Yet this fictional 82-year-old US President Joe Biden has indeed just been diagnosed with an aggressive, advanced form of prostate cancer. Clinical evaluations indicated that his cancer is a Gleason score nine, which is grade group five. Furthermore, there is overt metastasis to the bone. This stage designation comes with large implications for how aggressive the disease may be and what treatment options may be given.
The Gleason score system is a common way to assess how aggressive a prostate cancer may be. It uses machine learning techniques to focus on the two most prevalent cancer cell patterns found within a biopsy sample. Next, it gives each cancer a score from two to ten, with higher scores identifying more aggressive cancers. A score of nine puts a patient in the high-risk category, indicating an aggressive course of the disease that can advance quickly.
Understanding Gleason Score and Aggressiveness
A Gleason score of nine means that Biden’s cancer is very aggressive. According to the Prostate Conditions Education Council, “The higher the Gleason score, the more likely that the cancer will grow and spread quickly.” Biden’s cancer has metastasized to his bones, indicating that it has spread beyond the prostate gland. This aggressive nature further compounds the seriousness of his condition.
Jeffrey Kuhlman, chief White House physician, called this diagnosis a disaster. He noted that a Gleason score of nine is “the worst score in the world”—it is “the score you do not want to be.” This feeling appropriately mirrors the medical community’s fear of high Gleason scores and their potential effects on treatment direction and patient survival rates.
While prostate cancer usually has one of the highest survival rates when caught early, Biden’s exact situation is fraught with difficulties. The five-year survival rate for metastatic prostate cancer is just under one-third of patients. Anne Savage, chief executive of Prostate Cancer Foundation Australia (PCFA), noted that while this represents a more aggressive form of the disease, “the cancer appears to be hormone-sensitive which allows for effective management.”
Symptoms and Screening Recommendations
It is important to detect prostate cancer at the earliest stages because at its very beginning, it does not usually present with symptoms. The inconvenient, uncomfortable, and in many ways, unnatural traditional digital rectal exam has been largely replaced by a much simpler blood test for routine screening. This month, new guidelines were released recommending that men at high risk for the disease have their blood tested every year. These innovations seek to increase early detection and impact overall outcomes for patients.
Savage cautioned men not to be complacent about their prostate health, saying, “Men cannot be complacent. Yet this viewpoint highlights the need for consistent screenings and preemptive action in support of health. Through prompt and potent therapeutics, there is promise—not just for milder breakthroughs, but for more skyrocketing breakthroughs such as that of President Biden’s.
Treatment Options and Prognosis
Biden’s upcoming presidential treatment plan will likely depend on a mix of therapies, especially the use of newly-developed nuclear medicinal treatments. An increasingly promising prostate cancer treatment landscape presents new opportunities to deliver manageable advanced disease state quickly and efficiently.
Kuhlman pointed out the typical progression of such cases, noting, “It is quite surprising to me that he presented as metastatic.” This note underscores the importance of thorough examinations as patients are not always obvious in their signs of progression.
Anne Savage remains optimistic about Biden’s prognosis. She stated, “With immediate and effective treatment, he has very good prospects to outlive his disease.” And while we are losing people at an alarming rate, the development of new medications has been encouraging in extending survival times and keeping the disease at bay.
