When you have advanced prostate cancer: What living with the disease looks like

When You Have Advanced Prostate Cancer: What Life Looks Like

Goldlaner.com – When you have advanced prostate cancer, the journey is different than most people expect. Dr. Jamin Brahmbhatt, a urologist and robotic surgeon with Orlando Health and assistant professor at the University of Central Florida’s College of Medicine, shares his perspective. “How long do I have to live?” is the question patients ask first when told they have prostate cancer.

For early-stage or low-grade cases, reassurance is straightforward: the five-year relative survival rate exceeds 99% with treatment. Most men will not die from low-grade prostate cancer. However, when the disease spreads beyond the prostate to bones and other organs, the picture changes significantly.

Treatment Advances Are Changing Outcomes

Therapy for advanced prostate cancer has transformed over the past decade. New medications, improved imaging technology, and earlier combination treatments are extending lives. In a July 15 video, former President Joe Biden shared that his treatments have been progressing well.

In May 2025, Biden officially announced that he had an aggressive form of prostate cancer that had spread to his bones. Since then, based on official updates, he has continued hormone therapy, completed a course of radiation and maintained a public presence.

More than a year later, his cancer journey provides insight into what has evolved in treating advanced prostate cancer—and the hope these advances offer men living with the disease. I recently saw a patient diagnosed three years ago with cancer that had already spread to multiple bone areas. Since then, he has taken cruises, traveled with his family and spent weekends babysitting his grandchildren.

He gets tired and cannot garden the way he once did. But he is still alive and considers every day a blessing. His experience, and what we see with Biden, shows what living with metastatic prostate cancer can look like today.

Understanding Survival Statistics

Many patients search online for survival rates, but every number comes with important context. The American Cancer Society reports five-year relative survival of greater than 99% when prostate cancer is found in or near the prostate. The figure drops to 38% when it has reached distant parts of the body.

That 38% statistic reflects large groups of men treated years ago. It does not fully capture newer treatments or account for an individual’s age, overall health, and response to therapy. Survival statistics describe populations but cannot predict individual outcomes.

That is why the 38% figure cannot tell us how long Biden—or any individual patient—will live. These patients’ outlook depends on cancer details and treatment response. A man diagnosed with metastatic prostate cancer a decade ago and a man diagnosed today would not receive the same treatment.

The current approach uses the best treatments early rather than holding back. For years, doctors began with hormone therapy—usually injections that lower testosterone—and saved other options until the cancer stopped responding. Today, those injections are often combined from the start with newer hormone-blocking drugs and chemotherapy.

Three details about Biden’s cancer help doctors understand its aggressiveness and management. Official statements highlighted that his cancer had a Gleason score of 9. The cancer had spread to his bones, and it was labeled as hormone-sensitive. The Gleason score ranges from 6 to 10, with higher numbers indicating more aggressive cancer.

A score of 9 falls into the most aggressive category. However, the score alone cannot tell us whether the cancer has spread outside the prostate. When prostate cancer spreads, the most common destination is the bones—particularly the spine, pelvis and ribs. It can also reach organs such as the lungs or liver.

Once it has reached distant parts of the body, it is generally not curable, but treatment can put a brake on it for years. Prostate cancer can also be hormone-sensitive or hormone-resistant. Because it typically relies on testosterone to grow, lowering the hormone or blocking its effects can help control the cancer. Hormone-sensitive means it still responds to these treatments. Over time, most advanced or metastatic prostate cancers find ways to grow despite low testosterone levels.