As a cancer researcher and deeply aware of the high incidence and poor outcomes of prostate cancer in the Caribbean region, those words were impactful. Even with my professional background, I couldn’t emotionally process the details at that moment. All I could say was, “What did the doctor say?” He replied, “Well, the urologist wants me to see a radiation oncologist about ‘semillas’ (seeds). So, they recommend me for treatment.” Many men, including former president Joe Biden, have progressed to obtain treatment after consultation, even when their condition had progressed. However, based on my research and professional experience, there is also a valid case for considering the option of living without immediately treating prostate cancer. In certain contexts, this can be the right choice.
I took it upon myself to help my father understand his diagnosis and to help him navigate the important decisions ahead. Our situation offers a window into what it truly means to walk through a cancer diagnosis. My father and I were no strangers to prostate issues. His issues began over a decade ago when he was first diagnosed with benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate. This condition can be linked to changing hormone levels, infections, or inflammation. He suffered through typical BPH symptoms like difficulty starting urination, frequent urination, and urgency.
Although some studies show overlapping risk factors between BPH and prostate cancer, having an enlarged prostate does not mean one will eventually develop cancer. Both conditions may exist together or occur independently. The two conditions can occur separately. When my father was first diagnosed with BPH, the first thing I asked about was his prostate-specific antigen (PSA) levels- the amount of prostate-specific antigen in his blood. PSA is a protein that can be produced by both healthy and cancerous prostate cells, and its level can indicate a problem when it rises. PSA testing is commonly combined with a digital rectal exam (DRE) to provide a more comprehensive risk assessment. My father informed me that his PSA was elevated, but the medical team had recommended an active surveillance method called “watchful waiting,” involving PSA testing every six months to monitor for changes.
After several years of regular monitoring, his PSA level had doubled. A biopsy then confirmed he had developed intermediate-risk prostate cancer. After the diagnosis, my father had to decide what treatment option to take, and I said that the best option depends on the stage and spread of the cancer. Prostate cancer is staged from 1 to 4. Stages 1 and 2 indicate cancer confined to the prostate, categorized as early or intermediate risk. Stages 3 and 4 indicate local spread or metastasis and are considered more aggressive.
For early-stage patients, treatment options include surgery, radiation, and brachytherapy. Advanced stages are more likely to involve hormone therapy, radiation, or chemotherapy. Although the diagnosis was not unexpected due to his age and medical history, it was still emotionally difficult. We had already been conducting regular PSA checks, which remained appropriate even in some more aggressive cases.
Following the diagnosis, we decided to delay treatment, recognizing that most prostate cancers progress slowly. Research has shown that PSA testing can lead to overdiagnosis and unnecessary treatments, often accompanied by adverse side effects. Early-stage prostate cancer usually has a good prognosis and can be managed safely through continued monitoring.
In 2018, the U.S. Preventive Services Task Force began recommending personalized PSA screening, especially for high-risk groups. A genetic test showed my father had a low five-year risk of disease progression, reinforcing our decision to continue active surveillance. We monitor his PSA every six months. Although some have questioned this approach, he remains confident in his decision. Ultimately, making informed, evidence-based decisions in consultation with healthcare professionals is essential in managing prostate cancer effectively.
Reference: Luisel Ricks-Santi. Biden is getting prostate cancer treatment, but that’s not the best choice for all men − a cancer researcher describes how she helped her father decide. THE CONVERSATION. Published May 20, 2025. Accessed May 26, 2025. Biden is getting prostate cancer treatment, but that’s not the best choice for all men − a cancer researcher describes how she helped her father decide
