Will former President Biden seize a ‘teachable moment’ to raise public awareness of prostate cancer?

Interview with Dr. Peter Carroll

By Howard Wolinsky

President Biden says he ran for president in part to re-ignite the Cancer Moonshot campaign 2022 and to “change cancer forever.”

Facting a person battle against cancer--again because he had skin cancer and his son Beau died from a recurrence of barin cancer--he has an opportunity for a “teachable moment” to inform the Amertican public and also the global public about PCa, a cancer that is reaching “tsunami proportions,” with the biggest growth being in advanced cancers like the Gleason 9 {Grade Group 5), which was diagnosed in the ex-president last Friday.

Biden’s office has released dribs and drabs of information about Biden’s case, making it impossible for experts to get the full picture of what happened in the Biden case.

First, on May 14, it announced a “small nodule” had been found in Biden’s prostate that could be cancer—or not.

Then, four days later, on May 18, the Biden team confirmed that he had a Gleason 9 (Grade Group 5) that had metastasized into the bone.

Conspicuously absent? What was his last PSA and PSA history? Was Biden’s office unaware of the significance of that figure in predicting tha likely prognosis was?

Not surprsingly, this unleashed wild speculation and also conspiracy theories about whether Biden had prostate cancer while in the White House (he probably did) and also claims of cover-up and conspiracy that an ambitious (and elderly) President and First Lady wanted four more years in the White House, whatever the cost (can’t say, but that would be a case of epic deceit).

A prominent urologist told me: “It is almost impossible that a) his PSA wasn’t being followed, and b) he suddenly developed high grade metastatic disease. Just as we were lied to about his cognitive function, we’ve been lied to about this. My prediction is that it will turn out that he has been on ADT for years, which explains his frailty and his cognitive impairment. All speculation, of course. But the idea that this is an all-of-a-sudden diagnosis out of the blue is, frankly, nonsense. Thus, I suspect he has mCRPC now, and they can’t hide it any longer. The proof will be his untimely death in the next 2 years, which they won’t be able to hide.”

He’s not the only one talking that way. It’s been suggested that the Biden group only now is releasing his diagnosis--that Biden has been diagnosed for a while and was on Androgen Deprivation Therapy that caused cognitive probems resulting in his poor performance during a 2024 debate with Donald Trump and his inability to recognize donor/support movie star George Clooney. This isn’t just the conspiracy theorists sounding off.

Today, May 20, Biden’s office announced that apparently Biden’s “last known” PSA screening wnen he was VP at age 71-in 2014.

Peter Carroll, MD, MPH, a urologic oncologist at the University of California, San Francisco, a leader in the field, said it was within reason to stop screening then.

The next step is for Biden to release what his PSA levels and PSA history.

Carroll said in an interview today with The Active Surveillor that the media and commentators are missing the news by focusing on doctors checking out Biden’s prostate with a Digiral Rectal Exam at age 82, against all guidelines,

“The issue is not screening at (age} 82. The issue is when to stop screening. A baseline PSA is highly predictive. While 71 is a little early to stop screening, if you had a truly low PSA and no family history, you could argue that his future risk is quite low,” he said.

(Dr. Peter Carroll)

Guidelines, which are guides and not requirements, urge screening in men who have not been diagnosed at age 70 or 75. (It's a different debate for those of us who have been diagnosed.)

Carroll doesn’t think the Biden case demonstrates a need to review the guidelines.

He said: “I do see patients in their early eighties diagnosed with very advanced disease who have not been screened. Research from many years ago showed that treating men over 75 palliatively increases their risk of dying from prostate cancer, so caution is needed with high-risk tumors in older patients. A more nuanced approach would suggest that men over 75 or those with a short life expectancy due to comorbidity probably don't benefit from screening. However, men in good health, especially those who have never been screened, may consider screening even at age 70.

(President Biden, 2022.)

He said Biden could have developed the aggressive cancer within months or years.

However, he added: “We don't have good documentation of the natural history of Gleason 9 cancers because they tend to present with advanced disease. My sense is it would be months to years. While we have good data on Gleason 3+3 and emerging data on 3+4 and some 4+3, the natural history of Gleason 9 is largely unknown because these cancers are typically treated quickly.”

Meanwhile, the missing pieces: We don’t know what Biden’s last PSA level was nor his PSA history. These are key to make sense of the case of the President with bone metastases.

Biden should release that information so the public can be informed about prostate cancer, especially high-grade cancers like Biden’s. It’s a huge amd growing problem in America and in all other countries--rich, poor, or in the middle--with aging populations. (Check out my article today in MedPage Today.covering these trends and also Biden’s commitment to end cancer.)

Meanwhile, at UCSF and doctors’ offices around the country, patients with high PSA levels have rising anxiety levels and are clamoring to move up their biopsies.

Carroll said: “We are getting a lot of calls from patients who are very anxious and want to move their biopsies up. It has created panic in many men with an elevated PSA. A clear and complete story about President Biden's screening history would be helpful as a ‘teachable moment.’ for everyone.”

The message by now ought to be clear to Biden and his staff--open Biden’s medical history for scrutiny and discussion to educate the public and urge men to be screened for early detection.

….

Imagine the crisis we’d be facing now if Biden had been elected President and was dealing with a Gleason 9 and metastases and the side effects of hormonal therapy.

Could a person with metastatic disease run the country?

Carroll said: “Yes, but they have to be physically and mentally capable. The expectation is that the patient must be fit to run the country, both mentally and physically, and if they're not, they shouldn't. This is an important position that requires mental and physical vigor at a level that people trust.”

Side effects from ADT and chemo potentially could be too much for some patients.

…

What about future elections? Should candidates be screened for prostate cancer to avoid these issues?

Candidates for high office can’t be compelled to undergo screening tests, Carroll said. But the public may come to expect such information from their leaders, including youthful candidates— as a reassurance that the leaders are fit and can make it through their terms.

Carroll said: “I don't think it can be a requirement due to individual rights, but appropriate cancer screening should be done for important offices. While you can't force it, it can be strongly advised that candidates seek expert medical review in all domains. Prostate cancer is a common cancer, and knowing a candidate's overall health in detail for common cancers, like colon cancer (colonoscopy) and breast cancer (mammography), is important. It would be interesting to know which Presidents haven't been screened.

“Presidents Bush, Obama, and Trump disclosed their PSAs.”

Time is past for Biden to share his.

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He’s coming back: Dr. Jonathan Epstein in Q&A for Active Surveillors May 31

By Howard Wolinsky

Dr. Jonathan Epstein, the noted uropathologist, is coming back to The Active Surveillor audience for a Q&A at noon Eastern May 31.

Here’s your invitation:

When: May 31, 2025 noon Easterm (US and Canada)

Register in advance for this meeting:

https://us02web.zoom.us/meeting/register/sazI-npeR3OdGWyRIrVRYg

After registering, you will receive a confirmation email containing information about joining the meeting.

Here’s the scoop: Only 100 people at a time could get in to see his first lecture and Q&A last Saturday because of a glitxh with Zoom.

So I invited him back. And Dr. Epstein graciously accepted.

If you want to send question in advance, write to me at howard.wolinsky@gmail.com

Please get down to your essential question and limit the back story to help get your questions answered. We can’t dispense medical advice.

Meanwhile, The Active Surveillor YouTube Channel is getting a lot of traffic. More than 1,000 people have viewed the Epstein video. It would be worth checking out for background to hear Dr E.’s talk and response to questions.

While you’re there, view the other videos in my new The Active Surveillor’s YouTube Channel. Please like and subscribe.

Dr. Epstein’s slides are available here: https://docs.google.com/presentation/d/1OPXmN-m1R31spW-22s1rL_C0DSMX92tW/edit?usp=sharing&ouid=103480725196523876180&rtpof=true&sd=true

I’m giving valuable prizes to the first registrants ansd the 100th: the much-coveted The Active Surveillor T-shirt or plush prostate dolls.

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For more on Biden, check out my piece in MedPage Today

By Howard Wolinsky

In 2022, on the 60th anniversary of President John F. Kennedy's Moonshot speech, then-President Joe Biden -- who has had basal cell carcinomaopens in a new tab or window and whose son Beau died in 2015 from a recurrence of brain cancer -- reignited the Cancer Moonshot initiativeopens in a new tab or window.

"I give you my word as a Biden: This Cancer Moonshot is one of the reasons why I ran for President," he said. "We know this: Cancer does not discriminate red and blue; it doesn't care if you're a Republican or a Democrat. Beating cancer is something we can do together." In fact, more than once Biden stressed that re-launching this initiative to cut the cancer death rate in half in 25 years and improve the lives of people affected by cancer was one of the reasons he ran for president.

Now, just 4 months after leaving office, Biden himself is facing a serious cancer diagnosis: stage IV Gleason 9 (Grade Group 5) prostate cancer, which has metastasized to his bones.

"I give you my word as a Biden: This Cancer Moonshot is one of the reasons why I ran for President," he said. "We know this: Cancer does not discriminate red and blue; it doesn't care if you're a Republican or a Democrat. Beating cancer is something we can do together." In fact, more than once Biden stressed that re-launching this initiative to cut the cancer death rate in half in 25 years and improve the lives of people affected by cancer was one of the reasons he ran for president.

Now, just 4 months after leaving office, Biden himself is facing a serious cancer diagnosis: stage IV Gleason 9 (Grade Group 5) prostate cancer, which has metastasized to his bones.

Go to: https://www.medpagetoday.com/special-reports/apatientsjourney/115676?trw=no

ASPI webinar on the Great Biopsy Debate this Saturday

UMiami’s Sanoj Punnen, MD, takes on the debate over transperineal vs. transrectal biopsies. Active Surveillance Patients International (ASPI)’s monthly webinar will focus on these issues in a program entitled, “The great biopsy debate: Where do we stand on transperineal vs. transrectal?”

The program will be Saturday, May 24 from noon to 1:30 pm Eastern.

Register here: https://zoom.us/meeting/register/UZVDHmq9Rlyw6y_mqmK0hg#/registration

Check out Punnen’s presentation of the MAST AS study at the recent meeting of the American Urological Association: https://news.med.miami.edu/improving-prostate-cancer-prediction-during-active-surveillance/

Please send questions in advance to: contactus@aspatients.org

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