It happened fast. One minute, people were debating whether an 82-year-old was too old for a second term, and the next, the news cycle shifted from politics to pathology. In May 2025, former President Joe Biden’s office dropped a bombshell: he was facing an aggressive, late-stage cancer.
People were shocked. How did a man with the world's best doctors end up with metastatic disease? Honestly, the answer is a mix of medical guidelines, biological bad luck, and the sheer unpredictability of how cells break.
The official diagnosis for the Joe Biden prostate cancer stage is Stage 4. Specifically, it is metastatic prostate cancer. This isn't just a "wait and see" situation. It had already moved to his bones by the time a biopsy confirmed what his doctors feared after a routine physical in early 2025.
The Gleason Score: Why a 9 Changed Everything
When doctors talk about prostate cancer, they don't just look at where it is. They look at how "angry" the cells look under a microscope. This is the Gleason score.
Most men who get diagnosed in their 70s or 80s have a Gleason 6. That’s the "turtle" of cancers—it moves so slowly you’ll likely die of something else first. Biden didn't have the turtle. He had the tiger.
His Gleason score was a 9 out of 10.
That number basically means the cells are poorly differentiated. They don't look like prostate cells anymore; they look like chaos. A Gleason 9 is Grade Group 5, the most aggressive category possible. This explains why the cancer didn't just sit quietly in the gland. It jumped to the skeletal system, which is a classic pathway for this specific disease.
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How Was the Joe Biden Prostate Cancer Stage Missed?
This is the part that gets people riled up. You've got the President of the United States, a man who gets more checkups than an astronaut, and yet he ends up with Stage 4 cancer.
Was there a cover-up? Probably not.
Actually, it comes down to a controversial guideline from the U.S. Preventive Services Task Force (USPSTF). They generally recommend that men stop routine PSA (Prostate-Specific Antigen) screenings around age 75. Why? Because for most men that age, the "cure" is worse than the disease. Surgery and radiation can cause incontinence and impotence, and if the cancer is slow-growing, there's no point in treating it.
Records show Biden’s last PSA test was way back in 2014.
He followed the rules. He was 71 then. By the time he was in the White House, his doctors were likely following the standard "no-screening" protocol for octogenarians. But the problem with guidelines is they are built for the "average" man. Biden’s cancer wasn't average. It was high-grade and fast-moving.
By the time he started feeling urinary symptoms—frequent trips to the bathroom, difficulty starting—the "horse was already out of the barn," as some oncologists put it. A small nodule was felt during a physical in April 2025, leading to the imaging that showed the bone involvement.
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What "Hormone-Sensitive" Actually Means for Him
There is a silver lining in the clinical report. His medical team noted the cancer is "hormone-sensitive."
Prostate cancer cells are essentially "fed" by testosterone. If you take away the fuel, the fire dies down. This is called Androgen Deprivation Therapy (ADT). It’s not a cure—Stage 4 prostate cancer isn't considered curable—but it is highly treatable.
In late 2025, reports confirmed he had started a combination of:
- Hormone blockers: To tank his testosterone levels.
- Radiation therapy: Targeted at the bone lesions to prevent fractures and pain.
- Oral anti-androgens: Newer drugs like abiraterone or enzalutamide that block the hormone even more effectively.
Dr. Judd Moul from Duke University points out that men with metastatic disease today can live five, seven, or even ten-plus years. The landscape has changed. It's no longer a death sentence within months.
Realities of Treatment in the 80s
We have to be realistic, though. This kind of treatment is "rough," as some patients describe it.
When you strip a man’s body of testosterone, you aren't just hitting the cancer. You're hitting everything. You get hot flashes. You get "brain fog" or cognitive fatigue. You lose muscle mass and bone density. For someone who is already 82, the side effects of ADT can be just as challenging as the cancer itself.
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Biden has also had to deal with skin cancer (basal cell carcinoma) being removed from his forehead around the same time. His body is fighting on multiple fronts.
Why the Conversation is Shifting
The Joe Biden prostate cancer stage news has actually triggered a massive debate in urology circles. Should we really stop screening at 75?
Dr. Abhishek Bhat and other experts are seeing a "surge" in metastatic cases because we stopped looking for them. If Biden had been getting a simple yearly PSA test, it's very likely this would have been caught at Stage 1 or 2, years ago, when his Gleason score first started to climb.
Actionable Steps for Men and Families
If you or a loved one are looking at this situation and wondering what to do, the medical community suggests a few specific shifts in how we handle prostate health:
- Don't just follow the "Age 75" rule blindly. If you are healthy, active, and have a long life expectancy, talk to your urologist about continuing PSA screenings.
- Watch for "The Nodule." A digital rectal exam (DRE) feels like a relic of the past, but it’s how Biden’s nodule was found. It still matters.
- Know your Gleason. If a biopsy is done, the Gleason score is the single most important number for determining how aggressive you need to be with treatment.
- Consider mpMRI. If a PSA comes back high, a Multi-parametric MRI can often see a tumor before a needle ever touches the skin, potentially catching aggressive 9s and 10s earlier.
The former President's journey is a stark reminder that even with the best resources, biology plays by its own rules. The goal now for his team isn't to "beat" cancer, but to manage it as a chronic illness, keeping him active and comfortable for as many years as possible.
Key Medical Sources:
- UVA Health Oncology Reports on Gleason Scoring (2025)
- Journal of Clinical Oncology: Trends in Metastatic Prostate Cancer
- Official Health Statements from the Office of Joe Biden (May/Oct 2025)