It happened fast. One Sunday in May 2025, a headline hit the wires that made everyone stop. Former President Joe Biden, just months out of the White House, was diagnosed with an aggressive form of prostate cancer.
Honestly, the news felt like a gut punch to a lot of people. For years, his medical reports from Dr. Kevin O’Connor described him as "vigorous" and "fit for duty." Then, suddenly, we’re hearing about a Gleason score of 9 and Stage 4 disease that had already reached his bones. It’s kinda confusing, right? How does a man with the best doctors in the world go from "perfectly healthy" to "metastatic cancer" in the blink of an eye?
The truth is actually buried in how we treat—or don't treat—older men in medicine.
The Diagnosis: What Actually Happened?
Basically, it wasn't a routine checkup that caught it. Biden started experiencing "increasing urinary symptoms." You know the drill—difficulty going, frequent trips to the bathroom at night. Common stuff for an 82-year-old guy. Most men his age just assume it’s an enlarged prostate (BPH), which he actually had surgery for back in 2019.
But this time, doctors found a nodule. A biopsy confirmed the worst: high-grade, aggressive adenocarcinoma.
The "Gleason score" is the number everyone kept repeating. Biden’s was a 9. To give you some context, the scale only goes up to 10. A 9 means the cells look extremely abnormal under a microscope. They aren’t behaving like normal prostate cells anymore; they’re acting like a fast-moving invader.
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Why didn't they see it coming?
Here’s the part that trips people up. Biden’s last known PSA (Prostate-Specific Antigen) test was way back in 2014. That’s over a decade of no screening.
Wait, why?
Medical guidelines—specifically from the U.S. Preventive Services Task Force—usually suggest stopping PSA screens around age 70 or 75. The logic is that most prostate cancers in older men grow so slowly that the man will likely die with the cancer, not from it. Doctors worry that testing an 80-year-old leads to "over-treatment"—painful surgeries and radiation for something that might never have caused a problem.
In Biden's case, the "watchful waiting" approach backfired because his specific cancer was the rare, aggressive type.
Stage 4 and the "Bone Spread"
When the office of the former President announced the cancer had metastasized to the bones, the mood turned somber. In the medical world, once it hits the bones, it’s considered incurable.
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But "incurable" doesn't mean "terminal tomorrow."
Dr. Geoffrey Sonn from Stanford Medicine pointed out that metastatic prostate cancer is a whole different ballgame compared to something like pancreatic cancer. We have incredible tools now. Since Biden’s cancer is "hormone-sensitive," the primary treatment is Androgen Deprivation Therapy (ADT).
How Hormone Therapy Works
Prostate cancer cells usually "eat" testosterone to grow. ADT basically starves them. It’s not a cure, but it can put the cancer into a deep sleep for years.
- The Good News: Many men live 5, 7, or even 10 years on these meds.
- The Reality: Eventually, the cancer often learns how to grow without the hormone, becoming "castration-resistant."
The Controversy: Was There a Cover-Up?
You can't talk about Joe Biden’s health without mentioning the political firestorm. By late 2025, the House Oversight Committee was all over this. They released a report titled "The Biden Autopen Presidency," alleging that the White House physician, Dr. Kevin O’Connor, might have been less than transparent.
The big question: Did the cancer exist while he was in the Oval Office?
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Medical experts like Dr. Vipul Patel have noted that for cancer to reach the bones, it often (though not always) takes years of progression. If Biden was truly "fit" in February 2024, the rapid transition to Stage 4 by May 2025 is statistically rare, though not impossible. Dr. O'Connor ended up invoking his Fifth Amendment rights during congressional testimony, which... well, it didn't exactly quiet the rumors.
What This Means for You (The Actionable Part)
If you’re a man over 50—or you love one—this story is a huge wake-up call. The "stop screening at 70" rule is a guideline, not a law.
- Don't just look at the PSA. Biden’s case shows that a "nodule" can be found even when bloodwork isn't being tracked. If you have "new" urinary symptoms, don't just blame old age. Get a digital rectal exam (DRE) or an MRI.
- Advocate for yourself. If you are "active and robust" (like Biden was described), you might want to keep screening past 75. The guidelines assume the average 80-year-old is frail. If you’re not, the math changes.
- Understand the Gleason Score. If you or a loved one gets a biopsy, look for that number. 6 is low-risk. 7 is intermediate. 8-10 is the "red zone" where you need to move fast.
- Genetic Testing. We now know that certain genes (like BRCA2, often linked to breast cancer) can make prostate cancer way more aggressive. If you have a family history of any cancer, tell your urologist.
Biden’s battle is a reminder that even with the best care, biology is unpredictable. He’s currently resting in Wilmington, reportedly responding well to initial treatments. While the diagnosis is serious, the "broken places" quote he shared on X (formerly Twitter) suggests he’s leaning into the same resilience he’s used throughout his career.
To stay on top of this, you should check your own family history today. If your father or brother had prostate issues, your risk is double. Don't wait for "symptoms" like Biden did; by the time it hurts, it's often already on the move. Call your GP and ask if a baseline PSA test makes sense for your specific health profile.