What To Know About Prostate Cancer

Former President Joseph Biden recently became one of the more than 300,000 Americans who are diagnosed with prostate cancer in the United States each year.

Columbia urologist Christopher B. Anderson, MD—whose specialties include cancers of the prostate, bladder, and kidneys—has extensive experience diagnosing and treating prostate cancer, as well as researching the effectiveness of different therapies. Dr. Anderson explains current approaches to prostate cancer diagnosis and treatment, and shares good news about advances in care.

What are prostate cancer symptoms, and when should someone call the doctor?

Most prostate cancers are detected before they produce any symptoms. In the United States, we screen for prostate cancer using a blood test called prostate specific antigen (PSA). This test allows us to find small prostate cancers before they become symptomatic.

Occasionally, when prostate cancers are very aggressive, they can cause symptoms, including bone pain, weight loss, or difficulty urinating, although this is uncommon.

How is prostate cancer diagnosed? And what is a Gleason score?

Prostate cancer is diagnosed with a prostate biopsy. During this procedure, a needle is inserted into the prostate, and small pieces of tissue are taken and analyzed by a pathologist who checks the samples for cancer.

If prostate cancer is present, it is graded according to the Gleason score. The Gleason score goes from 6 to 10, with 6 being the least aggressive and 10 being the most aggressive.

How common is the aggressive prostate cancer that former President Biden has been diagnosed with?

Former President Biden has a more aggressive type of prostate cancer, defined by a high Gleason grade (9) and evidence of metastasis (spreading) to the bone. Overall, of the more than 300,000 patients diagnosed with prostate cancer in the United States each year, less than 10% have disease that has spread to other parts of the body at the time of diagnosis.

What are the usual next steps after diagnosis?

The best test to get for men with newly diagnosed high-grade prostate cancer is a PSMA-PET scan, which helps identify the location of the prostate cancer throughout the body. This helps us stage the disease to determine which treatments are needed. If the scan confirms metastatic cancer (spread to other parts of the body), the primary treatment is hormonal medications, which suppress cancer growth.

Hormonal medications work two ways: They decrease testosterone production in the body, and they block testosterone from reaching cancer cells. Although these medications are not curative, they are effective at suppressing cancer growth and shrinking prostate tumors. Men with metastatic prostate cancer treated with these medications often live for 5-10 years on treatment.

For some patients with metastatic prostate cancer, treatment could include radiation therapy and chemotherapy.

Are there ways to lower the risk of prostate cancer?

There are no effective ways to lower prostate cancer risk. That said, the leading cause of death for men with prostate cancer is heart disease (because most men with prostate cancer do not die from prostate cancer). Therefore, we counsel all patients with known or suspected cancer on the importance of healthy lifestyle choices, including exercise, weight loss, smoking cessation, and eating a balanced diet.

Is there any good news or recent developments about prostate cancer screening or treatment that patients should be aware of?

Prostate cancer screening is an effective method for early detection that leads to a lower risk of cancer spread and death. We currently recommend healthy men in their 50-60s to be screened using the PSA test, and sometimes even men in their 40s if they are at particularly high risk.

One of the main advancements in treatment for prostate cancer is understanding which patients can safely be treated less aggressively. In fact, many patients with localized disease with lower Gleason grades can be managed with observation or other less-aggressive treatments that help preserve quality of life.

For patients with more aggressive cancers, we are continuously looking for methods to make surgical and radiation techniques safer, more effective, and easier to recover from. Finally, there are constant advancements in the medical treatments that we use for patients with metastatic disease, including more effective hormonal medications and novel targeted therapies.