Dr. Jamin Brahmbhatt is a urologist and robotic surgeon with Orlando Health and an assistant professor on the University of Central Florida’s College of Medicine.
“How long do I have to live ?”
When I inform a affected person he has prostate cancer, that is normally what he asks me first.
With early-stage or low-grade prostate cancer, I can supply sturdy reassurance: Your life expectancy is nice — count on a five-year relative survival charge of better than 99% with remedy. Simply put, most males won’t die from low-grade prostate cancer.
However, as soon as the cancer has unfold exterior the prostate to the bones and different organs the reply turns into tougher. Treatment has modified dramatically over the previous decade for superior prostate cancer. New medication, higher imaging and the sooner use of mixed therapies are serving to males dwell longer.
In a video launched July 15, former President Joe Biden gave an replace on his prostate cancer, saying he was receiving therapies which were going effectively. In May 2025, Biden formally introduced that he had an aggressive type of prostate cancer that had unfold to his bones. Since then, based mostly on official updates, he has continued hormone remedy, accomplished a course of radiation and maintained a public presence.
His analysis introduced renewed consideration to prostate cancer screening and treatment. Now, greater than a 12 months later, his cancer journey gives a possibility to look at what has modified within the remedy of superior prostate cancer — and the hope these supply males residing with the illness.
I just lately noticed a affected person who was recognized three years in the past with cancer that had already unfold to a number of areas in his bones. Since then, he has taken cruises, traveled along with his household and spent weekends babysitting his grandchildren.
He will get drained and can’t backyard the best way he as soon as did. But he’s nonetheless alive and considers each day a blessing. His expertise, and what we see with Biden, reveals what residing with metastatic prostate cancer can appear to be at present.
Understanding survival charges
If they haven’t requested their physician already, many sufferers log on and discover five-year survival charges, however each quantity they could discover on-line comes with an enormous asterisk.
The American Cancer Society reports five-year relative survival of better than 99% when prostate cancer is present in or close to the prostate. The determine drops to 38% when it has reached distant elements of the physique.
But that quantity relies on giant teams of males handled years in the past. It doesn’t totally mirror the affect of newer therapies — or account for a person man’s age, total well being and response to remedy.
Survival statistics describe teams of sufferers however don’t predict what’s going to occur to one individual. That is why the 38% determine can’t inform us how lengthy Biden — or any particular person affected person — will dwell. These sufferers’ outlook depends upon particulars of their cancer and the way they’re responding to therapies.
A person recognized with metastatic prostate cancer a decade in the past and a person recognized at present wouldn’t obtain the identical remedy. The pondering now could be to use our greatest therapies early as a substitute of holding again.
For years, docs started with hormone remedy — normally injections that decrease testosterone — and saved different therapies till the cancer stopped responding.
Today, these injections are sometimes mixed from the beginning with a more recent hormone-blocking drug and/or chemotherapy. These combos have helped males dwell longer and are one of many largest shifts of the previous decade.
There are three particulars about Biden’s cancer that assist docs like me perceive how aggressive it’s and the way to manage it successfully. Official statements highlighted that his cancer had a Gleason rating of 9. The cancer had unfold to his bones, and it was labeled as hormone-sensitive.
The Gleason rating is assigned after a pathologist examines biopsy samples. Scores usually vary from 6 to 10, with greater numbers indicating extra aggressive cancer. A rating of 9 falls into probably the most aggressive class. However, the rating alone can’t inform us whether or not the cancer has unfold exterior the prostate.
When prostate cancer spreads, the commonest vacation spot is the bones — notably the backbone, pelvis and ribs. It also can attain organs such because the lungs or liver. Once it has reached distant elements of the physique, it’s usually not curable, however remedy can put a brake on it for years.
Prostate cancer will also be hormone-sensitive or hormone-resistant. Because it usually depends on testosterone to develop, decreasing the hormone or blocking its results may help management the cancer. Hormone-sensitive means it nonetheless responds to these therapies.
Over time, most superior or metastatic prostate cancers discover methods to develop regardless of low testosterone ranges, which imply they’re now hormone-resistant. Lowering testosterone alone is not sufficient to management the cancer, so docs have to flip to extra therapies.
The most delicate imaging check accessible at present is a PSMA PET scan. It makes use of a radioactive tracer that seeks out a protein discovered on the floor of prostate cancer cells. Areas containing cancer could seem as vibrant spots, serving to determine the place the cancer has unfold. The American Urological Association supports utilizing this imaging check to decide whether or not high-risk prostate cancer has unfold and to assist set up its stage.
A standard bone scan, used for many years, highlights areas the place bone is reacting to harm or illness. It stays another imaging choice, however PSMA PET is more and more changing its use.
What areas mild up and the place matter when deciding on therapies. A single spot within the backbone and cancer that has unfold to the liver are each referred to as stage 4, however they don’t seem to be the identical illness and will not be handled the identical manner.
Doctors additionally think about how a lot cancer has unfold. We label it as “low-volume” illness when the cancer has reached a restricted variety of areas. High quantity is when the unfold is extra widespread or has reached different organs such because the liver or lungs.
Both require remedy that works all through the physique. Treatment for metastatic illness usually contains remedy that works all through the physique. For males with low-volume illness, including radiation to the prostate may assist them dwell longer.
Biden has accomplished a course of radiation, however his crew has not disclosed what space was handled or sufficient element to decide whether or not his cancer could be thought-about low- or high-volume.
Beyond beginning extra therapies earlier, docs can more and more tailor remedy to the biology of a person man’s cancer. We can now check each the tumor and a affected person’s personal DNA for mutations that assist information remedy.
Roughly 1 in 10 men with metastatic prostate cancer carries an inherited mutation affecting the physique’s potential to restore DNA. The finest identified are BRCA1 and BRCA2, the identical genes linked to some breast and ovarian cancers.
Certain mutations discovered within the tumor or inherited DNA could make focused medication referred to as PARP inhibitors an choice. If a mutation is inherited, it additionally offers members of the family info they’ll act on by way of genetic counseling, testing and earlier screening.
Another advance is radioligand therapy. If a scan reveals that cancer cells carry a protein referred to as PSMA, docs can connect radiation to a molecule that seeks out that protein. Delivered by way of an IV, it targets cancer cells all through the physique. This strategy was expanded last year to extra males whose cancer had develop into hormone resistant.
Every remedy could cause negative effects. With hormone remedy, one of many first is commonly scorching flashes, comparable to what ladies expertise throughout menopause. These should not harmful, however they’ll have an effect on a person’s high quality of life.
Fatigue can also be widespread. Testosterone helps keep muscle, so decreasing it will probably cut back power and vitality. Regular strolling and resistance coaching may help protect muscle and cut back fatigue.
The facet impact nearly nobody talks about is lack of intercourse drive or low libido. At analysis, most males are fascinated about staying alive, not their libido. But months later, it usually issues. It is price discussing along with your care crew and your accomplice quite than assuming it’s merely the worth of remedy.
The facet impact I fear about most is weaker bones. Low testosterone reduces bone density, whereas cancer deposits can weaken the bone’s construction. Follow-up care ought to embody train, a bone-density scan, and guaranteeing satisfactory ranges of calcium and vitamin D. For males with hormone-resistant cancer that has unfold to bone, bone-protecting medication can cut back the chance of fractures and different issues.
New or worsening again ache, particularly with leg weak point, numbness or bother controlling the bladder or bowels? These might imply the cancer is urgent on the spinal twine. It is a real medical emergency that requires instant consideration.
Ideally, a number of docs work collectively to coordinate a affected person’s care. The urologist is commonly the start line. A medical oncologist manages therapies that work all through the physique, whereas a radiation oncologist targets particular areas, whether or not that’s the prostate itself or a painful bone lesion. The major care physician helps shield the affected person’s coronary heart and bones and takes care of the individual’s total well being.
A person’s age, different medical situations, potential to tolerate negative effects and targets for remedy all form remedy plans. Two males with practically equivalent check outcomes could also be supplied — or select — totally different paths based mostly on their well being and priorities.
Good communication amongst docs is important, however gaps can occur. Being your personal advocate means figuring out who’s in your care crew, asking questions and understanding your choices.
I additionally advocate bringing somebody you belief to necessary visits for assist and to take notes and assist you bear in mind what was mentioned.
For males apprehensive about prostate cancer, speak along with your well being care supplier about the advantages and dangers of PSA testing. Black males and people with a robust household historical past ought to start that dialog of their 40s. New urinary signs are sometimes not cancer, however they nonetheless deserve consideration, as does blood within the urine or semen, unexplained weight reduction and/or persistent again or bone ache.
For males residing with superior prostate cancer, there may be cause for hope. There are extra therapies and higher testing than there have been a decade in the past, and excellent care pays consideration to how a person feels, not simply to what his scans present.
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