6 doctors on Biden’s cancer diagnosis and his treatment options
The announcement of the weekend of the former Biden president that he has an “aggressive” form of prostate cancer which metastasized in his bone sparked the usual sympathy of supporters – and peaks among the detractors.
The announcement comes in the middle of new reports on Biden and his inner circle which hides insofar as his mental acuity slipped during his presidency and his campaign for re -election last year, and the advanced stadium of his cancer pulled immediate accusations of the right that the former president also hid problems with his physical health.
President Trump said it was surprised that cancer “was not informed a long time ago,” suggested that the public was not properly informed and said that “people should try to discover what happened.”
Times spoke to six doctors expert in prostate cancer. They declared that the Biden office shared on its state is indeed limited, but also that many hypotheses being rendered publicly on the progression of these cancers, the tests which can project them and the medical guidelines for care among the advanced age of Biden – 82 years – were simply out of the basis.
Cancer
In his statement on Sunday, Biden’s office said that the former president was seen last week “for a new conclusion of a prostate nodule after having experienced growing urinary symptoms” and was diagnosed on Friday with prostate cancer, characterized by a score of Gleason of 9 (group 5 year) with metastases at the bone “.
Dr. Mark Litwin, president of the UCLA Urology, said that the description indicated that Biden has a more advanced and aggressive form of prostate cancer than in most men, but that it was nevertheless “a very common scenario” – with around 10% of these cancers in men at a diagnosis.
Dr. Howard Sandler, president of the ONCOLOGY RADIATION DEPARTMENT OF CEDARS-SINAI, accepted.
“It is a bit unusual for him to present himself with prostate cancer which is metastatic bone at the first diagnosis, but not extraordinary,” he said. “It happens every day to the elderly.”
This is partly due to the nature of such cancer, modern screening guidelines for older men and advanced treatment options for such cancer when found, doctors said.
Prostate cancer in small amounts of slow growth is widespread in men from the age of Biden, whether it causes them problems or not. Most prostate cancers can be slowed even more considerably – for years after diagnosis – with medical intervention to block testosterone, which feeds these tumors.
For these reasons, many doctors recommend that men cease to have the prostate cancer antigens tested, by what is known as a PSA test, around 70 or 75, depending on the overall health of the individual.
This advice is based in part on the idea that finding slow prostate cancer and deciding to act in surgery or otherwise – which many alarmed patients are inclined to do when they get such news – can often lead to lower results than cancer would have been caused if they are simply left alone. This includes helplessness, incontinence and potentially fatal infections.
In addition, if an older patient is starting to experience symptoms and turns out to have more advanced prostate cancer, modern treatments are able to block cancer growth for years, doctors said – often beyond the moment when these patients are statistically likely to die of something else.
Even when older patients are tested and have somewhat high PSA levels, they are not always worrying, and they are often told to keep an eye on it, Litwin said. In simple terms, doctors “are generally not too much exercised by a diagnosis of prostate cancer in an 82-year-old man,” he said.
Dr. Sunil Patel, urological oncologist and assistant professor of urology and oncology within the Brady Urological Institute of the Johns Hopkins University School of Medicine, said that it is because the average life expectancy for an American man is under 85.
“And so most men at that time, at 75, they are like” ok, well, if it will not kill me in the next 10 years, I will leave it alone “, said Patel. “It is a really shared decision between the patient and the doctor.”
When observed advanced and aggressive prostate, as for Biden, the prognosis – and the treatment plan – is of course different, the doctors said. “He will certainly need treatment,” said Litwin. “This is not the type that we can simply observe over time as we often do.”
But that doesn’t mean Biden’s doctors dropped the ball earlier, said and others.
The diagnosis
Biden’s office did not say if he received PSA projections. A letter from the Blanche de Biden’s doctor in February of last year does not mention PSA tests, despite the other medical assessments of other presidents, including this information. Biden aid did not respond to requests for comments.
The doctors to which Times spoke had no special overview of Biden’s medical care, but said that his diagnosis had not made them feel less confident about the caliber of these care or suggested that they are a harmful intention to hide their condition.
To start, “he would be considered well in the norm of care” so that Biden has spoken of tests in recent years, given his age, said Sandler. “Certainly after 80 years.”
Litwin said he thought Biden was probably still tested, given his position, but that does not mean that he necessarily hid anything either. Certain forms of aggressive prostate cancer do not secrete antigens in the blood at levels that are reported in a PSA test, while others can develop and even metastate quickly-in a few months, and between annual routine screening, he said.
Patel said he had personally found a “very aggressive disease” in patients who had relatively normal PSA levels. “I don’t think anyone can blame anyone in terms of what was taken too late or something like that,” he said. “It doesn’t happen too rarely.”
Dr. Alicia Morgans, an associate professor of medicine at the Harvard Medical School, a genitorerinary medical oncologist and director of the survival program in Dana-Farber Cancer Institute, accepted. Even if a patient is a diligent to be tested every year, “there will be cancers that will occur between screening tests,” she said.
Morgans said things become even more complicated as men age, when their number of PSAs can increase and start to watch out before it is considered a clear indicator of cancer.
“Maybe it’s a moment. It was not a cancer before, it hasn’t really changed. Now, it has become a cancer. It is not anyone’s fault,” she said. “You can do everything correctly and things like this can happen.”
Treatment
Biden’s office said his cancer seemed “sensitive to hormones, allowing effective management”.
The doctors to which time spoke was relatively optimistic of the short -term prognosis – and even in the medium term of Biden. “It’s not curable, but it’s very treatable,” said Morgans.
“Without signifying a Glib ringtone, there has never been a better time to have metastatic prostate cancer in the history of medicine,” said Litwin – partly thanks to the Biden of Biden “Moonshot” initiative and the funding he sent to institutions such as UCLA, which helped develop new drugs.
“There are many very effective treatments for a patient in his situation,” said Litwin.
The standard and most likely course for Biden will be ADT, or therapy of deprivation of androgens, which involves a pill or a shot that will close the production of testosterone, said doctors.
“Now, an 82 -year -old man does not have the same testosterone production as a 22 -year -old man anyway, so there is not that far. But we have closed it,” said Litwin. “And by closing it, it cuts the main hormone that feeds prostate cancer. This alone can be very, very effective. ”
Dr. Geoffrey Sonn, urological oncologist and associate professor of urology at the Stanford Cancer Center, said that Biden cancer is serious, but the ADT treatment “will shrink prostate cancer cells, which stops developing, at least temporarily, in the vast majority of guys”.
“That is to say, this is not a permanent solution, in that these cells will eventually find a way to grow even with low levels of testosterone,” said Sonn. “But it can take several years, and sometimes longer.”
Recent studies have shown that the addition of additional drugs to an ADT diet can prolong life even more, “four, five, seven, 10” or more after a diagnosis of metastatic prostate cancer.
Dr. Mihir Desai, Urologist of Keck Medicine of USC, said that with modern progress, prostate cancer is simply different from other cancers.
“If you find, for example, colon cancer or pancreatic cancer or liver cancer are metastasé, then deterioration is quite fast and the results are very poor,” he said. But with cancer of the metastatic prostate not treated before, “there are many lines of treatment which can, if not cure it, certainly keep it under control for many years, with good quality of life.”
Sandler, who focuses on radiotherapy, said ADT treatment can lead to a loss of bone density or muscle mass, so Biden will probably be encouraged to stick to a fitness diet or take medication to counter these effects.
It can also receive radiation to target specific pockets of cancer more strongly, including where it has metastasized in the bone, but it would depend on the number of metastatic sites, said Sandler – with radiation more likely than few sites there are.
“If there is cancer everywhere, there is probably no advantage,” he said.
