Top NHS surgeon Ben Lamb says metastatic cancer like that diagnosed in former US president Joe Biden can cause fatigue, bone pain or weight loss
A top surgeon has described the symptoms which could indicate metastatic cancer after Joe Biden ’s office confirmed his has spread to his bones.
This is known as advanced prostate cancer, or metastatic prostate cancer, which is when cancer has spread from the prostate, usually to the bones or lymph nodes. Most common bones for prostate cancer to spread to include the spine, pelvis, ribs and skull.
A leading surgeon at one of the biggest NHS trusts in Britain says in the UK only one in five prostate cancers are diagnosed after they have spread. Prostate cancer is the most common form of cancer in men, affecting one in eight in their lifetime.
Ben Lamb, Consultant Urological and Robotic Surgeon at Barts Health NHS Trust, which runs five hospitals in London, said: “Diagnosis for most men is triggered by urinary symptoms causing them to seek help from their GP. In later stage disease, some men may have symptoms from metastatic disease, such as fatigue, bone pain or weight loss.
“Lymph node spread can cause blockage of the kidneys with renal failure and leg swelling. If the prostate tumour is large, it can cause bladder symptoms, though in most men in general, these are from benign enlargement of the prostate as men age.”
The NHS website states that prostate cancer does not usually cause any symptoms until the cancer has grown large enough to put pressure on the tube that carries urine from the bladder out of the penis, called the urethra. Signs that the cancer may have spread include bone and back pain, a loss of appetite, pain in the testicles and unintentional weight loss. Bone pain can be a dull ache or a stabbing pain.
Mr Biden, aged 82, has a cancer with a “Gleeson score” of nine out of ten – indicating it is among the most aggressive. This system is used to grade prostate tumours from samples of prostate cancer cells under a microscope. Looking at how many mutations they have gives doctors an idea of how the cancer might spread. A high score means the tumour cells look very abnormal and the cancer is likely to grow quickly.
Mr Lamb, senior lecturer at the Barts Cancer Institute at Queen Mary University of London, said: “An aggressive cancer means it is more likely to develop and spread, more likely to need treatment, and less likely to be cured by treatment. The Gleason score is a grading score given by pathologists to prostate biopsy samples under the microscope. It is strongly linked to the ‘aggressiveness’ of the cancer and the chance of dying of prostate cancer. The lowest score is 6 and the highest 10.”
Prof Suneil Jain, clinical oncologist at Queen’s University Belfast, said: “Most commonly a late diagnosis of prostate cancer means that the cancer has spread beyond the prostate gland. It means it has spread to other areas of the body, most commonly the bones or the lymph nodes, or sometimes to the lungs or the liver. Unfortunately, if the cancer has spread beyond the pelvis to other parts of the body, it often means the cancer is not curable, but it is important to note, it can be controlled for many years with improvements in therapy for prostate cancer. “
Biden’s office said the former president is currently reviewing treatment options with his doctors but confirmed his cancer is hormone-sensitive. This means it relies on male hormones such as testosterone for growth and survival. Hormone therapies can reduce testosterone levels or block their action, making prostate cancers shrink or grow more slowly for a time.
Mr Lamb said: “Metastatic prostate cancer is primarily treated with hormone therapy. Prostate cancer depends on testosterone to grow, and by blocking testosterone production and action, the cancer can be effectively treated but not cured.”
Chiara De Biase, director at Prostate Cancer UK, said: “We’re saddened to hear the news that President Joe Biden is facing a prostate cancer diagnosis. We thank him for sharing this difficult news, and our thoughts are with him and his family as they start to navigate it.
“Prostate cancer doesn’t care about who you are, your political standing, or your Olympic medals. This indiscriminate disease strikes dads, grandads, brothers, and uncles from every walk of life. If your dad or brother has had prostate cancer, or if you’re Black, you have the highest risk of getting the disease, and we strongly recommend you talk to your GP about the PSA blood test from the age of 45.
“Right now, you need to be aware of this and bring it up with a GP yourself. As prostate cancer often has no symptoms in its earlier stages, this situation is leading to too many men getting a late, incurable diagnosis. The earlier you find prostate cancer, the easier it is to treat. Find out your own risk, and what you can do about it, using Prostate Cancer UK’s online Risk Checker.”