Biden's Cancer Diagnosis Should Be a Teaching Moment – Healthcare Blog

Daniel Stone

Joe Biden's metastatic cancer diagnosis summarizes two controversial issues: PSA testing for prostate cancer and presidential politics. Understanding the risks of Americans requires basic information about PSA testing, as well as a frank discussion of the reasoning behind prostate cancer screening decisions in the former presidential case. The transport of information we get will only cause more uncomfortable problems for Biden and his family. The lack of sufficient explanations also did not contribute to the public's understanding of these important medical issues.

The prostate is a walnut-shaped gland at the base of the bladder that produces “prostate-specific antigens” or PSA. Chemically classified as glycoproteins, sugar/protein aggregates, leaked from the prostate into the blood, and their levels can be measured by conventional blood tests.

As men age, the prostate enlarges, improving PSA levels. Screening tests take advantage of the fact that prostate cancer usually has more PSA leaks than normal prostate tissue. In the case of prostate cancer, PSA is usually relatively fast.

Apart from these basic facts, the PSA story becomes hazy. Although elevated PSA may indicate cancer, most men with elevated PSA have benign prostate enlargement rather than prostate cancer. Worse, for screening, many men with prostate cancer suffer from mild and slow disease that does not require treatment. They coexist with disease, not death. This fact leads to the old motto that prostate cancer is a long-standing disease of the pope and Supreme Court justices.

The Medical Consulting Panel looks at skepticism about PSA screening, partly because it distinguishes benign PSA from cancer-related benign elevations. Confirmation of a suspected cancer diagnosis requires a prostate biopsy that can be painful and may have side effects. Furthermore, once a diagnosis is made, patients who may coexist with the disease may be unnecessarily affected by treatment, such as radiation and surgery. Finally, it is difficult to demonstrate the benefits of early treatment of prostate cancer in clinical studies.

For all these reasons

Despite these concerns, the pendulum has been turning towards more PSA tests in recent years. One reason is that improvements such as improved radiation image MRI allow for “active monitoring” that can track signs of spread of early lesions, allowing doctors to differentiate between relatively benign prostate cancer cases and possible progression. The intervention can then be targeted more specifically at high risk.

In my medical practice, despite the controversy in clinical benefits, I have generally advocated for prostate cancer screening. My experience has led me to believe that early diagnosis improves prognosis. However, even if there are no improved medical outcomes, patients and their families will benefit from early diagnosis for planning purposes. No one wants to be tortured by later-stage symptoms that restrict clinical and life choices.

In Biden's case, after some preliminary delays, a spokesperson revealed on May 20 that there has been no PSA test during Biden's vice president since 2014. The reason was not disclosed.

This decision may be justified based on questions about the benefits and risks of PSA testing. But given the importance of the health of the vice president and potential future president, one might wish that doctors would commit more information. The omission has sparked speculation that the increased political impact of the border or PSA may play a decisive role. More information about his last PSA and the basis for deciding not to continue screening may give this speculation a break.

In the past, the public has had insight into important medical conditions from the unfortunate illnesses that affected the first family. Colon cancer screening has attracted increasing attention after President Reagan's diagnosis in 1985. Betty Ford publicly disclosed her struggle with alcoholism and prescription drug dependence, which helps eliminate treatment for drug use disorders.

Biden's illness also provides opportunities. Considering prostate cancer poses the greatest risk of cancer deaths for non-smoking American men. Transparency in coping with the former president’s situation will serve the public interest by increasing awareness and understanding of the important, nuanced nursing decisions faced by many men.

Daniel Stone is a practical physician and geriatric physician at Cedars Sinai Medical Group. This one was originally Published in the Los Angeles Times