Former President Joe Biden’s diagnosis of advanced prostate cancer that has metastasized to his bones sparked widespread concern and questions about his health. These questions include how long the cancer may have taken to develop and whether he had been screened for it during previous checkups.
While it is unclear how long Biden has had cancer, its rapid spread is attributed to the disease’s aggressive nature. His cancer was classified as having a Gleason score of 9, placing him in Grade Group 5, the most severe category. The Gleason score is a system for grading the severity of prostate cancer based on the examination of cell samples under the microscope.
When prostate cancer progresses and spreads, the bones are one of the most vulnerable areas. The Mayo Clinic also reports that it can spread to lymph nodes, the liver, and the lungs.
Unfortunately, late-stage cancer diagnosis is not unusual. According to Cancer Research UK’s 2014 analysis, 46% of all cancers in the country were diagnosed at an advanced stage. A 2023 study published in the journal Lancet Oncology found that disruptions in care during the pandemic resulted in an increase in late-stage diagnoses across nearly all cancer types, including prostate.
Slower-growing cancers can take years to develop and be detected, whereas more aggressive cancers can appear suddenly and spread to other parts of the body more quickly.
Biden, 82, did not have a prostate cancer screening during his last medical checkup while in office in February 2024, according to records released at the time. Experts believe this is due to the fact that these screenings are not routinely recommended for men aged 70 and older.
“Doctors will stop screening for prostate cancer around the age of 75, because after that, the prostate cancers you typically find are very slow growing, and so the harms of all of the testing and treatment for something that may not kill you are weighed against the benefit. Dr. Céline Gounder, a CBS News medical contributor and editor-at-large for public health at KFF Health News, explained on “CBS Mornings” Monday that the risk might not be worth it.
Instead, Biden’s diagnosis came after he visited a doctor for urinary symptoms. His office reported last week that a small nodule in the prostate required further evaluation.
“Urinary symptoms are quite common in older men and are usually due to benign conditions like having an enlarged prostate,” Gounder told me. In this case, however, the tests revealed cancer.
Gounder believes the situation highlights the importance of tailoring medical decisions to the individual.
“He had new symptoms and is functionally active, which justified a closer look,” she told me.
There have been advances in treating advanced prostate cancer, and Gounder stated that the treatment goal in this case would be to control the cancer, slow its progression, and maintain quality of life. Biden’s cancer is hormone-sensitive, so a testosterone-blocking treatment should be effective, according to Gounder, who added that this may be combined with other medications or chemotherapy depending on the specific case.
In 2019, Biden was diagnosed with benign enlargement of the prostate, or BPH. That December, his campaign made available his medical evaluation, which stated: “This patient has been treated for Benign Prostatic Hyperplasia (BPH). This was initially treated with medication, followed by surgery. “He’s never had prostate cancer.”
According to Yale Medicine, BPH affects approximately 80% of men over the age of 70.
How do doctors screen for prostate cancer?
Prostate cancer is typically diagnosed using two methods: a prostate-specific antigen (PSA) test and a digital rectal exam (DRE). A PSA test is a blood test that can indicate a higher risk of prostate cancer but does not provide a definitive diagnosis. During a DRE, a doctor uses a gloved finger to feel for any bumps on the prostate via the rectal.
According to the U.S. Preventive Services Task Force, an independent panel of national experts, the decision to screen for prostate cancer among men aged 55 to 69 years should be made individually, and PSA screening is not recommended for men 70 and older.
“Many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction,” a summary of the task force’s recommendations states. “Clinicians should not screen men who do not express a preference for screening.”
According to the Cleveland Clinic, prostate cancer is the second most common cancer among men, trailing only skin cancer. The Centers for Disease Control and Prevention estimate that 13 out of every 100 males will develop prostate cancer at some point in their lives.