Robert de Niro, 80, Prostate Cancer Stalled Filming of ‘Hide and Seek’
President Biden Has Metastatic Prostate Cancer. Here's What You Should Know
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EDITOR'S NOTE: Dr. Jamin Brahmbhatt is a urologist and robotic surgeon with Orlando Health and an assistant professor at the University of Central Florida's College of Medicine.
President Joe Biden's diagnosis of metastatic prostate cancer has understandably raised concerns and questions: How long has he had cancer, how will he be treated, and what is his prognosis?
As a urologist, I regularly diagnose prostate cancer in my patients, and each time I share the diagnosis with them and their family, it's never easy. Over time, I've learned the importance of keeping conversations simple and straightforward — avoiding sugar-coating and instead using data, statistics and personal experience to help patients begin their cancer journey.
As his public announcement draws attention to this type of cancer, it's a reminder to regularly check on your own health. Here's what you need to know about metastatic prostate cancer: how it's detected, what treatments look like, and why early screening remains essential for men's health.
The former president's diagnosis began after he experienced "increasing urinary symptoms," his office said, and a prostate nodule was discovered.
The detection of a prostate nodule likely happened during a digital rectal examination (DRE). During a DRE, a doctor gently inserts a finger into the rectum to examine the prostate gland, located directly in front of the rectal wall. A healthy prostate typically feels smooth and symmetrical. A prostate nodule, however, feels firm, raised, and irregular — similar in texture to your knuckles.
Not all prostate nodules indicate cancer — many are benign and associated with conditions enlarged prostate (BPH), or prostate stones (calcifications). However, in Biden's case, further testing — likely including a prostate-specific antigen (PSA) blood test, imaging and biopsy — confirmed prostate cancer. Additional scans revealed that his cancer had spread to his bones, classifying it as high-risk, aggressive metastatic prostate cancer.
"Metastatic" means the cancer cells have spread beyond the original location (the prostate gland) into other areas — most commonly bones and lymph nodes. Biden's cancer has specifically spread to his bones, placing him among the 5% to 7% of prostate cancer cases in the United States that are metastatic at initial diagnosis. While this percentage seems small, it represents a significant number given that over 300,000 men in the US and approximately 1.5 million worldwide are diagnosed with prostate cancer every year.
Early-stage prostate cancer carries an excellent prognosis, with nearly a 100% five-year survival rate. However, when prostate cancer is metastatic at diagnosis, the five-year survival rate drops sharply to around 37%. Importantly, these survival rates are statistical averages, and individual outcomes vary considerably based on overall health, age, cancer aggressiveness, and how well a patient responds to treatment.
For Biden — and all prostate cancer patients — this diagnosis marks the beginning of a highly personalized journey. It remains impossible right now to accurately answer the question, "How long do I have?" Which of course is the question everyone wants answered.
Related articleProstate cancer severity is graded using a Gleason score, which ranges from 6 to 10. Lower scores (6–7) indicate slower-growing, less aggressive cancer cells, while higher scores (8–10) represent aggressive cancers more likely to spread quickly.
Biden's Gleason score of 9 signifies a highly aggressive prostate cancer that usually requires immediate and comprehensive treatment.
In my clinic, the moment of diagnosing advanced prostate cancer is always difficult, evoking fear, uncertainty and many questions. At that moment, I ask the patient to take a deep breath, slow down and work together as we build a care team.
This multidisciplinary team may include specialists from urology, medical oncology, radiation oncology, radiology and supportive care services. Each specialist contributes a unique perspective, helping to create a treatment plan that has the best interest of the patient and their life goals.
Localized prostate cancer can often be cured with treatments such as robotic-assisted prostate removal (prostatectomy) or radiation therapy. However, metastatic prostate cancer treatment shifts from cure to managing symptoms, controlling disease progression and maintaining quality of life. Common treatments for metastatic prostate cancer include:
Advanced treatments effectively control metastatic prostate cancer but often come with side effects affecting daily life. Common side effects include fatigue, changes in sexual function, hot flashes, mood swings, and loss of muscle mass.
Treatment for metastatic prostate cancer depends on several factors: the patient's overall health, age, other medical conditions and personal preferences. President Biden's medical team will carefully personalize his treatment, aligning it closely with his unique health circumstances and quality-of-life goals.
A common question emerging from Biden's diagnosis is whether his cancer could have been detected sooner or if it impacted him during his presidency. The President of the United States gets excellent medical care, and the truth is that we may never know.
Instead of getting stuck on these unanswerable questions, I recommend we refocus on something we can control: our own health. Biden's diagnosis is a powerful reminder of our responsibility and opportunity to proactively manage our health.
As a urologist, I experience daily how unpredictable prostate cancer can be. Some patients show clear signs of the disease, while others surprise even me with aggressive or unexpected cases. Cancer doesn't discriminate, and its trajectory can be uncertain. But one factor we can all control is our approach to prevention and early detection.
Symptoms to watch for are blood in the urine or semen; needing to urinate more often, including waking up at night to urinate; and trouble getting started when urinating. Signs of more advanced disease can also include accidental leaking, pain in the back and bones, fatigue, weight loss and weakness.
Related articleFormer President Biden's experience should be a call to action for us: Schedule regular health checkups, discuss prostate screening with your health-care provider, pay attention to your body's signals, and prioritize overall health.
By shifting the conversation from speculation about someone else's journey to actively engaging in your own, you're investing in the most priceless and valuable asset you have — your health.
Prostate Cancer: What To Expect When It Spreads - WebMD
Finding out that cancer has spread is never welcome news, but don't assume it's the worst news. The 5-year survival rate for prostate cancer that has moved into nearby parts of the body is nearly 100%. Here's what you should know about your treatment and what to expect going forward.
When this type of cancer spreads (your doctor may say it has metastasized), it tends to first show up in the tissues or lymph nodes that are closest to the prostate gland. If it's caught and treated at this point, which is known as "regional" stage, your odds of recovery are very good. If it travels further, the cancer usually ends up in your bones. At that point, the 5-year relative survival rate is about 38%.
DID YOU KNOW?
Which treatment you and your doctor will choose for your prostate cancer will largely depend on how far the cancer has spread and what symptoms, if any, you have.
Your doctor will talk to you about your best treatment options.
You may have already had surgery or radiation. Those treatments are sometimes used to target prostate cancer when it's still only in the prostate. When your cancer spreads, your doctor will most likely suggest hormone therapy. That usually means taking medication to lower the amount of androgen hormones (testosterone and DHT) in your body or prevent them from affecting cancer cells.
A related but rarely used option is surgical castration. The doctor removes your testicles, where most of these hormones are made. If you don't like the idea of losing them, the doctor can fit you with silicone sacs to insert into your scrotum. They'll preserve the look and feel.
If hormone therapy doesn't work, you might move on to vaccine therapy. The prostate cancer vaccine is designed to kick-start your immune system so it attacks cancer cells. Or your doctor might suggest chemotherapy. It might be a medication you take by mouth, or something your doctor injects into a vein.
If prostate cancer has spread to your bones, you'll likely need medication to ease your pain, lower the risk of fractures, and keep your body's calcium levels steady. It can be dangerous if they go too high or too low. Your doctor might prescribe a drug to help keep your bones strong. You might take corticosteroids to control pain, probably along with a pain reliever. Which pain medicine you get could range from ibuprofen to morphine, depending on how bad your pain is.
Your oncologist might also send you for radiation therapy in an effort to lessen bone pain and kill off cancer cells in your bones. Or they could inject you with a drug that gives off radiation. These medications are called radiopharmaceuticals.
You might think you'd know it if your cancer has spread, but that's not always true. Many men with advanced prostate cancer don't have any symptoms.
This is why your follow-up doctor visits are important. You're most likely to find out the cancer has spread if your doctor tests your blood and finds high levels of prostate-specific antigen, or PSA. They might also find it with a digital rectal exam or on an X-ray or other test. If you do have symptoms, they often include trouble peeing or blood in your urine. You might also feel very tired, short of breath, or lose weight without trying.
You're more likely to feel pain if the cancer has gone into your bones. Where it hurts will depend on which bones it affects. For instance, you might feel hip or back pain if cancer has spread into your pelvic bones.
No matter which treatments you decide to pursue, advanced prostate cancer is bound to take a toll on your day-to-day life. Loss of bladder control (incontinence), fatigue, and erectile dysfunction often go hand-in-hand with treatment. Men who have hormonal therapy may have hot flashes (similar to what many women have during menopause) or gain weight. Cancer that has spread to your bones can also be painful.
Be sure to tell your doctor about any pain or side effects. There are a wide array of medications and procedures that can help you feel better.
Self-care is also important: Take naps to fight fatigue and try to do some light exercise, like walking, to keep your energy levels up. Being active can also help combat weight gain, especially if you add some strength training to your routine. Check with your doctor first to make sure it's safe for you to exercise. They may suggest you work with a physical therapist.
Urological Health In Men: Are Most Men Ignoring These Early Signs Of Prostate Cancer?
Prostate cancer has a high rate of survival when detected in the early stages. If your family has a history of such cancers, or if you notice certain symptoms, go for a screening. Urological Health In Men: Are Most Men Ignoring These Early Signs Of Prostate Cancer? (Photo: Freepik)Prostate cancer signs in men: It is very important to report unusual signs to a doctor, as it could help catch a disease as big as cancer early on, with the initiation of timely treatment and recovery. Prostate cancer cases affect millions of people worldwide. In most cases, some signs and symptoms are ignored by patients, which can complicate the case. By the time doctors are able to diagnose the disease and begin treatment, a lot of damage has already happened to the body. It is, therefore, the need of the hour to stay alert and listen to the body, especially when it is trying to communicate about something as crucial as 'prostate cancer'.
What Is Prostate Cancer?Dr Prakash Sankapal, consultant - urology, Fortis Hiranandani Hospital, Vashi explains that the prostate is a male reproductive system organ, which is located below the bladder and behind the rectum. Its job is to aid in semen mobility by pushing it through the urethra and by adding fluid to it.
"When the prostate stops functioning properly, especially due to abnormal cell growth, it can lead to serious health concerns, including prostate cancer, which occurs when the cells in the prostate gland starts to grow uncontrollably, often without early symptoms. Over time, this can affect urinary function, sexual health, fertility, and even spread to other parts of the body if not detected and treated early," Dr Sankapal warns.
Symptoms Of Prostate CancerAccording to the doctor, the most worrying feature of prostate cancer is that its symptoms are so common, they often advance 'undetected'. Some of the most common symptoms of early-stage prostate cancer that go undetected are:
The doctor states that early signs should not be missed or ignored, else it could lead to a delayed diagnosis.
"The most glaring sign is when someone experiences difficulty urinating -- they get up frequently throughout the night to urinate, but the stream of urine is weak, or it hurts to urinate. The most obvious sign is passing blood in urine. If you observe any of these signs, get your prostate checked by a urologist immediately."
Is Erectile Dysfunction A Sign Of Prostate Cancer?According to the urologist, erectile dysfunction (ED) is a prominent symptom of prostate cancer. He explains that with age, ED becomes common -- they do not always mean cancer. But, if it is seen in healthy men who are not under stress, on any medication, or have any other serious health issues, it should be taken seriously.
"Instead of taking over-the-counter medications, visit a doctor. If prostate cancer is caught early, it is easier to treat and cure. Undergo checks with your primary care physician or urologist at age 45. Men, who are at a high risk for prostate cancer owing to family history, can have these doctor visits at age 40."
How To Detect Prostate CancerProstate-specific antigen (PSA) screening test is the most common way to detect prostate cancer. The doctor explains that the PSA protein is found in the blood, in the prostate. If the PSA levels are high, it could indicate prostate cancer.
Additionally, if a close relative -- like father, brother or grandfather -- has been diagnosed with prostate cancer, one should undergo testing to detect the presence of genetic mutations like BRCA1 and BRCA2, which can increase the risk of prostate cancer.
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