Former President Joe Biden’s diagnosis with an advanced stage of prostate cancer that has metastasized, or spread, to his bones prompted an outpouring of concern and questions about his condition. Those questions include how long the cancer may have taken to develop and whether he was screened for it during earlier checkups.
While it’s unclear exactly how long Biden has had cancer, its rapid spread is attributed to it being an aggressive form of the disease. His cancer was categorized as having a Gleason score of 9, which places him in Grade Group 5, the most severe category. The Gleason score is a system for grading the severity of prostate cancer based on analysis of cell samples under a microscope.
When prostate cancer is more advanced and spreads, the bones are among the areas most likely to be affected. It can also commonly spread to the lymph nodes, liver or lungs, according to the Mayo Clinic.
Unfortunately, late-stage cancer diagnoses are not uncommon. A 2014 analysis from Cancer Research UK, for example, found that 46% of all cancers in that country were diagnosed at an advanced stage. A 2023 study published in the journal Lancet Oncology found disruptions in care amid the pandemic also led to an increase in late-stage diagnoses across nearly all cancer types, including prostate.
Slower-growing cancers can take years to develop and be detected, while more aggressive ones can become apparent more rapidly and also spread to other parts of the body quicker.
Biden, who is now 82, did not undergo prostate cancer screening during his last medical checkup while in office, in February 2024, according to records released at the time. Experts say this is likely due to that fact that these screenings are not routinely recommended for men 70 years or older.
Instead, Biden’s diagnosis came after he recently saw a doctor due to urinary symptoms. A small nodule was found in the prostate, which necessitated further evaluation, his office said last week.
“Urinary symptoms are quite common in older men and are usually due to benign conditions like having an enlarged prostate,” Gounder said. In this case, however, the testing discovered cancer.
Gounder said the situation underscores the importance of tailoring medical decisions to the individual.
“He had new symptoms and is functionally active, which justified a closer look,” she said.
There have been advancements in treating advanced prostate cancer, and Gounder said the treatment goal in a case like this would be to control the cancer, slowing its progression and preserving quality of life. Biden’s type of cancer is hormone-sensitive, which means it should respond to a testosterone-blocking treatment, Gounder said, adding that this might be combined with other medications or chemotherapy, depending on the specific case.
Back in 2019, Biden was diagnosed with benign enlargement of the prostate, or BPH. That December, his campaign released his medical evaluation, which noted: “This patient has been treated for Benign Prostatic Hyperplasia (BPH). This was initially treated with medication and was then definitively treated with surgery. He has never had prostate cancer.”
BPH is very common in older men, with around 80% of men over 70 having it, according to Yale Medicine.
How do doctors screen for prostate cancer?
Prostate cancer testing typically involves two methods: a prostate-specific antigen, or PSA, test and a digital rectal exam, or DRE. A PSA test is a type of blood test that can indicate a higher chance of prostate cancer but is not a definitive diagnosis. A DRE involves a doctor using a gloved finger to feel for any bumps on the prostate via the rectum.
The U.S. Preventive Services Task Force, an independent panel of national experts, say the decision on screening for prostate cancer among men aged 55 to 69 years should be an individual one — and it recommends against PSA screening 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,” the task force’s recommendation summary notes. “Clinicians should not screen men who do not express a preference for screening.”
Prostate cancer is common, second only to skin cancer as the most common cancer affecting males, according to the Cleveland Clinic. According to the Centers for Disease Control and Prevention, for every 100 males, 13 will develop prostate cancer at some point in their lives.
