May 19, 2025

expert comments on prostate cancer – symptoms, diagnosis, and treatment

Scientists comment on the symptoms, diagnosis and treatment of prostate cancer, following Joe Biden’s diagnosis.

Prof Suneil Jain, Professor of Clinical Oncology, Queen’s University Belfast, said:

What is a late diagnosis of prostate cancer? How common is it to be diagnosed late/ when it has metastasized?

“Most commonly a late diagnosis of prostate cancer means that the cancer has spread beyond the prostate gland. In the UK, this is 15-20% of cases. Often, it means it has spread to other areas of the body, most commonly the bones or the lymph nodes, or sometimes to the lungs or the liver. Unfortunately, if the cancer has spread beyond the pelvis to other parts of the body, it often means the cancer is not curable, but it is important to note, it can be controlled for many years with improvements in therapy for prostate cancer. 

How does age factor into this?

“Prostate cancer is more common as men get older. The proportion of men who present with late stage prostate cancer is higher in older men. For instance, the National Prostate Cancer Audit has shown that 71% of men diagnosed with metastatic prostate cancer are aged 70 or older. 

Joe Biden’s cancer has been described as an aggressive type of prostate cancer. What does this mean?

“This generally means a prostate cancer that has spread, or could spread, and could, in time, threaten a man’s life. 

What does “characterized by a Gleason score of 9” mean?

“When a diagnostic biopsy is taken the pathology doctor looks at it under the microscope. They give the tumour a score, called the Gleason score, based on how aggressive it looks. The least aggressive prostate cancer is Gleason score 6, the most aggressive is Gleason score10. Anything scored 8 or higher is considered high risk. 

What are the symptoms of later stage prostate cancer?

“Some men get progressive urinary symptoms or erectile dysfunction. Others present with bone pain, fractures, weight loss or kidney failure. Some men actually have very few symptoms and the cancer is detected on a routine PSA test. 

PSA testing

“While we don’t have a formal screening programme, in the UK men have the right to discuss a PSA test with their GP. There are potential pros and cons to having a test done, so men need to be aware of this when they make a decision about whether to have one done. Some men elect to have a PSA done regularly, this is what we call a routine PSA test. The uptake and utilisation of PSA testing is quite variable in the UK. 

How is it treated?

“The treatment depends on how the patient is and what other health conditions they have. It also depends on what type of cancer it is and where it is in the body when diagnostic scans are performed. For late diagnosis prostate cancer, initial treatment will usually be with hormonal therapy. This is very effective, and most men will respond very well, with a reduction in cancer burden initially. In recent years there has been a lot of progress in the management of prostate cancer, with many new therapies becoming available. This has significantly extended the average life expectancy by a number of years. 

Would you like to comment on whether anyone outside Joe Biden’s direct team can comment on the specific situation and diagnosis?

“I think comments can only be generalised without the full clinical information. Every prostate cancer is different and no-one from outside his direct team will have all the information to be specific about President Biden’s specific diagnosis or situation.” 

References:

Dodkins, Joanna, Adrian Cook, Emily Mayne, Marina Parry, Julie Nossiter, Heather Payne, Thomas E. Cowling, et al. ‘Geographic, Socioeconomic and Demographic Inequalities in the Incidence of Metastatic Prostate Cancer at Time of Diagnosis in England: A Population-Based Evaluation’. BMJ Oncology 4, no. 1 (2025): e000643. https://doi.org/10.1136/bmjonc-2024-000643.

Ben Lamb, Consultant Urological and Robotic Surgeon, Barts Health and UCLH NHS Trusts, and Clinical Senior Lecturer, Barts Cancer Institute, Queen Mary University of London (QMUL), said:

“Most prostate cancer (around 4/5) in the UK is diagnosed before it is metastatic, with 1/5 diagnosed with metastatic disease. There is regional variation with the highest rates of diagnosis of metastatic disease in parts of Scotland, and the lowest in London and southeast of England. Late stage cancer can also include stage 3, where the cancer has broken out of the prostate, but not yet spread to other organs. Late diagnosis is linked to deprivation, ethnicity and older men.

“Diagnosis for most men is triggered by urinary symptoms causing them to seek help from their GP. In later stage disease, some men may have symptoms from metastatic disease, such as fatigue, bone pain or weight loss. Lymph node spread can cause blockage of the kidneys with renal failure and leg swelling. If the prostate tumour is large, it can cause bladder symptoms, though in most men in general, these are from benign enlargement of the prostate as men age.

“To diagnose, GPs will usually undertake a PSA test and refer to hospital care if it is elevated. Many men then get an MRI scan and if suspicious, they are recommended to have a prostate biopsy. Some men, particularly those with suspicion of metastatic disease may need other scans such as a bone scan, CT scan or PET scan to stage the disease (understand if there is spread from the prostate).

“An aggressive cancer means it is more likely to develop and spread, more likely to need treatment, and less likely to be cured by treatment.

“The Gleason score is a grading score given by pathologists to prostate biopsy samples under the microscope. It is strongly liked to the ‘aggressiveness’ of the cancer and the chance of dying of prostate cancer. The lowest score is 6 and the highest 10. We have recently shifted to using the ISUP grade group scoring, which goes from 1-5, and is easier to understand. Gleason 9 translates to ISUP grade group 5.

“Metastatic prostate cancer is primarily treated with hormone therapy. Prostate cancer depends on testosterone to grow, and by blocking testosterone production and action, the cancer can be effectively treated but not cured. Additional modern hormone drugs (known as ARTA’s) are given in addition, and these are known to prolong survival. Chemotherapy can also be given.”

Declared interests

None received.