Joe Biden’s recent diagnosis of aggressive prostate cancer has sparked significant concern about the stage of the disease. Doctors have characterized the malignancy with a Gleason score of 9 and bone metastasis, indicating a high-grade cancer with aberrant cells that grow rapidly. This aggressive form of the disease, despite its severity, has been noted as hormone-sensitive, which presents an opportunity for potential effective management. Hormone-sensitive prostate cancers require androgens to grow, and reducing these hormones can slow their progression. While the cancer appears aggressive, experts emphasize that hormone therapy remains a viable treatment option.
The hormone-sensitive designation doesn’t necessarily mean Biden has already begun hormone therapies, which is still unknown. However, it suggests the cancer could respond to such treatments, making it more treatable. Doctors explain that the classification of the prostate cancer as hormone-sensitive allows for targeted therapeutic approaches, which can offer significant advantages in managing the disease. Nevertheless, the cancer may eventually develop resistance to hormones over time, making long-term treatment planning a complex consideration.
The backbone of treatment for any metastatic prostate cancer is androgen deprivation therapy, which is designed to decrease the body’s level of testosterone. Historically, this therapy was conducted surgically through the removal of the testes, but modern treatments commonly involve pills or injections to achieve the same goal. Additional strategies may include blocking testosterone from secondary sources in the body, such as the adrenal glands. These methods not only reduce testosterone levels but also address other potential sources of the hormone that could contribute to cancer progression.
Experts emphasize that the prognosis and response to treatment can be significantly influenced by the initial classification of the prostate cancer as hormone-sensitive. While this classification offers a promising avenue for treatment, it also necessitates careful monitoring over time to assess for the development of hormone resistance. Doctors highlight that the ultimate test of hormone resistance is to lower testosterone levels and observe how the cancer progresses or regresses. Signs of disease worsening, such as a rising PSA, new symptoms, or new tumors identified on scans, may indicate the progression to hormone resistance.
Although the U.S. Preventive Services Task Force recommends against routine PSA screening for men over 70, some experts argue that the increased availability of effective treatments for prostate cancer makes screening more necessary. Medical professionals suggest that men should have the opportunity to discuss the potential benefits and harms of screening with their clinicians, incorporating their values and preferences in the decision. In addition to hormone therapy, other treatment options such as robotic prostate surgery, chemotherapy, and radiation may also be considered, depending on individual circumstances and medical advice.
The ongoing medical management of Biden’s condition underscores the importance of a comprehensive and informed approach to prostate cancer treatment. While the hormone-sensitive classification is a positive factor, the need for close monitoring and timely intervention is crucial. As the medical community continues to refine treatment strategies and monitoring methods, the hope remains that effective management of aggressive prostate cancer can be achieved through a combination of targeted therapies and proactive patient care.