Photo: Eileen T. Meslar/Chicago Tribune/Tribune News Service via Getty Images
On Sunday, representatives for Joe Biden announced that the 82-year-old former president has been diagnosed with metastatic (Stage 4) prostate cancer. The news, which follows a period of renewed scrutiny of how Biden’s inner circle handled concerns about his age and health during his reelection campaign, has (mostly) prompted an outpouring of support for Biden and his family, and it’s also shone a national spotlight on prostate cancer and how it can be detected and treated. Below is a look at how people in the medical community have responded to his diagnosis.
According to the statement released by Biden’s office, he was diagnosed on Friday following “a new finding of a prostate nodule after experiencing increasing urinary symptoms.” It also noted that the prostate cancer is “characterized by a Gleason score of 9 (Grade Group 5) with metastasis to the bone.” Gleason scores are the grading system for prostate cancer and range from 6 (low grade) to 10 (high grade); Grade 5 means high-grade, and refers to how malignant cancerous cells appear to be in the patient’s tissue sample. “While this represents a more aggressive form of the disease, the cancer appears to be hormone-sensitive which allows for effective management. The President and his family are reviewing treatment options with his physicians.”
According to the American Cancer Society, this year nearly 314,000 American men will be diagnosed with prostate cancer, and nearly 36,000 will die from the disease. It’s the second-most common form of cancer (after skin cancer), age is the biggest risk factor, and it’s the second leading cause of cancer death for American men (after lung cancer). On average, the five-year relative survival rate for someone diagnosed with metastatic prostate cancer is 37 percent.
But in the aftermath of Biden’s diagnosis, numerous oncologists and urologists have stressed that while his diagnosis is serious and his cancer is considered incurable, it isn’t necessarily a death sentence. As Fox Chase Cancer Center urologist Alexander Kutikov noted in an X post, “in the past 20 years, 5-year survival has improved markedly thanks to better imaging, advanced therapies, and more effective care. Often men live many years — and sometimes decades — with a terrific quality of life.”
Explained American Cancer Society chief science officer William Dahut to the Washington Post:
He could definitely live many years with this. There’s a wide range of how long people can live with metastatic prostate cancer. In the most aggressive cases, under a year, but there are reports of people living 15 or 20 years, too.
Another expert emphasized how common this ailment is to NBC News:
“Gleason 9 is, by definition, aggressive, but you don’t know how bad it is unless you know what the PET scan looks like,” said Dr. Alan Tan, genitourinary section lead at Vanderbilt University Medical Center in Nashville, Tennessee. Tan is not involved with Biden’s case. Tan said that this type of prostate cancer is not rare. “This is the most common thing I see in my clinic,” he said. “This is bread-and-butter genitourinary oncology.”
Duke University urologic oncologist Judd Moul spoke with the New York Times:
The first line of attack is to cut off the testosterone that feeds prostate cancer. Dr. Moul said that when he started out as a urologist in the 1980s, this was done by removing a man’s testicles. Today, men have a choice of two drugs given by injection that block the testicles from making testosterone or a pill that does the same thing. In addition, men take drugs that block any testosterone that manages to be made despite the drugs that inhibit its production. Dr. Moul said he sees men Mr. Biden’s age with similar prostate cancer diagnoses on a regular basis. “Survival rates have almost tripled in the last decade,” he said.
That is the targeted hormone therapy Biden’s office mentioned. Moul also told the Times that at that age, thanks to modern treatments, a patient like Biden “could hopefully pass away from natural causes and not from prostate cancer.”
“Most men in this situation would be treated with drugs and would not be advised to have either surgery or radiation therapy.” Dr. Matthew Smith of Massachusetts General Brigham Cancer Center told the Associated Press.
Soon after Biden’s diagnosis was announced, there was some speculation about how his doctors should have been able to detect the cancer before last week. In February 2024, amid renewed concerns over Biden’s health, his physician Kevin O’Connor said in a letter than Biden was “fit for duty” and that a recent assessment by a team of doctors had found “no new concerns.”
Here’s what Northwestern Medical Group oncologist Chris George told Reuters reporter Nandita Bose about the question of prostate-specific antigen (PSA) testing:
I would assume that the former president gets a very thorough physical every year. One of the best screening tools that we have to detect cancer is called the PSA. That’s a blood test that looks for cancer. I would be interested to know what his PSA was the last time it was checked … it’s sort of hard for me to believe that he’s had a PSA within the past year, that was normal. It’s possible. It’s definitely possible, but that would surprise me.
Johns Hopkins University oncologist Otis Brawley told the Washington Post that prostate cancer screening fails “all the time” and “is not a very good screening test, and we need a better test.”
It’s not clear if Biden was screened with a PSA test, as the screening is frequently discontinued for men after they reach their 70s unless they have specific risk factors. And as Dr. Celine Gounder pointed out to CBS News, some symptoms for prostate cancer are common and not linked to cancer:
Symptoms can include urinary issues, such as frequent urination, weak or interrupted flow, blood in urine and trouble either holding in or starting urination, according to Johns Hopkins, which says other symptoms can include difficulty getting and maintaining an erection, painful ejaculation and pain or stiffness in the lower back, hips or upper thighs.
Urinary symptoms, such as frequent urination or difficulty urinating, are quite common in older men and are usually due to benign conditions like having an enlarged prostate, CBS News medical contributor Dr. Celine Gounder says.
But in this case, Biden’s office said his symptoms led to a prostate exam that resulted in the discovery of a small nodule. Further testing determined it was cancerous. Some urologists were surprised that the 82-year-old underwent prostate cancer screening at all, according to Dr. Gounder, because routine screening in men over 75 is controversial. Many prostate cancers at that age are slow-growing, and overtreatment can do more harm than good, she said.
Per the American Cancer Society, late-age screening is definitely not the norm:
No major medical organization presently endorses routine screening for men at average risk because of concerns about overdiagnosis (detecting disease that would never have caused symptoms or harm), especially given the potential for serious side effects associated with prostate cancer treatment. However, newer biomarker and imaging tests increasingly limit unnecessary biopsies and reduce overdiagnosis and overtreatment. The American Cancer Society, and now the US Preventive Services Task Force, recommend “shared decision-making,” whereby health care providers educate men about the benefits and harms of PSA screening and encourage personal choice.
At CNN, Orlando Health urologist Jamin Brahmbhatt dismisses the speculation about Biden’s diagnosis, noting that, “I experience daily how unpredictable prostate cancer can be”:
Some patients show clear signs of the disease, while others surprise even me with aggressive or unexpected cases. Cancer doesn’t discriminate, and its trajectory can be uncertain. But one factor we can all control is our approach to prevention and early detection.
Symptoms to watch for are blood in the urine or semen; needing to urinate more often, including waking up at night to urinate; and trouble getting started when urinating. Signs of more advanced disease can also include accidental leaking, pain in the back and bones, fatigue, weight loss and weakness.
Former President Biden’s experience should be a call to action for us: Schedule regular health checkups, discuss prostate screening with your health-care provider, pay attention to your body’s signals, and prioritize overall health.
This post has been updated.
