Prostate cancer in older adults and the case of Joe Biden: A look at aging men's health

Prostate cancer is one of the most common diseases among men over 65, with an incidence that progressively increases with age. Recently, this topic has gained relevance following the diagnosis of former US President Joe Biden, who at 82 was diagnosed with aggressive prostate cancer that has spread to the bones. Although the tumor is hormone-sensitive, allowing for effective management, its occurrence raises questions about the detection and treatment of prostate cancer in older adults.

According to data from the Spanish Society of Medical Oncology (SEOM), prostate cancer is the most common cancer in men in Spain, with a higher incidence in men over 70 years of age. Most cases are diagnosed in localized stages, but a significant percentage progress to advanced forms, especially in older men. The risk of developing prostate cancer increases with age , and factors such as family history, diet, and ethnicity also influence its onset.

Early detection is essential to improve treatment outcomes . However, screening recommendations vary. Both the SEOM and the US Preventive Services Task Force—an independent panel of US experts in primary care and prevention that systematically reviews evidence of effectiveness and develops recommendations for preventive clinical services—advise against routine prostate-specific antigen (PSA) testing in men over 70 years of age due to the risks of overdiagnosis and overtreatment. In contrast, other organizations suggest that men with a life expectancy of more than 10 years consider screening. In either case, it is advisable to conduct an individualized assessment in consultation based on each patient's risk and circumstances.

Since Joe Biden publicly revealed a few days ago that he had been diagnosed with high-grade prostate cancer, with a Gleason score of 9—a system used to evaluate the aggressiveness of prostate cancer, based on the appearance of tumor cells under a microscope, which determines how aggressive the tumor is—and that it had spread to the bones, all alarm bells went off. His case has rekindled the debate about the importance of early detection and appropriate treatment of prostate cancer in older men.

This type of cancer, although incurable, can be treated if it is hormone-sensitive, and the tumor appears to respond to androgen deprivation therapy, allowing for effective management of the disease . According to reports, the former president experienced an increase in urinary symptoms, which led to tests that confirmed the diagnosis. Acute urinary retention, hematuria (blood in the urine), or obstructive renal failure are typical urological emergencies in older men with advanced prostate cancer.

The treatment of metastatic prostate cancer has evolved significantly in recent years. Androgen deprivation therapy (ADT), which seeks to reduce or block male hormone levels in the body, remains the gold standard or best procedure available to patients, but combining it with other medications has been shown to improve outcomes. Drugs such as enzalutamide, abiraterone, and darolutamide are also used to block testosterone production and reduce tumor growth. Furthermore, targeted therapies such as olaparib and radionuclide radiation therapy have shown efficacy in specific cases of castration-resistant cancer. Therefore, these therapeutic options offer new hope for patients with advanced forms of the disease.

Prostate health is essential for overall well-being and is a priority that should not be overlooked in the healthcare of the aging male population .