A sad note: Scott Adams says he has terminal prostate cancer. Adams is only 67 and a big voice on the right, and I’m certainly sorry to hear it.
He says he has “the same cancer” as Biden, and although that’s certainly true in the basic sense, it’s impossible to know exactly what similarities they share because we don’t know too much about when Adams was diagnosed or how (except he says it wasn’t recent), what his Gleason score and metastatic status were at the time of diagnosis, and what treatments he’s undergone in the past. At this point, however, he seems to have run out of effective treatments and is in serious pain. He says he’s probably going “to be checking out from this domain sometime this summer.” The article goes on to say he’s indicating it might be an assisted suicide.
Now, back to Joe Biden.
I wrote a lengthy post yesterday on that topic, and there was plenty of discussion in the comments. Some of it indicated to me that some of what I was saying may have been misunderstood. So I’m going to clarify here.
In yesterday’s post I was not saying that for sure the announcement about Biden’s diagnosis, and especially its recent timeline, was the truth. I said this:
Of course, there’s zero reason to trust anything that is said about his health, due to past experience with coverups of Biden’s state. But what we’re reading about his prostate cancer diagnosis could certainly be true …
I wrote that because a great many people, some of them doctors on cable news shows, are saying for various reasons that Biden had to have gotten the diagnosis much earlier. I very much disagree with that and I continue to say it’s possible that Biden’s diagnosis was in fact very recent. What are the odds? I’d need more information, such as whether he was being given regular PSA tests, and that information hasn’t been released yet.
I began yesterday’s post by saying I’m not a doctor. One of the commenters in the thread wondered why I was criticizing the opinion of one of the doctors who spoke about Biden’s diagnosis. I criticize doctors at times because I find flaws in what they’re saying (or what they’re reported to be saying; the two are not always the same).
For example, there’s this observation:
A handful of medical experts were quick to question how the former president could be diagnosed at such a late stage — especially given that prostate cancer can be detected early with routine bloodwork, which is recommended for men over the age of 50.
“It is inconceivable that this was not being followed before he left the Presidency,” Dr. Howard Formman said in a post on X.
Not in the least inconceivable. In fact, the PSA test (the screening blood test) is not routinely recommended for someone of Biden’s age. I wrote an entire post about that back in 2011 and linked to it yesterday; I’ll link to it again here. The directive about that is still in place; see this for more details, as well as this from ye olde CDC. From the latter site:
Men who are 70 and older should not be screened for prostate cancer routinely.
Of course, many men do continue to be screened by having the PSA test after 70. Unless Biden had some extra reason to be screened – such as, for example, a family history – his doctors may just have been following these recommendations and not screening him that way. Have you noticed there’s not been any mention of his PSA level (at least, I haven’t located anything that mentions it)? We merely read that his diagnosis began with a palpable nodule. He was probably being screened that way for something like prostate enlargement, very common in elderly men, and that precipitated the rest of the testing and the discovery of the cancer.
I’m not a doctor, but I know these things because I follow them and have followed them for years. And I know them also from the personal experience of people I know who have had prostate cancer diagnoses at advanced ages. The person I know who had a diagnosis of aggressive prostate cancer at a similar age as Biden was told by his urologist that he shouldn’t pay any attention to a slightly elevated PSA and shouldn’t have any testing, although his internist had already ordered it and recommended a special MRI. The MRI showed a very high likelihood of cancer and his biopsy showed it was very aggressive. When the biopsy results came back, the doctor who did it told him that it was a very good thing that his alert internist had done the testing because it may have been caught before it metastacized, which it almost certainly would have in fairly short order and that it might even be metasticized now on the cellular level. The point of that story is that his urologist would have missed it, and he probably would have been in Biden’s shoes if the urologist had been in charge. Plus, the urologist would just have been following the guidelines.
My guess is that Biden’s doctors followed the guidelines and he wasn’t having PSA testing.
More from Dr. Foreman on Biden:
“Gleason grade 9 would have had an elevated PSA level for some time before this diagnosis. And he must have had a PSA test numerous times before. This is odd,” he added. “I wish him well and hope he has an opportunity for maximizing his quality of life.”
I have no idea why this doctor says that, but it’s not “odd” for an 82 year old man not to be tested.
Let me repeat that the person I know with Gleason 9, who is about Biden’s age, had a PSA of only a tiny bit over 4 when diagnosed. He was having his PSA tested every year, and a year before his PSA was 2.3. As I already indicated, his urologist didn’t even think he should be tested but his internist was doing it anyway, and the internist decide this jump in a year needed further investigation. The urologist disagreed and recommended ignoring it, but the MRI and then biopsy was done and the surgeon who did the biopsy praised the internist’s decision because of the very aggressive nature of the cancer.
In addition – and any doctor should be aware of this – there’s a group of men who have prostate cancer and whose PSAs are not elevated:
A false-negative result means that the test shows that the PSA level is normal even though prostate cancer is present. Not all prostate cancers cause a high PSA level. PSA testing misses about 15% of prostate cancers.
Lastly, I know some men who were very conscientious about getting PSA testing and yet who had sudden elevations and were already metastatic at diagnosis. I’m not saying this is common, but it’s possible.
“Prostate cancer can develop between screening tests,” Morgans said. “It doesn’t necessarily grow super slowly. It can develop between screenings, and it can be aggressive when it does develop; that doesn’t mean it’s not treatable.”
That is what I already knew, and it could apply to Biden if he has in fact been getting regular PSA testing.
And there’s also this:
However, in hormone-resistant aggressive subtypes, PSA may be at a low level in the initial stages. …
There’s no single timeline, but aggressive prostate cancer progresses in the body rapidly. This tendency is in stark contrast to traditional adenocarcinomas of the prostate gland, which tend to progress very slowly for years. …
Aggressive prostate cancer tends to present with metastasis in the bones and lymph nodes in the pelvic region despite a low PSA level.
The announcement of Biden’s diagnosis, however, said that his cancer is not hormone resistant, which would give him a somewhat better prognosis.
Yesterday, commenter “Alan” wrote:
I was listening to Dr. David Samadi – a fairly famous urologist – on Megyn Kelly this evening and he made an interesting point: The only way to determine whether prostate cancer is hormone sensitive is to administer hormone blockers and watch whether the PSA decreases over time. No way they could have gone from nodule discovery to this point in a few weeks or months.
I responded that what that doctor said isn’t strictly true. It may be the only certain way to tell if a cancer is hormone-sensitive, but there are other ways to see if it’s most likely hormone-sensitive and therefore whether hormone blockers are a good idea. Here’s a description of one such test.
Put all of that together and I think it’s very possible the story being put out about Biden is the truth, although an incomplete one. I’d like a more specific timeline as well as information on whether or not he had regular PSA tests, and if not why not, and if so what his figures were over time.
And of course it’s also possible they’re lying; wouldn’t be the first time. But at the moment I see no reason to assume it.
