A Physician’s Take on President Biden’s Prostate Cancer Diagnosis
In May 2025, the news hit hard: former President Joe Biden, at 82 years old, was diagnosed with advanced prostate cancer. The announcement revealed a high-grade tumor—scored a 9 out of 10 on the Gleason scale—that had spread to his bones, making it Stage 4. This means it’s not curable, but treatments like hormone therapy, chemotherapy, or radiation can help manage it and keep him comfortable. As a doctor, I want to unpack this diagnosis in a way that’s clear for everyone. Let’s dive into what happened, why it might have gone undetected, and what this means for prostate cancer care, cutting through the noise of online speculation to focus on the medical reality.
The News Breaks: What We Know
On May 18, 2025, Biden’s team shared that he was diagnosed with prostate cancer the previous Friday after a routine exam found a suspicious lump during a digital rectal exam (DRE). Further tests confirmed an aggressive, hormone-sensitive cancer with a Gleason score of 9, indicating a high-grade tumor that had spread to the bones. Classified as Stage 4, this cancer is incurable but treatable, with options like testosterone-blocking therapies, chemotherapy, or radiation to manage progression and maintain quality of life. The diagnosis, reported by outlets like The New York Times and CBS News, sparked widespread discussion, not only about Biden’s health but also about the broader state of prostate cancer screening and detection in the United States.
The public’s reaction has been a mix of concern and curiosity, with online platforms amplifying political chatter and theories about whether this was missed during his presidency. But let’s set that aside. Instead, let’s talk about the medical side: how did an aggressive cancer like this slip through, and what can we learn from it?
Biden’s Last Prostate Check
Biden’s last recorded prostate-specific antigen (PSA) test—a blood test used to screen for prostate cancer—was in 2014, when he was around 71 or 72. This was in line with guidelines from the U.S. Preventive Services Task Force (USPSTF), which at the time suggested men over 70 skip routine PSA tests to avoid unnecessary procedures. His February 2024 checkup didn’t include a PSA test either, following the same logic. But here’s the catch: Biden’s cancer turned out to be a fast-moving type, and he also had a condition called benign prostatic hyperplasia (BPH) diagnosed in 2019, which can make PSA results tricky to interpret. Could more frequent testing have caught this sooner? It’s a question worth asking.
What Are the Guidelines for Prostate Cancer Screening?
Prostate cancer screening is a hot topic because it’s not a one-size-fits-all deal. The USPSTF, a group of experts who guide preventive care, stirred things up in 2012 by recommending against routine PSA testing for all men. Why? They worried about overdiagnosis, or finding slow-growing cancers that wouldn’t cause harm, and the risks of follow-up procedures like biopsies, which can lead to issues like infections or, down the line, side effects from treatments like surgery. Data from the American Urological Association shows PSA testing dropped by 20–39% and biopsies by 21% after this advice came out.
By 2018, the USPSTF softened their stance, suggesting men aged 55–69 talk with their doctors about whether PSA testing makes sense for them. For men over 70, they still say routine screening isn’t needed, assuming most cancers at that age grow too slowly to be a threat. Other groups, like the American Urological Association and the American Cancer Society, take a different approach. They suggest starting screening earlier, age 40 for high-risk folks like African Americans or those with a family history, and age 50 for others because some cancers don’t play by the “slow-growing” rule.
Why These Guidelines Aren’t Perfect
The USPSTF guidelines are meant to help the general population, but they can miss the mark for individuals like Biden. Here’s why:
They’re Built for the Masses
These guidelines look at what’s best for large groups, not individuals. If you’re a healthy 80-year-old who’s still hiking or working out, like Biden reportedly was, you might live well beyond the average life expectancy of 85 for a 70-year-old. That means you could benefit from screening, especially if you have risk factors like a family history of cancer. Guidelines don’t always account for that.
They Lean Toward Doing Less
The USPSTF often plays it safe, avoiding tests to prevent unnecessary stress or procedures. But this caution can backfire. Since the 2012 recommendation, metastatic prostate cancer cases—those that have spread, like Biden’s—have risen by about 6.5% per year, according to the SEER database. Skipping screening might mean missing aggressive cancers until it’s too late.
Life Expectancy Isn’t Everything
The guidelines assume that if you’re 70, you’ve got about 15 years of life left, and slow-growing prostate cancer won’t kill you in that time. But if you’re healthier than average or your cancer is a fast-mover, like Biden’s, that logic falls apart. His tumor’s high Gleason score shows it was aggressive, likely needing earlier action than the guidelines suggest.
Old Assumptions About Treatment Risks
The USPSTF worries a lot about the downsides of surgery, like incontinence or erectile dysfunction. That made sense years ago when surgery was the go-to treatment. But today, options like radiation, hormone therapy, or even “active surveillance” (watching the cancer closely without immediate treatment) are safer and more common. Biden’s hormone-sensitive cancer, for example, can be managed with drugs that block testosterone, slowing the cancer with fewer side effects.
The PSA Test: Helpful but Flawed
The PSA test measures a protein made by the prostate, with levels above 4 ng/mL raising a red flag. But it’s not foolproof. Cancer Research UK notes that 15% of men with normal PSA levels still have prostate cancer, and 80% with high levels don’t. Aggressive cancers, like Biden’s, can sometimes produce less PSA, making them harder to spot. Plus, things like BPH (which Biden had), infections, or even aging can bump up PSA levels, leading to false alarms. The PLCO trial found that over two-thirds of men with high PSA who got biopsies didn’t have cancer, which is why some worry about the test causing more stress than it’s worth.
New Tools to Catch Cancer Smarter
Thankfully, we’re not stuck with just PSA tests anymore. Multiparametric MRI (mpMRI) is a big step forward, letting doctors see suspicious spots in the prostate before deciding on a biopsy. A 2024 study showed mpMRI cuts down on unnecessary biopsies and helps avoid diagnosing harmless cancers. Other tests, like the 4Kscore, Prostate Health Index (PHI), or PCA3 (a urine test), can also help figure out if a high PSA is from cancer or something else.
In Biden’s case, a lump found during a DRE led to further tests, likely including imaging and a biopsy. If he’d had an mpMRI or these extra tests earlier, especially with his BPH muddying the waters, the cancer might have been caught before it spread. These advances show we can screen smarter, especially for older men or those with symptoms.
Could This Have Been Prevented?
Biden’s diagnosis is a tough pill to swallow. Following USPSTF guidelines, he skipped PSA tests after 2014, which was standard for his age. But his cancer’s aggressive nature, Gleason 9 and metastatic, suggests it might have been brewing for years. Experts quoted in STAT say it could have been detectable earlier with regular screening, maybe even at a stage where surgery or radiation could have stopped it. While we can’t know for sure, combining PSA with tools like mpMRI might have made a difference.
A Call for Smarter, Personalized Care
Biden’s story shows why we need to rethink prostate cancer screening. Guidelines are a starting point, but they don’t fit everyone. If you’re over 70, healthy, and have risk factors like a family history or being African American, talking to your doctor about screening is crucial. New tools like mpMRI and advanced blood or urine tests can help catch serious cancers without putting you through unnecessary procedures.
Biden’s openness about his diagnosis is a chance to get people talking. Prostate cancer affects 1 in 8 men, and it’s the second-leading cause of cancer death in men, per the American Cancer Society. By sharing his story, Biden’s encouraging men to have honest conversations with their doctors, weighing their risks and options. His case is a reminder that one-size-fits-all rules don’t always work, and a tailored approach could save lives.
References
- The New York Times. (2025, May 20). Joe Biden’s Cancer Diagnosis Is a Familiar Scenario for Prostate Experts.
- CBS News. (2025, May 19). Biden’s prostate cancer diagnosis raises questions about screening and how the disease spreads.
- The New York Times. (2025, May 20). Biden Did Not Get Prostate Cancer Diagnosis Before Last Week, Spokesman Says.
- The Washington Post. (2025, May 22). Opinion | After Biden’s diagnosis, a hospice nurse shares her hopes for him.
- U.S. Preventive Services Task Force. (2018, May 7). Recommendation: Prostate Cancer: Screening.
- news.virginia.edu. (2025, May 19). Q&A: How Did President Biden’s Prostate Cancer Advance Without Detection?
- Reuters. (2025, May 20). Biden had not received prostate cancer screening since 2014, spokesperson says.
- The New York Times. (2025, May 18). What a Prostate Cancer Diagnosis Like Biden’s Means for Patients.
- STAT. (2025, May 21). Biden’s diagnosis highlights little-noticed rise in late-stage prostate cancers.
- Fox News. (2025, May 25). Prostate cancer screening after 70: Experts question guidance after Biden’s diagnosis.
- American Urological Association. (2022, August 31). Impact of United States Preventive Services Task Force Recommendations on Prostate Cancer Diagnosis.
- NPR. (2025, May 19). How treatable is prostate cancer? A doctor reacts to Biden’s diagnosis.
- The Independent. (2025, May 19). Why the standard test for prostate cancer often misses the most dangerous types.