't hired for autism study

Claim: David Geier, appointed by U.S. Secretary of Health and Human Services Robert F. Kennedy Jr. to lead autism-related research, is not a licensed medical doctor. Rating: What's True: The U.S. Department of Health and Human Services' directory website states that David Geier is currently employed by the department as a "senior data analyst." Geier has never held a medical license and he was charged in Maryland with practicing medicine without one. What's False: According to HHS Secretary Robert F. Kennedy Jr., Geier was not hired to conduct or lead autism research, but rather to review historical vaccine safety data from the CDC's Vaccine Safety Datalink. On May 14, 2025, U.S. Secretary of Health and Human Services Robert F. Kennedy Jr. appeared before the Senate Health, Education, Labor, and Pensions Committee, where senators questioned him on a range of issues — including the controversial hiring of David Geier. The hearing came weeks after a viral rumor claimed that Geier, whom Kennedy reportedly chose to work on autism-related research, was not a licensed doctor and had a history of unethical medical practices, including administering dangerous hormone treatments to autistic children. As Snopes reported in early January 2025, investigating the reasons for the growing prevalence of autism diagnoses was one of the stated goals of President Donald Trump's second administration. Readers messaged us asking whether Geier, reportedly in charge of the "autism solution" under Kennedy, "ever had a medical license" and "chemically castrated autistic children." Similar claims also spread on social media. "David Geier is neither a doctor nor a scientist; he is a discredited conspiracy theorist and hack researcher who RFK Jr. hired to advance his anti-science, anti-vaccine agenda," one Facebook post on the topic stated. Similar claims about Geier circulated on X, Bluesky, Facebook, and Reddit. "Vaccine skeptic hired to head federal study of immunizations and autism," one Reddit post on the topic read. Julia Davis, a columnist for The Daily Beast and the creator of the Russian Media Monitor, wrote on X that "the man tapped by RFK Jr to run a clinical trial looking to tie vaccines to autism has been charged with practicing medicine without a license, given autistic children a dangerous drug not approved for use in the US & improperly prescribed puberty blockers." In short, the claims were a mixture of true and false information. Geier, who in fact has never held a medical license and was previously charged in Maryland with practicing medicine without one, is now listed as a "senior data analyst" at the Department of Health and Human Services (HHS) website. In the mid-2000s, he and his father promoted an unapproved treatment for autism that involved administering Lupron, a testosterone-suppressing drug. While multiple news outlets have reported that Geier may be involved in a federal effort to analyze potential links between vaccines and autism, a longstanding and widely debunked theory, during a May 14, 2025, Senate hearing, Kennedy testified that Geier was not hired to lead autism research, but rather to review historical vaccine safety data from the Centers for Disease Control and Prevention's (CDC) Vaccine Safety Datalink. We have reached out to Geier and HHS to inquire about his role in the department and will update this article if we receive a response. Geier is a controversial figure in the debate over autism and vaccines. CNN, for instance, described Geier as a "self-proclaimed autism expert who published a since-retracted paper with his father, Mark Geier, purporting to show links between vaccines and autism." In fact, one of the articles the Geiers co-authored was retracted because, according to the editors of the Science and Engineering Ethics journal, it contained "a number of errors, and mistakes of various types that raise concerns about the validity of the conclusion." Similarly, the BBC described Geier as a "leading vaccine sceptic who was fined by the state of Maryland for practicing medicine without a medical degree or licence and prescribing dangerous treatments to autistic children." Geier is the son of Mark Geier, a physician whose medical license was revoked in multiple states for misconduct. According to Children's Health Defense, Kennedy's nonprofit anti-vaccine group, Mark Geier died in late March 2025. Unlike his father, David Geier never obtained a medical license. In 2011, the Maryland State Board of Physicians charged him with practicing medicine without a license. "David Geier has never obtained a license to practice medicine nor has he held a license to practice any health occupation," the board wrote. "In 2002, he obtained a Bachelor of Arts degree from the University of Maryland, Baltimore County. He has not attended any medical school." According to an unreported opinion from the Court of Special Appeals of Maryland, an administrative law judge initially recommended dismissing the charges. However, in July 2012, the board rejected this recommendation, concluding that Geier "who is not a physician, had diagnosed a patient, determined which blood tests to order for the patient, and ordered those blood tests," and as a penalty for practicing medicine without a license imposed a $10,000 fine. Geier appealed the board's decision, but the Circuit Court for Montgomery County upheld the ruling in April 2014. Subsequently, the Maryland Court of Special Appeals affirmed the lower court's decision, maintaining the board's findings and the fine. According to Science magazine, in the mid-2000s, the Geiers promoted a discredited theory suggesting that autism was caused by a harmful interaction between mercury (specifically thimerosal, a preservative formerly used in vaccines) and testosterone. They claimed that lowering testosterone could improve autism symptoms, and developed an unapproved treatment plan involving daily injections of Lupron, a drug used to treat "symptoms of prostate cancer, early-onset puberty and other hormone-related conditions." In children, Lupron is approved only for treating rare cases of precocious puberty. The board found "that Dr. Geier treated patients with Lupron, a medication that was not approved by the U.S. Food and Drug Administration ("FDA") for use on children in the absence of precocious puberty, and that Dr. Geier did not perform an adequate examination to determine if the patients had precocious puberty." On April 10, 2025, Kennedy said during a broadcasted cabinet meeting chaired by Trump, "We've launched a massive testing and research effort that's going to involve hundreds of scientists from around the world. By September, we will know what has caused the autism epidemic and we'll be able to eliminate those exposures." During a May 14 Senate hearing, when Sen. Maggie Hassan, D-N.H., questioned Kennedy about Geier's alleged role of leading autism research at HHS, he testified, "We did not hire David Geier to manage autism research at HHS." He clarified Geier's role was to compare current data from the Vaccine Safety Datalink with what he previously accessed in the 2000s. Below is a transcription of the relevant part of the hearing: KENNEDY: So, do you want to know why we brought David Geier in? HASSAN: Sure. KENNEDY: Because it wasn't to run autism research. In 2002, the CDC runs a Vaccine Safety Datalink which is supposed to be the vaccine information for the biggest HMOs that are supposed to allow CDC to have a surveillance system for vaccine injury. It's a backs-up system. The CDC will not let any physicians in there to look at it, or any scientists, independent scientists. HASSAN: He's neither a scientist nor a physician. KENNEDY: The Congress ordered CDC to open it to the Geiers. So they are the only scientists who have ever been in there. HASSAN: But again, Mr. Geier is not a scientist. […] KENNEDY: David Geier is the only living independent scientist who's seen the VSD inside. There's been a lot of monkey business with the VSD, including allegations of fraud. He was hired by an independent contractor — not as an HHS employee — but by an independent contractor, to look at the documents that we were getting to the VSD to see if they conformed with what he saw between 2002 and 2016. And that's the only reason that he was brought in, to see if there was […] . There is so much information that has disappeared from that database. The only way we could find out what information disappeared was because he was the one guy who saw it. Kennedy said Geier was hired "by an independent contractor — not as an HHS employee." However, according to the HHS directory website (archived), as of this writing Geier was listed as a senior data analyst in the HHS' Office of Secretary for the Assistant Secretary for Financial Resources. The exact circumstances of his hiring remain unclear. (HHS Employee Directory via Wayback Machine) The listing did not provide further details about the nature or scope of Geier's responsibilities. Between April and early May 2025, several news outlets reported Geier would "lead" or "oversee" a study on the causes of autism. We have not independently verified these reports. The Washington Post first reported on Geier's hiring on March 25, 2025. The outlet said the HHS hired Geier "to conduct the analysis, according to the officials, who spoke on the condition of anonymity for fear of retaliation." In a brief phone interview with the Post the same day, Geier said "he had no comment about whether he has a role in the study, how he was hired, and whether he holds the same views about vaccines and autism as described in his previous research." "I don't have any comment to say," he told the Post, "Talk to the secretary. He's the person that's in charge." The Post noted it was not clear "how or why Geier, who is not a physician and has an undergraduate degree from the University of Maryland at Baltimore County, was chosen." According to the Post, an unnamed federal health official identified Geier as the person who "would be the one analyzing the [vaccine safety] data." Similarly, The New York Times reported Geier "joined his department to work on a study examining the long-debunked theory," vaguely crediting "people familiar with the matter." Additionally, the NBC article on the matter cited "two sources familiar with the plan" that "learned about the matter during recent meetings at the CDC but were not authorized to speak about it publicly." All in all, in mid-May 2025, Kennedy denied the claims that HHS hired Geier to lead a federal study examining potential links between vaccines and autism, saying he was brought on only to review vaccine safety data from the CDC's Vaccine Safety Datalink, not to conduct or lead an autism-related study. In mid-April 2025, we investigated whether Kennedy said autistic children "will never pay taxes. They'll never hold a job. They'll never play baseball. They'll never write a poem. They'll never go out on a date. Many of them will never use a toilet unassisted," and unpacked rumors about the National Institutes of Health's alleged plans to launch a "disease registry" to track Americans with autism. "'Rare in His Brilliance': Tribute to Dr. Mark Geier — Advocate for Vaccine Safety and Autistic Children." Children's Health Defense, 27 Mar. 2025, Accessed 8 May 2025. AFP News Agency. "RFK Jr Says Study Will Reveal Cause of Autism 'Epidemic' in September | AFP." YouTube, 10 Apr. 2025, Accessed 8 May 2025. Chicago Tribune. "Autism Doctor Loses License in Illinois, Missouri." Chicago Tribune, 5 Nov. 2012, Accessed 8 May 2025. Deng, Grace. "What to Know about Reports RFK Jr. Is Launching Registry to Track Americans with Autism." Snopes, 22 Apr. 2025, Edwards, Erika, and Brandy Zadrozny. "HHS Taps Anti-Vaccine Activist to Look at Debunked Links between Autism and Vaccines, Sources Say." NBC News, 26 Mar. 2025, "Four Vaccine Myths and Where They Came From." Geier, Max G. "Book Review: Etulain,Lincoln and Oregon Country Politics in the Civil War Era, by Max G. Geier Lincoln and Oregon Country Politics in the Civil War Era . By Richard W. Etulain . ( Corvallis , Oregon State University Press , 2013 . Xii + 210 Pp. $19.95 Paper)." Pacific Historical Review, vol. 83, no. 4, Nov. 2014, pp. 698–99, Accessed 6 Nov. 2019. "HHS Employee Directory." 2025, Accessed 8 May 2025. Jewett, Christina, et al. "RFK Jr. Turns to a Discredited Vaccine Researcher for Autism Study." The New York Times, 27 Mar. 2025, "Julia Davis - the Daily Beast." The Daily Beast, 2025, Accessed 8 May 2025. Kern, Janet K., et al. "RETRACTED ARTICLE: Systematic Assessment of Research on Autism Spectrum Disorder and Mercury Reveals Conflicts of Interest and the Need for Transparency in Autism Research." Science and Engineering Ethics, vol. 23, no. 6, Oct. 2015, pp. 1689–90, Accessed 11 June 2021. ---. "Systematic Assessment of Research on Autism Spectrum Disorder (ASD) and Mercury Reveals Conflicts of Interest and the Need for Transparency in Autism Research." Science and Engineering Ethics, vol. 23, no. 6, Nov. 2017, pp. 1691–718, Accessed 11 June 2021. King, Jordan. "RFK Jr Autism Study Led by Man Who Injected Children with Anti-Puberty Drug." Newsweek, 17 Apr. 2025, kreidler, Marc. "Maryland Medical Board Suspends Dr. Mark Geier's License | Quackwatch." 8 May 2011, Accessed 8 May 2025. "Lupron (Leuprolide): Uses & Side Effects." Cleveland Clinic, "MARYLAND BOARD of PHYSICIANS v. GEIER (2015) | FindLaw." Findlaw, 2015, Accessed 8 May 2025. Rascouët-Paz, Anna. "Yes, RFK Jr. Said Autistic Children Will Never Pay Taxes, Hold a Job, Play Baseball or Write a Poem." Snopes, 18 Apr. 2025, Schreiber, Melody. "Autistic People and Experts Voice Alarm at RFK's 'Terrible' Approach to Condition." The Guardian, The Guardian, 24 Apr. 2025, Stolberg, Sheryl Gay, et al. "Kennedy Instructs Anti-Vaccine Group to Remove Fake C.D.C. Page." The New York Times, 23 Mar. 2025, Sun, Lena H., and Fenit Nirappil. "Vaccine Skeptic Hired to Head Federal Study of Immunizations and Autism." The Washington Post, 25 Mar. 2025, Tirrell, Meg, et al. "RFK Jr. Claims New Research Effort Will Find Cause of 'Autism Epidemic' by September." CNN, 10 Apr. 2025, Accessed 8 May 2025. Wendling, Mike. "RFK Jr Pledges to Find the Cause of Autism 'by September.'" BBC, 11 Apr. 2025, X (Formerly Twitter), 2025, Accessed 8 May 2025.

How Do Doctors Treat ‘Aggressive' Prostate Cancer like Joe Biden's?
How Do Doctors Treat ‘Aggressive' Prostate Cancer like Joe Biden's?

Scientific American

time19-05-2025

  • Health
  • Scientific American

How Do Doctors Treat ‘Aggressive' Prostate Cancer like Joe Biden's?

Former president Joe Biden has been diagnosed with prostate cancer, his office announced on Sunday. The 82-year-old has what is described as an 'aggressive form' of cancer that has already spread to his bones. Though his disease is serious, there are promising treatment options, and Biden could potentially live for years with the diagnosis. What is a Gleason score, and what does Biden's mean? Biden has a Gleason score—a benchmark ranking of prostate cancer severity —of 9 out of 10, his office revealed. This puts him in a category called Gleason Grade Group 5. The numbers represent the proportion of prostate cells that look malignant rather than normal under a microscope; a higher number represents a more serious, faster-spreading cancer. Biden's score suggests that a large portion of his cells look abnormal and that his cancer is relatively high-risk: 'He has the most aggressive Gleason pattern,' says oncologist Marc B. Garnick, a professor of medicine at Harvard Medical School and Beth Israel Deaconess Medical Center in Boston. On supporting science journalism If you're enjoying this article, consider supporting our award-winning journalism by subscribing. By purchasing a subscription you are helping to ensure the future of impactful stories about the discoveries and ideas shaping our world today. In Biden's case, the cancer has already become metastatic, meaning it has moved beyond its origin point in the prostate and reached his bones. 'Unfortunately, I'd say it is a very serious condition when prostate cancer spreads outside of the prostate and goes to distant places like the bone,' says Peter Nelson, vice president of precision oncology at the Fred Hutchinson Cancer Center in Seattle and head of the prostate cancer research program at the Fred Hutch/University of Washington/Seattle Children's Cancer Consortium. 'Essentially it's not a curable cancer.' Just how serious the situation is depends on the details of the cancer's spread to the bones. 'The critical question is: How many bone metastases does he have, and what is the anatomic location of the metastases?' Garnick says. 'This is a situation where the devil is in the details.' What are Biden's treatment options? The treatment for Biden's form of cancer, called metastatic hormone sensitive prostate cancer, is likely to be what's known as doublet therapy—a combination of two drugs that target the production and activity of testosterone. This hormone is key to the situation because it fuels the growth of prostate cancer cells. Its active form, called dihydrotestosterone, interacts with a cell part called the androgen receptor. This receptor then tells the cell to proliferate and grow. Biden could possibly be prescribed a drug such as leuprolide (Lupron) or relugolix, both of which shut off the signal in the brain that tells the testicles to make testosterone. In addition, he'll probably take a second drug, such as apalutamide, enzalutamide, darolutamide or abiraterone. These agents inhibit the cells' androgen receptors to block the action of testosterone. The drugs, taken as a combination of injections and pills, can work together to shrink the prostate gland and bone lesions. If Biden responds well to the treatment, it's likely that he won't need chemotherapy. 'I would say he has a more than 90 percent chance of responding to the treatment and likely has at least several years of predicted response to that therapy,' Nelson says. 'The problem is: it's not a cure, and eventually the prostate cancer becomes resistant to that type of therapy.' This treatment can also lead to side effects such as loss of muscle mass and strength, deterioration of bone health and metabolic effects. 'Testosterone is a very important hormone for men, so when you suppress it, you can have these side effects,' Nelson adds. Still, Biden's prospects are much more promising than they would have been even a decade ago, thanks to advances in treatment research. 'In the past, the median duration of survival of someone presenting with bone metastases [from] prostate cancer was two and a half years,' Garnick says. 'We now have patients living five, 10 and 15 years because of the new modalities available.' What else can doctors do? In addition to prescribing hormone therapy, Biden's doctors will likely test the former president's tumor to see if he has any mutations in certain cancer genes that would suggest specialized treatments were called for. For instance, some prostate cancers end up being genetically linked to other cancers such as breast and ovarian cancer, through the presence of the genes BRCA1 or BRCA2. 'Those are genomic abnormalities that can exist that can increase the likelihood of prostate cancer,' Garnick says. If that's the case for Biden, he could receive specific drugs, such as poly (ADP-ribose) polymerase, or PARP, inhibitors, that target the type of prostate cancer he has. How bad is prostate cancer in general? Prostate cancer is among the most common forms of cancer in older men. The American Cancer Society estimates there will be about 313,780 new diagnoses of the condition and 35,770 deaths attributed to it in the U.S. in 2025. 'It's not surprising that a man in his 60s to 80s would have a diagnosis like this—[prostate cancer] affects one in eight men in the U.S.,' Nelson says. 'The ironic part is: Biden did so much to emphasize the importance of biomedical research in addressing our cancer burden. But he should benefit from that investment in making improvements in understanding cancer and how we can better develop therapies for it.' Biden's successor, President Donald Trump, has shifted course since beginning his second term. His administration has made significant cuts to funding for cancer research and has eliminated thousands of jobs in the Department of Health and Human Services, including hundreds of employees at the National Institutes of Health, the world's largest funder of cancer research. 'My plea is not to turn our back on the tremendous progress that's being made,' Nelson says. 'We still have a long way to go because we're not curing advanced prostate cancer, even though we're extending men's lives. We still need major investments in biomedical research to develop true cures.'

'Taken aback that it's this far advanced': Medical expert weighs in on Joe Biden's 'most aggressive type' of prostate cancer with bone metastasis
'Taken aback that it's this far advanced': Medical expert weighs in on Joe Biden's 'most aggressive type' of prostate cancer with bone metastasis

Sky News AU

time19-05-2025

  • Health
  • Sky News AU

'Taken aback that it's this far advanced': Medical expert weighs in on Joe Biden's 'most aggressive type' of prostate cancer with bone metastasis

Former President Joe Biden was diagnosed with an "aggressive form" of prostate cancer that has a five-year survival rate of between 30% and 40%. The former president's prostate cancer is characterized by a Gleason score of 9 and Grade Group 5 with bone metastasis, indicating that it is "pretty far advanced," Fox News senior medical analyst Dr. Marc Siegel said on 'Fox Report.' "It's the most aggressive type," Siegel said. "That means it has the highest risk of spread — which obviously he has had." Biden is also presenting with urinary symptoms, which is another sign that the cancer is advanced. Prostate cancer often presents as asymptomatic in its early stages, he said. "This was found by physical examination by a prostate exam," Siegel said. "A lot of times we find an elevation in prostate-specific antigen, PSA, and then we go after it… I mean, he must have had the best possible care here. I'm a little taken aback that it's this far advanced." Siegel said he conducts a prostate-specific antigen, or PSA, test on every male over the age of 45 years old. The test measures how much PSA is in the blood and is primarily used to screen for prostate cancer, according to Mayo Clinic. While the PSA test is not always a perfect indicator of prostate cancer, someone who has a rise in PSA automatically gets an MRI, Siegel said. After the MRI, a decision is made about whether to conduct a biopsy. More than 80% of men over the age of 80 years old have some prostate cancer cells in their body, according to Siegel. "It would be really surprising if they weren't doing a very close screening on this because everybody knows in the medical community that this is the one cancer in men you really look out for," he said. "… He doesn't seem to have a lot of risk factors that I would think about other than age, but age is enough and he's 82, so that's a big risk factor." Doctors will likely treat Biden with hormone therapy, Siegel said. They may also attempt to radiate the lesion found on the bone or remove the prostate altogether. "Sometimes they decide to do more than one therapy," Siegel said. "They might try to take the prostate out, do radiation and the hormone therapy altogether. That's not uncommon." There are two types of medications used to treat this type of advanced prostate cancer — Lupron, which stops testosterone production, and Casodex, which stops testosterone from binding. Side effects of the medication can leave people feeling "fatigued and listless", according to Siegel. "The other thing I'm concerned about is bone pain, because those metastases to the bone can be pretty painful," he said. If the cancer is caught early while its still localized to the prostate gland, it's curable "most of the time", Siegel said. "The goal is to get it before it leaves the prostate," Siegel said. "When it's left the prostate, it becomes much more difficult to cure." Originally published as 'Taken aback that it's this far advanced': Medical expert weighs in on Joe Biden's 'most aggressive type' of prostate cancer with bone metastasis

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