RUSH TRANSCRIPT Biden family ░░░░░░░░ facing themselves as they ░░░░░░░░ evaluating what his treatment ░░░░░░░░ might be All right ░░░░░░░░ Saenz thanks so much ░░░░░░░░ s turn now to ░░░░░░░░ ezekiel emanuel He s ░░░░░░░░ cancer specialist and vice ░░░░░░░░ for the global initiative ░░░░░░░░ the university of Pennsylvania ░░░░░░░░ doctor emanuel thank you ░░░░░░░░ much for joining us ░░░░░░░░ take us through the ░░░░░░░░ Biden s statement says ░░░░░░░░ prostate cancer is characterized ░░░░░░░░ a gleason score of ░░░░░░░░ grade group five with ░░░░░░░░ to the bone Put ░░░░░░░░ into English for us ░░░░░░░░ it s a stage ░░░░░░░░ So gleason goes up ░░░░░░░░ Scale 10 That s ░░░░░░░░ highest which means it ░░░░░░░░ the most aggressive cancer ░░░░░░░░ it s at 10 ░░░░░░░░ so he s in ░░░░░░░░ most aggressive category And ░░░░░░░░ importantly the metastasis means ░░░░░░░░ the cancer has spread ░░░░░░░░ of the prostate to ░░░░░░░░ bone where prostate cancer ░░░░░░░░ goes Which which also ░░░░░░░░ it s incurable He ░░░░░░░░ not be cured of ░░░░░░░░ I should say it ░░░░░░░░ also important to recognize ░░░░░░░░ most people with prostate ░░░░░░░░ don t die from ░░░░░░░░ prostate cancer they die ░░░░░░░░ with the prostate cancer ░░░░░░░░ this is a prostate ░░░░░░░░ which as you noted ░░░░░░░░ probably treatable with hormonal ░░░░░░░░ that blocks testosterone and ░░░░░░░░ So my impression and ░░░░░░░░ could be completely wrong ░░░░░░░░ correct me If so ░░░░░░░░ that prostate cancer is ░░░░░░░░ caught pretty early on ░░░░░░░░ it s rare to ░░░░░░░░ diagnosed with prostate cancer ░░░░░░░░ advanced as his is ░░░░░░░░ that right That is ░░░░░░░░ About 7 of people ░░░░░░░░ it diagnosed when it ░░░░░░░░ metastatic So how long ░░░░░░░░ this cancer been growing ░░░░░░░░ And would there have ░░░░░░░░ symptoms before the last ░░░░░░░░ of weeks Would there ░░░░░░░░ indications in his medical ░░░░░░░░ that have been made ░░░░░░░░ from when he was ░░░░░░░░ president candidate and then ░░░░░░░░ It has been growing ░░░░░░░░ years It didn t ░░░░░░░░ pop up in the ░░░░░░░░ few days or the ░░░░░░░░ few weeks or the ░░░░░░░░ 200 days Cancer grows ░░░░░░░░ time Initially we don ░░░░░░░░ we can t see ░░░░░░░░ diagnose it because it ░░░░░░░░ a few Thousand 100 ░░░░░░░░ cells It needs to ░░░░░░░░ more than tens of ░░░░░░░░ of Cells to be ░░░░░░░░ And that takes time ░░░░░░░░ develop in most cases ░░░░░░░░ every case but in ░░░░░░░░ cancer it does And ░░░░░░░░ cancer it does In ░░░░░░░░ cancer it does And ░░░░░░░░ there has been cancer ░░░░░░░░ President Biden and his ░░░░░░░░ don t appear to ░░░░░░░░ known about that And ░░░░░░░░ that s that s ░░░░░░░░ we know I think ░░░░░░░░ there are really four ░░░░░░░░ here One is if ░░░░░░░░ took a psa which ░░░░░░░░ haven t seen it ░░░░░░░░ low And some people ░░░░░░░░ get diagnosed with low ░░░░░░░░ We have that from ░░░░░░░░ clinical trials And you ░░░░░░░░ have a low psa ░░░░░░░░ still have cancer It ░░░░░░░░ be that his doctor ░░░░░░░░ the United States preventive ░░░░░░░░ task force old Recommendations ░░░░░░░░ 2018 did not offer ░░░░░░░░ a man over 70 ░░░░░░░░ not offer psa screening ░░░░░░░░ 70 It could be ░░░░░░░░ he did offer it ░░░░░░░░ President Biden was president ░░░░░░░░ going to run for ░░░░░░░░ and had you know ░░░░░░░░ thought 10 years more ░░░░░░░░ life And they discussed ░░░░░░░░ and decided not to ░░░░░░░░ for it And then ░░░░░░░░ could have been tested ░░░░░░░░ and we just didn ░░░░░░░░ see the result So ░░░░░░░░ would Those Are the ░░░░░░░░ and only possibilities Because ░░░░░░░░ would they decide not ░░░░░░░░ test for it Because ░░░░░░░░ it s you ve ░░░░░░░░ that presidents Obama and ░░░░░░░░ took the psa test ░░░░░░░░ detects prostate cancer Biden ░░░░░░░░ didn t is that ░░░░░░░░ Biden is older and ░░░░░░░░ recommendations are no longer ░░░░░░░░ people over 70 to ░░░░░░░░ the test Because there ░░░░░░░░ so many people with ░░░░░░░░ psa levels like what ░░░░░░░░ what s the reason ░░░░░░░░ not get the test ░░░░░░░░ let me make three ░░░░░░░░ Jake The first one ░░░░░░░░ yes the preventative services ░░░░░░░░ force in 2018 said ░░░░░░░░ over men over 70 ░░░░░░░░ not get tested But ░░░░░░░░ groups like the American ░░░░░░░░ association the American cancer ░░░░░░░░ have said anyone who ░░░░░░░░ more than 10 years ░░░░░░░░ life expectancy should have ░░░░░░░░ discussion about getting tested ░░░░░░░░ s the first thing ░░░░░░░░ there are many different ░░░░░░░░ and they don t ░░░░░░░░ agree on the 70 ░░░░░░░░ cutoff And we noted ░░░░░░░░ the preventative services task ░░░░░░░░ is revising its guideline ░░░░░░░░ to say if you ░░░░░░░░ got 10 years you ░░░░░░░░ be tested The second ░░░░░░░░ is that it the ░░░░░░░░ is a bad test ░░░░░░░░ actually would have preferred ░░░░░░░░ to have gotten a ░░░░░░░░ test And I can ░░░░░░░░ of many people who ░░░░░░░░ you know it s ░░░░░░░░ a lot of what ░░░░░░░░ call false positives It ░░░░░░░░ elevated It s turns ░░░░░░░░ not to be cancer ░░░░░░░░ that s actually the ░░░░░░░░ of cases when it ░░░░░░░░ elevated to between 4 ░░░░░░░░ 10 And I think ░░░░░░░░ lot of people think ░░░░░░░░ s not a great ░░░░░░░░ test And so that ░░░░░░░░ a reason not to ░░░░░░░░ it I don t ░░░░░░░░ what the discussion is ░░░░░░░░ don t know what ░░░░░░░░ o connor or President ░░░░░░░░ were discussed If they ░░░░░░░░ that option and declined ░░░░░░░░ That is a view ░░░░░░░░ very rational people can ░░░░░░░░ and actually a view ░░░░░░░░ increasing numbers of people ░░░░░░░░ taken over time So ░░░░░░░░ zeke if you could ░░░░░░░░ guess one of the ░░░░░░░░ that s so scary ░░░░░░░░ this diagnosis is usually ░░░░░░░░ there is prostate cancer ░░░░░░░░ think there s some ░░░░░░░░ of symptom usually urinary ░░░░░░░░ something like that that ░░░░░░░░ causes the patient to ░░░░░░░░ to the doctor and ░░░░░░░░ something s going on ░░░░░░░░ I m just really ░░░░░░░░ again it s a ░░░░░░░░ thing It s so ░░░░░░░░ s just possible to ░░░░░░░░ it this far with ░░░░░░░░ aggressive form of cancer ░░░░░░░░ cancer that has metastasized ░░░░░░░░ the bone And he ░░░░░░░░ only have had symptoms ░░░░░░░░ the last couple of ░░░░░░░░ So Jake you re ░░░░░░░░ perceptive about this again ░░░░░░░░ haven t examined President ░░░░░░░░ I don t know ░░░░░░░░ particulars of the case ░░░░░░░░ I understand he had ░░░░░░░░ s called benign prostatic ░░░░░░░░ He had an enlarged ░░░░░░░░ that was causing urinary ░░░░░░░░ And at some point ░░░░░░░░ got surgery for that ░░░░░░░░ he his prostate was ░░░░░░░░ out or pieces of ░░░░░░░░ prostate were taken out ░░░░░░░░ is usually by a ░░░░░░░░ a transurethral Procedure And ░░░░░░░░ may be that he ░░░░░░░░ having perfectly fine urinary ░░░░░░░░ until very very recently ░░░░░░░░ he had much less ░░░░░░░░ There that wasn t ░░░░░░░░ blockage or any of ░░░░░░░░ usual symptoms that you ░░░░░░░░ associate with an enlarged ░░░░░░░░ from a cancer That ░░░░░░░░ a hypothesis Again I ░░░░░░░░ t examined him I ░░░░░░░░ not his doctor but ░░░░░░░░ is not unreasonable in ░░░░░░░░ situation All right doctor ░░░░░░░░ emanuel thank you so ░░░░░░░░ for