Prostate cancer: screening and treatment options

Prostate cancer: screening and treatment options

Prostate cancer: screening and treatment options

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Diverging Reports Breakdown

How Doctors Treat Aggressive Prostate Cancer Like Joe Biden’s

Former President Joe Biden has an aggressive form of prostate cancer that has spread to his bones. 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. Doctors also now add chemotherapy to hormone-suppression to better control cancer growth. immunotherapy, an exciting new treatment that harnesses the immune system to fight certain cancer types, is so far not effective against prostate cancer, says Dr. Michael Morris, prostate cancer section head at Memorial Sloan Kettering Cancer Center. But there are many ways of manipulating theimmune system to activate the prostate cancer against another type of cancer, he says. For now, there is no real role for immunotherapy for a patient who presents with prostate cancer today, Morris says. But new immune-based interventions are being explored, says Morris, and may be as effective as immunotherapy against other types of cancer in the near future, if they are proven to be safe and effective in the long-term.

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In a statement from his personal office on May 18, former President Joe Biden revealed he has an aggressive form of prostate cancer that has spread to his bones. “While this represents a more aggressive form of the disease, the cancer appears to be hormone-sensitive which allows for effective management,” his office said in a statement. “The President and his family are reviewing treatment options with his physicians.” 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. Here’s what oncologists who treat prostate cancer say are the most common strategies for treating a cancer like Biden’s, and some of the challenges.

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The latest ways to curb aggressive prostate cancer “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. Read More: The Race to Explain Why More Young Adults Are Getting Cancer With respect to having prostate cancer initially diagnosed at such an aggressive state, after it has already spread, “I don’t think there is any reason to think this could not be the natural history of prostate cancer in an older person,” says Dr. Robert Figlin, cancer center director at Cedars-Sinai Cancer Center. “And this would not [indicate] something that was missed or mismanaged in past years. This is certainly something that can occur in the course of a male’s life—it’s not unusual to present in this way.” Many older men are diagnosed with aggressive disease, with studies showing that about 20% of prostate cancer cases are diagnosed in men 75 years and older, and that men 70 and older tended to have higher Gleason scores, an indicator of the cancer’s aggressiveness, at diagnosis. (Biden’s Gleason score is 9, his office said in the statement, indicating a more aggressive cancer.) “Prostate cancer can sit dormant for years and suddenly decide to wake up,” says Hussain. “I’ve seen all kinds of cases—all shades of grey.”

Treatment options also depend on a patient’s overall health. Other conditions a person might have can affect their ability to tolerate the therapies and side effects. “We have to take into account other diseases a man may have, other medical conditions that may be life-limiting, goals that man has in terms of longevity and quality of life, and other medications he may be taking,” says Dr. Michael Morris, prostate cancer section head at Memorial Sloan Kettering Cancer Center. What about immunotherapy? Immunotherapy—an exciting new treatment that harnesses the immune system to fight certain cancer types—is so far not effective against prostate cancer. While it has been successful in slowing melanoma, breast, lung, kidney and bladder cancers, and lymphoma, prostate cancer remains relatively hidden from the immune system, making it what doctors call a “cold” cancer. “I’d rather call it a sneaky cancer,” says Hussain. “Prostate cancer cells literally sit inside the bone marrow next to the white blood cells,” which are immune cells. “The white blood cells can’t see it, so unlike other cancers, prostate cancer has still not been responsive to immunotherapies.”

Read More: A New Immune Treatment May Work Against Several Cancer Types However, while current immunotherapy strategies may not be as effective against prostate cancer, new immune-based interventions are being explored, says Morris. “For now, for a patient who presents today with prostate cancer, there is no real role for immunotherapy,” he says. “But there are many ways of manipulating the immune system to activate against prostate cancer. If you ask me in another couple of years, we will have a quite a different message.” Doctors are also exploring whether introducing chemotherapy earlier, along with hormone-suppressing treatments could improve their chances of controlling the cancer and preventing it from spreading and becoming more aggressive. “One of the most important questions for patients with newly diagnosed metastatic disease would need to answer is whether they need docetaxel chemotherapy in addition to [hormone suppressing] therapy,” says Dr. Timothy Daskivich, associate professor of urology at Cedars-Sinai. “Data suggests that patients with higher volume metastases benefit the most from docetaxel. If these patients don’t get it up front, it could be a missed opportunity.”

Screening for prostate cancer Prostate cancer screening—done with a blood test for prostate specific antigen (PSA), a marker of cancer cells—has helped to lower deaths from the disease. But the screening has been controversial, since prostate cancer generally grows slowly and the test can pick up signs of benign prostate growth, which also occurs as men age. However, the American Cancer Society currently recommends that men with average risk of prostate cancer get screened beginning at age 50, if they are expected to live at least 10 more years, and that men with higher risk, including African-American men and those with a father or brother diagnosed with the disease, start earlier, at age 45. The U.S. Preventive Services Task Force recommends that most men stop screening at age 70, since at that time, men may be more likely to die of causes other than prostate cancer, and the risks of over-treating slow-growing cancers may outweigh the benefits.

A legacy of advocacy for new approaches to cancer

As vice president under President Barack Obama, Biden led the Cancer Moonshot to spur research into new treatments. As president in 2022, he set a nationwide goal of reducing cancer death rates by 50% over 25 years. The quest was personal for Biden, whose son Beau died in 2015 of brain cancer at age 46.

“Cancer touches us all,” he wrote in an Instagram post on May 19. “Like so many of you, Jill and I have learned that we are strongest in the broken places. Thank you for lifting us up with love and support.”

Source: Time.com | View original article

Biden is getting prostate cancer treatment, but that’s not the best choice for all men − a cancer researcher describes how she helped her father decide

My father was diagnosed with prostate cancer 10 years ago. I helped him make the life-changing decisions he would need to make. I struggled with our conversations about what “curing” his cancer meant. I wanted to ensure he would have the best outcome and could still live his best life. I felt overwhelming anxiety because I did not want to fail him or my family. I couldn’t help second-guessing our decisions, and I sometimes questioned our decision not to immediately treat his cancer. Nearly half of patients with prostate. cancer are overdiagnosed, leading to overtreatment. Research suggests that all patients with. prostate cancer overdiagnosis will ultimately be considered over-diagnosed during their lifetime, because the cancer. is slow-growing and will not harm the patient. The cancer. risk categorization is based on the patient’s. gender, age, race, and the location of the tumor, such as in the U.S. or in the Caribbean. It can be grouped into four stages. Stages 1 and 2, when the tumor is still confined to the prostate, are considered early-stage or intermediate risk. St stages 3 and 4, when it has spread beyond the borders

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“Me encontraron càncer en la pròstata,” my father told me. “They found cancer in my prostate.”

As a cancer researcher who knows very well about the high incidence and decreased survival rates of prostate cancer in the Caribbean, I anguished over these words. Even though I study cancer in my day job, I struggled to take in this news. At the time, all I could muster in response was, “What did the doctor say?”

“The urologist wants me to see the radiation oncologist to discuss ‘semillas’ (seeds),” he said. “They are recommending treatment.” Many men, including former President Joe Biden, whose case is advanced, do choose with their doctors to treat prostate cancer.

However, I understood from my work that not undergoing treatment was also an option. In some cases, that is the better choice.

So I took it upon myself to educate my father on his disease and assist him with the life-changing decisions he would need to make. Our journey can give you a preview of what a cancer diagnosis can be like.

Prostate cancer diagnosis

Prostate cancer was not a new topic for my father and me. His battle with his prostate health started over 10 years ago with an initial diagnosis of benign prostate hyperplasia, or BPH.

The prostate gets bigger with age for a number of reasons, including changing hormone levels, infection or inflammation. Two of the most frequent symptoms of BPH are difficulty urinating and a sudden, urgent need to urinate, both of which my father experienced.

Although research suggests that the factors that contribute to BPH similarly contribute to prostate cancer, there is no evidence that an enlarged prostate will necessarily develop into cancer.

Upon my father’s initial BPH diagnosis, I asked about his PSA levels, the amount of prostate-specific antigens in his blood. PSA is a protein that both normal and cancerous prostate cells produce, and elevated amounts are considered red flags for prostate cancer. When combined with a digital rectal exam, a PSA test can allow doctors to more accurately predict a person’s risk of having prostate cancer.

My father said his PSA levels were elevated but that the doctors would begin active surveillance, what he called “watchful waiting,” and monitor his PSA every six months to see if it rose.

After several years of monitoring his PSA, doctors found my father’s PSA level had doubled. He then got a biopsy that indicated he had intermediate-risk prostate cancer.

Cancer risk categorization

After his diagnosis, my father was faced with the decision of how to proceed with treatment. I explained that categorizing how aggressive the cancer is and how far it has spread can help determine the best course of treatment.

Prostate cancer can be grouped into four stages. Stages 1 and 2, when the tumor is still confined to the prostate, are considered early-stage or intermediate risk. Stages 3 and 4, when the tumor has spread beyond the borders of the prostate, are considered more advanced and high risk.

Some patients with early-stage or intermediate-risk prostate cancer undergo additional treatment, including surgery, radiation or radioactive seed implants called brachytherapy. Patients with late-stage prostate cancer typically undergo hormone therapy along with surgery or radiation, or chemotherapy with or without radiation.

Although I was not surprised by my father’s diagnosis, given his advanced age and his battle with prostate disease over the past decade, I still struggled emotionally. I struggled with our conversations about what “curing” his cancer meant and how to explain his treatment options to him. I wanted to ensure he would have the best outcome and could still live his best life.

Our initial inclination was to undergo active surveillance. That meant we would monitor his PSA every six months instead of immediately starting treatment. That is appropriate for patients with early-stage and less aggressive tumors.

Prostate cancer screening problems

My father was leaning on me to help him decide how to proceed. I felt overwhelming anxiety because I did not want to fail him or my family. Even with all my expertise studying cancer genetics and working with cancer patients, I couldn’t help second-guessing our decisions, and I sometimes questioned our decision not to immediately treat his cancer.

Some people diagnosed with prostate cancer don’t immediately start treatment, because many of the tumors found through PSA testing grow so slowly that they are unlikely to be life-threatening. Detecting these slow-growing tumors is considered overdiagnosis, because the cancer ultimately will not harm the patient during their lifetime. Nearly half of all patients with prostate cancer are overdiagnosed, often leading to overtreatment.

Research suggests that many prostate cancer patients undergo unnecessarily aggressive treatments, which are often associated with significant harms, like urinary and bowel incontinence, sexual impotence and, in some cases, death. Several studies in the U.S. have shown that patients with early-stage prostate cancer generally have a good prognosis, and the cancer rarely progresses further. With careful observation, most will never need treatment and can be spared the burdens of unnecessary therapy until there are clear signs of progression.

Overdiagnosis and overtreatment of prostate cancer led the U.S. Preventive Services Task Force to recommend against PSA-based screening in 2012, with caveats for high-risk groups including African American men and those with a family history of prostate cancer. The recommendation was updated in 2018 to make screening a personal choice after discussion with a clinician.

Those recommendations have resulted in reduced screening and increased prostate cancer diagnoses. Given that Black men are more likely to see the cancer progress to aggressive forms of the disease after initial diagnosis, this may worsen existing health disparities.

Developing tests that better identify patients at risk of dying from prostate cancer can decrease overtreatment. In the meantime, educating patients can help them decide if screening is appropriate for them. For underserved and marginalized communities, community outreach can help improve health literacy and enhance awareness and screening.

When I looked through my father’s stack of medical records, I found a beacon of light that eased my apprehension. His doctor had ordered a genetic test that estimates how aggressive a tumor may be by measuring the activity of specific genes in cancer cells. An increase in gene activity linked to cancer would indicate that it is likely to grow fast and spread.

The test predicted that my father’s risk of dying from the disease in the next five years was less than 5%. Based on these results, we both understood that he had adequate time to make a decision and seek additional guidance.

My father ultimately decided to continue active surveillance and forgo immediate treatment.

Surviving prostate cancer

I still worry about my father’s diagnosis, because his cancer is at risk for progression. So every six months, I inquire about his PSA levels. His doctors are monitoring his PSA levels as part of his survivorship plan, which is a record of information about his cancer diagnosis, treatment history and potential follow-up tests.

My father’s decision to undergo active surveillance was controversial among our friends and family. Many were under the impression that prostate cancer required immediate treatment. Several shared successful treatment stories, sometimes followed by stories of adverse treatment-related side effects.

To date, my father believes that active surveillance was the best decision for him and understands that this may not be the same for someone else. Talk to your doctor to see what the best options are for you or your loved ones.

This is an updated version of an article originally published on Aug. 8, 2023.

Source: Theconversation.com | View original article

Joe Biden diagnosed with Prostate Cancer: Why India must prioritise screening and break the silence

Doctors say prostate cancer risk rises notably after age 50, though it can occur earlier. Family history and diets high in red meat but low in fruits and vegetables also elevate the risk. Dr Pramod Krishnappa of NU Hospitals, Bengaluru, cites 2024 ICMR data, noted that 43% of prostate cancers in India are diagnosed at an advanced stage. He advocates routine annual blood tests to improve early detection and treatment outcomes. Prostate cancer that looks “very abnormal” is assigned the highest rating. Early prostate cancer may not give any kind of symptoms, however sometimes one may see blood in the urine. Some symptoms like. increase in frequency of urination, while passing urine. can also increase prosthetic symptoms like weight loss and some. similar symptoms like Proignstatic Hyperplasia can also have prostate cancer. The cancer is easily detectable through PSA blood test, which can be done at any hospital in India. For confidential support call the Samaritans in the UK on 08457 90 90 90, visit a local Samaritans branch or click here for details.

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Joe Biden diagnosed with Prostate Cancer: Why India must prioritise screening and break the silence

Doctors say prostate cancer risk rises notably after age 50, though it can occur earlier. Family history and diets high in red meat but low in fruits and vegetables also elevate the risk

Chetana Belagere Published May 20, 2025 | 6:00 AM ⚊ Updated May 20, 2025 | 6:00 AM

Pain during urination can be signs of prostate cancer. (Creative Commons)

Synopsis: President Joe Biden’s prostate cancer diagnosis has drawn global attention to a largely silent yet deadly disease affecting millions of men. Dr Pramod Krishnappa of NU Hospitals, Bengaluru, citing 2024 ICMR data, noted that 43% of prostate cancers in India are diagnosed at an advanced stage. He advocates routine annual blood tests to improve early detection and treatment outcomes

When global leaders fall ill, the world watches. President Joe Biden’s recent diagnosis of prostate cancer has not only sparked concern but also highlighted a silent killer that affects millions of men globally — often without symptoms, without warning, and far too often, without a timely diagnosis.

Speaking to South First, internationally renowned Consultant Uro-Andrologist at NU Hospitals in Bengaluru Dr Pramod Krishnappa explains, “as per the recent ICMR data published in Indian journal of Urology in 2024 revealed a very astounding fact that around 43 percent of all prostate cancers were diagnosed at the distant metastatic stage, which means, out of 100 patients 43 were diagnosed at a very late stage, during which the outcomes of the treatment may not be that great. So, it’s high time that we must include a simple blood test to detect prostate health issues in ones annual health check.”

What is prostate cancer?

Speaking to South First, a senior Oncologist from Kidwai Hospital in Bengaluru says, “the prostate is a small glad in men, located below the bladder and in front of the rectum, responsible for producing seminal fluid.”

Explaining further he adds, “Prostate Cancer occurs when cells in the prostate begin to grow uncontrollably. Most cases grow slowly, but some can be aggressive and spread rapidly,” he explains.

Also Read: How Gamma Knife is bringing new era of brain treatment

What happened to Joe Biden?

President Biden, according to a press statement has been diagnosed with an “aggressive” form of prostate cancer. He was diagnosed with the disease after he experienced few urinary symptoms, and on examination a prostate nodule was found. The treatment options are now being worked out.

“While this represents a more aggressive form of the disease, the cancer appears to be hormone-sensitive, which allows for effective management. The president and his family are reviewing treatment options with his physicians,” said the statement from the Democrat’s office on Sunday. The statement also says that the cancer was found to have a Gleason score of 9 (Grade Group 5).”

Explaining what it means, Dr Pramod says, Prostate cancer that looks “very abnormal” is assigned the highest rating. He explained that International Society for Urological Pathology says ISUP grade 4/5 or if the Prostate Specific Antigen is above 20 ng/ml based on the digital rectal examination then it is considered as high risk.

Simplifying further he said, “basically if prostate cancer has spread beyond the prostate and involving other nearby or distant organs it is considered as ‘aggressive’.”

According to reports, in Biden’s case, the cancer has reportedly spread to his bones.

Who is at risk and What are the symptoms of Prostate Cancer?

According to doctors the risk for prostate cancer increases significantly after the age of 50 years. However, there have been cases where even those in their 40s have been detected with prostate cancer.

Having a family history where men with a father or brother who had prostate cancer are more likely to develop it. Also, diets high in red meat and low in fruits and vegetables may increase cancer risk.

Dr Pramod however says, “the early prostate cancer may not give any kind of symptoms however sometimes one may see blood in the urine, unintentional weight loss and some vague prosthetic symptoms like increase in frequency of urination, burning while passing urine.”

Dr Pramod warns that blood in the urine is somthing that no body should ignore. Meanwhile Dr Madhavi Nair says, men above the age of 50 often have issues like sleep disturbances and struggles to use the bathroom.

“As prostate cancer is easily detectable through PSA blood test. However, Benign Prostatic Hyperplasia can also have similar symptoms like prostate cancer. Hence they may assume ‘this is nothing serious; my friend has it too and it is only BPH, so even I probably just have that,” etc. So one should not ignore any symptoms of changes and meet a urologist for further evaluation.”

The unspoken threat

Prostate cancer is the second most common cancer in men worldwide, says a study published by researchers from Global Center for Evidence Synthesis of Chandigarh, in Science Direct in Febraury 2025 on “understanding Current trends incidence projections of prostate cancer in India: A comprehensive analysis of national and regional data from the global burden of disease study (1990-2021).” The study says prostate cancer is the fifth leading cause of cancer-related mortality among male patients and fourth most common cancer worldwide.

“In India, the trends and burden of Prostate Cancer have been understudied compared to Western countries. However, with the rapid socio-economic development and adoption of Western lifestyles, there has been an observed increase in the incidence of PC. This trend highlights the need for comprehensive epidemiological studies to understand the scope of the problem better and to inform public health strategies,” argued the authors of the study. Yet, awareness remains shockingly low.

“Men often don’t come forward for checkups until it’s too late,” says Dr Shivalingaiah, renowned urologist from Bengaluru. “Unlike women’s health where there is a visible push for breast and cervical cancer screening, prostate health is still not part of regular conversations or public health policy,” he adds.

Meanwhile Dr Madhavi Nair, Consultant-Surgical Oncology at Manipal Hospital says, there is a lot of stigma around prostate cancer mainly because it affects elderly men. “Many patients, often over 70, experience symptoms like difficulty urinating, frequent night time bathroom trips, and a sensation of incomplete emptying.”

The study found the highest number of cases were found in Delhi, Kerala, and Mizoram and Uttarakhand. Meanwhile Dr Shivalingaiah explains that according to National Cancer Registry Programme (NCRP) data for 2012-2016, the age-adjusted incidence rate of prostate cancer in Bengaluru (a major urban center in Karnataka) was approximately 6.0 per 100,000 men. “This is lower than some other urban registries like Delhi (11.8 per 100,000) and Mumbai (9.7 per 100,000) but indicates a significant burden in urban Karnataka,” he explained.

A missed opportunity in preventive healthcare

Unlike many other cancers, prostate cancer, when detected early, has a very high survival rate. Simple screening tools like PSA (Prostate-Specific Antigen) blood tests and digital rectal exams (DRE) can catch early-stage disease before it spreads.

However, India does not have a national prostate cancer screening program. Even in many state-run hospitals, there is no standardised protocol for screening men above 50.

“This is a gap in our healthcare strategy,” says a preventive medicine expert from Karnataka. “Just as we screen women for breast cancer, we need regular prostate cancer screening camps at the PHC level, especially for men over 50 or those with a family history of cancer,” she adds on condition of anonymity.

States like Kerala and Tamil Nadu, known for better healthcare indices, have introduced non-communicable disease (NCD) screening programs — but prostate cancer is often missing from the checklist.

Dr Pramod says, “offer early PSA testing to well-informed men at elevated risk of having PCa:

Men from 50 years of age

Men from 45 years of age and a family history of PCa

Men carrying breast cancer gene 2 (BRCA2) mutations from 40 years of age.”

The weight of stigma

A major barrier is cultural stigma. Discussions around men’s reproductive organs are still taboo in many Indian homes. Prostate health, which involves the urinary and sexual systems, is shrouded in embarrassment and silence.

“For years, I ignored the symptoms — frequent urination, slight pain — thinking it was old age,” says 68-year-old Rajan, a retired banker from Bengaluru. “It wasn’t until my daughter, a nurse, insisted I get tested that I found out it was cancer.”

This silence can cost lives. There needs to be a cultural shift in how men approach health. Campaigns that normalize discussions around prostate health, much like those done for menstrual hygiene or mental health, are urgently needed.

Senior doctor from Kidwai says, “prostate cancer awareness begins with conversation. Talk to your doctor about your risk, especially if you are over 50 or have a family history. Encourage the men in your life to stay informed and proactive about their health.”

Doctors stress that early detection saves lives. “Let’s raise awareness, break the stigma, and promote routine check-ups. Together, we can fight prostate cancer,” adds the doctor.

Is prostate cancer curable?

Dr Pramod explains that “traditionally, probably two decades back, if someone has been diagnosed with PC it used to be usually the radiotherapy. But in early 2000, with the advent of surgical robots, there has been a major shift from radiotherapy to radical prosthetic surgery, where the surgeries are very precise and give excellent results. Not just the cancer outcomes but also in terms of functional outcomes like sexual health and urinary leakage.”

He says, the main concerns after somebody’s diagnosis of prostate cancer or somebody plans for a prosthetic surgery, the two functional concerns would be erectile dysfunction and persistent urinary leakage. However, with the advent of robotic surgeries, these two complications can be prevented to the maximum extent possible. Even if someone gets ED or urinary leakage there are other measures or therapies and treatments which includes penal implants too.

Meanwhile Dr Madhavi Nair says, there are several new and effective treatment options for prostate cancer. “Fortunately, it is a slow-growing cancer and responds well to multiple lines of treatment. Robotic surgery, especially robotic radical prostatectomy, has transformed prostate cancer care offering a less invasive, low-morbidity procedure with faster recovery and abetter outcomes, so the open surgery is rarely needed.”

She adds that there are a lot of new lines of hormonal treatment. And now they are exploring PSMA-directed therapy and high-density frequency ultrasound. These are all new therapies that are coming up.”

In addition to surgery, advanced hormonal therapies, PSMA-targeted treatment, and high-intensity focused ultrasound (HIFU) are showing promise,” she said.

She adds that since prostate cancer is one of the most common cancers in the world, and it is going to only increase because “our population is trending towards a larger section of men being in the above 70 years age group we are definitely going to see a lot more of prostate cancers.”

(Edited by Ananya Rao)

Source: Thesouthfirst.com | View original article

What a urologist wants you to know about prostate screening

Prostate-specific antigen, or PSA, is a protein produced by the prostate. The PSA blood test measures this protein to help screen for prostate cancer. The controversy around PSA testing isn’t really about the test itself, but about how its results are interpreted and acted upon. Not all prostate cancers cause elevated PSA levels. Some aggressive cancers may produce normal PSA results. Ultimately, the PSA level is a starting point for further evaluation and deeper conversations with your doctor. The U.S. Preventive Services Task Force (USPSTF) recommended against routine PSA screening in 2012 due to concerns of “overdiagnosis” The current stance emphasizes personalized discussions between patients and doctors, acknowledging that there’s no one-size-fits-all approach to PSA Testing. For most patients, PSA typically initiate PSA screenings at age 50. For those at higher risk, such as African Americans or those with a first-degree family member who has prostate cancer, most patients should start PSA at 40.

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EDITOR’S NOTE: Dr. Jamin Brahmbhatt is a urologist and robotic surgeon with Orlando Health and an assistant professor at the University of Central Florida’s College of Medicine.

When I learned that former President Joe Biden had not undergone prostate-specific antigen (PSA) screening since 2014—and was later diagnosed with metastatic prostate cancer—I knew there would be renewed interest and debate about prostate cancer screening guidelines.

As a urologist, I regularly discuss the complexities surrounding PSA testing with my patients. The PSA test remains valuable for early detection, but it continues to generate controversy due to its limitations. Here’s what you should know about PSA screening, why medical guidelines vary and why individualized approaches are essential.

What is the PSA test?

Prostate-specific antigen, or PSA, is a protein produced by the prostate. The PSA blood test measures this protein to help screen for prostate cancer. Typically, a PSA level above 4 on lab results is flagged as “abnormal,” prompting further evaluation. However, even PSA numbers below 4 can be concerning if they’re rapidly increasing. That’s why PSA tests are done annually: to monitor trends over time.

Elevated PSA levels don’t always mean cancer. Noncancerous conditions like an enlarged prostate, prostatitis (inflammation), recent ejaculation, stress or even strenuous activity can temporarily raise PSA. Ultimately, the PSA level is just a starting point for a deeper investigation (or conversation).

Additionally, not all prostate cancers cause elevated PSA levels. Some aggressive cancers may produce normal PSA results. Ultimately, the PSA level is a starting point for further evaluation and deeper conversations with your doctor.

What’s the disagreement around PSA screening?

The controversy around PSA testing isn’t really about the test itself, but about how its results are interpreted and acted upon. Before 2012, PSA screening was routinely recommended for all men over age 50. I completed my urology training that same year, witnessing firsthand how dramatically the screening landscape changed almost overnight.

In 2012, the U.S. Preventive Services Task Force (USPSTF) recommended against routine PSA screening due to concerns of “overdiagnosis.” The worry was that screening could detect slow-growing cancers that may never cause harm but still result in unnecessary biopsies, anxiety, and treatments—some of which caused more harm than good.

The recommendation led doctors to scale back, causing routine PSA testing to decline sharply. However, by 2018, new research and rising concerns about aggressive prostate cancers led the USPSTF to revise their recommendations again, advising men aged 55 to 69 to engage in shared decision-making with their providers.

This current stance emphasizes personalized discussions between patients and doctors, acknowledging that there’s no one-size-fits-all approach to PSA testing. According to their website, the USPSTF is now working on another update, so we can expect further adjustments in the near future.

As someone who experienced this shift firsthand early in my career, I deeply appreciate how critical shared decision-making and patient involvement are in navigating these complex screening choices. These ongoing changes in recommendations have also reinforced the importance for me as a physician to stay informed, continuously adapting my practice as new research and technologies emerge.

Understanding the screening guidelines

Urologist Dr. Jamin Brahmbhatt regularly discusses PSA testing with his patients. Halfpoint Images/Moment RF/Getty Images

Several organizations provide prostate cancer screening guidelines, including the USPSTF, the American Cancer Society and the American Urological Association (AUA). Each offers slightly different recommendations for both patients and health care providers. The USPSTF generally focuses on minimizing potential harm from overtreatment, while the AUA provides detailed, individualized recommendations based on clinical factors and risk profiles.

Even after practicing urology for more than a decade, I still sometimes find it challenging to navigate these subtle differences in guidelines. Although I primarily follow the AUA guidelines—my overarching professional body—I’ve established a balanced approach that feels comfortable for me and, I believe, best serves my patients’ interests.

I start PSA testing at age 40 for men at higher risk, such as African Americans or those with a first-degree family member who has prostate cancer. For most patients, I typically initiate annual PSA screening at age 50.

It’s important to know that primary care doctors perform most prostate cancer screenings. Depending on their training, clinical judgment and professional guidelines, their approach may differ slightly from my take as a urologist. This highlights the importance of clear communication among you the patient, your primary care provider and your specialists. Only through these conversations can we create personalized screening strategies that align with your health goals.

Could Biden’s cancer have been caught earlier?

President Biden’s case raises a question: Could earlier PSA screening have detected his cancer sooner, at a more treatable stage? We will never know for certain. According to current guidelines, stopping screening in one’s 70s is considered appropriate. Perhaps there was a shared decision to stop testing. From a guideline perspective, nothing was necessarily done incorrectly. Still, Biden’s diagnosis highlights the potential consequences of discontinuing prostate screening for an otherwise healthy older adult.

Life expectancy and screening guidelines

Men in the United States now have an average life expectancy of approximately 76 years, with many living healthy, active lives well into their 80s and beyond. Older guidelines based on shorter lifespans now need updating to reflect today’s longer, healthier lives. I believe that decisions about prostate screening in older adults should thus focus more on individual health status rather than chronological age alone.

Changing guidelines based on longer life expectancy will require thorough research and evidence-based data. Consequently, updates to recommendations will take time. What you can do in the meantime is be proactive in your conversations with your doctors about not just prostate cancer screenings but all cancer screenings.

Prostate cancer isn’t the only medical condition subject to evolving guidelines. Screening recommendations for colorectal and breast cancers have also changed recently. Colon cancer screening now generally starts at age 45 instead of 50 due to rising cases among younger adults.

Breast cancer guidelines continue to vary among organizations, but the USPSTF updated its recommendation last year to say that most women should start getting mammograms earlier. These frequent shifts reflect ongoing research and the importance of personalized, informed conversations between patients and health care providers.

Improvements in prostate cancer screening and treatment

Historically, an elevated PSA test led directly to a prostate biopsy, potentially causing unnecessary anxiety and sometimes overtreatment. Today, however, we have more advanced PSA-based tests that help better identify significant prostate cancers. Advanced imaging, like prostate MRI, allows us to pinpoint suspicious areas before performing a biopsy, increasing accuracy and decreasing unnecessary procedures.

Biopsy techniques have also improved, some shifting from traditional transrectal biopsies to transperineal methods, reducing infection risks. Treatments have similarly evolved, emphasizing active surveillance of low-risk cancers and minimally invasive focal therapies. These advancements have significantly reduced side effects and improved quality of life, even among older patients.

PSA after age 70: My personal approach

In my office, I frequently discuss PSA screening with patients who are over 70. If a patient remains active and healthy and we anticipate good life expectancy, I generally recommend that we continue regular PSA tests. However, the final decision always belongs to the patient, after we carefully weigh the pros and cons together.

If your doctor hasn’t initiated this conversation yet, it’s important for you to bring it up. And remember, regardless of age, promptly inform your health care provider about any new urinary symptoms or health concerns. Staying proactive gives you the best chance to maintain good health this year and next.

Source: Cnn.com | View original article

Biden diagnosed with rare cancer: Understanding the rarity of prostate cancer

Former US President Joe Biden has been reportedly diagnosed with an aggressive form of prostate cancer that has spread to his bones. While this type of diagnosis is rare, doctors believe it could still respond well to treatment. Only about 8% of prostate cancers are already advanced by the time they are diagnosed. Doctors believe Biden may have had undiagnosed prostate cancer for many years.

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CHENNAI: Former US President Joe Biden has been reportedly diagnosed with an aggressive form of prostate cancer that has spread to his bones. While this type of diagnosis is rare, doctors believe it could still respond well to treatment.

The diagnosis showed that a nodule was found on Biden’s prostate, which led to further tests and the cancer was confirmed. The current status shows that the cancerous cells have spread (metastasized) to his bones.

While the doctors are optimistic that treatment will be effective, especially hormone therapy, in Biden’s case, the nature of prostate cancer is quite rare.

Rarity of Biden’s Case

Most prostate cancers are found early during routine screenings. Only about 8% of prostate cancers are already advanced by the time they are diagnosed. Doctors believe Biden may have had undiagnosed prostate cancer for many years.

Prostate cancer is usually detected through blood tests (PSA tests) or rectal exams. However, screening is not routinely done for men in their 70s or 80s, since many older men die from other causes before prostate cancer becomes a serious issue. From 2012 to 2018, national guidelines in the US discouraged screening, which caused a decline in early detection and an increase in advanced cases.

But as people live longer, some doctors now support screening older, healthy men. Hence the US screening guidelines are now undergoing some changes.

In the past, more men were screened, leading to many low-risk cancers being treated unnecessarily. Screening is becoming more common again as doctors improve at identifying which cancers need treatment.

In the case of Biden, his 2024 physical exam did not mention a prostate cancer screening, which isn’t unusual for his age. His 2019 exam noted an enlarged prostate, but no cancer was diagnosed at that time.

Source: Newindianexpress.com | View original article

Biden’s cancer renews debate about prostate screenings for older men

Prostate cancer is the second most common cause of cancer deaths for men. Prostate cancer kills 35,000 a year. The American Cancer Society does not recommend routine testing for prostate cancer for men of any age. The U.S. Preventive Services Task Force, which makes medical recommendations about preventive services such as screenings, recommends against screening in men 70 years and older. For men ages 55 to 69, the decision should be an individual one, the task force says. The path ahead for Biden, 82, will probably involve the production of testosterone, which feeds the prostate cancer in the same way that estrogen is associated with breast cancer, a researcher says. It would not be unusual for a man Biden’s age to skip that kind of screening, according to prostate cancer experts who spoke to The Washington Post but were not involved with his treatment or diagnosis. The cancer has spread to his bones, an aggressive form that has a Gleason score of 9 on a scale that goes up to 10, meaning it is aggressive.

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Former president Joe Biden’s newly diagnosed prostate cancer, an aggressive form that has spread to his bones, has renewed the debate about who should receive annual screenings for signs of the disease. Prostate cancer, the second most common cause of cancer deaths for men, kills 35,000 a year. Sunday’s announcement of Biden’s illness incited unsubstantiated speculation online that the former president could have known long ago, perhaps through testing or symptoms, that he had cancer. His medical records as president do not indicate whether his blood tests included screening for prostate-specific antigen (PSA), which, when elevated, can indicate a higher risk of prostate cancer.

But it would not be unusual for a man Biden’s age to skip that kind of screening, according to prostate cancer experts who spoke to The Washington Post but were not involved with his treatment or diagnosis.

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“For most cancer screenings, there is an age when we say, no more screening,” said Michael Morris, head of the prostate cancer section at Memorial Sloan Kettering Cancer Center in New York City. “The majority of prostate cancers that are diagnosed are not the aggressive kind that we’ve been reading about [in the Biden stories]. Most prostate cancers are not a threat to a man’s longevity.”

The U.S. Preventive Services Task Force, which makes medical recommendations about preventive services such as screenings, recommends against screening in men 70 years and older. For men ages 55 to 69, the decision should be an individual one, it says.

The guidelines note that “many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction.”

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The American Cancer Society does not recommend routine testing for prostate cancer for men of any age. It recommends that men discuss screening with their provider at age 40 for those with more than one first-degree relative with prostate cancer at an early age; at age 45 for those at high risk, including African American men with a first-degree relative diagnosed at an early age; and age 50 for those at average risk.

However, the ACS says in its recommendations that “because prostate cancer often grows slowly, men without symptoms of prostate cancer who have less than a 10-year life expectancy should not be offered prostate cancer screening, because they aren’t likely to benefit from it.”

The organization emphasizes that “overall health status, and not age alone, is important when making decisions about screening.”

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The American Urological Association’s guidelines are the most aggressive. It recommends that screening be offered beginning at age 40 for men at high risk and that physicians offer regular screening every two to four years for people age 50 to 69. The guidelines do not mention recommendations for men 70 or older.

Phillip Koo, chief medical officer at the Prostate Cancer Foundation, said the risk-benefit analysis for screening has changed in recent years. The foundation recommends increased screening.

Koo said the number of treatment options has multiplied and the main treatment for early prostate cancer — removing the tumor — is now mostly done by laparoscopic or minimally invasive surgery, which involves only tiny incisions made by robots. For many patients, it can be an outpatient procedure.

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“The take-home message is patients can be their own biggest advocates and have the biggest impact on their lives by early detection and treatment,” Koo said.

Biden’s office said doctors detected a nodule on the former president’s prostate and microscopic analysis detected cancerous cells. His cancer received a Gleason score of 9 on a scale that goes up to 10, meaning it is aggressive. Further investigation revealed the cancer has spread to bone.

As part of his medical checkup while in office, President Barack Obama did have his PSA levels checked, which is consistent with screening guidelines that suggest African American men and their providers consider screening as early as age 40. Obama was 47 at the start of his presidency.

President Donald Trump had his PSA checked in April this year. It was normal.

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The path ahead for Biden, 82, will probably involve hormone therapy to block the production of testosterone, which feeds prostate cancer in the same way that estrogen is associated with breast cancer.

“It’s like a car — the engine making that car go is a molecular engine called the androgen receptor. And so testosterone is the gas for that engine, and PSA is the exhaust,” said Peter Nelson, a prostate cancer researcher at the Fred Hutchinson Cancer Center, which is affiliated with the University of Washington School of Medicine.

“Men get an injection of an ‘antihormone’ to lower testosterone to extremely low levels. We learned that does a great job initially, but some androgen is still around. So if you add a second drug that further blocks the gas tank, you can improve survival by several years,” Nelson said.

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The hormone therapy can extend a cancer patient’s life but typically includes significant side effects, such as fatigue, hot flashes, cognitive issues, weight gain, loss of libido, lower bone density and risk of fractures, oncologists told The Washington Post.

“The side effect of uncontrolled metastatic disease is much worse than hormonal therapy,” said Morris, the Memorial Sloan Kettering Cancer Center physician. “You die from uncontrolled metastatic disease, and hormone therapy prolongs life and prevents the onset of symptoms from metastatic disease,” including pain.

Otis Brawley, a Johns Hopkins University medical oncologist who treats patients with metastatic prostate cancer, said the hormone therapy can be psychologically difficult for patients.

“I see a lot of guys who struggle with those drugs. I know a lot of guys who refuse to take them because they don’t want these drugs to interfere with their nature,” Brawley said.

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But an older patient may find the therapy less jarring, Brawley said.

“The older guy has gotten a little bit better acclimated to the lower androgen, so lowering it a little bit more is going to be less of a side effect,” he said.

Several prostate cancer specialists, including William Dahut, chief scientific officer of the American Cancer Society, said the average life expectancy at diagnosis for someone with metastatic prostate cancer that has spread to the bone is in the range of three to five years, though some patients can live quite a bit longer.

Dahut said there are limited details about Biden’s case, and his prognosis could depend on many factors yet unknown.

That includes the degree of bone spread, any symptoms from bone lesions and whether the cancer has spread to organs such as Biden’s liver, Dahut said.

Another important factor will be the initial degree of response to hormonal therapy, he said.

Source: Washingtonpost.com | View original article

Source: https://www.uniondemocrat.com/lifestyle/article_c1fadc5f-18b1-4fc5-a443-8f1d4a180fb8.html

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