Bob Casey was on a train bound for Washington, D.C., when he got a call that stopped him in his tracks.

“It was just two words,” the former senator remembers. “It’s cancer.”

Casey, a Scranton native serving his third term in the U.S. Senate, was diagnosed with prostate cancer in late 2022. He was 62 and had no symptoms of disease. The cancer was caught by a routine blood test that revealed elevated levels of prostate-specific antigen.

Casey was shaken by the diagnosis, but knew the cancer was manageable and detected early. He had decisions to make and time to make them.

“I can’t imagine hearing those two words, ‘It’s cancer,’ and having it be the kind of cancer which is not manageable,” Casey said in a recent interview. “It hits you really hard, but I also had a general sense that this was more manageable, so it wasn’t as devastating as it would have been if it were some other kind of cancer. But even with that, it still hits you hard.”

Casey had successful surgery in 2023 and has remained healthy since, an example of advances in testing and treatment that have dramatically improved survival rates for the second-leading cause of cancer deaths in American men. Only lung cancer is more lethal. About one in eight men will be diagnosed over their lifetime with prostate cancer, according to the American Cancer Society.

Scranton native and former President Joe Biden was diagnosed last month with aggressive prostate cancer that spread to his bones. Prostate cancers are graded using what’s known as a Gleason score. Scores range from 6 to 10. Biden’s score is 9, suggesting his cancer is among the most aggressive types. It can be treated, but not cured.

Casey said he sent Biden, 82, a message of support, but hasn’t spoken to his old friend and political ally since the diagnosis.

“I reached out just to say, ‘You’re not alone,’ and to tell him that we’re thinking of him,” he said. “I did see him right before he left (the White House) in January. I really haven’t been in touch with him since, but (the diagnosis) is a hell of a thing after all he’s been through.”

Casey, 65, credits the support and advocacy of Terese Casey, his wife of 40 years and a key partner in his treatment and recovery.

“She jumped right in helping me research it, and we interviewed a group of surgeons,” he said. “Technically, I had three options — just let it go and see what happens; No. 2 was to get radiation; and No. 3 was to have surgery. I chose a prostatectomy, where you just get it out. I was really fortunate. I had a good doctor and got a good result.”

Choosing the right doctor and treatment plan are key not only to survival, but quality of life, said Don Ezrin, a three-time cancer survivor who until recently chaired the Northeast Pennsylvania Prostate Cancer Survivors Support Group. The group no longer meets in person, but maintains a vibrant presence on Facebook, one of many regional pages for cancer survivors on the platform.

A Vietnam-era Air Force veteran, Ezrin learned he was at risk during his discharge physical. His doctor told him his prostate was enlarged.

“I really remember the doctor with his rubber glove going, ‘What is this? That’s a bit enlarged,’” Ezrin said. “So I was watching it thoroughly, and the minute it raised its ugly head, we proceeded to do something.”

Ezrin was diagnosed with prostate cancer in 2002. He opted for intensity modulated radiation therapy, which was not widely available in Northeast Pennsylvania at the time. His cancer has been under control for 20 years, which he credits in part to choosing the right treatment.

“You’ve got to understand that each medical professional is very similar to a car salesman,” the 78-year-old retiree said. “They want to sell what they practice, and if you start asking questions and they’re not in that field, they’re going to shut you down real quick, which was the reason for starting the group.”

Every treatment — whether surgery, radiation or hormone therapy — comes with side effects, Ezrin said. When he was diagnosed, his wife, Lisa, was 40. Ezrin was 57, and leery of the sexual side effects of some treatment options.

“I was not ready to give up what I call ‘the finer things of life,’ which is what can happen if you choose the wrong therapy to treat prostate cancer,” Ezrin said. “A lot of the drugs that are out there today can rob you of the desire to want to do anything other than just exist.

“I’ve seen guys bounce back immediately and I’ve seen guys just fall apart. The bottom line is you’ve got to get educated on what you’re up against and then make the best choice for you, your family and your financial situation.”

Casey echoed Ezrin’s call to research options widely before making treatment decisions. Seeking the support and counsel of survivors is also important, he said. Shortly after he announced his diagnosis, other members of Congress reached out with advice and support.

“That was a big help, and again, I was very fortunate to have good doctors and a good result,” he said. “And the recovery was pretty fast. I think I was back voting in the Senate on day 12.”

Casey was defeated in the November election and exited the Senate in January. His win over prostate cancer gives him more time to spend with his two grandchildren. Another is due in June.

“On Jan. 3, the first day of the new Congress, I purposely got in my car and drove to their house to be with them,” Casey said. “I’ve been really lucky. I had a great run and had a lot of years in government and now I’ve got to do something else. I’m still working on that, still trying to figure that out, but I’ve been fortunate.”

The former president’s diagnosis and treatment going forward should serve as a reminder to men of a certain age to get tested regularly, Casey said.

“Whenever these things happen to someone who’s prominent, it obviously brings a lot of attention to the topic,” he said. “It’s a powerful reminder for men to get the test, especially when you’re in your 40s and 50s. It’s important and it’s so simple. You get a blood test. Treatment has come a long way over the past 25 or so years. What used to be a death sentence no longer is.”