Biden’s Cancer Has A High Gleason Score. Doctors Explain What That Means.

Over the weekend, President Joe Biden’s office announced that the former president has prostate cancer that has spread to his bones.

“On Friday he was diagnosed with prostate cancer, characterized by a Gleason score of 9 (Grade Group 5) with metastasis to the bone,” the official statement read.

The statement also categorized his diagnosis as “a more aggressive form of the disease” and noted that there are certain hormone-based treatments available.

Biden’s diagnosis sent shockwaves throughout the country and the world, along with people who have faced this diagnosis themselves.

One in eight people are diagnosed with prostate cancer in the United States, making it the most common type of cancer in men. There are treatments available, whether it’s caught early or in later stages, like Biden’s.

Below, doctors explain what Biden’s diagnosis means and what you should know about early detection.

A Gleason score applies exclusively to prostate cancer, and is used by doctors to measure how advanced it is.

“The Gleason score is one of the first measures that describes the appearance of the cancer under the microscope. And that’s a very strong indicator of how aggressive the prostate cancer is,” said Dr. Michael Leapman, clinical program leader of the prostate and urologic cancers program at Yale Cancer Center in Connecticut.

In the official statement, Biden’s office said he has a Gleason score of 9 and Grade Group of 5. Grade Group refers to the new way doctors measure one’s Gleason score, and Grade Group 5 is “the highest grade that we assign to prostate cancer,” Leapman said.

In the old Gleason system, which goes from 6 to 10, Biden’s Gleason score is a 9, which is “among the most aggressive types [of prostate cancer],” said Dr. Jason Efstathiou, a radiation oncologist at Mass General Brigham in Boston.

“And what does that mean? It means that it can grow quickly and it is more likely to spread,” Efstathiou explained.

“When prostate cancer has spread beyond the prostate, the most common sites are the lymph nodes and/or the bone, and when it’s spread in that manner, it’s called metastatic prostate cancer, and that makes it more serious and certainly harder to cure,” Efstathiou said. In Biden’s case, it has spread to the bones, according to the official statement.

Roughly 5-10% of prostate cancers are diagnosed after they have spread, Efstathiou noted. “Gleason 9 cancers are more likely than lower grade cancers to be metastatic at diagnosis or to spread later on,” Efstathiou said.

“Unfortunately, prostate cancer that has left the bones is not currently curable. We don’t have any cures for prostate cancer that has metastasized,” said Leapman.

While there isn’t currently a cure, there are other options to extend someone’s lifespan. “We do, fortunately, have very good treatments that can control and shrink prostate cancer that has metastasized for many, many years,” Leapman added.

Cancer research has grown in recent decades to allow for therapies and treatments for patients, said Dr. Nitim Yerram, the co-director of urologic oncology at the John Theurer Cancer Center at Hackensack University Medical Center in New Jersey.

The official statement from Biden’s office said that “the President and his family are reviewing treatment options with his physicians.”

And while no one other than Biden’s own care team knows his current treatment options, experts said there are a few common treatment routes for metastatic prostate cancer.

“Talking about patients that are initially diagnosed with prostate cancer that has spread beyond the prostate with metastatic prostate cancer, treatment typically includes a combination of therapies, but by far and away, the backbone is what’s called hormone therapy,” said Efstathiou.

“And what does hormone therapy do? It reduces testosterone and testosterone production, and can also block the action of testosterone — and testosterone is actually the fuel for prostate cancer, and so what these hormone therapies are doing are cutting off the fuel supply and starving the prostate cancer cells,” he explained.

Hormone therapy is usually combined with other therapies, he added. “So, while the backbone is hormonal therapy, in recent years, research and trials have shown that adding on other targeted therapies can improve survival and outcomes even further.”

Radiation therapy, chemotherapy and immunotherapy are examples of other targeted therapies that can help control symptoms and the disease, added Efstathiou.

“If you or a loved one is diagnosed with these more advanced prostate cancers … it’s important for them to know that they’re not alone, that there are many effective treatments, that research has been moving fast. In just the past two decades, there are well over a dozen new drug therapies specifically for metastatic prostate cancer,” he said.

“So while it’s serious, there is hope, and there certainly is progress as well.”

“We know that the the best thing we can do to reduce any man’s risk of dying from prostate cancer or developing metastatic prostate cancer is to find it early,” said Leapman.

The best way to do this is through PSA screening, which measures “a blood marker called PSA, which stands for prostate specific antigen, and if that level is elevated, that can be an indicator that there is prostate cancer,” Leapman noted.

The official guidelines recommend PSA screenings for men ages 55 to 69, but you should talk to your primary care doctor to see if PSA screening is right for you and at what age.

“Some of the guidelines would start that at at age 50, and some guidelines even recommend a baseline PSA level drawn between ages 45 to 49,” said Efstathiou.

Some folks are at higher risk of prostate cancer — Black men, those with a familial history and those with certain genetic mutations. For those people, PSA screening should “certainly be considered,” said Efstathiou.

In the official statement about Biden’s diagnosis, “increasing urinary symptoms” were mentioned. But it is often a symptomless cancer, said Yerram.

“Most men who are diagnosed with prostate cancer do not have symptoms because we’re catching things early,” said Leapman.

This is particularly true in its early stages, added Efstathiou.

This doesn’t mean there are never signs, though. “When [symptoms] do occur, it could manifest as urinary difficulties, like difficulty starting or stopping the urinary stream, more frequent urination, a weak stream,” Efstathiou said.

It may also present as blood in the urine or semen, he added.

When it comes to more advanced prostate cancer, sometimes — but not often — it could present with bone pain, weight loss or fatigue, said Efstathiou.

If you have any of these concerning symptoms, it’s important to talk to your doctor, Efstathiou said.

“Prostate cancer is not the one that typically spreads quickly, ” said Yeram. “So, [Biden] has had this for some amount of time, and I’m sure it was undiagnosed prior to what they recently recently released,” said Yerram.

Typically, routine PSA screening is not recommended for people over the age of 70, he added. “I suspect, given the president’s age, he may not have gotten routine PSA screening — I can’t speak to his care specifically, but I would say the chance of having aggressive prostate cancer while you’re getting routinely screened with a blood test of the PSA is extremely low,” Yeeram said. (This is why doctors typically recommend PSA screening, Yeeram added.)

“The time from cancer development to symptom onset can vary widely. Even aggressive prostate cancer can go quietly for months or even years before symptoms appear … in some cases, by the time symptoms develop, the disease has already spread. That’s why regular screening and early evaluation are essential, especially in men at higher risk,” Efstathiou said.

As mentioned above, higher-risk men include those with certain genetic mutations, Black men and those with a family history of the disease, added Efstathiou.

“It’s even possible for some advanced prostate cancers to present with low PSA and to develop very quickly,” noted Efstathiou.

“Certainly, Gleason 9 prostate cancers can grow more quickly, and have a greater ability and likelihood to spread and that can happen quickly — even though that timeline can vary quite a bit,” Efstathiou said.

“The one thing I really want to emphasize in the current climate, and this is the most important thing, is with federal funding being slashed for research, and the NIH being gutted, and all the other support that the government is slowly taking away, this is years in the making to be able to provide new therapies to help patients,” said Yerram. “And I’m sure [Biden] will be one to benefit from all that,” he said.

“I think it should make us all rethink what’s happening on an everyday basis in our country and really emphasize that it’s really the government that helps with the advancement of new therapies, and we should really, really advocate for such funding,” noted Yerram.