Doctors not involved in former former President Joe Biden’s care said his diagnoses shows the nuance and challenges of screening for prostate cancer.
Experts say Joe Biden’s cancer no longer curable, but treatable
Former President Joe Biden’s cancer cells are ranked with a “high Gleason score.” Here’s what that means for his treatment.
Former president Joe Biden has been diagnosed with an aggressive form of prostate cancer that has spread to the bone.
Doctors not involved in the former president’s care said his diagnosis shows the nuance and challenges of screening for prostate cancer.
Some, including President Donald Trump, have suggested that Biden likely knew about his cancer for a long time. But it’s possible, several doctors said, that his tumor was missed or that he has a particularly aggressive form of cancer that was unlikely to be detected by routine testing.
Because prostate cancer is typically so slow-growing, men over 70 are not recommended for routine screening.
“He could be receiving the best medical care that we have to offer as a nation and not be screened for prostate cancer,” said Dr. Michael Morris, a Memorial Sloan Kettering oncologist who specializes in treating men with prostate cancer. “Excellent care means not under-testing. It also means not over-testing.”
But someone of his stature likely would have received regular prostate-specific antigen tests, a blood test used to track prostate cancer risk, said Dr. Lee Richstone, the chair of urology at Northwell Lenox Hill Hospital in New York City.
“I would be very surprised if his PSA was not followed regularly, even at his age,” Richstone said.
The results of annual physicals, released while Biden was president from 2021 to 2025, did not include any information about PSA screening.
Some aggressive forms of prostate cancer yield normal PSA test results, Richstone said. In such cases, cancer can be diagnosed via a rectal exam or an MRI.
Biden’s personal staff announced on May 18 that he had been diagnosed two days earlier after experiencing urinary symptoms. A “nodule” was discovered on his prostate, according to his office’s statement statement, and the cancer had spread to his bone.
While the prognosis is more serious for a tumor that has spread, there are still treatment options available, doctors said, and his future is hard to predict especially without knowing the details of his tumor or how he will react to treatment.
How dangerous is prostate cancer?
Other than skin cancer, prostate cancer is the most common cancer among American men, according to the American Cancer Society.
The risk of getting prostate cancer increases with age. Black men are more likely than white men to get it and are twice as likely to die from the disease, according to the American Cancer Society.
An estimated 3.5 million men were living with prostate cancer in the United States in 2022, according to NCI.
For most men, prostate cancer is a slow-growing tumor and can be monitored without treatment.
When caught early, doctors often recommend active surveillance, meaning monitoring the tumor for signs of growth but not immediately treating a cancer that might never turn dangerous.
Only about 2% of men die within five years of a prostate cancer diagnosis, according to NCI.
But in cases such as Biden’s when the cancer is aggressive, some older patients “have a significant risk of dying from prostate cancer,” Richstone said.
For cancer that has metastasized, the median 5-year survival dips to nearly 38%, according to NCI.
While those aggregate numbers represent the overall population, patients survive longer, said Dr. Atish Choudhury, an oncologist at Dana-Farber Cancer Institute in Boston.
“The prognosis from this point is very much dependent on really how much cancer is actually outside of the prostate,” Choudhury said, as well as how he responds to treatment.
“There have been tremendous advancements in the treatment of prostate cancer, even after it had spread to the bone, such that people are living for years and years with this particular diagnosis,” he said.
What we know about Biden’s cancer
On May 18, Biden’s personal office disclosed the former president had a Gleason score of 9, grade group 5. The statement also said his cancer had spread to the bone.
With a Gleason score of 8, 9 or 10 ‒ at the high end of the scale ‒ cancer cells look different from healthy cells, and Grade 5 is the most advanced stage, where the cells look very abnormal, according to the Cleveland Clinic.
Biden and his family are reviewing treatment options with his doctors, Biden’s office said in a statement.
Biden’s cancer “appears to be hormone-sensitive which allows for effective management,” a spokesperson said.
What types of treatments could Biden get?
Men with prostate cancer that has spread often can get hormone-based treatments to fight the disease, said Morris of Memorial Sloan Kettering.
Even though “everything sounds bad” when a patient is diagnosed with an aggressive prostate cancer that has spread, combination therapies including hormone treatments “are especially potent and durable,” Morris said.
Doctors might attempt to prescribe medicine to lower Biden’s testosterone levels. Or they could prescribe newer drugs that target the “testosterone apparatus in the cancer itself,” Morris said.
“Frequently, we do both,” he said.
Other treatments could include radiation or chemotherapy, depending on how far the cancer has spread and Biden’s overall health, several doctors said.
Debate over PSA screening
The role of screening for prostate cancer has been debated for years amid changing guidelines.
The number of prostate cancers diagnosed each year declined from 2007 to 2014, which coincided with changes in screening recommendations, the American Cancer Society said. Since 2014, the rate has increased 3% per year.
The influential U.S. Preventive Services Task Force recommends men aged 55 to 69 years at typical risk decide whether to screen for prostate cancer with a PSA test. Men should discuss with a doctor the potential benefits and harms of screening before taking a PSA, the task force said.
Choudhury said the medical profession has attempted to balance the risks and benefits of screening.
Benefits can include detecting potentially dangerous cases earlier. When the less aggressive screening guidance was implemented last decade, studies show men were being diagnosed later and at more advanced stages.
But screening also brings potential harms. Risks can include detecting cancers that aren’t deadly, unnecessary biopsies or treatments that produce side effects or anxiety, Choudhury said.
Other doctors believe the task force’s recommendation on PSA screening misses the mark.
“Occasionally you see people like President Biden present with metastatic cancer, and then you say, ‘What if we had been screening him? Could we have caught it early?'” asked Dr. Edmund Folefac, a medical oncologist at the Ohio State University Comprehensive Cancer Center. “Why didn’t we screen it? Because we’re considering everybody as part of a group, rather than as individuals.”
Richstone said the task force built recommendations based on “antiquated practices.”
Doctors now usually follow elevated PSA results with an MRI, a step that has reduced the number of biopsies, Richstone said.
“Our biopsies are targeted, leading to much more accurate diagnosis, recognizing significant cancers and less likely recognizing insignificant cancers,” Richstone said.
When to get checked out
Urinary symptoms like Biden experienced can be a common complaint among men with prostate cancer, Morris said, but trouble urinating due to an enlarged prostate can also be a normal part of aging.
Morris urged any man who has trouble urinating or notices sudden changes such as bleeding to consult a doctor. A primary care doctor or a urologist might conduct an exam or order a PSA test to diagnose the condition, Morris said.
“If you do have symptoms and an issue that’s interfering with your life, that’s no longer in the realm of screening,” and should get checked out Morris said.