Former US President Joe Biden Has “Grade Group 5” Prostate Cancer: Here’s What That Means

“Last week, President Joe Biden was seen for a new finding of a prostate nodule after experiencing increasing urinary symptoms. On Friday he was diagnosed with prostate cancer, characterized by a Gleason score of 9 (Grade Group 5) with metastasis to the bone,” reads the statement, per C-SPAN.

“While this represents a more aggressive form of the disease, the cancer appears to be hormone-sensitive which allows for effective management.”

What is prostate cancer?

Prostate cancer is a disease in which abnormal cells grow and divide uncontrollably in the prostate gland, a walnut-sized part of the male reproductive system that’s located just below the bladder and produces the fluid that makes up part of semen.

In Biden’s case, the cancer has also metastasized, meaning that abnormal cells have spread from the prostate gland to another part of the body. Bones are one of the most common sites for prostate cancer to spread to, but it also commonly spreads to the lymph nodes, liver, and lungs.

Many people don’t experience symptoms at all, but like Biden, they might experience urinary symptoms. These can include: difficulty starting to pee; an inconsistent flow; pain or burning while peeing; blood in the pee; and the bladder not fully emptying. Other symptoms can include painful ejaculation and blood in semen. 

The most common sign that prostate cancer has spread to the bone is bone pain that usually doesn’t go away with rest.

How common is prostate cancer?

Besides skin cancer, prostate cancer is the most common cancer diagnosed in men in the US, with around one in eight men developing the disease in their lifetime. While a family history of prostate cancer or being African American can increase the risk of developing the disease, according to the Centers for Disease Control and Prevention, the most common risk factor is age. 

“The older a man is, the greater the chance of getting prostate cancer,” the agency states. Biden is 82 years old; the rate of new prostate cancer cases in the 80-84 age group in 2021 (the most recent data from the US) was 514 per 100,000 men.

What is a Gleason score?

President Biden was also given a Gleason score, which, according to the National Cancer Institute (NCI), is “a way of describing prostate cancer based on how abnormal the cancer cells in a biopsy sample look under a microscope and how quickly they are likely to grow and spread.” In other words, it’s an indicator of how aggressive the cancer is, and so can be used to help plan how best to treat it, and what the likely outcome (known as prognosis) of the cancer will be.

“The Gleason score is calculated by adding together the two grades of cancer cells that make up the largest areas of the biopsied tissue sample,” explains the NCI. The lowest number each of those areas can be given is three, which results in a score that’s typically between 6 and 10.

The higher the score is, the more aggressive the cancer is considered to be. Biden’s cancer was given a Gleason score of 9, or Grade Group 5, which suggests that it’s on the more aggressive side and is likely to grow and spread – as has already happened.

Can this type of cancer be treated?

How treatment of prostate cancer is approached depends on multiple factors, including the stage and grade of the cancer, someone’s age and health, the likelihood that treatments will cure or help the cancer, and the patient’s own feelings about treatments and possible side effects.

Where prostate cancer has a high Gleason score and has already metastasized, treatment is likely to be based on controlling the spread of the cancer, not curing it. “In general, if cancer has spread to the bones, we don’t think it is considered a curable cancer,” Dr William Dahut, the Chief Scientific Officer at the American Cancer Society and a trained prostate cancer physician, told BBC News.

Treatments at this stage can include combinations of hormone therapy, chemotherapy, radiotherapy, targeted cancer drugs, and drugs like painkillers. They aren’t going to cure the cancer, but they can help to reduce someone’s symptoms and prolong their life.

The statement from Biden’s office says that the former president and his family “are reviewing treatment options with his physicians,” but given that the cancer appears to be hormone-sensitive, hormone therapies could be one possible avenue. In prostate cancer, the tumor relies on testosterone to grow, so this treatment works by blocking or lowering the amount of testosterone in the body.

What’s the prognosis like?

According to the American Cancer Society, the five-year relative survival rate for those with prostate cancer that hasn’t spread elsewhere is more than 99 percent. This means that, compared to those without this cancer, those with it are around 99 percent as likely to live at least five years after being diagnosed. This is the same for those who’ve been diagnosed with regional prostate cancer too, where the abnormal cells have spread nearby or to the lymph nodes.

However, in cases where the cancer has metastasized to the bones, lungs, or liver, the five-year relative survival rate is much lower, at 37 percent.

Still, it’s important to note that survival rates are an estimate rather than a guarantee. While Biden’s cancer is indicated to be particularly aggressive, thanks to treatments, “people can live many years with the diagnosis,” said Dahut.

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The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of qualified health providers with questions you may have regarding medical conditions.