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Prostate cancer can often go undiagnosed until it reaches an advanced stage, according to medical experts. Former President Joe Biden's office revealed on Sunday that he has been diagnosed with an "aggressive" form of prostate cancer which has metastasized to his bones.

This announcement left many questioning why the cancer was only detected with a high Gleason score of 9. Dr. Alicia Morgans, a genitourinary medical oncologist at Dana-Farber Cancer Institute, explained to ABC News that late-stage diagnoses are not uncommon among older patients. "Prostate cancer does not follow a rule book," Morgans stated, emphasizing the challenges in detecting the disease early despite rigorous screening protocols.

One common screening method is the measurement of prostate-specific antigens (PSA) through a blood test. Although there is no definitive level that indicates cancer, a PSA level of 4 nanograms per milliliter often prompts further testing. However, the U.S. Preventive Services Task Force advises against PSA-based screenings for men over 70 due to potential harms, such as false positives and overdiagnosis.

It remains unclear whether President Biden had undergone regular PSA screenings. Morgans noted that many men above age 70 might opt out of these screenings, considering their overall health objectives. "It's plausible that President Biden, like so many men over that age, decided not to do PSA screening," she said.

Dr. Alan Bryce, chief clinical officer at City of Hope Cancer Center Phoenix, highlighted the importance of shared decision-making in pursuing prostate cancer screening. He remarked that some patients with borderline-high PSA results might choose not to undergo further testing, prioritizing their quality of life. "As physicians, we present patients with options and recommendations but, at the end of the day, it's still the patient's decision," Bryce emphasized.

Advanced prostate cancer can present various symptoms including a weak urination stream, frequent urination, erectile dysfunction, fatigue, weight loss, and pain in the bones, yet many patients remain asymptomatic. Dr. Morgans pointed out that it is common for patients to be unaware of their condition due to the absence of noticeable symptoms. Bryce added that some symptoms may simply be age-related, making it challenging to distinguish between normal aging processes and cancerous developments.

The insights from these experts underscore the complexities involved in prostate cancer screening and diagnosis, particularly in older adults.