Biden Suffering From Aggressive Prostate Cancer

[unicorn]

10 hours ago, PeterRS said:

This is so typical of @unicorn's aggressive and total misunderstood response in the thread about the Japanese farmer holding out against expansion at Narita airport in order to keep his farm. He quotes one study and assumes it is the only valid one. And there he is wrong. There are six doctors in my family. Every  one disagrees with @unicorn's dogmatic and aggressive responses.

That post is so preposterous it boggles the mind. First of all, I didn't quote a study, I referenced a consensus statement written by experts who have gone through all of the many studies which examined the issue. They would never issue a statement based on one study. If you'd bothered to examine the link (which you didn't), you'd have found the 43 papers the group reviewed before coming up the recommendations. Secondly, it wasn't just their statement, but every single other organization (AAFP, AUA, Canadian Task Force, etc.) which agrees that screening those over 70 is harmful. Even organizations whose members stand to profit $$ from this screening (i.e. the American Cancer Society and American Urological Association) agree. 

As for the six doctors in your family who also believe they're more knowledgeable than the worlds' experts, that only provides support for the old adage: the apple doesn't fall far from the tree.

As for the silly Japanese farmer argument, while I can't claim to have the world's experts behind me, I disproved every assertion made by those who thought the farmer was a hero rather than an idiot. If someone won't change his mind when new evidence gets presented, that only lends support to another adage: birds of a feather flock together.

 

[Moses]

41 minutes ago, unicorn said:

First of all, I didn't quote a study, I referenced a consensus statement written by experts who have gone through all of the many studies which examined the issue.

I did the same. But you ignored it.

And that was "consensus" dated by 2024. Screening is necessary - it saves life.

[PeterRS]

50 minutes ago, unicorn said:

1. That post is so preposterous it boggles the mind. First of all, I didn't quote a study, I referenced a consensus statement written by experts who have gone through all of the many studies which examined the issue. 

2. As for the six doctors in your family who also believe they're more knowledgeable than the worlds' experts, that only provides support for the old adage: the apple doesn't fall far from the tree.

3. As for the silly Japanese farmer argument, while I can't claim to have the world's experts behind me . . .

1. You clearly have no idea what the word study means. It can reference one or many investigations. And for your information, I do read extensively which you clearly do not.

2. No comment!

3. Silly? There is only one silly person in the debate you tried to encourage - but he is more than silly. He is preposterously, nauseatingly mind-blowingly idiotic in thinking that he knows better than another man. And that man is at the centre of the issue. Give it up! Your argument can never win against his.

[unicorn]

2 hours ago, Moses said:

I did the same. But you ignored it.

And that was "consensus" dated by 2024. Screening is necessary - it saves life.

No, you did not do the same: "...Adequate evidence from randomized clinical trials (RCTs) shows that PSA-based screening programs in men aged 55 to 69 years may prevent approximately 1.3 deaths from prostate cancer over approximately 13 years per 1000 men screened. Screening programs may also prevent approximately 3 cases of metastatic prostate cancer per 1000 men screened. Current results from screening trials show no reductions in all-cause mortality from screening...". But what can one expect from the forum's resident liar? Not everyone on this forum is a brilliant mind, but you're unique in your propensity to lie (as opposed to just spouting dumb stuff).

You are correct that I don't think that any of those consensus statements came out this year, and, since technology advances, there could be updates. If you know of any recent studies which contradict the current professional guidelines, please share with a link (though, knowing you, I will certainly go through any link you post, since you have a habit of stating that a source says one thing, when it actually says the opposite). So far, no one has posted any evidence which contradict these guidelines, unless you believe personal opinions constitute hard evidence (which apparently some people on this forum do in fact believe). I'm doubtful that such evidence exists, since it would be so ground-breaking that it would make international news everywhere. However, I'm all ears.

[unicorn]

2 hours ago, PeterRS said:

1. You clearly have no idea what the word study means. And for your information, I do read extensively which you clearly do not.

A consensus statement (or professional guideline) is different from a scientific study. By definition (quite different, in fact). However, consensus statements are made by evaluating scientific studies--lots of studies. And if you've read extensively about this subject and know of even one (or, preferably, more than one) study which was somehow overlooked by the experts on the subject, why not share with everyone, instead of pretending to be such a smart-ass (with nothing but the opinions of his relatives to back him up)? Or will you fess up to lying about having read "extensively" on this subject? (And, no, polling your relatives doesn't constitute a valid scientific study)

[Moses]

13 minutes ago, unicorn said:

But what can one expect from the forum's resident liar? Not everyone on this forum is a brilliant mind, but you're unique in your propensity to lie (as opposed to just spouting dumb stuff).

Well. I suppose it wasn't very easy for you to admit to such unsightly features of your character.

[Riobard]

Outside of the meta-communication tone, mostly valueless, in which forum opinion is expressed, the opinion divide here is not so unbridgeable in that one must consider that for some the screening leans to being essential for them in spite of some guidance entities putting forward the recommendation of non-screening. Such entities are not indicating that it’s essentialist that screening be assiduously avoided as opposed to discretionary even to the extent that testing deviates from the recommended guidance. They are referring to overall population benefit while also aware of epidemiological data regarding incidence and prevalence of disease occurrence, morbidity, and mortality.

There are extant examples of clinical guidance that come across as much more rigid and dogmatic. For example, try to get a refill of HIV PrEP without a venipuncture lab test following a period of time in which you engaged in no activity for which PrEP is indicated and consumed none of the previous supply. I would think that disease transmissibility combined with personal vulnerability to undiagnosed disease and disease exacerbated by the inadequate antiretroviral uptake that characterizes PrEP come into play. That said, I am tasked with the aggravation of accepting this apparent rigidity with equanimity because while my personal circumstances appear to place me above the requirement the overall population benefit of required testing for eligibility of PrEP access the barrier imposed has considered multiple factors, like PSA guidance entities have done without an absolute manifest hurdle.

What characterizes disagreement in the clinical guidance domain is that they are less at each others’ throats and tend to acknowledge the challenge of constructing definitive recommendations based on the data at hand. All sides include elaboration of the material they reference. There is no absence of common ground. However, discretion is often an artefact of uncertainly, is tantamount to equivocating. That leads to more heated splits in opinion within the general population rank and file.

Guidance can be thou shall or shall not in certain contexts. Not so with PSA screening. The discussion launched with questions about prostate cancer screening for an old man who may have benefited from code blue paddles at the podium a year ago.

Also, the adage that two things can be simultaneously true, as exemplified in the clinical literature. The number of lives saved by PSA screening is not indisputably zero and the overall population offset, by standard denominator, of PCa mortality conferred by screening is small enough to tip the guidance away from widespread application.

[vinapu]

glad you guys have fun but said that it's at Pres. Binden expense 

[Keithambrose]

8 hours ago, Riobard said:

Outside of the meta-communication tone, mostly valueless, in which forum opinion is expressed, the opinion divide here is not so unbridgeable in that one must consider that for some the screening leans to being essential for them in spite of some guidance entities putting forward the recommendation of non-screening. Such entities are not indicating that it’s essentialist that screening be assiduously avoided as opposed to discretionary even to the extent that testing deviates from the recommended guidance. They are referring to overall population benefit while also aware of epidemiological data regarding incidence and prevalence of disease occurrence, morbidity, and mortality.

There are extant examples of clinical guidance that come across as much more rigid and dogmatic. For example, try to get a refill of HIV PrEP without a venipuncture lab test following a period of time in which you engaged in no activity for which PrEP is indicated and consumed none of the previous supply. I would think that disease transmissibility combined with personal vulnerability to undiagnosed disease and disease exacerbated by the inadequate antiretroviral uptake that characterizes PrEP come into play. That said, I am tasked with the aggravation of accepting this apparent rigidity with equanimity because while my personal circumstances appear to place me above the requirement the overall population benefit of required testing for eligibility of PrEP access the barrier imposed has considered multiple factors, like PSA guidance entities have done without an absolute manifest hurdle.

What characterizes disagreement in the clinical guidance domain is that they are less at each others’ throats and tend to acknowledge the challenge of constructing definitive recommendations based on the data at hand. All sides include elaboration of the material they reference. There is no absence of common ground. However, discretion is often an artefact of uncertainly, is tantamount to equivocating. That leads to more heated splits in opinion within the general population rank and file.

Guidance can be thou shall or shall not in certain contexts. Not so with PSA screening. The discussion launched with questions about prostate cancer screening for an old man who may have benefited from code blue paddles at the podium a year ago.

Also, the adage that two things can be simultaneously true, as exemplified in the clinical literature. The number of lives saved by PSA screening is not indisputably zero and the overall population offset, by standard denominator, of PCa mortality conferred by screening is small enough to tip the guidance away from widespread application.

Interesting,  but I would like to know the original language in which this article  was written?

[Riobard]

1 hour ago, Keithambrose said:

Interesting,  but I would like to know the original language in which this article  was written?

A response that would be deemed unnecessarily aggressive but for the reality that you cannot restrain yourself. Cheap gets cheap laughs. Sad case. 

… Academic English. I haven’t been asked to alter writing style in published work because manuscript peer review, either side of that endeavour wherein I’ve been subject to review or expected to review, is a process that is vetted to exclude the obnoxious.

I think that in your case you often only have something to say because you have a pressing need to be part of something. But you can shut it and still belong. Try it. Because otherwise who has trapped you here? Who hurt you?

[Riobard]

On 5/19/2025 at 5:47 PM, Keithambrose said:

I'm glad to know that a recommendation  from a leading cancer hospital in the US is only an opinion. Very reassuring.  

This is not a very bright or useful comment and it conveys that you can only lazily skim the surface of what is not so very complex a topic. 

A recommendation is, de facto, an opinion. Clearly your choice of language “only an opinion” was intended to sarcastically devalue the content of another poster, with whom you have a bone to pick, whose entries were no less supported by evidence than that of a reputable cherry-picked facility that you name dropped as if it rendered said poster’s perspective inferior.

Every bit of the stratified by age PSA screening guidance is accompanied by a grade of strength of clinical evidence and a grade of strength of recommendation. There is nothing about it that is not opinion and accompanied by the imperative of flexibility.

That your clinician recommended an MRI was an opinion. The only certainty was that there could be more info to augment an opinion about whether the PSA value denoted malignancy.

Your pressing need to have singled out your case experience as if it truly contradicted the prevailing established guidance is fraught comparatively with zero evidence as well as zero strength of application to the recommendation agenda. 

Your desire to butt heads was the only message that came through.

Decentre. 

[PeterRS]

12 hours ago, unicorn said:

A consensus statement (or professional guideline) is different from a scientific study. By definition (quite different, in fact). However, consensus statements are made by evaluating scientific studies--lots of studies. And if you've read extensively about this subject and know of even one (or, preferably, more than one) study which was somehow overlooked by the experts on the subject, why not share with everyone, instead of pretending to be such a smart-ass (with nothing but the opinions of his relatives to back him up)? Or will you fess up to lying about having read "extensively" on this subject? (And, no, polling your relatives doesn't constitute a valid scientific study)

Such a pathetically childish and ridiculous statement is not worthy of comment by anyone on this forum.

[PeterRS]

15 hours ago, unicorn said:

As for the silly Japanese farmer argument, while I can't claim to have the world's experts behind me, I disproved every assertion made by those who thought the farmer was a hero rather than an idiot. If someone won't change his mind when new evidence gets presented, that only lends support to another adage: birds of a feather flock together.

What absolute nonsense! You considently and totally wrongly trash those who have lived and worked in Japan - and even gone to school in Japan - you either have zero idea or totally reject what this subject is all about. So you should just shut up and pay more attention to those who do. Otherwise you continue to look a fool!

[Keithambrose]

7 hours ago, Riobard said:

This is not a very bright or useful comment and it conveys that you can only lazily skim the surface of what is not so very complex a topic. 

A recommendation is, de facto, an opinion. Clearly your choice of language “only an opinion” was intended to sarcastically devalue the content of another poster, with whom you have a bone to pick, whose entries were no less supported by evidence than that of a reputable cherry-picked facility that you name dropped as if it rendered said poster’s perspective inferior.

Every bit of the stratified by age PSA screening guidance is accompanied by a grade of strength of clinical evidence and a grade of strength of recommendation. There is nothing about it that is not opinion and accompanied by the imperative of flexibility.

That your clinician recommended an MRI was an opinion. The only certainty was that there could be more info to augment an opinion about whether the PSA value denoted malignancy.

Your pressing need to have singled out your case experience as if it truly contradicted the prevailing established guidance is fraught comparatively with zero evidence as well as zero strength of application to the recommendation agenda. 

Your desire to butt heads was the only message that came through.

Decentre. 

Yawn, yawn.....

[Riobard]

4 hours ago, Keithambrose said:

Yawn, yawn.....

Believe me, you took that out of my mouth. 

Translation: “I’m compellingly interesting by having mic dropped Johns Hopkins … why couldn’t my contrarian input on the PSA topic have been more recognized by other than the non-credentialed? All it takes for me to dismiss what I realize reflects expertise is that what becomes too much for me could only have been boring. Raspberries”. 

[unicorn]

On 5/21/2025 at 3:59 PM, unicorn said:

... And if you've read extensively about this subject and know of even one (or, preferably, more than one) study which was somehow overlooked by the experts on the subject, why not share with everyone, instead of pretending to be such a smart-ass (with nothing but the opinions of his relatives to back him up)? Or will you fess up to lying about having read "extensively" on this subject? ...

13 hours ago, PeterRS said:

Such a pathetically childish and ridiculous statement is not worthy of comment by anyone on this forum.

No surprise. No facts to backup your BS statement. Was anyone taking any bets?

 

[Keithambrose]

7 hours ago, Riobard said:

Believe me, you took that out of my mouth. 

Translation: “I’m compellingly interesting by having mic dropped Johns Hopkins … why couldn’t my contrarian input on the PSA topic have been more recognized by other than the non-credentialed? All it takes for me to dismiss what I realize reflects expertise is that what becomes too much for me could only have been boring. Raspberries”. 

I continue to wonder what language this is?

[PeterRS]

There is - finally - one interesting and believable article in today's CNN website -

GIVEN BIDEN'S DIAGNOSIS, WHAT A UROLOGIST WANTS YOU TO KNOW ABOUT PROSTATE SCREENING 

- which of course is what this thread is actually about. 

The writer confirms that Biden had not undergone a PSA test since 2014. He accepts that the PSA test is not  one to bank on, but only because there is controversy about how the results are interpreted. He mentions the shifts in thinking in 2012 (against PSA testing) and again in 2018 (new research leading to greater emphasis on PSA testing partly resulting from the rising concern about more aggressive cancers, especially in groups that are younger that the previously suggested 55-69 year olds.)

He mentions that the US Preventative Task Force, the Amercan Cancer Society and the American Urological Association each offer slightly different interpretations on prostate cancer screening guidelines. Funny how this does not accord with @unicorn's adamant assertion! The writer says he generally follows the AUA guidelines. He starts testing at 40 for those with higher risk. For others, he typically initiates cancer screening "at age 50".

He stresses that with men living longer, there is a need constantly to review guidelines on all health issues. He points out that colon cancer screening now typically starts at age 45 whereas until recently it was age 50.  

Finally he adds, "In my office, I frequently discuss PSA screening with patients who are over 70. If a patient remains active and healthy and we anticipate good life expectancy, I generally recommend that we continue regular PSA tests. However, the final decision always belongs to the patient, after we carefully weigh the pros and cons together."

https://edition.cnn.com/2025/05/22/health/prostrate-screening-psa-wellness

[unicorn]

12 hours ago, PeterRS said:

...In my office, I frequently discuss PSA screening with patients who are over 70. If a patient remains active and healthy and we anticipate good life expectancy, I generally recommend that we continue regular PSA tests...

Well, all public health experts and professional organizations have guidelines which state that PSA screening in those 70+ is harmful, and should not be offered (see above), much less "generally recommended." Such behavior is, therefore, by definition unprofessional. While there's nothing wrong with a discussion, the fact that the writer states he "generally recommends" the test is de facto proof that these discussions contain misinformation. The vast majority of men over 70 have prostate cancer, few of which will ever affect the life of that person (and probably most of these cancers even regress).  Checking PSA in one's 70s or 80s is like playing Russian Roulette with a bullet in all spots except one. You're going to get burned most of the time.

Neither that speaker, nor, much less, the poster of this post, has any data to backup the (incorrect) contention that testing in the 70s (or beyond) is helpful for the man being tested. Just because you can name someone (such as the Secretary of Health and Human Services) who agrees with you does not entail a shred of evidence that your false beliefs are correct.

This is all just more BS, without a shred of scientific fact. It's all a bunch of "someone agrees with me" rather than "Here's some data to support my belief." The only "support" you offer for your belief is testimonials, rather than fact.  It's all rather childish. So RFK, Jr. thinks vaccines are harmful. Where's the evidence? And what's your excuse? Do you have a worm in your brain?

[PeterRS]

10 hours ago, unicorn said:

Well, all public health experts and professional organizations have guidelines which state that PSA screening in those 70+ is harmful, and should not be offered (see above), much less "generally recommended." Such behavior is, therefore, by definition unprofessional. While there's nothing wrong with a discussion, the fact that the writer states he "generally recommends" the test is de facto proof that these discussions contain misinformation.

Oh! How typical! You make a statement which three major US cancer bodies reject - but you in your ivory tower believe they are wrong. Only you are right! And you seriously expect to be taken seriously? Hahaha!

[Guest Raposa]

On 5/22/2025 at 6:54 AM, Riobard said:

A response that would be deemed unnecessarily aggressive but for the reality that you cannot restrain yourself. Cheap gets cheap laughs. Sad case. 

… Academic English. I haven’t been asked to alter writing style in published work because manuscript peer review, either side of that endeavour wherein I’ve been subject to review or expected to review, is a process that is vetted to exclude the obnoxious.

I think that in your case you often only have something to say because you have a pressing need to be part of something. But you can shut it and still belong. Try it. Because otherwise who has trapped you here? Who hurt you?

I do enjoy your use of the English language, but it can be discussed whether such a language style frequently used is appropriate for a forum such as this. 

I am reminded of the occasional language used by V in V for Vendetta:

“The only verdict is vengeance; a vendetta, held as a votive not in vain, for the value and veracity of such shall one day vindicate the vigilant and the virtuous. Verily this vichyssoise of verbiage veers most verbose, so let me simply add that it’s my very good honour to meet you and you may call me V.”

― Alan Moore, V for Vendetta

[Guest Raposa]

Deleted

Edited May 24 by Raposa
Useless post

[lookin]

I feel sorry for President Biden to have to go through all of this and I'm hopeful that the hormone treatments will effectively manage his cancer for the rest of his life.  He'll have good doctors who know the latest options.

I had a PSA test when I was 62 and it was in the normal range.  For the next twelve years, my doctor would give me a digital rectal exam at my annual physical except for one year when she missed.  I was out in the parking lot when I realized it and almost walked back in to remind her, but I decided to wait another year.

The next year she found a lump on my prostate and sent me for a biopsy.  It came back with a Gleason 9 score, the same score Biden got and the highest one there is.  I also got a PSA test which came back within the normal range.  I wanted to learn everything I could about this unusual form of prostate cancer and I was lucky to join a terrific support group and learn about some other tests I could do.

I had the biopsy sample genetically tested and found I had an aggressive fast-growing cancer, but one that did not create a high PSA.  I also had a CT scan that told me the cancer had not yet metastasized outside the prostate wall, but that it was about to.

My support group recommended one of the best surgeons in the area and he wanted his hospital to check the biopsy results and, using the same biopsy samples, they came back with a Gleason score of 7.

So how about that?  An aggressive fast-growing form of prostate cancer, that a PSA test wouldn't have picked up, that generated two different Gleason scores, and that a digital rectal exam found just in time.

I decided on surgery, one where they check to make sure the walls are clear of cancer cells and, if they're not, they go back in and cut a little wider.  The surgeon also took out twenty-three nearby lymph nodes, just in case some cancer cells had escaped from the prostate and were in circulation.  The lymph nodes all came back clear.

That was seven years ago and I get an ultra-sensitive PSA test twice a year.  Knock on wood, they've been coming back undetectable.

I'm writing all this to let my esteemed fellow-posters know that there's more than one kind of prostate cancer and that generalities don't cover them all.  I think each of us is his own best advocate and should do the level of screening and testing he feels is right for him.  If you decide to do little or no testing, the odds are likely to be in your favor.  If you decide to go for a higher level of surveillance, don't let anybody talk you out of it.

President Biden and I are both lucky to have access to good medical care and I hope that others will have access to the knowledge and support they need to take good care of themselves.

[unicorn]

While one cannot, of course, come to any conclusions from a single case, @lookin's post demonstrates one of the problems with PSA screening. Some of the more aggressive cancers won't produce PSA, while harmless ones will. Another problem is interpretation of the biopsy results. A Gleason score of 9 is highly alarming and would warrant aggressive treatment. A Gleason score of 7 indicates a possibly harmless cancer, for which active surveillance would be an option. Which was correct? Any pathologist would know that giving a score of 9 would prompt aggressive treatment, while a 7 might not. I'm happy there was a good end-result for the poster. 

[lookin]

6 minutes ago, unicorn said:

Another problem is interpretation of the biopsy results. A Gleason score of 9 is highly alarming and would warrant aggressive treatment. A Gleason score of 7 indicates a possibly harmless cancer, for which active surveillance would be an option. Which was correct?

It turns out the second test from my surgeon's lab was the correct one.  When my prostate was removed, they looked at the entire prostate - rather than just the biopsy samples - and confirmed the Gleason score of 7.  My surgeon's lab concluded that the first lab had misinterpreted the "worst" of the cells they were looking at.  After looking at the entire prostate, rather than the biopsy samples, my surgeon's lab further concluded that the Gleason score of 7 was a 3+4 which was better than the 4+3 they had read from the samples.  As you say, that could have led to a period of 'watchful waiting'.  The deciding factor for me, however, was the genetic analysis that showed an aggressive form of cancer that would have spread quickly had it escaped the prostate.  I lost no time getting the surgery.

I realize this is only one case of many but I decided early on that I was going to learn everything I could about the specific form of cancer that I had.  I was blessed to be surrounded by very knowledgeable support group members, in the hands of an excellent surgical team, and covered by good insurance.