When the news broke in May 2025 that former President Joe Biden had been diagnosed with an aggressive form of prostate cancer, it felt like a punch to the gut for a lot of people. Not just because of the man himself, but because the details were—honestly—pretty scary. We're talking about a Gleason score of 9 and the cancer already spreading to his bones.
It felt sudden. One minute he’s the "healthy, vigorous" 82-year-old the White House doctors kept telling us about, and the next, he's facing a Stage 4 diagnosis.
People started asking the same questions immediately: How did his doctors miss this? Was he sick while he was still in the Oval Office? And what does this mean for every other guy out there hitting their 70s and 80s?
The truth is, Joe Biden and prostate cancer is a story about the messy reality of aging and the controversial "rules" of medical screening that most of us don't even know exist until we're in the thick of it.
The Diagnosis: What a Gleason 9 Actually Means
Let’s get the clinical stuff out of the way first, but in plain English. In mid-May 2025, just months after leaving office, Biden's team confirmed a small nodule was found during a routine check-up. That led to a biopsy, and that biopsy came back with a Gleason score of 9.
If you aren’t a urologist, that number might not mean much. But on a scale of 6 to 10, a 9 is essentially a red alert. It means the cells don't look like healthy prostate cells anymore; they look "aggressive" and "poorly differentiated." Basically, they’ve gone rogue.
To make matters worse, the cancer had already metastasized. It moved into his bones. When prostate cancer travels, it has a "favorite" destination, and that’s the skeletal system. This is officially classified as Stage 4.
Now, "Stage 4" sounds like an immediate death sentence. It’s not. Not necessarily. But it does change the goal of treatment from "curing it" to "managing it." Because it's hormone-sensitive, his doctors are using therapies that essentially starve the cancer of testosterone. Think of it like taking the fuel away from a fire. The fire is still there, but you’re trying to keep it from spreading further.
Did He Have It While He Was President?
This is the part that gets political and heated. Dr. Ezekiel Emanuel, a former Obama administration advisor, didn't mince words on MSNBC. He argued that a cancer this advanced doesn't just "erupt" in a few hundred days. He suggested Biden probably had it when he took the oath in 2021.
💡 You might also like: The Truth About Electrolytes for Water Bottles: Why Your Plain Water Might Be Failing You
Is that true? Honestly, we don't know for sure, but the math of biology suggests he’s likely right. High-grade cancers can move fast, sure, but they usually have a "silent" phase that lasts years.
The White House medical reports from 2021, 2023, and 2024 were all "clean." They mentioned stiff gaits, sleep apnea, and even a basal cell carcinoma (a common skin cancer) removed from his chest. But they didn't mention the prostate.
Why? Because they weren't looking for it.
The "75-Year-Old Rule" Nobody Tells You About
Here is the kicker: The U.S. Preventive Services Task Force generally recommends stopping routine PSA (Prostate-Specific Antigen) blood tests after age 75.
It sounds backwards, right? "You’re older, so let’s stop checking?"
But the logic is that most prostate cancers in older men grow so slowly that you’ll die with it, not of it. Doctors worry about "overtreating" an 80-year-old with surgery and radiation that could ruin their quality of life for a cancer that might never have caused a problem.
Biden followed these standard guidelines. His last PSA test was reportedly over a decade ago. He did exactly what the "book" said to do. But for Joe Biden, the gamble didn't pay off. His cancer wasn't the slow-moving kind; it was the aggressive kind that flies under the radar until it hits the bone and starts causing pain.
The Common Misconceptions
There’s been a lot of junk science floating around since the announcement.
📖 Related: Walking Pneumonia Symptoms: Why You Might Have It and Not Even Know It
- "The PSA test is a scam." No, it’s just limited. It’s a "check engine" light, not a definitive diagnosis. Some aggressive cancers, like the one Biden has, can actually "forget" how to produce PSA, meaning a blood test might look normal even while the cancer grows.
- "He was showing symptoms during the debates." People love to play armchair doctor. While some speculate that bone metastasis could cause cognitive fatigue, there's no medical evidence connecting his verbal slips or "brain fog" directly to prostate cancer. Most experts, like Dr. Toni Choueiri from Dana-Farber, say we shouldn't jump to conclusions.
- "Supplements could have prevented this." You'll see "The People's Chemist" or other gurus claiming saw palmetto or ginseng could have saved him. There is zero evidence for this. Supplements can help with an enlarged prostate (BPH), but they don't stop a Gleason 9 tumor.
Why This Matters for You
The "Biden Case" is a wake-up call for how we handle men's health as they age. If you’re a man in your 70s, or you have a father or husband in that bracket, the takeaway isn't "test everyone forever." It's "shared decision-making."
If Joe Biden—the man with the most scrutinized health on the planet—can have Stage 4 cancer go undetected, it can happen to anyone.
The medical community is now debating whether the "stop at 75" rule is too rigid. For a man who is otherwise healthy and "vigorous," like Biden was described, maybe continuing those tests makes sense.
Actionable Steps to Take Today
If you're worried about prostate health, don't just wait for a symptom. By the time you feel bone pain or have major trouble urinating, the cancer has often already left the building (the prostate).
- Have the "PSA Conversation": If you’re over 70, don't let your doctor just skip the test because of the guidelines. Ask: "Based on my family history and current health, should we keep monitoring this?"
- Don't Ignore the "Small" Stuff: Biden's diagnosis followed "increasing urinary symptoms." Frequent trips to the bathroom at night or a weak stream are often just an enlarged prostate (BPH), but they deserve a real check, not just a shrug.
- Know Your Family History: If your dad or brother had it, you are at double the risk. This changes when you should start (and stop) screening.
- Understand the "Aggressive" Variable: Remember that not all prostate cancers are the same. Some are "turtles" (slow) and some are "rabbits" (fast). You want to know which one you're dealing with before deciding on treatment.
Joe Biden's battle is a reminder that even with the best doctors in the world, medicine is often a game of probabilities. It’s about balance—trying to find the dangerous stuff without ruining the life you’re trying to save.