Biden’s Cancer Diagnosis

Questions about Joe Biden’s cancer diagnosis have been among the most searched on the internet since he announced his illness Sunday morning. How could the disease have gone undetected in the former commander in chief, a man with access to the best medical care? Why does the government advise men over 69 not to get annual prostate scans? Does the diagnosis explain Biden’s occasionally doddering affect? Did the White House hide it when he was running for re-election?

We have (some) answers. For today’s newsletter, I spoke with Gina Kolata, a science reporter who writes about diseases and treatments.

What do we know about Biden’s form of cancer?

It’s aggressive. The cells have an ugly, disordered appearance under a microscope. Pathologists gave them a Gleason score of 9 (out of 10) for their likelihood to advance quickly. The cancer has already moved from Biden’s prostate to his bones, which means it cannot be cured — only controlled with drugs.

What about his prognosis?

Patients with a Stage 4 diagnosis typically live five to 10 years. That’s much better than it would have been just a few years ago. Doctors will likely give him a drug that stops his testes from making testosterone, which fuels the cancer, plus another drug that mops up any testosterone in his bloodstream. He might also get chemotherapy, radiation or other drugs that are specific for his cancer.

President Trump and others have suggested (without evidence) that there might have been a cover-up.

I don’t have reporting about that. But Biden aides told our colleague Tyler Pager yesterday that physicians stopped testing Biden’s P.S.A. — his prostate-specific antigen, which surges with cancer — after 2014. The president’s doctors likely didn’t know there was a problem.

Why didn’t they test him? Isn’t the president one of the most medically scrutinized humans on the planet?