An announcement on Sunday that former US President Joe Biden (82) has aggressive incurable prostate cancer has raised concern among the medical fraternity, with many asking how his disease could have been missed, and saying that it should have been detected earlier.
Responding to the statement, which said Biden had sought medical attention after experiencing urinary symptoms, and that the cancer has already metastasised to the bone, some doctors suggested the delay could be part of a wider “cover-up” of the ageing statesman’s health.
They questioned why his prostate cancer, which can be detected early using routine blood tests recommended for all men over 50, was not spotted earlier.
The Telegraph reports that on Monday, JD Vance, the US Vice-President, also raised concerns about why the public was kept in the dark about Biden’s health woes.
“I don’t think he was able to do a good job for the American people, and that’s not politics… that’s because I don’t think he was in good enough health,” said Vance.
“Why didn’t people have more accurate information about what he was actually dealing with? This is serious stuff.”
Biden, the oldest serving President in American history, was given a clear bill of health and deemed “fit to serve” by his doctor last February amid growing concerns over his age and claims of declining health.
Dr Kevin O’Connor had said there were “no new concerns” with the then President’s health.
The official statement said: “On Friday, he was diagnosed with prostate cancer, characterised by a Gleason score of 9 (Grade Group 5) with metastasis to the bone.”
Gleason score
Prostate cancers are graded for aggressiveness using the Gleason score. A score of nine suggests Biden’s cancer is among the most aggressive.
Metastasised cancer, when the disease spreads to other parts of the body, is much harder to treat than localised cancer because it can be hard for drugs to reach all the tumours and completely root out the disease.
“While this represents a more aggressive form of the disease, the cancer appears to be hormone-sensitive, which allows for effective management,” Biden’s office said. “The President and his family are reviewing treatment options with his physicians.”
Dr Howie Forman, a Professor of Radiology and Biomedical Imaging at Yale, who has worked in the US senate as a health policy fellow, said: “It is inconceivable that this was not being followed before he left the presidency.
“The prostate-specific antigen (PSA) test would have shown he had elevated levels of cancer cells for some time before this diagnosis,” he wrote on X. “And he must have had a PSA test numerous times before. This is odd.”
‘State-of-the-art care’
It is unclear whether the former President was screened for prostate cancer during his time in office, which means his aggressive form of the disease may have developed undetected.
Health bodies have warned that PSA testing is often unreliable, but other doctors have also queried how the cancer was missed.
Dr David Shusterman, a urologist, said: “It’s unusual to hear that someone has prostate cancer when they’re annually being followed up. The fact that we find it at a Gleason 9 is unheard of.”
Dr Stephen Quay, a physician and cancer expert, went further, saying it would be “malpractice” to not test for prostate cancer in a serving US President.
“It is highly likely he was carrying a diagnosis of prostate cancer throughout his White House tenure and the American people were uninformed,” he added.
Prostate cancers are generally slower growing than other forms of cancer and can take up to eight years to spread to other parts of the body, but some aggressive forms can spread quickly.
It is unclear whether or not Biden will receive surgery. Some patients get chemotherapy or radiation on top of hormone therapy.
Outcomes have improved in recent decades and patients can expect to live with metastatic prostate cancer for four or five years, said Dr Matthew Smith of Massachusetts General Brigham Cancer Centre.
“It is treatable, but not curable,” said Sophie Smith, a senior specialist nurse at Prostate Cancer UK. But treatments are “very effective” even if it has spread, she said, adding that men with advanced forms of prostate cancer can “easily live for five to 10 years”.
‘Aides shielded public from decline’
In February 2023, Biden had a lesion removed from his chest that was a basal cell carcinoma, a common form of skin cancer. In November 2021, he had a benign but potentially precancerous lesion removed from his colon.
In the wake of his new diagnosis, a resurfaced video from 2022 is being widely shared of Biden accidentally saying he had cancer, which sparked speculation surrounding his health at the time.
Delivering a speech on environmental pollution in Massachusetts, he said in the present tense: “That’s why I – and so damn many other people I grew up with – have cancer.”
His diagnosis comes just days after Original Sin, a new book based on the accounts of White House insiders, claimed that aides had shielded the public from the extent of his decline while he was serving as President.
Another doctor said Biden would have most likely had prostate cancer while he was President.
Dr Zeke Emanuel, who was appointed to the Covid-19 Advisory Board by Biden, said the condition would not have developed in the “last 100 days”.
“He had it while he was President,” he added. “He probably had it at the start of his presidency in 2021. Yes, I don’t think there’s any disagreement about that.”
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