Why it's tough to detect prostate cancer
Former US president
's health was a matter of intense focus while he was in office due to his episodes of forgetfulness and verbal slip-ups. But amid the speculation over his alleged cognitive decline, a far more serious illness was silently progressing inside his body.
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Biden, 82, was diagnosed with prostate cancer last week, and the disease has already metastasised to his bones. His condition has been characterised by a Gleason score of 9, near the top of the 6-10 scale used to grade prostate cancer severity.
'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.
Usual, But Unexpected
Delayed diagnosis, experts say, is common in people who skip regular health check-ups or overlook clear signs of the disease.
However, they add that late detection in someone as high-profile as Biden, who was president of the US until Jan this year and, therefore, was regularly monitored by a team of doctors, is unexpected and concerning.
While some have questioned whether Biden's cancer could have been detected earlier, experts stress that his doctors were likely following standard protocol. Specialists note that prostate cancer is usually easy to detect early through a simple blood test — Serum PSA (Prostate-Specific Antigen).
'Early detection is possible in 99% of cases through PSA testing,' said Dr Amrendra Pathak, senior urologist at Sir Ganga Ram Hospital, Delhi.
However, PSA screening isn't routinely recommended for men over 70, as the risk of overdiagnosis and unnecessary treatment may outweigh the benefits, according to reports on Medium, the online publishing platform.
Leading medical bodies — including the US Preventive Services Task Force and the National Comprehensive Cancer Network — recommend discontinuing routine PSA testing after a certain age, unless the patient is in exceptionally good health.
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Given Biden's age and prior treatment for an enlarged prostate, the absence of a PSA test during his 2024 physical appears to be in line with the guidelines.
A Tricky Customer
Even with regular screening, however, prostate cancer can evade early detection. In some cases, the disease is metastatic from the outset, leaving no window for early diagnosis. In others, it may progress rapidly between PSA tests or fail to trigger elevated PSA levels at all.
Studies also show that roughly 15% of men with prostate cancer may have normal PSA levels, especially since what is considered a 'normal' range increases with age.
Dr Manav Suryavanshi, senior consultant and head of the urology division at Amrita Institute of Medical Sciences, Faridabad added: 'PSA is a critical marker, and in men who are predisposed to prostate cancer — due to family history, genetic mutations like BRCA1/2, or ethnicity — stricter and more frequent screening protocols are essential.
In most clinical cases, if these protocols are followed rigorously, prostate cancer is usually detected at an early, localised stage where treatment is not only effective but also potentially curative.
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In early stages, when the disease is localised to the prostate, it can be cured by surgically removing the gland. But doctors say if it reaches a locally advanced stage, that is, if it spreads outside of the prostate gland into nearby tissues, multimodal therapy including surgery, radiotherapy, and hormonal treatment is required.
Prostate cancer in India is on the rise, with nearly five lakh new cases being reported every year, said Dr Harit Chaturvedi, chairman, Max Institute of Cancer Care. The burden is expected to rise further due to population growth, increasing life expectancy, and an aging male population in the country.
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