Biden will be here soon: Former President metastatic prostate cancer

If he were younger with no serious comorbidities and his cancer were oligometastatic/castrate-sensitive, I think the latest cutting-edge standard of care would still be SBRT to the metastasis and prostate, then Orgovyx and one of the -lutamides indefinitely.

If it's polymetastatic and/or castrate-resistant, then replace the SBRT with Pluvicto, as you mention, and maybe add chemo.

At his age, though, they might make less-harsh choices, especially if there's an elevated risk of his dying from a secondary complication like heart disease.

Note that I'd pick SBRT (Photon) over Proton radiation to the prostate itself for metastatic cancer BECAUSE it's less precise. The cancer has already breached the prostate wall, so letting the radiation spread a bit could catch any loose cancer cells or micrometastases in the vicinity (even though it also means more side-effects).

This is sad, regardless of political affiliation. However, maybe this event will bring some much-needed attention to Prostate Cancer. Maybe it will squelch the "Good Cancer" label. I could believe that his PSA had not been checked. I suggest to everyone that they get a PSA or push their spouse, friend, brother, father, etc. to get the PSA done. I had no symptoms and came out G9 Group 5 at 52. The only thing that put me on this journey was getting my PSA checked because I asked for it. I am personally annoyed that this test is not as common as the CBC blood tests. Unfortunately, I have met guys of all ages who have never had a PSA check. Anyway, I pray for all guys that have this horrible disease. Maybe the former President can use his platform to get more attention to Prostate Cancer.

Unfortunately, none of us will ever know the circumstances surrounding Joe Biden’s cancer.
We don’t even know if he had already received treatment and it was not publicized. Things are kept quiet all the time.
We all know from this forum all the different ways PCa can form, spread and go undetected. But I think it unlikely that the most powerful man in the world - who has had serious health problems in the past - was not tested, monitored or scanned.
We’re only learning now of his apparent cognitive decline and just how serious it was. It leads me to believe that he had other health issues that were also kept under wraps.
I am NOT making a political statement here but simply stating the realities of the optics employed for office of the presidency. JFK, for one, had so many health issues that he never would have gotten elected had the public known of them.
I wish Joe Biden the best and hope he does well on whatever ADT regimen his doctors prescribe.
Phil

I can assure you it does not take years for it to go to the bones. My PSA went from 0.4 to 400 in less than a year and had move to my bones.

Or maybe he has had the cancer for some time now and has been getting treated with ADT and just chose not to disclose it? I did.

I insisted on yearly PSA screening. I missed one when covid hit and during the 17 month interim between testing my PSA jumped from 2.1 to 12.2 and I was diagnosed with Stage 4, Gleason 9, w/mets to RT iliac and local lymph nodes. It can happen quite quickly. I truly believe PCPs and Urologists should go back to doing digital rectal exams routinely during exams.

It doesn't seem to be the case that Biden was not being screened or that his doctors missed something. From today's coverage: "Otis Brawley, a medical oncologist at Johns Hopkins University who treats patients with metastatic prostate cancer, said it would not be surprising if previous prostate exams or screenings while Biden was president failed to turn up indications of cancer. “We need a better test,” he said."

Joining the chorus of "Yes, test", my PSA did not exceed 4.0 until I was 70 with a 4.6.
Slow, steady increases over time; 4 was considered the "standard" and higher if over 70 and/or with BPH, so no real worries. Note: Now I know better about lower PSA readings, rates of increase, etc.
So at 71, with a 5.6, I reluctantly went to the urologist, anticipating the "negative" or worse, questionable upcoming diagnosis.
The MRI however showed Prads 3 & 4, which was the alarm, and the subsequent biopsy revealed numerous 7s, and the dreaded 8s and a 9. And PSA had risen rapidly to over 7.
Therefore, I am an example of continued PSA monitoring alerting me at 72 to serious PCa on the earlier side and leading to treatment.
And yes, I wish that I had acted sooner and perhaps avoided EPE and additional post RP treatment for persistent PSA.
"We get too soon old; and too late smart."
Best to all. And yes, tell your friends and family loudly to get, and continue to get tested.

Biden's diagnosis has brought people out of the woodwork asking about my health. I'm Gleason 9, age 67, but no spread beyond the bladder beck. I suspect the high survival rate made a lot of people comfortable, and this took them out of their comfort zone.

Diagnosed in 2022 at age 71. My Gleason was 8 and also did a bone scan, but the cancer had not spread. Five treatments of high dose proton beam and three shots of Lupron was my treatment plan and I feel pretty good today.

Praying for former President Biden to choose the right treatment for him and a good quality of life upon completion.