What we can learn from President Biden’s prostate cancer diagnosis

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Welcome to another episode of Life Without Leaks. I’m your host Bruce Kassover, and today we’re going to be talking about a very timely topic: Prostate cancer.

As most of you probably know by now, former president Joe Biden was recently diagnosed with prostate cancer, and what they’ve disclosed about his condition has prompted a lot of questions from our listeners. We’re going to run through most of them today and hopefully will give you a better understanding of the condition, how it’s treated, and what you can do for your own well-being. 

Let’s start with what prostate cancer is in the first place. As it turns out, it’s one of the most common types of cancer that men experience. According to The Prostate Cancer Foundation, more than 3 million men in America are living with the condition, and 1 in 9 men will be diagnosed with prostate cancer in his lifetime. If you’re of African descent, that number is even higher, at 1 in 7. 

In fact, it’s more likely for a man to develop prostate cancer than to develop colon, kidney, skin or stomach cancers combined.

The good news is that prostate cancer is very treatable, especially if it’s detected in the early stages. 

So what is the prostate? It’s a small, walnut-shaped gland that’s located just below the bladder where the bladder connects to the urethra. Its main functions are supporting sperm nourishment and transport, aiding in urine control, and secreting PSA, or prostate specific antigen, which is a protein that helps sperm to retain its liquid state.

Like most any other organ, the prostate can develop cancer. We aren’t entirely sure what causes prostate cancer, but when it occurs, what happens is that cells in your prostate become abnormal and begin to grow and divide very rapidly. This can form a mass of abnormal cells – that’s a tumor – which can then spread to other parts of the body. 

Cancers in the prostate typically grow slowly, and if caught early enough, are usually fairly easy to treat. However, some types of prostate cancer are more aggressive and can spread quickly, especially if not treated. That’s what makes early detection so important – when caught in time, the cure rate is around 90%.

One of the challenges that men face is that the symptoms of prostate cancer can be similar to the symptoms of other conditions, so it’s important that you pay attention to your body and take action if you notice any changes. Even if you don’t have symptoms, it’s important to get a prostate exam. It’s usually recommended for most men to have one around age 50, but if you’re African American or you have a family history of prostate cancer, 45 is usually a better age. 

When it comes to symptoms, here are a few things to look out for: 

• Trouble urinating, including starting and stopping urination, or a weak urine stream.
• Blood in the urine or semen
• Painful urination or ejaculation
• Erectile dysfunction
• Bone pain
• Frequent urination
• Needing to use the bathroom multiple times at night
• Pelvic pain
• And pain when sitting

Keep in mind that in the early stages of prostate cancer, most men don’t experience any symptoms at all, which is another reason why screening with your physician is so important. 

What does that screening look like? Your doctor will likely recommend a blood test to assess your PSA levels, a urine test and possible a physical exam to check the prostate for any abnormalities. After these tests, if your doctor thinks it might be prostate cancer, you may have additional tests such as an ultrasound or a biopsy.

Now, if you were reading the news stories about President Biden’s diagnosis closely, you may remember that they mentioned that he had something called a Gleason Score of 9. That was confusing to a lot of people who weren’t familiar with how the condition is assessed and who usually hear about cancers running from stage zero to stage four.

That confusion is understandable because they’re both numbers used to assess your condition. When talking about cancer stages, a 0 is for diseases that haven’t spread, regardless of what type of cancer they are. Stages 1 through 3 are used for diseases that are either localized or limited to the surrounding tissue and lymph nodes. And stage 4 refers to cancers that have become metastatic; that is, they’ve spread to other areas of the body. 

The Gleason score is something completely different and is used specifically to measure how aggressive prostate cancer is. It’s based on how the cancer cells look under a microscope, and the assessment can run from a score of 6 to 10.  The Gleason score is used to help doctors predict how quickly the cancer is likely to grow and spread, and it plays a key role in choosing the best treatment plan.

The way it works is that a pathologist will examine a biopsy and identify the two most predominant patterns of cancer cells. Each of these two groups of cells will be graded on a scale from 1 to 5, with 1 being cells that look very similar to normal prostate cells – these are the least aggressive – and 5 being those cells that look very abnormal, which are the most aggressive. 

Those two scores are then added together. A total of 6 or more suggests low-grade cancer, a score of 7 indicates an intermediate risk, and a score of 8 to 10 indicates a high-grade, aggressive cancer. 

The good news is that treatment for prostate cancer has been shown to be very effective, and, if caught early, doctors can often prevent it from spreading.

The type of treatment you choose will depend on what stage you’re at once the prostate cancer has been detected.

Many men and their physicians choose to take a “wait and see” approach (also known as “watchful waiting”) when the cancer isn’t aggressive, since prostate cancer is typically slow growing and some of the treatment options have side effects that may out weigh the benefit of the treatment.

If you do decide to treat the prostate cancer, your doctor may suggest surgery to remove the prostate – also called a prostatectomy – or radiation therapy. For advanced stages of prostate cancer that’s metastasized to other parts of the body, your doctor may prescribe chemotherapy or hormone therapy.

If the phrase ‘hormone therapy’ rings a bell, it may be because President Biden’s cancer was described as being ‘hormone sensitive.’ That’s not uncommon with prostate cancers, and what it means is that doctors may be able to control the disease by reducing the body’s levels of male hormones called ‘androgens.’ The most well-known of these is testosterone. That can be done in a number of ways, including with medications or surgical procedures. 

The best thing you can do is to be proactive with your prostate health. Get a screening when its appropriate and talk with your doctor about what you can do to maintain a healthy prostate. For more information, visit the National Association for Continence online at www.NAFC.org.