1 in 8 Men Will Face Prostate Cancer — Here’s How to Be Ready

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Last week, former President Joe Biden was diagnosed with an aggressive form of prostate cancer after doctors identified a new prostate nodule during an evaluation prompted by worsening urinary symptoms. According to a statement from his personal office, he received the diagnosis on Friday. The cancer was classified with a Gleason score of 9 (Grade Group 5), indicating a high-grade, fast-growing cancer. It has already spread to the bone, which means it is considered metastatic, requiring prompt and intensive treatment.

Prostate cancer is one of the most common cancers in men, especially as they age. While it can be a serious disease, many men diagnosed with prostate cancer do not die from it. Early detection and understanding your treatment options can make a big difference.

What Is Prostate Cancer?

The prostate is a small gland about the size of a walnut, located below the bladder and in front of the rectum. It plays a role in producing semen. Prostate cancer happens when cells in the prostate start to grow uncontrollably. Some prostate cancers grow slowly and may never cause harm, while others can grow and spread quickly.

How Common Is It?

Prostate cancer is the second most common cancer in men worldwide. In the United States, about one in eight men will be diagnosed with prostate cancer during their lifetime. It is more common in men over age 50, Black men and those with a family history of prostate cancer.

What Are the Symptoms?

Early prostate cancer often doesn’t cause symptoms. That’s why screening is important. When symptoms do appear, they may include the following:

• Difficulty starting or stopping urination
• Weak urine stream
• Frequent urination, especially at night
• Blood in urine or semen
• Painful urination or ejaculation
• Pain in the lower back, hips or pelvis

These symptoms can also be caused by noncancerous conditions like an enlarged prostate (BPH), so it’s important to talk to a doctor if you notice changes.

Screening and Early Detection

Prostate cancer screening usually involves a blood test called the prostate-specific antigen (PSA) and sometimes a digital rectal exam (DRE).

• PSA Test: This measures the level of PSA in your blood. Higher levels can be a sign of prostate cancer, but they can also be caused by other conditions.
• DRE: During this exam, a doctor feels the prostate through the rectum to check for lumps or abnormalities.

Screening doesn’t give a definite answer but helps determine whether more tests, like a biopsy, are needed. The decision to screen depends on age, health, risk factors and personal preferences. Most guidelines suggest discussing screening with a doctor starting at age 50 — or earlier if you’re at higher risk.

Diagnosing Prostate Cancer

If PSA levels are high or the DRE is abnormal, your doctor may recommend a prostate biopsy. This involves removing small samples of prostate tissue to check for cancer cells.

Understanding the Gleason Score

If cancer is found, one of the key things your doctor will discuss is the Gleason score. This score helps predict how aggressive the cancer is.

Here’s how it works:

• The Gleason score is based on how the cancer cells look under a microscope.
• Two patterns of cells are graded from 1 to 5, then added together.
• The most common pattern is listed first, then the second most common. For example, a score of 3 + 4 = 7.

A lower Gleason score (like 6) means the cancer is likely slow-growing. Higher scores (like 8, 9 or 10) suggest a more aggressive cancer that may need more urgent treatment.

Treatment Options

Treatment depends on how aggressive the cancer is and whether it has spread. The American Urologic Association (AUA) does not recommend routine PSA screening in men aged 70 years or older or any man with a less than 10- to 15-year life expectancy. However, options may include:

• Active surveillance: For low-risk cases, regular monitoring without immediate treatment.
• Surgery: Removing the prostate (prostatectomy).
• Radiation therapy: Targeted rays to kill cancer cells.
• Hormone therapy: Reducing testosterone to slow cancer growth.
• Chemotherapy: Often used if the cancer has spread beyond the prostate.

Your doctor will work with you to choose the best plan based on your Gleason score, PSA levels, health and preferences.