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“It's a very common scenario," said Dr. Matthew Smith of Massachusetts General Brigham Cancer Center. Men can “feel completely well and a diagnosis of metastatic prostate cancer could come as quite a surprise.�

Guidelines recommend against prostate cancer screening for men 70 and older so Biden may not have been getting regular PSA blood tests, Smith said. What's more, while the PSA test can help flag some cancers in some men, it does not do a great job of identifying aggressive prostate cancer, Smith said.

When caught early, prostate cancer is highly survivable, but it is also the second-leading cause of cancer death in men. About one in eight men will be diagnosed over their lifetime with prostate cancer, according to the American Cancer Society.

Here are some things to know about prostate cancer that has spread.

What is the prostate gland?

The prostate is part of the reproductive system in men. It makes fluid for semen. It’s located below the bladder and it wraps around the urethra, the tube that carries urine and semen out through the penis.

How serious is Biden's cancer?

Biden's cancer has spread to the bone, his office said. That makes it more serious than localized or early-stage prostate cancer.

Outcomes have improved in recent decades and patients can expect to live with metastatic prostate cancer for four or five years, Smith said.

“It’s very treatable, but not curable,� he said.

What are the treatment options?

Prostate cancer can be treated with drugs that lower levels of hormones in the body or stop them from getting into prostate cancer cells. The drugs can slow down the growth of cancer cells.

“Most men in this situation would be treated with drugs and would not be advised to have either surgery or radiation therapy," Smith said.

What is a Gleason score?

Prostate cancers are graded for aggressiveness using what’s known as a Gleason score. The scores range from 6 to 10, with 8, 9 and 10 prostate cancers behaving more aggressively. Biden’s office said his score was 9, suggesting his cancer is among the most aggressive.

Should older men get screened?

Screening with PSA blood tests can lead to unnecessary treatment with side effects that affect quality of life. Guidelines recommend against PSA screening for men 70 and older.

The PSA test looks for high levels of a protein that may mean cancer but can also be caused by less serious prostate problems or even vigorous exercise.

For men aged 55 to 69 the U.S. Preventive Services Task Force says screening “offers a small potential benefit of reducing the chance of death from prostate cancer in some men.� The task force adds that “many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction.�

Is late-stage diagnosis more common in older men?

Yes. Of all men diagnosed with prostate cancer between 2017 and 2021 whose cancer staging was recorded, men 75 and older were more likely to be diagnosed with late-stage disease compared to those younger than 75.

One in five men 75 and older with prostate cancer were diagnosed with cancer that had metastasized, compared to just 6.3% of men under 75, according to an AP analysis of federal data from the U.S. Cancer Statistics Working Group.

Between 2017 and 2021, 90,551 men were diagnosed with late-stage prostate cancer, representing around 8.8% of prostate cancer diagnoses. More than 40% of them were 75 or older. ___

AP data journalist Kasturi Pananjady contributed to this report.

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