BBC News
Former U.S. President Joe Biden has been diagnosed with aggressive prostate cancer that has spread to his bones.
Biden received the news on Friday after seeing a doctor last week due to urinary symptoms.
Here’s what you need to know about prostate cancer and its treatment options.
What is prostate cancer?
Prostate cancer affects the tissues of the prostate, which is part of the male reproductive system and helps make semen. It is located between the penis and bladder.
According to the NHS, it usually develops slowly and is therefore often famous for years. This means that some people can live for decades without the need for treatment. But this also means that symptoms usually don't appear until the cancer has recovered.
Biden was diagnosed with urine symptoms, one of the most common signs of prostate cancer. That's because it is usually detected only if the prostate is large enough to be the urethra (the tube that connects the bladder to the penis).
These symptoms may include the need to urinate more frequently, as well as slow or weak urine flow.
Screening for prostate cancer is part of routine presidential health checks, according to Jeffrey Kuhlman, a former White House doctor for President Barack Obama.
According to the American Cancer Society, prostate cancer is the second leading cause of cancer death in men in the United States, second only to lung cancer.
According to the American Cancer Society’s forecast, there will be more than 300,000 new cases in the United States this year. About one in eight men will be diagnosed with prostate cancer in their lifetime.
Dr. Ryan Cleary, a urologist at MEDSTAR Health, told the BBC that while men in their 80s were diagnosed with prostate cancer, Biden's cancer grade and stage "was more advanced than most men encounter in diagnosis."
What is Gleason score?
His office said in a statement announcing the diagnosis that the former president's prostate cancer "has a 9-point characteristic."
The Gleason score is the most common method of the possibility of disease promotion and spreading - also known as metastatic carcinoma.
Specifically, it refers to the abnormal appearance of cancer cells in samples under a microscope. The scale ranges from six to ten, with a higher number, indicating that cancer is more aggressive.
The scale begins with six because it is calculated by combining the two most common cancer cell patterns found in patients. The minimum score assigned to cancer cells was three. That's why the lowest Gleason score for cancer diagnosis is six.
The Gleason scores of nine including Biden's mean it is a "advanced cancer." The cancer cells with nine ratings look very abnormal and may grow rapidly.
What is Biden's treatment choice?
As far as Biden is concerned, cancer is inherently aggressive and has spread across his bones.
The difference does limit treatment options, said Dr. Jamin Vinod Brahmbhatt, a urologist at Orlando Health Medicine Group.
He said that despite medical-based treatments such as chemotherapy, steroids and hormone therapy, none of them are “curable.”
“There are more medical options that can stabilize patients and control cancer, but it will never completely get rid of cancer.”
Biden's cancer is also considered hormone-sensitive, meaning that cancer uses hormones to grow or develop.
These types of cancer can be managed by drugs that block or reduce the amount of hormones in the body.
Dr. Brahmin said that while this “opened up Biden’s toolkit for treatment options,” it would take weeks or months to see his reaction.
Dr. Coulman said Biden could also choose "advanced disease clinical trials" that "complied with inclusion criteria."
Biden and his family are said to be reviewing treatment options.
What is his prognosis?
Biden's office said in a statement Sunday that cancer appears to be hormone-sensitive and "allows effective management."
The full details of the Biden case are still unclear. "Usually, after five years of metastatic prostate cancer, about one-third of patients are still alive," Dr. Cleary said.
The advanced stage of prostate cancer can limit a person's life span and lead to symptoms that make daily life more difficult.
Dr. Coulman described “10 to 15 years of function” when studying aggressive cancer treatments and said it is important to consider treatments that maintain Biden’s quality of life in the coming years.
"If you have any inspiration, check if you have symptoms," said Dr. Brahmbhatt.