Leading medical experts today offered their opinions on the complication surrounding Joe Biden’s unexpected cancer diagnosis, suggesting that he may have been too elderly and fragile to undergo testing.
The former president’s office said on Sunday that he had been diagnosed with late-stage cancer, which had probably been spreading for years because it had already spread to his bones.
A basic blood test, for instance, can identify about 90% of patients with the disease, so many medical professionals were shocked to learn how the cancer could have gone unnoticed and why he had not been examined while in office, when he had access to the nation’s top physicians.
With some experts saying “it is inconceivable” that Biden would not have undergone routine testing, the diagnosis caused current President Donald Trump to wonder if the lack of discovery was an indication of a “cover-up.”
However, due to concerns about needless side effects from treatments and a short life expectancy, physicians informed the Daily Mail that men over 70 are frequently not routinely examined for prostate cancer.
“We often think that men who are going to live 15 to 30 years will benefit the most from prostate cancer screening,” Dr. Shawn Dason, urologic oncologist at The Ohio State University Comprehensive Cancer Center, told the Daily Mail.
“[So] it would be rare for someone to undergo this testing to screen for prostate cancer above the age of 80. This may have been why he was diagnosed at an advanced stage.”
Remarkably, medical professionals also hinted that Biden, 82, had likely not had a prostate cancer screening since he assumed office in 2021 at the age of 78, and that the cancer may have been progressing since then.
Prostate cancer claims the lives of 35,000 American men each year, and more than 300,000 receive a diagnosis. It is the most prevalent type of cancer among men.
It has an almost 100% survival rate if found in the prostate and is regarded as one of the most curable if discovered early.
Doctors told the Daily Mail that there is no conspiracy, as some politicians and professionals have claimed, because others must have truly missed the diagnosis.
Every two to three years, males between the ages of 55 and 69 should get screened for prostate cancer, according to the United States Preventive Services Task Force (USPSTF). Those who are more vulnerable or have a family history, like Black men, could require more frequent screening.
For a number of reasons, including the possibility of overdiagnosis and overtreatment, the possibility of false positives, and the reality that prostate cancer frequently progresses slowly—many men die with the cancer, not from it—the FDA advises against testing males over 70.
This indicates that there are more risks associated with treating the cancer than advantages.
A prostate-specific antigen (PSA) test, which measures the quantity of proteins produced by the prostate gland, is used to screen for prostate cancer.
To confirm cancer, a man may have a prostate biopsy and imaging if his PSA levels are elevated.
Biden probably ceased being checked for prostate cancer at the age of 75, two years before to taking office, according to Dr. Todd M. Morgan, urological surgeon and Chief of Urologic Oncology at the University of Michigan Health.
“For a healthy man in his 80s, continued screening is not routinely recommended,” Dr Morgan told the Daily Mail.
“If President Biden followed guideline-concordant care, he likely discontinued PSA testing several years ago.”
With a Grade Group of five and a Gleason score of nine, the 82-year-old’s cancer was classified as “aggressive” and rapidly spreading.
Based on how aberrant the cancer cells appear under a microscope, doctors use the Gleason grading system to assign a number to prostate cancer. In general, the more aggressive the malignancy, the higher the score (which ranges from 1 to 10).
A score of six or lower indicates that the cancer is spreading gradually. An aggressive cancer with an intermediate risk is indicated by a score of seven.
Grade Groups, on the other hand, range from one, which indicates that the cancer will probably grow and spread slowly throughout the body, to five, which indicates that it will probably grow and spread swiftly.
Biden was diagnosed a few days after medical professionals discovered a “small nodule” on his prostate, a walnut-sized gland that controls urine flow and produces semen in men.
Doctors speculate that the nodule may indicate that he did not receive a PSA test on a regular basis.
Other specialists, however, asserted that cancer might have escaped detection even if the former president had been checked.
“Aggressive prostate cancer can occur at low PSA levels,” Yale Cancer Centre chief of genitourinary oncology and medical oncologist Dr. Daniel Petrylak told the Daily Mail.
“Higher grade tumors tend to make less PSA per cancer cell than low grade tumors, so it is possible that this tumor may have been missed by PSA.”
The standard unit of measurement for PSA levels is nanogrammes per millilitre (ng/mL). A level over 4 ng/mL is generally regarded as abnormal and may lead to a recommendation for additional testing.
However, some physicians adopt a higher cutoff (e.g., 5 ng/ml) for older men because PSA levels rise with ageing.
“People can have cancer with five and six [PSA levels] and for some unlucky people it can metastasize in 10 months. It’s a tiny chance but this is a unique cancer,” Dr. Stuart Fischer, an internal medicine physician in New York, told the Daily Mail.
“For other people, it goes very slowly.”
Biden’s medical records throughout his time in office showed that he suffered from a number of ailments, including high cholesterol, irregular pulse, and sleep apnoea, which may have taken precedence.
“Doctors also have to balance cancer screening with managing other health concerns – like cognitive changes or heart problems – especially in older patients,” said Dr. Tanya Dorff, medical oncologist and section chief of the Genitourinary Disease Program at City of Hope in California.
“This doesn’t mean prostate cancer is overlooked, but care is personalized based on what’s most relevant to the patient’s overall health.”
Although the precise stage of Biden’s illness is unknown, experts disagree on how long it might have taken for it to spread to his bones.
Usually, stage three or stage four cancer has progressed to the bones.
Dr. Dorff told the Daily Mail: “From my experience, aggressive prostate cancers can sometimes develop quickly, even when patients are monitored closely,” adding that timelines can vary.
But according to Dr. Dason, “this process takes years.”
“We often don’t know precisely, but it’s not a rapid process,” he added.
The absence of symptoms could possibly have contributed to the disease’s undetected spread. Although it can cause problems urinating and blood in the urine or semen, these symptoms are frequently confused with older age or less serious illnesses.
Dr. Morgan said that “Without regular PSA testing, even an aggressive prostate cancer can progress without causing symptoms. Tumors often cause no urinary symptoms while confined to the prostate,” adding that either bone pain or unexplained weight loss might be the first sign.
“Alternatively, by the time the cancer causes symptoms in the prostate, it may have already spread.”
Finding it after it has spread is ‘not surprising’ in situations like these, he said.
The Daily Mail was informed by experts that older men with metastatic prostate cancer frequently’respond well’ to treatments, which include immunotherapy, ultrasonography, and drugs that inhibit the hormone testosterone, despite the grave diagnosis.
Dr. Petrylak said, “The survival is variable, and can range from three to seven years. A small fraction of patients live 10 years.”
Additionally, Dr. Edmund Folefac, medical oncologist at the Ohio State University Comprehensive Cancer Center, told the Daily Mail, “With modern treatments, he has a very good chance of surviving many years.”
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