Former President Joe Biden has been diagnosed with an "aggressive" form of prostate cancer.
The Democrat’s office says the diagnosis on Friday came after a nodule was discovered on his prostate. Cancer cells have reportedly spread to the bone.
Biden’s office says the cancer appears to be hormone sensitive, allowing for “effective management.”
To learn more about the disease and the former president’s prognosis, WAMC's Lucas Willard spoke with Dr. Rahul Ravilla, a medical oncologist at New York Oncology Hematology…
At age of 60, it would be, the risk would be probably one in 50, but it goes down to one in three by the time you are 90 years old. I mean, that's the thing. So, it becomes very common by the time you hit 80 years and above. But fortunately, most people don't even know that they have cancer because it's so low grade. Their PSA is usually around four or five. They don't even bother to get a biopsy. And many people die from something else, like a heart problem, a stroke or pneumonia or something. And then, if they have an autopsy or something, they will be incidentally found to have a prostate cancer, but it wouldn't have killed them in their lifetime. So, it's common in that way. Yeah.
Is it common for this type of cancer to be aggressive, as it's been described? Is this something that can easily spread to other parts of the body?
Rarely. Yes, like in in President Biden's situation, it happened. Yeah. So, we sometimes see patients presenting with widespread cancer, they were relatively asymptomatic. They had no idea they have cancer. And they say, ‘Oh, I have back pain’ or they have trouble passing urine. And you check their blood work, and then you see a PSA, like, 200, 500 and they will say, ‘Yeah, I had to check like, like one or one year ago, two years ago, it was normal. How did this happen?’ So it happens, yeah, but not common. It's not common, yeah.
And how can somebody with President Biden's advanced age, over the age of 80, how does their body respond to treatment? Is that considered, the age of the patient considered when trying to find a form of treatment for the individual and the cancer?
Yes, true. So, you know, the treatments are all always tailored to many things that the patient comes with. I mean, the age is one of the factor, they're underlying health issues like heart problems, any neurological problems, or if they have like diabetes, I mean, stroke, history of stroke, all these things are factored into how we plan the treatments. Generally, the hormonal treatments, where we suppress the testosterone, we block the androgen receptor, they are reasonably well targeted. I mean, they may experience some fatigue. They may experience some, we should call, like weakness, like their muscle mass can go down because of the lack of testosterone, so that would impact some of the abilities, like, you know, everyday activities, they may not be able to run the way they used to. They may not be able to hike like they used to. But, you know, routine stuff, like driving a car, doing writing, reading, those abilities don't get impacted like the chemo does. I mean, see, if you are if somebody is going through a chemotherapy, then there would be significant impact on their activities of daily living. But hormonal treatments in general, do not. That being said, this is not something that you will take like for a few months, you will be on this treatment lifelong. It means for the rest of the life, you will be on these treatments. So, they do have cumulative effects as the time passes, like over months and years, you will see some of this gradual decline in their abilities because of these underlying treatments.
And does that resulting lifestyle change, can that have a negative effect on the body? Because while you're treating the symptoms and you're treating the cancer with these injections to help suppress testosterone in the body, but do the effects of that have a negative impact as an unfortunate kind of correlation?
Right. I mean, you know, so there is definitely a negative impact, but I wouldn't say it would majorly change his lifestyle. So that's the thing. I mean, like from the treatments itself, I wouldn't say he's not going to be immunosuppressed from the hormonal treatments. So, he can, you know, visit people, he can, you can be I can have a public appearances and all those things. But, you wouldn't see it. I mean, in the sense, like you wouldn't really see it that he's going through treatments, especially if it is hormonal treatments. Now we don't know more details. I mean, sometimes if you have a very widespread disease, means if the cancer has spread to too many areas of the bones, we may have to give some chemo. It's not like, you know, he'll be on chemo forever, but for just few weeks, like probably anywhere between 12 to 16 weeks, we may have to give some chemo. If, I don't know if the doctors would recommend it for President Biden or not, but if they do that would impact, for a temporary period, from the effects of the chemo. But again, the hormonal treatments, you if it is just going to be hormonal treatments, you won't see an effect on his you know, immediately. I mean, at least in the beginning, you won't see it. I mean, it may take months or years for you to really see a difference. So again, many patients who are on these treatments are able to vacation travel, you know, they're doing the stuff like, you know, as a routine, but, yeah, I mean, it won't be completely normal, but at the same time, it won't be a very significant difference in their performance.
Now, while prostate cancer is common, a common form of cancer, what can people do to be sure that they are being screened for it, that they are preventing this? What can people do before, you know it comes to the point it’s discovered?
Yeah, yeah. And again, in eight out of 10 patients, we can catch the prostate cancer early. So, so in my opinion, getting an annual PSA test, and if there is any elevations, you know, consulting with the urologist, because the urologists are the ones who generally do the initial workup, like where they do an MRI of the prostate. Because, before we used to biopsy everybody with a prostate, PSA rise, because to rule out the cancer, we need to do a biopsy. But now we have a tool called MRI of the prostate, which can really pick it up. You know, it has very good sensitivity and specificity that it will be able to minimize the needs for undergoing through a biopsy. Or even if you have to do a biopsy, it will tell you which area to focus. And you know, again, that's primary you start with the primary care. You get your PSs checked, and then if there is a PSA rise, usually it will the normal range is below four. If it's hitting four or above, then that's when you would be seeing a urologist, and they will do the additional workup. And even then, like, you know, sometimes, like, if, if we find a cancer, there are some types of prostate cancers that are so low grade that you don't even have to do anything. I mean, you just okay watch it. You will be watched with an MRIs, with a prostate biopsies or PSAs, and you don't have to go through any treatments. And if you do have to go through the treatments again, surgery and radiation, have very good long term outcomes. And you know, in those cases where the 20% were unfortunate cases where the cancer is already widespread, even then, I won't lose hope on this. Like, you know, we have very good advanced treatments, like we have hormonal treatments, chemotherapies, radio ligand therapies. So, you know, the longevity of prostate cancer patients, even in the advanced cases, is very good. So, yeah, hopefully, you know, for President Biden, it won't be much impactful. But again, you know, it's sad that he had to deal with this now so
Well. Dr. Ravilla, thank you so much for your time. I appreciate it.
No problem. Thank you.
