A MARTÍNEZ, HOST:
Hunter Biden says his father's cancer appears to be worsening. He told the BBC that prostate cancer is causing former President Joe Biden a lot of pain in his bones and has spread, quote, "elsewhere." To help us understand this, we've called Dr. Otis Brawley. He's a prostate cancer expert at the Kimmel Cancer Center at Johns Hopkins University, Dr, so we knew that Joe Biden's prostate cancer spread to his bones when he revealed his diagnosis last year. But when you hear a comment like Hunter Biden, what he said, what does it tell you about the severity of his disease?
OTIS BRAWLEY: Yeah. Thank you for having me. Prostate cancer starts in the prostate and then spreads to organs in the pelvis, and then it can go onto bone. We frequently will treat it with hormones to try to deprive it of androgen, and then the tumor will shrink for a time. And then there's a point in time when the tumor starts growing despite that treatment, and we have to go on to other treatments. And so I cannot speculate on the president's prognosis. I certainly wish him well, but I can tell you that there's still a number of different treatments that are available and patients like this can do quite well.
MARTÍNEZ: So if it gets to the bones, it's not necessarily the worst news possible?
BRAWLEY: That's right. That's right. Indeed, of my patients who are in their 70s and 80s, perhaps the majority who have metastatic disease to bone, ultimately die of cardiovascular disease or something unrelated to their prostate cancer.
MARTÍNEZ: OK. So what does pain management then look like day to day for a patient like Joe Biden's at 83?
BRAWLEY: It can vary. If there's pain just in one or two sites, it can be radiation focally localized to those areas to try to sterilize the bone of the tumor. And the pain is actually caused because the tumor interrupts the bony architecture and causes a fracture. It's just like a fracture that you or I might have from trauma, and that's the pain that the person has. If we can sterilize the tumor from that site, you can actually promote bone healing.
Sometimes our surgeons will actually put a bone cement into the crack to actually stop the crack from moving. If those things don't work, we have to resort to oral medications like nonsteroidals, or we can actually start ramping things up even to opioids. There are also some radiopharmaceuticals. These are radioactive drugs that we can inject to actually kill off the cancer and again, promote healing.
MARTÍNEZ: Joe Biden is still making public appearances and plans to release a memoir after the election. Doctor, is that a typical level of activity for someone with this diagnosis?
BRAWLEY: You know, there is no typical level.
MARTÍNEZ: OK.
BRAWLEY: I've had patients like the president who've had this for 25 years. Certainly, that's an outlier, but many people are very functional for five or six years, you know, so the life expectancy of your typical 83-year-old without prostate cancer is six years. And many of our prostate cancer patients surpass that, even.
MARTÍNEZ: OK. That's Dr. Otis Brawley. He's an oncologist and the Bloomberg distinguished professor at Johns Hopkins University's Kimmel Cancer Center. Doctor, thank you.
BRAWLEY: Thank you.
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