Honestly, when the news broke in May 2025 that Joe Biden was facing an aggressive form of prostate cancer, it felt like a punch to the gut for a lot of people. Not just because he's a former president, but because of the sheer "how did we miss this?" factor. You’ve probably seen the headlines. One day he’s the "robust" 81-year-old leader, and the next, we’re hearing about a Gleason score of 9 and bone metastasis. It's scary. It’s confusing. And frankly, it’s a massive wake-up call about how we handle men's health as they get older.
We need to talk about what actually happened.
The story isn't just about one man. It’s about a medical system that sometimes stops looking right when the risks start climbing. Biden hadn't had a PSA (prostate-specific antigen) test since 2014. That is an eleven-year gap. If you’re wondering why on earth his doctors would skip that, you aren’t alone. But the answer is actually buried in standard medical guidelines that most of us don't even know exist.
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The Screening Gap: Why Doctors Stopped Looking
Here is the kicker: medical guidelines generally suggest stopping routine prostate cancer screenings around age 75.
The logic? Most prostate cancers in older men grow so slowly that they’ll never actually cause a problem. Doctors call it "over-diagnosis." They worry that treating a tiny, slow-moving tumor in an 80-year-old does more harm through surgery and radiation than the cancer ever would.
But Joe Biden’s case blew a hole in that "one-size-fits-all" logic. His cancer wasn't the slow-moving kind. By the time it was caught in May 2025—after he started experiencing actual urinary symptoms—it had already reached the bones.
- The Nodule: It started with a small physical finding.
- The Aggression: A Gleason score of 9 (out of 10) means the cells look nothing like healthy tissue.
- The Spread: Once it hits the bone, the game changes from "cure" to "control."
Dr. Kirsten Greene from UVA Health pointed out something most people missed: if you stop screening at 75, a "silent" cancer can grow for years without a single symptom. By the time you feel it, it’s often already on the move.
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Understanding the Gleason Score of 9
If you aren't a doctor, "Gleason score" sounds like something from a high school math test. It isn't. It’s basically a grading system for how "angry" the cancer looks under a microscope.
Scores of 6 are low-grade. They usually just get watched.
Scores of 8, 9, or 10? That’s high-grade. That is the aggressive stuff.
Biden’s score of 9 put him in Grade Group 5. That is the most severe category. It explains why the cancer didn't just sit there—it migrated. When we talk about Joe Biden and prostate cancer, this is the detail that matters most because it dictated everything that followed, from the hormone shots to the "ringing of the bell" in Philadelphia.
The Treatment: More Than Just a Pill
By October 2025, the former president was at Penn Medicine, undergoing a grueling regimen. This wasn't a simple "zap it and go" situation. Because the cancer was metastatic (meaning it spread), the goal shifted to systemic control.
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Hormone Therapy (ADT)
They started with Androgen Deprivation Therapy. Basically, prostate cancer cells eat testosterone for breakfast. ADT starves them. It’s effective, but it’s tough on the body. It can cause fatigue, muscle loss, and even "brain fog," which—given the public discourse around Biden’s cognitive health—added a whole other layer of complexity to the situation.
Radiation Therapy
Then came the radiation. This was focused on the primary site and potentially the bone lesions to reduce pain and stop further spread. In late October 2025, a video went viral of Biden ringing the silver bell at the clinic. It’s a tradition. It marks the end of a treatment phase. His daughter, Ashley Biden, called him "damn brave," and honestly, regardless of your politics, going through that at 82 is no small feat.
The Controversy: Was It a Cover-Up?
We can't talk about Joe Biden and prostate cancer without mentioning the political firestorm. The House Oversight Committee didn't just take the news lying down. They started asking pointed questions of Dr. Kevin O’Connor, the White House physician.
The core of the argument? If Biden was being called "fit for duty" and "healthy" in February 2024, how did he have Stage 4 cancer just over a year later?
- Some argue the cancer was missed.
- Others claim it was an "aggressive" spike that happened fast.
- The Committee hinted at something more "deliberate."
Dr. O’Connor has faced intense scrutiny for his "healthy, active, robust" descriptions in previous physicals. While urologists note that PSA levels can spike suddenly, the lack of a PSA test for over a decade remains a massive point of contention. It’s a reminder that even the most powerful people in the world are subject to the same medical blind spots as the rest of us.
The "New Normal" for Men Over 80
There's a weird myth that if you're over 80, you shouldn't worry about cancer. "Something else will get you first," people say. Biden’s diagnosis proves that isn't always true.
The trend of late-stage prostate cancer is actually rising. Why? Because we’ve gotten so good at not screening that we're missing the aggressive cases that still happen in older age. Biden is functionally active. He travels. He’s on Amtrak. He’s planning a library. For a man like that, the "harms" of screening are often much lower than the harm of an undiagnosed Stage 4 tumor.
Actionable Next Steps for You or Your Family
If you’re reading this because you’re worried about yourself or an aging parent, don’t just panic. Take these specific steps based on what we’ve learned from the Biden case:
- Don't stop at 75 automatically. If you (or your dad) are in great shape and expect to live another 10-15 years, talk to a urologist about continuing PSA tests. The "stop at 75" rule is for people with limited life expectancy.
- Watch for the "Small" Changes. Biden’s diagnosis came after "increasing urinary symptoms." Don't ignore a weak stream or getting up four times a night. Sure, it’s usually just an enlarged prostate (BPH), but you need to know.
- Ask for the Gleason Breakdown. If a biopsy is ever done, the Gleason score is your roadmap. A 6 is a "wait and see." A 9 is an "act now."
- Consider "Shared Decision Making." This is the term doctors use now. It means the doctor shouldn't just tell you what to do based on an age chart. They should look at your specific health, your goals, and your risks.
Biden’s journey with prostate cancer is far from over. He’s still undergoing treatment, still being monitored, and still dealing with the side effects of hormone therapy. It’s a reminder that health is never a static "pass/fail" grade. It’s a constant, shifting conversation between a patient and their medical team.
Check your records. When was your last PSA? If you can't remember, it's probably time to ask.
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