The news hit like a ton of bricks in May 2025. Former President Joe Biden, just months out of the Oval Office, was diagnosed with an aggressive form of prostate cancer. Honestly, for a man who spent his vice presidency and presidency spearheading the "Cancer Moonshot," the irony was pretty thick. But it wasn't just a political headline. It sparked a massive, sometimes heated debate about how we treat—and ignore—men’s health as they get older.
People were confused. How does the most closely watched man on the planet end up with a Gleason score of 9 and bone metastasis? You've probably heard the rumors. Some say it was hidden. Others say it was just the "natural" course of things for an 82-year-old.
Basically, the truth is a mix of medical guidelines, biology, and the reality of aging.
The Diagnosis: Why It Surprised Everyone (And Why It Shouldn't Have)
On May 18, 2025, Biden’s office dropped the bombshell. He had prostate cancer. And it wasn't the slow-growing kind most guys joke about. It was "aggressive" and had already spread to his bones.
Here is the kicker: his 2024 physical exam, conducted by Dr. Kevin O’Connor, called him "fit for duty." There was no mention of cancer. Naturally, this led to a lot of finger-pointing. The House Oversight Committee even started asking if things were covered up. But if you look at the medical standards, there’s a simpler, if frustrating, explanation.
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- The Screening Gap: Biden’s last recorded PSA (Prostate-Specific Antigen) test was way back in 2014.
- The 70-Year Rule: Current medical guidelines, like those from the U.S. Preventive Services Task Force, usually suggest stopping routine PSA screens at age 70 or 75.
- The Logic: Most prostate cancers in older men grow so slowly they’ll never actually hurt them. The "harm" of treatment (incontinence, etc.) is often seen as worse than the disease.
But Joe Biden didn't have the "slow" kind. He had a Gleason 9. That’s Grade Group 5—the most aggressive category there is. When a nodule was finally found during a routine physical in early 2025 because he was having urinary issues, the horse had already left the barn.
Understanding the "Gleason 9" and Bone Metastasis
When doctors talk about a Gleason score, they are basically grading how "weird" and aggressive the cancer cells look under a microscope.
[Image showing the Gleason Scale for prostate cancer grading]
A score of 9 means the cells look nothing like healthy prostate tissue. They are disorganized and built to travel. In Biden’s case, they traveled to the bones. This is called metastatic castration-sensitive prostate cancer (mCSPC)—at least initially.
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It sounds terrifying, and it is serious. But here is something kinda surprising: being "hormone-sensitive" is actually a good thing in this context. It means the cancer still relies on testosterone to grow. If you cut off the "fuel" (testosterone), you can often shrink the tumors and keep them at bay for years.
The Treatment: Radiation, Hormones, and "Ringing the Bell"
By October 2025, we saw the video that went viral. Joe Biden, looking a bit thinner but standing tall, ringing the bell at Penn Medicine in Philadelphia. His daughter, Ashley, posted it on Instagram. It was a big moment. He had finished several weeks of radiation therapy.
But radiation is only half the battle. To manage an aggressive Gleason 9 that has reached the bones, the "standard of care" is usually a "triplet" or "doublet" therapy.
- Hormone Therapy (ADT): Drugs like Lupron or Orgovyx to tank testosterone levels.
- Advanced Anti-Androgens: Meds like Xtandi or Erleada that block any remaining "fuel" from reaching the cancer cells.
- Radiation or Chemo: Used to target the original tumor in the prostate or painful spots in the bones.
Dr. Geoffrey Sonn from Stanford Medicine pointed out that with modern treatments, some men live for a decade or more even with stage 4 disease. It’s not an immediate death sentence anymore. It's more like managing a chronic, high-stakes illness.
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The Controversy: Was It a Cover-Up?
You can’t talk about Biden’s health without the politics. Rep. James Comer and the House Oversight Committee went after Dr. O’Connor hard in 2025. They wanted to know why a "robust" 81-year-old in 2024 suddenly had metastatic cancer in 2025.
O'Connor eventually invoked the Fifth Amendment during a closed-door deposition. That's never a great look for "transparency." But urologists will tell you that PSA levels can stay low for years and then spike suddenly. Or, as mentioned earlier, some very aggressive cancers stop producing PSA altogether. They "forget" how to be prostate cells and become "neuroendocrine" types that are invisible to standard blood tests.
What This Means for You (Actionable Insights)
If you're a man over 50, or you've got one in your life, the Biden news is a wake-up call. The "stop at 70" rule is a guideline, not a law.
- Advocate for "Shared Decision Making": Don't just let a doctor stop your PSA tests because you hit a certain age. If you're healthy and have a long life expectancy, you might want to keep testing.
- Watch for "Obstructive" Symptoms: Biden’s nodule was found after he complained of "urinary symptoms." If you’re waking up 4 times a night or the "stream" isn't what it used to be, don't just blame "getting old." Get a digital rectal exam (DRE). Yes, the finger. It found Biden’s nodule when a blood test might have missed it.
- Understand the Gleason: If you get a biopsy, the Gleason score is your roadmap. 6 is low-risk. 7 is intermediate. 8-10 is "buckle up, we need to move fast."
- Genetic Testing: If you have a family history, ask about BRCA mutations. They don't just cause breast cancer; they make prostate cancer much more aggressive.
Biden's journey from the "Cancer Moonshot" to being a cancer patient himself is a reminder that no one is immune. But it also shows that even at 82, with an aggressive stage 4 diagnosis, modern medicine has a lot of tools left in the bag. It’s about balance—weighing the risks of treatment against the risks of the disease—and making sure you're the one making the choice, not a guideline.
Keep an eye on the symptoms. Trust your gut. And maybe don't be so quick to skip that annual checkup, even if you feel "robust."
Sources:
- Moffitt Cancer Center, "Joe Biden Starts New Treatment for Prostate Cancer," October 2025.
- University of Michigan Health, "What Biden's Diagnosis Means for Older Patients," May 2025.
- CBS News, "Biden completes round of radiation therapy," October 2025.
- House Oversight Committee Records, May 2025.