When the news broke on Sunday that former President Joe Biden had been diagnosed with prostate cancer that had spread into his bones, Dr. Arpeet Shah was surprised.
Soon, his phone started blowing up with texts from other urologists, who were equally flummoxed as to how this could have happened to a man of Biden’s stature.
“That was certainly a conversation amongst urologists yesterday, texting each other,” Shah told Business Insider on Monday, the day after Biden’s diagnosis was made public. “It is surprising that this wasn’t caught, or it was caught at such an aggressive stage.”
Shah, a board-certified urologist at Associated Urological Specialists in suburban Chicago says over the course of the decade he’s been in practice, he’s been alarmed at the number of new, minimally invasive, highly effective prostate cancer prevention and treatment options that have blossomed. This is especially true, he says, when it comes to metastatic cancer cases like Joe Biden’s.
“Over the last 10 years, there’s just been a robust increase in the number of treatment options,” Shah said.
Other cancer experts BI spoke with agree that new therapies allow for longer lives, better outcomes, and many patients can keep on going about their normal life while doing them. Here are three major breakthroughs driving the trend:
1. Patients are taking more cancer-fighting pills at home, forgoing uncomfortable, gooey injections
Testosterone-lowering drugs and procedures have been the bedrock of modern prostate cancer treatment, in use for more than 80 years.
Prostate cancer grows by using testosterone as its fuel. This makes drugs that drive down testosterone levels (androgen receptor blockers) a great first-line treatment.
These treatments can be uncomfortable. Drugs like leuprolide acetate are injected under the skin or into a muscle every three to six months. Those injections are somewhat “gelatenous” Shah said, and they might leave a lump under the skin that lasts for weeks or months as the medication slowly releases in the body.
New pills, in particular the drug relugolix (approved by the FDA in late 2020), can work faster than those old injections — possibly helping a person’s testosterone levels to normalize faster after treatment, too.
Patients spend less time weathering the uncomfortable, menopause-like side effects of prostate cancer treatment, like hot flashes, low energy, and bone density issues.
“We see a lot of patients who really enjoy taking the pill more,” Shah says. These days, he says, many of his patients just do their own cancer treatment from home using pills.
“Most often, patients are taking multiple pills per day to treat their prostate cancer,” he said. “They don’t have to go to the hospital to get the medication. And these pills are generally very well tolerated to a point where people are able to do their daily living as they were before their diagnosis.”
2. New treatments can outsmart cancer, even when it tries to evade hormone-suppressing drugs
Scientists have gotten better at outsmarting prostate cancer — not only lowering testosterone production.
New innovations prevent cancer cells from absorbing leftover testosterone in the body, meaning the disease can’t get a good foothold to grow.
Pills in this category include darolutamide (FDA approved in 2019), apalutamide (2018), enzalutamide (2014), and abiraterone (2011).
“We can oftentimes get this disease to be almost like a chronic disease, like high blood pressure or diabetes, where patients know they have it, but they’re getting treated and they can move on with the rest of their life,” Shah said.
When that’s not enough, other techniques are at hand. These include targeted liquid forms of radiation, as well as gene therapies that target specific mutations.
Dr. Alicia Morgans, a genitourinary medical oncologist at Dana-Farber Cancer Institute and board member of ZERO Prostate Cancer, says patients today can live with metastatic prostate cancer for years, or even decades, thanks to these kinds of treatments.
The five-year relative survival rate for prostate cancer in the US is near 98% — and getting better year over year.
“Every year we’re seeing new approvals in prostate cancer,” Morgans said.
3. New types of blood tests and MRIs
Shah said there’s also been a ton of advancement in prostate cancer detection and early screening, going beyond the traditional rectal exam and blood tests.
Newer blood tests like the IsoPSA blood test zero in on prostate cancer better than their predecessors. There are also more sophisticated imaging scans doctors can do, like the multiparametric MRI, that can zoom in on suspicious lesions in the prostate.
For Shah, Biden’s diagnosis is a “sobering reminder” to screen early and often.
He encourages most men over 50 years old, and some as young as 40 (depending on risk factors) to speak to their doctor and get screened, “because this is such a treatable and most often curable disease when caught early.”
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