According to a statement from his office, former President Joe Biden has been diagnosed with prostate cancer, which has also spread to his bones. Doctors have reported a Gleason score of 9, just one point below the most severe rating. The Gleason system evaluates how abnormal prostate cancer cells look under a microscope; higher scores indicate more aggressive and rapidly growing tumors.
Bone metastases in prostate cancer signal late-stage disease and can lead to complications such as fractures and severe pain. As per 2023 research in Oncology Letters, around 80% of patients with late-stage prostate cancer may develop bone metastases. Prostate cancer that spreads to the bones generally has a poor prognosis, with the American Cancer Society (ACA) estimating the five-year survival rate to be under 3%.
Despite the seriousness of the diagnosis, Biden’s medical team has stated that the cancer is hormone-sensitive, which “allows for effective management,” according to the statement. This suggests it may respond to hormone therapy, which works by blocking the growth signals that prostate cancer cells require to multiply. As of now, Biden and his family are reportedly “reviewing treatment options with his physicians.”
Why prostate cancer often goes undetected
Prostate cancer is among the most common cancers affecting older men, with age being the primary risk factor. At 82, the former president is within the demographic most susceptible to both the development and progression of the disease. Most cases occur in men over 65, with those over 70 being more than four times as likely to have advanced disease and a higher likelihood of mortality compared to younger men.
Typically, the disease progresses slowly and remains confined to the prostate. Many men live with it for years without serious issues. However, aggressive cancer may not show noticeable symptoms until it has spread. Common signs include difficulty urinating, frequent urination, blood in the urine, fatigue, weight loss, and pain in the back, hips, and pelvis. These symptoms should alert men to consult a doctor.
Prostate cancer is particularly insidious because it often grows quietly. In Biden’s case, recent urinary issues prompted medical attention, leading to the discovery of both the primary tumor and the bone metastases. Regular screening can be crucial for high-risk individuals, including those in Biden’s age group, to differentiate between curable disease and late-stage cancer. (Here are the 4 stages of prostate cancer, explained.)
What President Biden’s Gleason score means
The Gleason score is an essential tool for doctors to evaluate the abnormality of prostate cancer cells. Named after Dr. Donald Gleason, the grading system categorizes cancers as either less or more aggressive, based on how the patient’s prostate tissue samples appear under a microscope. Pathologists assign grades between one and five to the two most common cell patterns found in the patient’s cancer, which are then added together to form the total Gleason score. Higher numbers indicate more abnormal and aggressive cancer cells.
President Biden’s Gleason score of 9 (out of 10) places his cancer in Grade Group 5, the most severe category, indicating highly abnormal and rapidly spreading cancer cells. Although higher scores suggest a worse clinical outlook, Biden’s cancer is hormone-sensitive.
This means there is a possibility that it might respond to androgen deprivation therapy (ADT), which aims to slow the growth of androgens, including testosterone and dihydrotestosterone (DHT). If successful, this therapy could slow cancer growth or potentially shrink it. ADT can be administered before or alongside radiation, but for patients with non-curative, aggressive cancer, it may be used to prolong life while managing the disease.
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