Prostate Cancer: Insights and Hope

Dr. Jamin Brahmbhatt is a urologist and robotic surgeon affiliated with Orlando Health and serves as an assistant professor at the University of Central Florida’s College of Medicine.

When I inform a patient that he has prostate cancer, the first question he usually asks is, “How long do I have to live?” It’s a completely understandable concern.

For those diagnosed with early-stage or low-grade prostate cancer, I can offer some solid reassurance. The life expectancy is quite favorable, with treatment boasting a five-year relative survival rate exceeding 99%. To put it simply, most men won’t succumb to low-grade prostate cancer.

However, once the cancer spreads beyond the prostate to the bones and other organs, the situation becomes more complex. Over the last decade, treatments for advanced prostate cancer have dramatically evolved. New medications, improved imaging techniques, and the early introduction of combined therapies all contribute to longer survival for many men.

On July 15, former President Joe Biden provided an update regarding his prostate cancer, mentioning that his treatments have been going well. In May 2025, he announced his diagnosis of an aggressive type of prostate cancer that had already spread to his bones. Since then, according to his updates, he has been undergoing hormone therapy, completed radiation, and has remained publicly active.

Biden’s diagnosis has drawn renewed attention to prostate cancer screening and treatment. Now, over a year later, his experience offers a moment to reflect on the advancements in treating advanced prostate cancer and the hope it brings to men living with the condition.

Recently, I saw a patient diagnosed three years ago with cancer that had already spread to multiple areas in his bones. Despite this, he has enjoyed cruising, traveling with family, and babysitting his grandchildren.

While he gets tired and can’t garden as he used to, he still appreciates each day as a blessing. His story, alongside Biden’s journey, paints a picture of what living with metastatic prostate cancer can look like today.

Understanding Survival Rates

Many patients, if they haven’t asked their doctor, often turn to the internet for five-year survival rates. A word of caution: every figure they find online comes with significant caveats.

The American Cancer Society indicates a five-year relative survival rate of over 99% when prostate cancer is detected while still localized. In contrast, this rate falls to 38% when the cancer has spread to distant locations.

However, that statistic reflects treatments given to large groups of men years ago, not necessarily the impact of modern therapies, nor does it consider individual factors like age and overall health.

Survival rates generally describe groups rather than predicting individual outcomes. Consequently, while the 38% figure is informative, it doesn’t accurately represent how long someone like Biden—or any individual patient—might live. Outcomes depend heavily on individual cancer characteristics and treatment responses.

A man diagnosed with metastatic prostate cancer a decade ago would not have followed the same treatment path as a man diagnosed today. Current medical thinking emphasizes employing the most effective treatments sooner rather than waiting.

Traditionally, treatment commenced with hormone therapy, often focused on testosterone suppression, with other interventions saved for later when the cancer became unmanageable. Nowadays, those hormone injections are frequently combined right from the start with newer hormone-blocking medications and/or chemotherapy, significantly improving survival rates—this has been one of the field’s most pivotal shifts in recent years.

As for Biden’s cancer, three key factors illuminate its aggressiveness and how to manage it. Official announcements have underscored a Gleason score of 9, the fact that it has spread to his bones, and its classification as hormone-sensitive.

The Gleason score, determined by examining biopsy samples, typically ranges from 6 to 10, with higher figures pointing to more aggressive cancer. A score of 9 is particularly concerning. Yet, it doesn’t automatically tell us if the cancer has metastasized.

When prostate cancer does spread, its most common target is the bones—typically the spine, pelvis, and ribs. It can also affect organs like the lungs or liver, marking a point where cure is generally no longer possible, although treatment can still control it for extended periods.

Prostate cancer can be hormone-sensitive or resistant. As it usually thrives on testosterone, lowering or blocking this hormone can assist in controlling the disease. Hormone-sensitive indicates it’s still responsive to such treatment.

Over time, many advanced or metastatic prostate cancers develop ways to resist hormonal control, hence becoming hormone-resistant. In these cases, additional therapies become necessary.

One of the most advanced imaging tests available today is the PSMA PET scan. It uses a radioactive tracer that targets a protein on prostate cancer cells, revealing locations where the cancer may have spread. The American Urological Association advocates for its use in determining if high-risk prostate cancer has metastasized, as well as in staging the disease.

While traditional bone scans remain an option for identifying areas of bone stress from injury or disease, PSMA PET scans are increasingly favored.

When considering treatment strategies, it’s critical to note where the cancer has spread. A solitary bone lesion and cancer that has reached the liver are both classified as stage 4, yet they aren’t treated alike.

Additionally, how extensively the cancer has spread is crucial. We categorize “low-volume” disease when it has infiltrated limited areas versus “high-volume” disease, where it has spread significantly or involved organs like the liver or lungs.

Both scenarios necessitate systemic treatment. For those with low-volume disease, incorporating radiation to the prostate can potentially enhance longevity.

Biden has undergone radiation treatment, but details regarding the specific area treated or whether his cancer constitutes low- or high-volume remain undisclosed.

Moving beyond just starting treatment earlier, doctors can increasingly personalize therapies based on an individual man’s cancer biology. We can now analyze both the tumor and a patient’s own DNA for mutations that aid in treatment selection.

About 1 in 10 men diagnosed with metastatic prostate cancer carries genetic mutations affecting DNA repair. The most notable ones, BRCA1 and BRCA2, are linked to breast and ovarian cancers as well.

Depending on identified mutations, targeted drugs like PARP inhibitors may become viable. If a mutation is inherited, it also provides important information for family members regarding genetic counseling and earlier screening.

Another promising advance is radioligand therapy. If scans reveal cancer cells with the PSMA protein, doctors can attach radiation to a molecule designed to seek it out. Delivered via IV, this targets cancer cells throughout the body and was expanded last year to more men facing hormone resistance.

It’s vital to acknowledge that every treatment comes with potential side effects. Hormone therapy frequently leads to hot flashes, akin to those experienced by women during menopause. While not typically harmful, they can certainly impact one’s quality of life.

Fatigue is also a common side effect. Testosterone is critical in maintaining muscle, and reduced levels can lead to diminished strength and energy. Engaging in regular walking and resistance exercises can help preserve muscle mass and combat fatigue.

One effect often overlooked is decreased libido. At diagnosis, many men are understandably focused on survival rather than sexual health, but this can become a concern as time goes on. It’s essential to discuss this with your care team and partner rather than accepting it as a mere consequence of treatment.

Perhaps the most pressing concern for me is the risk of weakened bones. Low testosterone levels reduce bone density, and cancer can exacerbate bone fragility. Ensuring follow-up care includes exercising, bone density assessments, and tracking calcium and vitamin D levels is crucial. For men with hormone-resistant cancer that has spread to bone, medications that protect bone integrity can reduce fracture risk.

Any new or worsening back pain—especially coupled with leg weakness, numbness, or difficulty controlling the bladder or bowels—could indicate the cancer is affecting the spinal cord. This situation requires immediate medical intervention.

Ideally, a patient should have multiple doctors collaborating closely on their care. The urologist typically starts the process, while a medical oncologist oversees systemic treatments, and a radiation oncologist focuses on specific areas, whether that be the prostate or a painful lesion. A primary care doctor is essential for overall health management and protecting the patient’s heart and bones.

Factors like a man’s age, pre-existing health conditions, tolerance for side effects, and treatment goals all influence care plans. Two individuals with nearly identical cancer profiles might choose entirely different treatment roads based on their health and priorities.

Effective communication among healthcare providers is key, yet sometimes gaps occur. Patients must arm themselves with knowledge about their care team, ask questions, and comprehend their choices.

I often suggest having a trusted companion accompany you to significant appointments for support, helping to jot down notes and remember discussions.

For men concerned about prostate cancer, it’s vital to talk to your healthcare provider regarding the pros and cons of PSA testing. Black men and those with strong family histories should initiate this dialogue in their 40s. New urinary symptoms often aren’t indicative of cancer, but they do warrant attention, as do any instances of blood in the urine or semen, unexplained weight loss, and persistent back or bone pain.

For those living with advanced prostate cancer, there’s genuine cause for optimism. Treatments and testing have progressed significantly over the past decade, and quality care emphasizes the patient’s overall well-being, not solely their scan results.