President Biden has Metastatic Cancer
What Biden’s Prostate Cancer Tells Us About Screening, Guidelines, and Risk
President Joe Biden has been diagnosed with metastatic prostate cancer — a fast-moving, high-grade disease that has already spread to his bones. This isn’t just a moment of breaking medical news. It’s a case study in the limits of population-based guidelines, the reality of aggressive cancers, and a teachable moment for men, physicians, and families everywhere.
Today, we’ll break down what this diagnosis means, why it wasn’t caught earlier, and what current medical recommendations actually say about prostate cancer screening in older adults.
The Diagnosis: A Tiger, Not a Turtle
According to reports, President Biden began experiencing urinary symptoms — frequency, urgency, or weak stream, perhaps — the kind many older men chalk up to age or benign prostatic hyperplasia. But this time, the symptoms led to further workup.
A nodule was discovered on his prostate, prompting a biopsy and imaging. The pathology? A Gleason score of 9 out of 10 — classified as Grade Group 5, the most aggressive form of prostate cancer.
Worse still, it had already metastasized — most notably to his bones. Once prostate cancer spreads beyond the gland, there is no cure, only the possibility of slowing progression with treatment. And even that has limits.
With the best available treatment, fewer than 25% of patients with this kind of metastatic prostate cancer survive five years.
— Rusthoven et al., 2016
This isn’t the “you’ll die with it, not of it” kind of cancer. This is the you will die from it kind.
A Common Cancer, but Rarely This Aggressive
Prostate cancer is the most commonly diagnosed cancer in American men after skin cancer, with over 300,000 new cases estimated in 2024 alone.
Yet most of these cases are low- to intermediate-risk, and often detected early. In fact, most men diagnosed with prostate cancer will never die from it.
But in rare cases — like President Biden’s — the disease is a biological tiger. It grows quickly. It spreads silently. And it doesn’t always produce high PSA levels, making it difficult to detect until symptoms appear.
Prostate cancer is also the second leading cause of cancer death in American men, after lung cancer.
Why Wasn’t It Caught Earlier?
Here’s the uncomfortable truth: he wasn’t supposed to be screened — at least, not according to current U.S. guidelines.
The U.S. Preventive Services Task Force (USPSTF) recommends that men aged 55 to 69 discuss the pros and cons of PSA-based screening with their doctor. But for men aged 70 and older, routine screening is not recommended.
“For men 70 years and older, the USPSTF recommends against PSA-based screening for prostate cancer.”
— USPSTF, 2018
The logic? Most prostate cancers are slow-growing. Detecting and treating them in older adults may lead to unnecessary biopsies, surgery, or radiation — along with side effects like incontinence or sexual dysfunction — without improving survival.
But there’s the catch: those guidelines are designed for populations, not for individuals. And President Biden wasn’t dealing with an indolent cancer. He had a tiger in the house — and tigers don’t wait for guidelines.
What Happens Now?
President Biden’s treatment will be palliative, not curative. That doesn't mean it's without value — far from it. The goal now is to slow the cancer’s progression, maintain quality of life, and prevent complications like spinal cord compression or fractures.
He’ll likely undergo:
Androgen deprivation therapy (ADT) – to suppress testosterone, the fuel for most prostate cancers.
Advanced hormone therapy – using androgen receptor inhibitors like enzalutamide or apalutamide.
Bone-protective medications – such as denosumab or zoledronic acid, to help prevent skeletal events.
Possibly radioligand therapy, chemotherapy, or clinical trials for more aggressive disease.
But even with the best care, the five-year survival for metastatic Grade Group 5 prostate cancer remains less than 25%.
What Should Men (and Doctors) Take from This?
1. Screening isn’t simple.
PSA isn’t a perfect test. It can miss aggressive cancers and overdiagnose slow ones. But it’s the best tool we have. And its value isn’t just in the number — it’s in how the trends change, especially when paired with digital rectal exams and patient risk factors.
2. Guidelines are maps, not mandates.
They’re based on studies, data, and population averages. But your patient isn’t a population. He’s a person. Some 75-year-olds are frail. Others are climbing mountains. If someone in their 70s wants to continue PSA screening — and understands the risks — that should be a shared decision, not an automatic “no.”
3. Most prostate cancers aren’t fatal — but some are.
The vast majority of men diagnosed with prostate cancer will live long lives. But when the rare aggressive forms appear, they remind us why vigilance still matters.
Final Thoughts
President Biden’s diagnosis is not just a news story. It’s a reminder that we are still playing catch-up with prostate cancer — in screening, in treatment, and in public awareness.
If you’re over 50 — or have a family history of prostate cancer — talk to your doctor. Ask whether PSA screening is right for you. If you’re a clinician, personalize your recommendations. Don’t just quote guidelines. Consider the patient in front of you.
As for President Biden — he will now navigate a disease that has outpaced the best intentions of our medical system. And so we watch, we learn, and hopefully… we act.
📚 References
Rusthoven CG, et al. Survival Outcomes for Patients with Gleason Score 9–10 Prostate Cancer Treated with Different Therapy Modalities. JAMA Oncol. 2016;2(1):59–66. PMID: 26928470
U.S. Preventive Services Task Force. Final Recommendation Statement: Prostate Cancer: Screening. 2018. USPSTF Website
Siegel RL, et al. Cancer Statistics, 2024. CA Cancer J Clin. 2024;74(1):7–33. DOI:10.3322/caac.21745
🩺 This post was adapted from The Unfiltered MD podcast. Subscribe for more breaking medical insight, clinical nuance, and myth-busting — all without the fluff.
Thank you for explaining Terry.
I really appreciate your explanation and recommendations. I have a PSA test every year (62M), and I am not afraid of digital exams. I’m looking forward to discussing this with my GP next month during my annual physical.