How do doctors deal with ‘aggressive’ prostate cancer like Joe Biden’s?

How do doctors deal with ‘aggressive’ prostate cancer like Joe Biden’s?

By Clara Moskowitz Edited by Dean Visser

Former President Joe Biden has been diagnosed with prostate cancer, his office announced on Sunday. The 82 -year -old has what is described as an “aggressive form” of cancer that has already extended to his bones. Although his illness is serious, there are promising treatment options, and Biden could live for years with the diagnosis.

What is a Gleason score and what does Biden mean?

Biden has a Gleason score, a reference classification of the gravity of prostate cancer, of 9 out of 10, revealed his office. This places it in a category called Gleason Grade Group 5. The numbers represent the proportion of prostate cells that seem malignant instead of normal under a microscope; A higher number represents a more serious and faster extension cancer. The Biden score suggests that a large part of its cells looks abnormal and that its cancer is relatively high at risk: “It has the most aggressive glason pattern,” says oncologist Marc B. Garnick, a professor of medicine at Harvard’s Faculty of Medicine and the Diacondés Medical Center of Beth Israel in Boston.

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In the case of Biden, the cancer has already become metastatic, which means that it has moved beyond its point of origin in the prostate and reached its bones. “Unfortunately, I would say that it is a very serious condition when prostate cancer extends outside the prostate and goes to distant places like The Bone,” says Peter Nelson, vice president of precision oncology at the Fred Hutchinson Cancer Center Children’s Cancer Consorcium. “Essentially, it is not a curable cancer.”

How serious is the situation depends on the details of the spread of cancer to the bones. “The critical question is: how many bone metastases does it have and what is the anatomical location of metastasis?” Garnick says. “This is a situation in which the devil is in the details.”

What are Biden treatment options?

It is likely that the treatment for the form of drum cancer, called prostate cancer sensitive to metastatic hormonal hormone, is what is known as double therapy, a combination of two medications that are directed to the production and activity of testosterone. This hormone is key to the situation because it feeds the growth of prostate cancer cells. Its active form, called dihydrotestosterone, interacts with a cell piece called androgen receiver. This receiver then tells the cell that proliferates and grows.

Biden could prescribe a medication like Leuprolide (LUPRON) or Renugolix, which turn off the signal in the brain that tells the testicles that testosterone. In addition, it will probably take a second drug, such as Apalutamide, Enzalutamide, Darolutamide or Abiraterone. These agents inhibit cell androgen receptors to block the action of testosterone.

Drugs, taken as a combination of injections and pills, can work together to reduce the prostate gland and bone lesions. If Biden responds well to treatment, you don’t need chemotherapy.

“I would say that it has more than 90 percent chance to respond to treatment and probably has at least several years of response to that therapy,” says Nelson. “The problem is: it is not a cure, and finally prostate cancer becomes resistant to that type of therapy.” This treatment can also lead to side effects such as the loss of muscle mass and strength, the deterioration of bone health and metabolic effects. “Testosterone is a very important hormone for men, so when you suppress it, you can have these side effects,” adds Nelson.

Even so, Biden’s prospects are much more promising than they would have been a decade ago, thanks to the advances in treatment research. “In the past, the median of the survival of someone who occurs with bone metastasis [from] Prostate cancer was two and a half years, “says Garnick.” Now we have patients who live five, 10 and 15 years due to the new available modalities. “

What else can doctors do?

In addition to prescribing hormonal therapy, Biden doctors will probably evaluate the former president’s tumor to see if he has any mutation in certain cancer genes that suggested specialized treatments.

For example, some prostate cancers end genetically related to other cancers such as breast cancer and ovary, through the presence of genes BRCA1 either BRCA2. “Those are genomic abnormalities that may exist that can increase the probability of prostate cancer,” says Garnick. If that is the case of Biden, you could receive specific medications, such as the Poly (ADP-Ribosa) polymerase, or PLP, inhibitors, which are directed to the type of prostate cancer it has.

How bad is prostate cancer in general?

Prostate cancer is among the most common forms of cancer in older men. He Estimates of the American Cancer Society There will be around 313,780 new diagnoses of the condition and 35,770 deaths attributed to it in the United States in 2025.

“It is not surprising that a man in his 60s has a diagnosis like this,[prostate cancer] It affects one in eight men in the United States, “says Nelson.” The ironic part is: Biden did a lot to emphasize the importance of biomedical research to address our cancer load. But it must benefit from this investment in making improvements in cancer understanding and how we can develop better therapies for it. ”

Biden’s successor, President Donald Trump, has changed the course since his second term began. Its administration has made significant cuts for funds for cancer research and has eliminated thousands of jobs in the Department of Health and Human Services, including hundreds of employees of the National Health Institutes, the largest financier in the world of cancer research. “My plea is not to turn the back to the tremendous progress that is being done,” says Nelson. “We still have a long way to go because we are not healing advanced prostate cancer, although we are extending the life of men. We still need large investments in biomedical research to develop true priests.”