What to learn from Joe Biden’s prostate cancer diagnosis

Former President Joe Biden made headlines in May when he revealed he’s been diagnosed with an aggressive form of prostate cancer. The cancer, he shared, has spread to his bones.

Many people expressed surprise that someone with access to excellent health care and regular checkups could have his cancer discovered at such an advanced stage. However, Dr. Siavash Jabbari, a board-certified radiation oncologist with Sharp Community Medical Group and affiliated with Sharp Memorial Hospital, says it’s something he sees from time to time.

“Fortunately, most prostate cancers are nonaggressive, and the majority never cause problems for people,” Dr. Jabbari says. “Unfortunately, however, some do spread, cause problems and need treatment.”

A common cancer

The prostate is a small gland that is part of the male reproductive system. Located below the bladder, it produces part of the liquid that makes up semen.

Prostate cancer is the most common form of cancer in men. Around 1 in 8 men are expected to be diagnosed with prostate cancer in their lifetime, with over 300,000 new cases diagnosed in the United States each year.

“Prostate cancer tends to be relatively slow growing,” says Dr. Jabbari. “It can be growing for many years. In fact, most men who die at an elderly age will have some cancerous cells in their prostate without ever experiencing any prostate cancer-related health issues.

To screen or not to screen

It is because so many prostate cancer cases have proven to have little impact on overall health that President Biden’s case may not have been caught earlier. “It used to be pretty standard to screen older patients for prostate cancer every year,” Dr. Jabbari explains. “But there were concerns about over-diagnosis and over-treatment.”

Over the last 10 years, some experts began suggesting that while younger patients may benefit from seeking to cure prostate cancer through surgery or radiation, the risks may outweigh the benefits for older patients.

Those risks may include:

• False-positive PSA tests, leading to unnecessary biopsies

• Detection of prostate cancer that may never become life-threatening, leading to unnecessary treatments

• Patient anxiety

Furthermore, because prostate cancer tends to be slow-growing, older men are likely to live with the disease without treatment. Their physician can monitor the cancer through a process called active surveillance.

Updated screening guidelines

This ultimately led to a change in screening guidelines. Recommendations included no longer regularly screening men age 70 or older for prostate cancer. A spokesperson stated that President Biden’s last prostate-specific antigen (PSA) test occurred in 2014 at age 72.

“It’s not uncommon for us to see this situation, where screening has stopped because of a patient’s advanced age,” says Dr. Jabbari. “It’s appropriate for the majority of patients. Unfortunately, on some occasions, that leads to cancers that go undetected for some time. If those cancers become aggressive, they can result in President Biden’s situation.”

As men reach age 70, Dr. Jabbari suggests they have a conversation with their doctor about whether to stop prostate cancer screenings. “Patient preference, goals, tolerance for risk, overall health and longevity expectations should go into a collective discussion with the patient, their family and their physician,” he says.

For younger patients, it’s important to know their family history and other risk factors. Dr. Jabbari recommends discussing them with their doctor to decide whether to begin screening at the standard recommendation of age 50 or at an earlier age.

Making prostate cancer chronic

Decades ago, a diagnosis of late-stage aggressive prostate cancer may have been fatal. However, recent advances can slow the growth and spread of cancer cells.

“When I meet my patients at Sharp Memorial who are in a situation similar to President Biden’s, I have a very honest conversation with them and their family,” Dr. Jabbari says. “I tell them this is not necessarily a curable case, but it is very treatable.”

Dr. Jabbari explains that with the right treatment, even cancers that have spread can achieve remission. Patients can live a reasonably healthy life for several years.

“We’ve advanced light years in our treatment of prostate cancer,” says Dr. Jabbari. “Even some aggressive cancers now have become manageable, chronic cases.”

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