First, my sympathies for the Biden family. I’ve been there.
Now, here’s my puzzlement. Prostate cancer is notoriously slow-growing. Although prostate cancer is the second-leading cause of cancer deaths among men (second to only lung cancer), that’s not because it’s so deadly, but because it’s so common. It’s a fact that more men die with prostate cancer than of it.
Of those who die, the typical mechanism of death is by the cancer cells metastasizing to other organs and/or to the bones. It takes years for that to happen – typically something like 5-10 years even without treatment, and even longer with treatment.
Even after the metastasizing occurs, death is usually half a dozen years away or more. After all, the cancer cells are still slow-growing prostate cancer cells, even though they’re now in a new home in another organ or in the bones.
The usual treatment for prostate cancer is to remove the prostate gland, a walnut-sized gland “down there” whose main function is to provide the ejaculate that is the vehicle for sperm cells produced in the testicles. After a prostatectomy, a man can still have an orgasm, and it’s a much tidier affair. The surgery is usually done with what’s often called a “robot” but, in reality, is a human-operated arthroscopic system that utilizes fine motor controls and a viewing system.
An alternative treatment that is often elected is radiation treatment. The prostate is irradiated five times a week for about six weeks. In one of nature’s happy coincidences, prostate cancer cells are more vulnerable to radiation than normal cells. The intended result is for the prostate cancer cells to die (or, more accurately, be sufficiently damaged that they cannot reproduce) while the other cells survive.
In practice, the radiation damages other cells to some extent, which sometimes inconveniences the patient with regard to, for example, urinary and sexual functions.
Neither approach is thought to directly impact a man’s cognitive function. But it should be mentioned that prostate cancer is a disease of older men. Radiation five times a week for six weeks has an effect on older men, even when the radiation is all below the waist. And being under anesthetic for four hours for a prostatectomy is not trivial trauma for a 75-year-old man.
Both treatments are effective, but recurrences are common. A prostatectomy tends to leave at least a few viable cancer cells behind in the prostate “bed” from which the prostate gland is removed. Radiation treatment, too, is known not to kill all the prostate cancer cells. The hope is that it kills enough of them that the man dies of something else before the remaining ones regroup and reproduce.
If the cancer has spread beyond the prostate – i.e., it has metastasized – then all bets are off. Neither a prostatectomy nor radiation treatment are directed toward anything other than the prostate gland.
The announcement from the Bidens is that he has “an aggressive form” of prostate cancer which has metastasized to his bones. The particular bones are not specified, but the hips and pelvis are the most likely. Nor is it specified to what extent the bone metastasis has taken place.
In advanced stages, metastasizing will spread to many bones. The common symptom is worsening bone pain, a deep, achy, persistent and ultimately agonizing sensation.
Prostate cancer is usually detected long before any symptoms are noticeable. A routine blood test, which is part of every older man’s annual physical, measures a compound called “prostate specific antigen” or PSA.
Elevated levels of PSA suggest, but do not prove, prostate cancer. The doctor typically orders up further tests to confirm the suspicions. The ultimate confirming test is a biopsy.
Here’s my puzzlement. How is it that Biden’s first inkling that he has prostate cancer is when it has metastasized to his bones, given that metastasizing takes years and he presumably has been getting PSA tests at least annually?
My guess is that the Bidens have known of his cancer for a long time. It’s quite possible – nay, it’s likely – that he has undergone radiation treatment for it. (Prostatectomy treatment appears out of the question, because reports are that a nodule was discovered on his prostate; so it’s still there.)
The radiation treatment appears to have ultimately failed, as it not infrequently does. When the cancer became detectable again, it would have produced elevated PSA levels. By the time it was metastasizing, those levels would be very high.
Again, this does not happen in a matter of weeks or months, but years. It’s inconceivable that the Bidens were unaware of this cancer last November.








