By CARLA K. JOHNSON
Updated 5:42 PM EDT, May 19, 2025

... “It’s a very common scenario,” said Dr. Matthew Smith of Massachusetts General Brigham Cancer Center. Men can “feel completely well and a diagnosis of metastatic prostate cancer could come as quite a surprise.”

Guidelines recommend against prostate cancer screening for men 70 and older so Biden may not have been getting regular PSA blood tests, Smith said. What’s more, while the PSA test can help flag some cancers in some men, it does not do a great job of identifying aggressive prostate cancer, Smith said ...

https://apnews.com/article/biden-prostate-cancer-2acca9da55ea0f0a09546cd918437444

By the time you and the docs realize something is probably seriously wrong, it's too late, tho. And I've not heard of any great advances in its treatment or prevention. RIP Gilda Radner.

The theory is that most prostate cancers are slow growing and a man 70 years old is likely to die of something else. And that is true in the large majority of cases. But for want of a test that probably has actual cost under $50, a lot of men will die unnecessarily. This is essentially rationing of care.

My prostate cancer was diagnosed at age 63. At that time, my PCP was ordering the tests every 5 years by default, but I specifically asked for the PSA test to be included in my annual checkup every year. SOmetimes we have to be our own advocates. Even so, it is still surprising that this wouldn't have been caught in Biden's case

Guidelines are not absolutes. Although many health non-care organizations and denial-of-coverage insurance companies like to pretend that they are and so will refuse to cover something that's not clearly within the guidelines.

In the case of insurance companies, they often initially deny guideline directed testing as well. Saves them money, especially as they hope you might die in the meantime. I base this on over a half century of medical practice as a physician as well as from these past few years of being a patient.

The current guidelines (2023) from the American Urological Association state, in part https://www.auanet.org/guidelines-and-quality/guidelines/early-detection-of-prostate-cancer-guidelines
The US Preventive Services Task Force was more directive (back in 2018) and bluntly states https://www.auanet.org/guidelines-and-quality/guidelines/early-detection-of-prostate-cancer-guidelines

My own prostate cancer was diagnosed in my seventies on the basis of an elevated PSA ordered by my primary care NP. If this had not been done, it would have been found on the annual PSA my urologist would have ordered. Before the elevated one, my PSA had been stable at the upper limit of starting to worry. The last had been done 4 months prior to the one ordered by my NP.

In my own experience I know of NO urologist or PCP who follows the "do not draw PSA on men (or women) over 70" guidelines. If PSA is normal-normal it might be done every other year (or even three) but it will be done at least every 3-4 years if you're over fifty.

As mine was high-normal, both my NP and Urologist checked it annually as they practice in different healthcare settings and each wanted the results in their medical records.

Neither you (in the general sense), nor I and likely none of the talking-heads knows (or has any right to know) the specifics of why the diagnosis was not made until it was.

Joe Biden is no longer the President. He's an oldie with a dreadful disease. Leave him TF in Peace.

I was trending from 3.5 toward 4.0 from age 59 through 63. There was no extra screening in my case, but I also got no push-back when I asked for annual PSA tests, and as soon as the test over 4.0 emerged, we moved into action. That suggests strongly to me that the idea of doing nothing before 4.0 is really a bad guideline. I would strongly suggest anybody over 2.5 insist on annual tests, and if they see a more-or-less linear trajectory toward 4.0, insist on additional screening sooner -- don't wait for 4.0 if the data is pointing that direction. In our system, the patient might have to fund that out of pocket, and I know not everybody can do that.



I agree. The problem is the guidelines, not the practitioners. The guideline is based on an assumption of a very slow-developing cancer, and that is just not valid. There are millions of men in the US population today who will have fast-progressing prostate cancer at some point, and their options and outcomes are much better with earlier detection.

I agree with you about Biden's privacy. But I think part of the attention comes from the question, "If the former President can go undetected before metastasizing, what chances do regular people have?" What I am trying to communicate is that this can be very manageable for most people, but men need to be their own advocates here.

My PSA was flat at just under 4 for about 6 years. It had reached that level slowly over a decade. In four months it went from just under 4 to nearly 7

In medschool we were taught that, starting age 40, one's (if one is White; although that caveat not mentioned at the time) risk of having prostate cancer was essentially a decadal equivalent if a prostate was fully sectioned and carefully examined.

That is, if one is 40, the risk of prostate cancer being found was 40%, if 60 then 60% and so on. My urologist tells me that really is not all that wrong. He also says that it is still true that most men with prostate cancer will die with it, not from it.

However, "most" is not all.

If it is the bones (either from local invasion, or as distant metastasis) it is very likely to bring a grim and painful death unless there is the involvement of a dedicated team willing to work closely with patient and family. Methods of "local control" (destroying individual tumor mets) have advanced greatly. Pain control has made less of an advance.

For people with bony involvement (or any metastatic disease), early referral for a palliative care consult (this does not mean immediately going into a facility to die!) seems to give better quality of life no matter at what stage the treatment might be presently.

The concept of "battling the cancer" is now being shown (as some of us had long suspected) to perhaps do more harm than good to quality of remaining life for some people as it can lead to feelings of anxiety or guilt for "not fighting hard enough".

This paradigm can, in a sense, absolve the healthcare providers of responsibility for treatment failure. Yes, I've seen this more than once.

If the prognosis (medically based best estimate) is correct and the cancer is terminal then the "battle" must eventually be lost which some patients find devastating. It seems to go better if one can recognize and accept that this life has a beginning, and also has an end.

An end of some sort. Various faith traditions interpret this in different ways. Relief from fear, comfort from loss are two things which most traditions attempt to provide.

That's disgusting.

might not kill a man in his 90s even if it was detected at age 70. The problem is that not all prostate cancer cells are slow growing.

When one gets a biopsy, there will typically be 12 samples taken (6 locations on each side of the prostate). The Gleason score is the composite of what was found in each of those 12 locations. In early diagnosis, maybe half of them will show no cancer cells at all, and the others might show only slow-growing cancer cells. But it is just a sample. There could be fast-growing cancers cells just a millimeter away from where one of the needles sampled.

Prostate cancer can be found and diagnosed in its later stages, experts said.

By Mary Kekatos
May 19, 2025, 6:36 PM

Former President Joe Biden's office announced on Sunday that he was diagnosed with an "aggressive" form of prostate cancer.

Biden's office also said the cancer had metastasized, spreading to his bones.

Although some people were left wondering why the cancer was caught only after reaching a Gleason score of 9, oncology experts told ABC News that it's not uncommon for older prostate cancer patients to receive a diagnosis after the disease has advanced or spread ...

https://abcnews.go.com/Health/biden-aggressive-prostate-cancer-recently/story?id=121957364

He just wasn’t, and isn’t, a sneaky kind of guy. Very honest and genuine. Wasn’t always thinking about how to pull something over on someone else to get an advantage for himself, unlike some other conniving attention-desperate shit we know.

I think humans have a built-in lie detector, they just won’t listen to it. They’d rather believe bullshit.

I mean everybody has an opinion about the Tom Brady Deflate-gate, or the Caitlin v. Angel wars or Belichick's granddaughter-aged fiance.

The big issue is that less than 5% of the population takes civics seriously, and the media is more than eager to cater to pop culture pap if it is good for their ratings.

May 19, 2025 5:51 PM ET

... Recent studies show that survival for men with prostate cancer that has spread to the bone is just under two years. But this form of cancer, though aggressive, can sometimes be controlled ...

“The good news is this: we have now entered an era of different treatments that I call therapy intensification where we are trying to attack cancer with a multi-modality approach,” says Dr. Maha Hussain, deputy director of the Robert H. Lurie Comprehensive Cancer Center at Northwestern University Feinberg School of Medicine. “We can come up with a significant prolongation of life by comparison to when I entered the field." She has seen patients with prostate cancer that has spread survive and "live many, many years.”

Most prostate cancer is fueled by the male hormone testosterone, so the most effective strategies to control it starve the cancer by cutting off its supply, say experts. Historically, doctors have removed the testes—the main source of the hormone—but today, pills and injections can suppress testosterone not just in the testes but in other organs that produce small amounts, such as the adrenal glands, as well. Doctors also now add chemotherapy to hormone-suppression to better control cancer growth.

Exactly which combinations of treatments are right for Biden will depend on whether his cancer is new or if it was previously diagnosed and recently re-emerged. Either scenario is possible, say experts ...

https://time.com/7286596/joe-biden-prostate-cancer-treatment/

who has actual, personal experience to tell us exactly what you have told us. I'm sick and tired of the know-nothings on the right speculating and prognosticating on the basis of only their own imaginations with no real, medical knowledge or personal experience. So, I thank you sincerely for enlightening those of us who are truly interested and not out to bloviate or cash in.

One of the most reasonable and caring articles I've read regarding Joe Biden's diagnosis.

to Mr. Crim.

Last edited Sun May 25, 2025, 07:19 PM - Edit history (1)

on Diagnosing Prostrate Cancer, Struggle.

and whether they think they do or not.

There are two standard procedures that are done to initially test for prostate cancer 1. a PSA blood test and 2. a DRE (digital rectal exam). These tests should be done annually, usually as part of the annual physical. If the PSA level is found to be high, then a prostate biopsy (NOT fun) and/or an MRI will be recommended. The biopsy is used to determine the Gleason score (1-10), which is a measure of how aggressive the cancer is.

Unfortunately, the ‘official’ age recommendations for PSA testing (ages 55-70) are seriously out of date. Plenty of men both younger and older develop prostate cancer, and it’s important to test for it before it reaches stage 4 (treatable but incurable). Treatment is also easier the sooner the cancer is caught.

Men who are initially diagnosed with a Gleason score of 8-10 have almost invariably not had their PSA tested for several years - generally because of the official age recommendations. This is especially regrettable since PSA testing is cheap and easy.

The takeaway - ask your doctor for a PSA test at your annual physical or if you experience symptoms (usually urinary). Personally, I’d insist on it (it’s not generally done unless you specifically ask for it).

https://www.healthline.com/health/prostate-cancer-free-psa

I don't know if they are "out of date," I'm not sure when they were declared.

The idea of stopping the screening after age 70 is based on the claim that "you will most likely die from something else before you die from prostate cancer because it is usually slow growing." That does not sound like medicine. It sounds like money, as in medical insurance expenses. (I assume there are data to support it.) That does not take into account that cancer any place in one's body presents a reduced level of overall health and well being. So, while waiting for something else to kill you, you are probably experiencing a reduced quality of life.

At age 79, I had to demand a limited biopsy from a prostate surgeon I was referred to. I finally told him my parents lived to be 93 and 97. There was a pretty good probability I might live quite a lot longer. (Statistics and probability are heavily involved in today's medical recommendations. Congratulations, you are a data point.)

I had had some urinary symptoms - blood in urine. A urology PA mentioned an MRI as one of the options. I jumped at that unobtrusive option, and it found the prostate cancer. It was well contained with moderate risk (biopsy found Gleason 3 + 4). The tumor location was one that could be felt via physical exam in the most common area for prostate cancer to occur. (Hurray, I fit the data.)

At this point the options were "active surveillance" with frequent biopsies, or surgery, or radiation. There are other options as well which I looked for on my own. The surgeon's PA recommended radiation - if I did not want to "wait and watch".

After much research, some of which had been done years before (I had a history of prostate symptoms), I chose proton beam radiation which required living in another state for 6 weeks and three or four preliminary visits. Half way through the treatments I began feeling better. After the final treatment, I had enough energy to immediately load up the minivan myself and take off. Preparing for the daily radiation treatments and coping with some intestinal irritation was a nuisance, but otherwise the whole process went well. That was 2.5 years ago. I'm doing very well and planning to play (fairly competitive) pickleball for many more years.

I had a lesion on my liver that was found when they were doing a routine cardiac workup. It was benign, but they had to check it because of the size. I don't think this is uncommon. I had a younger friend die from aggressive cancer nearly five years ago, and that was found during a physical (she was in her 30s).

Blood test caught it, biopsies proved it, PET scans mapped it.

What was the “routine” blood test?

I’m not buying it.

One year ago my 85 year old husband noticed a lump near his armpit and our family doctor ordered a "routine" blood test immediately. Why was it ordered? Here is a "standard" answer and I think it has validity......" complete blood count to measure the number of platelets, red blood cells, and white blood cells in your system". Your implication of the word "routine" being bogus is beyond disgusting!!!

People, you are reading something into my post that isn’t there. Presuming you read the article, you would know that he had a non routine blood test ordered by mistake. I was wondering what that test is. Because it goes against the thought that the cancer grew undetectable. That was the point I was trying to make.

cuz im not a maggot