What to know about prostate cancer after former President Joe Biden’s diagnosis

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

Biden’s office said the cancer was diagnosed after “increasing urinary symptoms” and that it has metastasized, spreading to his bones.

The statement added that the cancer is “hormone-sensitive,” which may allow for effective treatment options, which Biden and his family are reviewing.

Here’s what to know about prostate cancer including the signs and symptoms, how it is diagnosed and how it is treated.

What is prostate cancer?

Prostate cancer is the most common cancer — after skin cancer — diagnosed in American men, according to the American Cancer Society (ACS), the nation’s leading cancer advocacy organization.

The prostate is found below the bladder and in front of the rectum. Most prostate cancers develop from gland cells in the prostate, which make fluid that is added to semen, the ACS said.

Diagnosis rates have increased about 3% every year since 2014, according to ACS.

It’s estimated that about one in eight men will be diagnosed with prostate cancer in his lifetime.

ACS estimates that there will be about 313,780 cases of prostate cancer and about 35,770 prostate cancer deaths in 2025.

What are the signs and symptoms?

Early prostate cancer generally does not cause symptoms but, when symptoms do occur, they include problems with urination or blood in the urine or semen, according to ACS.

When prostate cancer is advanced, meaning it has grown larger or has metastasized, it can cause other problems including erectile dysfunction; weakness or numbness in the legs; loss of bladder or bowel control; weight loss; fatigue; or pain the ribs, hips or spine when the cancer has spread to the bones, ACS said.

Dr. Maha Hussain, a prostate cancer expert and the Genevieve Teuton professor of medicine in the division of hematology-oncology at Northwestern University Feinberg School of Medicine in Chicago, told ABC News it is more common for prostate cancer to be found through regular annual exams than because of symptom occurrence.

She added that many symptoms, such as frequent urination or difficulty passing urine, may not be due to prostate cancer but rather due to an enlarged prostate, which is common among older men.

How to screen for prostate cancer

Prostate cancer can often be found early through screening tests, which increases the odds of successful treatment.

ACS recommends men speak with their health care provider about the decision to screen and to have those discussions at age 40 or 45 for those at high risk and at age 50 for those at average risk.

One screening test involves a blood test that measures level of prostate-specific antigens (PSA), which are proteins made by cells in the prostate gland.

Although there is no cutoff level that clearly indicates the presence of cancer, the ACS said many doctors use a cutoff of four nanograms per milliliter to recommend further tests with a urologist.

Dr. Nitin Yerram, co-director of urologic oncology at the John Theurer Cancer Center at Hackensack University Medical Center in New Jersey, said although PSA testing is a good tool, there are some pitfalls as well.

“Using PSA screening is like using a sledgehammer to hammer a small nail, so it’s not very precise,” he told ABC News. “And PSA can be elevated for a variety of different reasons, whether it be inflammation, infection. Cancer is one of them, but [the test] doesn’t differentiate between all of those.”

He added, “That said, it is still a great tool, and it’s very important for men with an elevated PSA to get further work up to help determine why that’s elevated.”

Prostate cancer can also be tested for via digital rectal exam, which is when a physician inserts a gloved, lubricated finger into the rectum to feel for bumps or hard areas on the prostate that indicate cancer, according to ACS.

Patients may also undergo a prostate biopsy, which is when prostate cell samples are studied under a microscope to check for cancer.

The National Cancer Institute said prostate biopsies can be assigned a Gleason score to determine how likely the cancer is to grow and spread. The score is determined by “adding together the two grades of cancer cells that make up the largest areas of the biopsied tissue sample,” according to NCI.

The Gleason score usually ranges from six to 10 with higher scores indicating a stronger likelihood of progression. President Biden’s office said he received a Gleason score of nine.

What are the treatment options?

Treatment options for prostate cancer vary depending on what stage the cancer is in and how far it has spread.

“The good news is, nowadays, we have had significant improvement in the medical management of prostate cancer that has spread, and there’s been significant prolongation of life, and so there are all kinds of different treatment options available for these patients,” Hussain said.

For prostate cancers that are small or localized to the prostate, doctors may recommend observation or active surveillance to monitor if symptoms are changing or if the cancer is starting to grow.

Surgery and radiation therapy are the most common treatments for men who are classified as low or intermediate risk, experts told ABC News.

For men whose cancer is more advanced, chemotherapy or hormone therapy — the latter of which is also known as androgen deprivation therapy — are most common.

“Testosterone, we know, is a driver of prostate cancer, and obviously all men have testosterone,” Yerram said. “And so central to an anti-androgen therapy plan is really to reduce the levels of testosterone to as close to zero as possible to help stop progression of that prostate cancer and to provide treatment.”

“Specifically on President Biden, who obviously I’m not taking care of, but he has stage 4 cancer, so for him, anti-androgen therapy or chemotherapy will likely be first line for him,” Yerram added.

Experts said it is important for prostate cancer patients to follow up with their doctor after treatment to look for signs of cancer recurrence or treatment side effects.

What are the survival rates?

For localized or regional cancer, meaning the cancer is in the prostate or the cancer has spread to nearby structures, there is a five-year survival rate of more than 99%, according to ACS.

For For cancers that have spread to other parts of the body such as lungs, liver, or bone, the five-year survival rate is about 37%, ACS said.

Hussain said that although metastatic prostate cancer is not curable, it is very much treatable, and that survival rates have increased over the last three decades.

“We’ve really come a very, very long way in terms of how long patients are living,” Hussain said. “When I entered the field, let’s say 1990, the average longevity with metastatic prostate cancer, roughly, was about two-and-a-half years. Now. we have more than doubled that and … we have many men who are actually living even much longer in my practice over the years.”