Why wasn't Joe Biden's 'aggressive' prostate cancer spotted sooner? Experts weigh in

The late-stage crab diagnosis of erstwhile U.S. president Joe Biden has immoderate aesculapian professionals wondering however the illness was capable to spell undetected erstwhile his wellness had been nether aggravated scrutiny adjacent the extremity of his presidency.

In a connection connected Sunday, Biden's bureau said the 82-year-old has been diagnosed with prostate crab and that it's dispersed to the bone. He was diagnosed with Stage 4 cancer, which is considered to beryllium the astir advanced.

Prostate crab cells are usually graded connected a standard of 1 to 10 nether the Gleason system.

This grading strategy involves looking astatine cells nether a microscope and measuring however abnormal they are and their likelihood of spread. The higher the grade, the much assertive the cancer.

According to Biden's office, helium scored a 9, which would suggest that his crab is among the astir "aggressive."

WATCH | Biden acknowledgment supporters aft sharing crab diagnosis:

"It's sad, of course," Dr. Peter Black, manager of the Vancouver Prostate Centre, said astir Biden's diagnosis.

"It's thing that we tin inactive power for a fewer years, but it's decidedly going to interaction his prime of beingness and possibly his longevity."

Considering each of the statement astir Biden's wellness during his presidency and the commencement of his 2nd statesmanlike campaign, earlier helium pulled retired of the contention past summer, the diagnosis has raised questions astir wherefore this wasn't caught sooner and what it means for his semipermanent health..

What is prostate cancer, and what are the symptoms? 

The prostate, a gland successful the antheral reproductive strategy that makes a fluid that is portion of semen, is beneath the bladder. Cancer starts successful the cells of the prostate and tin turn into adjacent tissue. The crab tin besides dispersed to different parts of the body, including the bladder, adjacent lymph nodes, bones and the brain, according to the Canadian Cancer Society.

"There's a wide spectrum of prostate cancer," said Black, who is besides a urologist astatine Vancouver General Hospital. "From precise early, comparatively harmless disease, to thing that's precocious hazard and has already spread."

Symptoms tin alteration from idiosyncratic to person, said Dr. James Dickinson, a prof of household medicine and assemblage wellness sciences astatine the University of Calgary.

But astir often, helium said, there are nary symptoms astatine all. Some uncommon symptoms see occupation urinating oregon humor successful the urine.

"It whitethorn make and dispersed rather wide earlier anybody notices," helium said.

How galore radical successful Canada are diagnosed with it? 

The Canadian Cancer Society says prostate crab is the astir communal cancer among Canadian men and, wrong that group, the third-leading cancer-related origin of death.

In 2024, the enactment estimated that 27,900 men would beryllium diagnosed with prostate cancer, with 5,000 of them expected to dice from the disease.

It is astir communal successful older men and mostly seen successful Black men, including radical of African and Caribbean ancestry, according to the organization.

How are radical screened for it? 

There are 2 methods utilized to surface for prostate cancer, though probe finds that each 1 has its downsides.

There's the prostate-specific antigen (PSA) test, which is simply a humor trial that looks astatine the levels of PSA — a substance made by the prostate. As radical age, PSA levels thin to increase.

Levels that are higher than mean could mean there's an contented with the prostate, but crab isn't ever the culprit. Other reasons could beryllium an enlarged prostate oregon inflamed prostate gland owed to an infection.

There's besides a integer rectal exam (DRE), which involves a health-care supplier inserting a gloved digit into the rectum and feeling for thing unusual, similar lumps, the crab nine says.

But Black, of the Vancouver Prostate Centre, said while health-care providers often utilized this method successful the past, they've "drifted away" from it arsenic it's not precise helpful. As a result, PSA investigating is much commonly used. 

When is screening recommended? 

Prostate crab screening has been controversial, Black said, adding that helium would urge PSA investigating for different steadfast men betwixt the ages of 50 and 75.

"I'm pro-screening due to the fact that I spot the payment and I spot what happens if we don't screen," helium said.

People older than 70 oregon 75 are mostly not actively screened due to the fact that experts accidental the illness is usually dilatory growing.

Debate implicit the benefits of PSA investigating means that not everyone is successful favour.

More than a decennary ago, the Canadian Task Force connected Preventive Health Care recommended against PSA screening due to the fact that "the imaginable harms of screening outweigh the benefits."

It maintains this stance, saying that the main problems are false-positive results and overdiagnosis, the reappraisal indicated. A affirmative PSA trial effect often leads to much tests specified arsenic a biopsy, which carries risks of bleeding, infection and urinary incontinence.

At this time, the task unit says determination are "no screening tests that person been proven to accurately place prostate cancer." But, it adds, determination are respective tests being developed to amended the accuracy of PSA screening.

Meanwhile, the U.S. Preventive Services Task Force recommends that men betwixt the ages of 55 and 69 talk with their health-care supplier astir whether they should get screened. 

Why wasn't Biden's crab spotted sooner? 

Experts accidental due to the fact that determination aren't galore evident symptoms, it's casual for prostate crab to alert nether the radar.

In February 2024, Biden had his past yearly carnal arsenic president. At the time, his doctors said that "this year's carnal identifies nary caller concerns."

Dr. Dana Rathkopf, a aesculapian oncologist astatine New York's Memorial Sloan Kettering Cancer Center, said portion she doesn't cognize the specifics of the case, she doesn't judge this diagnosis was missed during an earlier exam.

"Cancer cells are chaotic," she said successful an interrogation with CBS News. "There are galore radical that person entree to [the] highest levels of attraction and acquisition regular screening and inactive get diagnosed with precocious disease."

Black said if Biden had been tested, it's imaginable his PSA levels were "normal."

"Sometimes the assertive prostate cancers don't marque arsenic overmuch PSA," helium said.

What does attraction include? 

Prostate crab that is successful the aboriginal stages and not spreading volition apt lone beryllium monitored, said the University of Calgary's Dickinson. It mightiness not extremity up being harmful, helium said, and truthful treating it wouldn't beryllium adjuvant to the patient.

Meanwhile for higher-risk cases, wherever the PSA is precocious but the crab is constricted to the prostate, Black said surgery oregon radiation is usually recommended.

In cases wherever the illness has spread, he said radiation is often utilized alongside hormone therapy.

Hormone therapy lowers the magnitude of definite hormones successful the assemblage that would usually assistance prostate crab cells grow. By doing this, prostate cancers tin shrink oregon turn much slowly.

WATCH | Vancouver Prostate Centre manager comments connected Biden's diagnosis:

This is the benignant of attraction being looked astatine for Biden, and portion Black said it usually responds successful the beginning, it's a substance of however agelong it volition proceed to work.

Without knowing each the details of Biden's case, Black said typically men with a akin diagnosis unrecorded about five years with existent treatments.

The five-year endurance complaint for radical who are successful the archetypal 3 stages of the illness is adjacent to 100 per cent, according to Statistics Canada.

But if diagnosed astatine Stage 4, which is erstwhile the crab has dispersed beyond the prostate, the endurance complaint for the adjacent 5 years drops to 41 per cent.