Biden Suffering From Aggressive Prostate Cancer

[unicorn]

Wow. That story demonstrates another problem with screening. Obviously, it's not the test itself, but what one does with the results which determines the outcome. With a low PSA and a Gleason of 7, especially 3+4, the expected outcome is wildly different from a Gleason of 9. One has to wonder about the reason for the massive difference. Was the first pathologist just doing "CYA" (Cover Your Ass) because he wanted to force the patient into surgery? Did he genuinely lack the skill to interpret the biopsy? (pap smears are generally read by computers these days, so more reliable) More than likely, in this case active surveillance would have been a great option, as the outcome would probably have been fine in any case. The science is still out on genetic analysis. If the science proves robust, that may change outcomes (and subsequent changes in guideline recommendations), but that's speculation at this time. 

Most of the time, when men find out they have a cancer, the immediate reaction is "Get it out!", and the surgeon or radiation therapist is happy to oblige. Pathologists, as in this case, may push the scales further in the wrong direction, either through lack of skill or unscrupulous behavior. 

[lookin]

5 hours ago, unicorn said:

With a low PSA and a Gleason of 7, especially 3+4, the expected outcome is wildly different from a Gleason of 9. One has to wonder about the reason for the massive difference. Was the first pathologist just doing "CYA" (Cover Your Ass) because he wanted to force the patient into surgery? Did he genuinely lack the skill to interpret the biopsy?

The second pathology lab speculated that the first pathologist looked at the cells sliced through by the biopsy needles and decided they were very strange looking and gave them a Gleason score of 5.  The more experienced pathologist at the second lab looked at them and concluded they were Gleason 3 cells that had been sliced through by a biopsy needle.  I don't think anyone was trying to "force" the diagnosis.  They just had different levels of skill and experience.

5 hours ago, unicorn said:

Most of the time, when men find out they have a cancer, the immediate reaction is "Get it out!", and the surgeon or radiation therapist is happy to oblige. Pathologists, as in this case, may push the scales further in the wrong direction, either through lack of skill or unscrupulous behavior. 

The first doctor I saw was also a surgeon and his lab was the one that came up with the Gleason 9.  Neither was trying to "push the scales".  In fact, although he was a surgeon, his recommendation was for treatment with radiation.  He based it on my age and his belief that I would have more side effects from surgery than from radiation.  The second doctor, also a surgeon, said he looked at functional age rather than chronological age, and thought I'd be a good candidate for either surgery or radiation.  I chose surgery because I'd have radiation as a backup if the surgery didn't get all the cancer.  With radiation, surgery is not a backup if the radiation fails.  Hormone treatment is a backup if neither surgery nor radiation get all the cancer.

I apologize for going into all this detail.  My intention is to let folks know that prostate cancer does not always lend itself to generalizations.  There are a number of variables and they can be dealt with one by one.  Second opinions are valuable at every stage.  You are your own best advocate and, if that's difficult for you, try asking a friend or loved one to come along to your appointments with you.

In addition to President Biden's medical issues that he's dealing with, he's also had to put up with kibbitzers bloviating from the sidelines and reaching useless conclusions.  He's having a tough enough time and those who offer snide and uninformed comments are showing cruelty rather than compassion.

I'll bow out of this for now.  If anyone is going through any of this, please feel free to PM me if I can be of any help.

And thanks to the OP for starting this thread!  👍

[unicorn]

36 minutes ago, lookin said:

...although he was a surgeon, his recommendation was for treatment with radiation.  He based it on my age and his belief that I would have more side effects from surgery than from radiation.  The second doctor, also a surgeon, said he looked at functional age rather than chronological age, and thought I'd be a good candidate for either surgery or radiation.  I chose surgery because I'd have radiation as a backup if the surgery didn't get all the cancer...

I'm glad you had a good outcome. With modern technology, the advice regarding surgery vs radiation may have been out of date. Radiation now has better cure rates and fewer side-effects. The first surgeon may have had it right in that respect:

 

[khaolakguy]

46 minutes ago, lookin said:

I apologize for going into all this detail.  My intention is to let folks know that prostate cancer does not always lend itself to generalizations.

Don't apologise! Your personal experience has been illuminating and thank you for sharing. 

[Moses]

As of 2024-2025 data, ChatGPT:

[unicorn]

17 hours ago, Moses said:

As of 2024-2025 data, ChatGPT:

Well, since these data followed the patients for over 10 years, and new radiation techniques which protect the bladder and rectum have only been around 7-8 years, the data would tend to over-estimate the complication rates of radiation therapy. However, given the identical 5 and 10-year overall survival rates (i.e. those who survived regardless of cause of death), one has to ask whether the outcomes are any better or worse for those who chose surveillance (in other words, neither surgery nor radiation). Those studies tend to show surveillance as a wiser choice:

https://jamanetwork.com/journals/jamaoncology/article-abstract/2826069

(The abbreviation PCA means prostate cancer)

"...3946 participants had PCA, among whom 655 were treated with prostatectomy and 1056 with radiotherapy. The 12-year hazard risk of urinary or sexual complications was 7.23 times greater for those with prostatectomy (95% CI, 5.96-8.78; P < .001) and 2.76 times greater for radiotherapy... 

The incidence per 1000 person-years of any 1 of the 10 treatment-related complications was 124.26 for prostatectomy, 62.15 for radiotherapy, and 23.61 for untreated participants...

This cohort study found that, even after accounting for age-related symptoms and disease, PCA treatment was associated with higher rates of complications in the 12 years after treatment. Given the uncertain benefit of PCA treatment for most patients, these findings highlight the importance of patient counseling before PCA screening and treatment and provide a rationale for pursuing opportunities for cancer prevention...". 

Unfortunately, as this discussion clearly shows, adequate patient counseling and eduction both prior to obtaining consent for PSA screening, and after results are given, are more the exception than the rule. You earlier asked "How can a blood test lead to bad results?". Well, this is the answer.

[unicorn]

On 5/24/2025 at 4:47 AM, PeterRS said:

Oh! How typical! You make a statement which three major US cancer bodies reject - but you in your ivory tower believe they are wrong....

That statement is so incredibly both stupid and factually wrong, it hardly deserves comment, but here I go. As you know, I wasn't quoting my opinion, but rather consensus statements and professional guidelines which were put together by groups of health care experts (which you are definitely not) who read, digested, and spent large amounts discussing among themselves (none of which you did). It is you (and your family members, apparently) who have the arrogance and foolishness to believe you know better.