New information regarding former President Joe Biden’s prostate cancer diagnosis indicates that while his case is not common, it is not entirely unheard of, according to the healthcare professionals who treated him.
At 82, Biden received a diagnosis of aggressive cancer on Friday after a nodule was found in his prostate, his personal staff announced. The cancer has spread to his bones, but his office stated that he is likely to respond well to treatment.
Most prostate cancer diagnoses occur at an early stage through routine screenings, which may include blood tests or rectal exams.
However, approximately 8% of cases have already metastasized to other organs by the time of diagnosis. In such instances, oncologists believe the patient may have had prostate cancer for several years, possibly up to a decade.
“We’ve encountered numerous patients facing significant health challenges,” stated Dr. William Dahoot, chief science officer at the American Cancer Society.
That said, exceptions exist.
“While most prostate cancers are slow-growing, some can develop rapidly and pose a high risk of metastasis,” explained Dr. Aron Weiser, a urologist and chief medical officer. “Is it common? No. But it can occur, dependent on the unique biology of that cancer.”
Screening facilitates early detection, yet there is disagreement among healthcare professionals regarding who should be screened for prostate cancer.
Many physicians refrain from screening men in their late 70s or 80s, as these individuals are generally more likely to die from other medical issues than prostate cancer. Nevertheless, with increasing life expectancies, some doctors consider screening appropriate for healthier older men.
According to the American Cancer Society’s recommendations, men in their 50s and 60s should be screened every two years. Men with elevated levels of prostate-specific antigens—a protein made by the prostate—should undergo annual screenings. Additionally, men at higher risk for prostate cancer, such as African Americans or those with a family history of the disease, should begin screening in their 40s.
However, current guidelines from the U.S. Task Force on Preventive Services, an independent panel that advises on practices often covered by insurance, state that men aged 55 to 69 should only consider discussing blood tests with their physicians. The task force is currently reviewing new screening guidelines for prostate cancer, with many healthcare providers advocating for a broader recommendation.
Weiser noted that there was a broader screening approach in the late 1980s and early 1990s, leading to premature diagnoses and treatments that may not have impacted patients’ lives. The 2012-2018 U.S. Preventive Services Task Force recommended blood tests to help identify prostate cancer, resulting in decreased screening rates.
“Prostate cancer behaves differently; many cases are benign, not causing issues for individuals,” Weiser remarked. “The goal should be to identify aggressive cancers.”
In recent years, there has been a shift back toward increased screening as doctors have improved their understanding of which cases require treatment versus those that should be monitored.
Nevertheless, Dahut expressed ongoing concerns among patients and physicians about whether the benefits of screening outweigh the risks of overdiagnosis and overtreatment. Screening rates have declined steadily since 2012, and Dahut notes that this trend has led to a 5% increase in diagnoses of more advanced prostate cancer.
It remains unclear whether Biden has undergone prostate cancer screenings in recent years. His annual physical examination in February 2024 did not indicate a screening was performed, which is not unusual for someone of his age. A physical exam in 2019 revealed an enlarged prostate but did not lead to a cancer diagnosis at that time.
Dr. David Shusterman, a urologist based in New York, stated that Biden’s advanced diagnosis is atypical among patients who are screened regularly.
“It is rare for metastasis to have occurred in someone who regularly sees a urologist,” he said.
Diagnosis is often more prevalent in individuals who do not maintain regular medical consultations. Rick Gum is one such case; he was never screened before his prostate cancer diagnosis in 2018. Gum, a 73-year-old trucking company owner from Big Rock, Illinois, initially sought care for a hernia but was found to have aggressive cancer that had spread to his bones.
“I learned the hard way,” he remarked. “I should have visited the doctor.”
Gum noted that his cancer was too advanced for standard treatment, prompting his participation in various clinical trials at Northwest Medicine, which included chemotherapy, radiotherapy, and treatments involving radioisotopes.
“I’ve enjoyed seven excellent years since my diagnosis,” he reflected. “They’ve been quality years. I ride motorcycles, travel a bit, and love my work. I’ve been able to do it all.”
According to the American Cancer Society, around 37% of patients with metastatic prostate cancer survive at least five years post-diagnosis.
Dr. Peter Nelson, vice president of precision oncology at the Fred Hutch Cancer Center, mentioned that patients like Biden could have over a 90% response rate to treatments that lower testosterone—a hormone that can promote cancer growth. These hormonal therapies are typically administered through injections or tablets.
“He may start with multiple medications and anticipate several years of effective treatment before any resistance develops,” Nelson noted. Some patients also receive chemotherapy or radiation in conjunction with hormone therapy, he added.
According to sources familiar with the family’s perspective, Biden and his family are exploring “multiple treatment options,” including hormone therapy.
