EPISODE 6: What We Can Learn from President Biden's Cancer Diagnosis

Dr. Avi Baskin joins us to discuss President Biden's aggressive prostate cancer diagnosis and what it means for men's health screening practices. We explore how prostate cancer can grow silently for years before symptoms appear and why screening recommendations matter.

• Screening vs. diagnostic testing for prostate cancer explained
• How the President's diagnosis aligns with typical presentation patterns among older men
• Current screening guidelines and debates about when to stop screening
• Treatment options for metastatic prostate cancer and potential outcomes
• The increased aggressiveness of prostate cancer diagnosed in older men
• Why early baseline screening starting at age 40-45 is recommended for high-risk groups
• The importance of not waiting for symptoms to appear before getting tested

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#prostatecancer

#presidentbiden

#earlydetection

Chapters

• 0:11 Welcome to Real Health Black Men
• 0:44 President Biden's diagnosis explained
• 2:36 Screening vs diagnostic testing
• 5:04 Prostate cancer screening debates
• 7:45 Treatment options and prognosis
• 10:34 Recommendations for early screening
• 12:28 How to support the podcast

Transcript

Grantley Martelly: 0:11

This is the Real Health Black Men podcast, where we empower men to take control of their health. We provide vital information and build community support. Join us as we discuss everything from major health challenges to mental wellness to physical fitness. So if you're ready to level up your health and your life, you're in the right place. Let's get started.

Grantley Martelly: 0:44

So welcome back to Real Health Black Men podcast. We've all heard about President Biden's diagnosis of aggressive prostate cancer and I wanted to do a short episode just for my listeners, to just try to explain what's going on, see if we can get a perspective from a professional. And today I have Dr Avi Baskin from Vanderbilt University Medical Center and he's joining us to help us have this discussion. So, dr Avi, welcome, and could you just introduce yourself? Tell us a little bit about yourself and we'll get into the discussion.

Grantley Martelly: 1:17

Yeah, thanks so much for having me Again. I'm Dr Baskin. I'm finishing up a urologic oncology fellowship at Vanderbilt University Medical Center. And I'm Dr Baskin. I'm finishing up a urologic oncology fellowship at Vanderbilt University Medical Center and I'm starting on faculty as a urologic oncologist at University of California in Irvine, so really excited to be here today. A lot of the work that I've been doing during my fellowship focuses around prostate cancer, both in terms of long-term outcomes, of how patients do over time, but also in terms of study on treatment regret. So I'm really excited to be here and this is an opportunity just to bring more awareness to the issue.

Grantley Martelly: 1:51

Thank you, dr Baskin. So we've all heard about President Biden's diagnosis with stage four aggressive prostate cancer and, to us as laypeople and as former patients, we wonder how could the President of the United States with the best medical team, the best medical science, access to the best medical care, go from us being told a few years ago, after his medical, that he was in reasonable health for a man at his age, and now, four months after he leaves office, we're being told he has stage four aggressive prostate cancer? Could you help us to understand how something like this could happen, and is it normal or is it abnormal for things like these to happen in this area of prostate cancer or any cancers?

Grantley Martelly: 2:36

Yeah Well, it's definitely surprising news and I think you know it's very unfortunate, but the reality of prostate cancer is actually isn't uncommon. So for men who are over 75, about 20% of them, when diagnosed with prostate cancer, are diagnosed with metastatic disease. Prostate cancer is challenging because it can grow silently, no symptoms, for years and if a patient isn't screened, it definitely can be missed. It's important that when we talk about President Biden and how he was diagnosed, we talk about president biden and how he was diagnosed. We talk about the difference first between what a screening test is and what a diagnostic test is. A screening test that we may have heard of as prostate specific antigen for prostate cancer. It identifies individuals at risk of the condition. A diagnostic test is used to confirm or rule out a suspicious diagnosis when a person has symptoms of a disease. From what I've been able to find online and what's been reported, joe Biden last had a screening test for PSA for prostate cancer in 2014 when he was 71.

Grantley Martelly: 3:34

The US Preventative Task Force Service recommends stopping prostate cancer screening at age 70, so that would be in line overall from what we know, as physicians had followed those nationally recommended guidelines. So that would be in line Overall. From what we know, his physicians had followed those nationally recommended guidelines Back in May. It was reported then that he had difficulty urinating, leading to a prostate exam where they found the prostate cancer. So he wasn't necessarily screened for prostate cancer, he was actually, it was found on a diagnostic test, which is how it can happen. And going back to what we talked about at the beginning, you know, unfortunately prostate cancer does present like this a lot. So you know, unfortunately prostate cancer does present like this a lot. So you know, while it seems abrupt that a person who had a physical a couple of years ago purport to be in great health, you know is our president with presumed the best medical care and medical advice out there, it's actually not an uncommon story that we see that sort of brings a little bit more sense to it.

Grantley Martelly: 4:19

It seems like just missed him by a year, right that age 71, 70 cut off. There's a lot of other urological issues that men could have that are not prostate cancer, like difficulty urinating.

Dr. Avi Baskin: 4:31

Yeah, and you know that's the challenge with prostate cancer. I think as we age, men's prostates get bigger, and when men's prostates get bigger they can cause problems with urinating. Sometimes prostate cancer can be associated with those problems, but sometimes you have prostate cancer growing and you have no symptoms whatsoever, and that's kind of one of the challenges that we face. Just because a patient may have problems with urination doesn't necessarily indicate prostate cancer. It can be a host of other things, but we're trying to parse out what to be worried about and what not to be worried about.

Grantley Martelly: 5:04

So there are various thoughts you brought up screening and there are various schools of thoughts about prostate cancer screening and maybe you can enlighten us a little bit about this. There was an article in the Economist recently about should men be screened for prostate cancer, citing some British studies about maybe over-screening, over-treatment, but yet still looking at people of high probability. That prostate cancer Health Education Network. They wrote an article. Their president, who is a 24-year prostate cancer survivor, was writing it to say we need more screening for men because we keep missing these things. So there seems to be some conflicts in the medical community about the screening process and when it should and when it should not be done.

Dr. Avi Baskin: 5:50

Yeah, screening is definitely a complex and controversial topic. I think President Biden's case specifically opens up the debate about not only whether to screen but whether to stop screening, because in his case, as far as we know, he was screened for prostate cancer in his younger years and they stopped around age 70 or age 71. The question is in my mind is you know what happens when a person who was older than 70 or an older man gets diagnosed with prostate cancer? How aggressive is that prostate cancer? We know from multiple studies that men who are diagnosed with prostate cancer at age 70 are more likely to die of prostate cancer than men diagnosed with similar prostate cancer types greater stage at younger ages. Even in low-grade prostate cancer or low-risk prostate cancer, the gene expression profiles of older men exhibit more aggressive features than younger men.

Dr. Avi Baskin: 6:42

So the question in my mind is you know when do we stop screening? It's recommended in the guidelines the United States Preventative Service Task Force, the AOA guidelines to stop at age 70. We have to worry about a percentage of men who are going to live longer like President Biden, and maybe for those men extend it. You know, maybe I'm biased as a urologist, but in my opinion it's worth to screen into the 70s on a case-by-case basis, discussing the other risks and benefits, and what we really have to focus on is not necessarily stopping the screening, but it's once a man is screened and that leads to potential workup, invasive testing for biopsies and getting a diagnosis or thinking about treatment options. How do we stop over diagnosis and over treatment after the screening point so that we get the full advantage of screening and preventing deaths that way, but also limiting all the side effects that come with potential treatment options?

Grantley Martelly: 7:32

What are some of the potential treatment options available for a person who's been diagnosed with the kind of cancer that President Biden has, and what are the potential outcomes for those different kinds of treatments?

Dr. Avi Baskin: 7:45

So for systemic disease or metastatic prostate cancer, you are going to basically have therapy that it's basically hormone therapy that decreases the testosterone all the way to zero. There's also certain types of chemotherapy or other targeted therapies for metastatic prostate cancer that may be available, as well as, potentially, radiation to the prostate for certain types of therapy that can be used in tandem. The bottom line here is there's going to be multiple different types of therapy that will be available to President Biden. It just depends on some features. So the first thing is and what we really don't know is they said he's had metastatic prostate cancer and it's gone to the bone. There are various types.

Dr. Avi Baskin: 8:25

If he has a lot of prostate cancer, meaning a lot of different sites of metastases, he may have different options compared to someone who has just a few. So those details so far are unknown. And then when we talk about what is he looking like in terms of prognosis, it really depends. Looking on the clinical trial data for someone with metastatic prostate cancer and as high volume disease spread to multiple parts of the body, you could be looking at kind of a medium survival of three to five years for someone with just metastatic prostate cancer that's maybe gone to only one bone or a couple of different sites, you may be into the six to eight year range, so it really depends. It's important to note, though, that for men who present with metastatic prostate cancer like Joe Biden, kind of out of the blue, some men do live 10 plus years on therapy, so it really depends on the details of it, of his specific diagnosis and medical history, to understand exactly what his prognosis will be.

Grantley Martelly: 9:22

I think one of the things in that, then, is that with modern treatment because one of the reasons for this podcast is to help men to see that treatments are changing all the time, science is changing all the time we're not locked in. So don't be afraid, because there could be potential treatments out there that are coming available that helps you to live longer and live a very good life.

Dr. Avi Baskin: 9:47

Yeah, it really is dependent on the cancer type and there's a lot of new. You know there's, like you mentioned, a lot of new, different treatment options. You know drugs being approved, and then there's new imaging tests and then there's also new ways to prognosticate, meaning looking at tissue and saying, hey, is it more or less aggressive? And those things have all kind of come into play. So what I'd really recommend is I know it's prostate cancer. It affects one in eight men. I think everyone has someone who's been touched by it. But it's really all about seeing a urologist, seeing a medical oncologist, understanding what the options are, because a lot of times, even in Joe Biden's case, I can't speak, obviously, to specifics, but you know, at his age, prostate cancer still might not be the thing that limits his overall lifespan. So it's really important to get in and get medical care and understand, you know, what your options are.

Grantley Martelly: 10:34

Well, that brings us directly to our last questions is what can we learn from this as men, and what is the discussions that we need to be having with our doctors and with our families about prostate cancer?

Dr. Avi Baskin: 10:47

For everyone. Really, what I'd recommend is getting screened, and getting screened early, and it really depends on your individual risk factors. You know, black men, those who have had family members with prostate cancer or aggressive prostate cancer, probably should get screened early. The American Urologic Association recommends screening at 40 to 45 years of age. What you can do is get a screen test early and see where your baseline is. If it's low, less than one, you're in a pretty good position for the longer term.

Dr. Avi Baskin: 11:15

It doesn't mean you've got to get screened every year, but getting that baseline can be really important. So what I'd recommend is talking to your doctor, you know, talking to your friends, you know the support groups that I mentioned are really important, you know, get a baseline, know where you're at and then, you know, get on some sort of schedule. Again, it doesn't have to be every year the AUA recommends every two to four years but it's really important because, as we saw in Joe Biden's case, sometimes with prostate cancer you really don't know at all until it's spread. It can be really silent and have no symptoms for a long time. So I think it's kind of a reminder in this case don't wait for symptoms. Get screened and be thoughtful about it, because getting screened doesn't commit you to any sort of treatment, doesn't commit you to anything down the line, but at least you have the information to go off of.

Grantley Martelly: 11:59

If you don't have information, you don't know what to talk about. Right Screen gives you a baseline, you can have the conversation, but if you have no data, what are you going to do? So I came across this saying in wrapping this up that says early screening is still the best defense against prostate cancer. Early screening is still the best defense against prostate cancer.

Grantley Martelly: 12:23

Because even as in my case, you were talking about pain and symptoms. I had no symptoms. Besides the fact that my PSA went up four times in succession. That's the only thing I had. If I waited for pain. Many men said to me Grantley, did you have any pain? I said, if you wait for pain, what's going on inside of you is already changing. So I asked my doctor to do the test so that I had the baseline, so that I can have an intelligent conversation with him about what I need to do.

Dr. Avi Baskin: 12:49

Yeah, no, absolutely. I mean, unfortunately, the nature of it is that, like you said, if you're waiting for symptoms and pain, you know realistically that's going to be far down the disease progression, meaning you may have already had metastases, you may have already had it going through the prostate to other kind of local areas. The other thing that I think is important to note is I think patients are rightfully concerned about a prostate biopsy and that it's painful and the recovery takes a little bit of time. There's a lot of different tests that have now been developed that you can do after you have a PSA test to try to differentiate blood tests, urine tests, mri scans of the prostate, just to look and see before you commit yourself to biopsies. There's a lot that's out there and I think getting the information and knowing that is very important.

Grantley Martelly: 13:36

Thank you, Dr Baskin, for coming in today and enlightening us about this. I really appreciate it.

Dr. Avi Baskin: 13:42

Thank you so much for having me.

Grantley Martelly: 13:47

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