Details released so far about former President Joe Biden’s prostate cancer diagnosis suggest his case is uncommon but not unheard of, according to doctors who treat the disease.
Biden, 82, was diagnosed with an aggressive form of cancer on Friday, following the discovery of a nodule on his prostate, his personal office said in a statement. The cancer has spread to the bone, his office said, but seems likely to respond to treatment.
Most cases of prostate cancer are diagnosed at an early stage, often with the help of routine screenings involving blood tests or rectal exams.
But in around 8% of cases, the cancer has already metastasized — or spread to other organs — by the time it’s diagnosed. At that point, the patient has likely had prostate cancer for several years to a decade, multiple oncologists said.
In Biden’s case, “we definitely would anticipate that he has had prostate cancer for many, many years,” said Dr. William Dahut, chief scientific officer for the American Cancer Society.
There are exceptions, however.
“Most prostate cancers are slow-growing, but some people can develop a high-risk cancer that happens relatively quickly and can spread quickly,” said Dr. Alon Weizer, a urologist and chief medical officer of Mount Sinai Medical Center. “Is that super common? No. But it can occur and it all depends on the underlying biology of that individual cancer.”
Though screenings can help with early detection, medical professionals don’t always agree on who should get screened for prostate cancer.
Many doctors do not screen men in their late 70s or 80s, since those individuals are likely to die of another medical condition before they die of prostate cancer. But as people continue to live longer, some doctors feel that screenings are appropriate for older men in good health.
The American Cancer Society recommends that men in their 50s and 60s get screened every two years. Men whose blood tests show elevated levels of prostate-specific antigen, a protein produced by the prostate gland, should get annual screenings, according to the ACS. And men with a higher risk of prostate cancer, such as African Americans or those with a family history of the disease, should start screenings in their 40s.
But the current guidelines from the U.S. Preventive Services Task Force — an independent panel of experts whose recommendations often determine whether screenings are covered by insurance — say that men ages 55 to 69 should merely discuss getting a blood test with their physician. The task force is weighing new guidelines for prostate cancer screenings, with many doctors calling for a more expansive and emphatic recommendation.
Weizer said doctors used to screen more widely for prostate cancer in the late 1980s and early 1990s, which led to diagnosing and treating cases that might not have otherwise impacted a person’s life. The U.S. Preventive Services Task Force from 2012 to 2018 recommended against blood tests that helped identify prostate cancer, which led to a drop-off in screenings.
“Prostate cancer is an unusual type of cancer in the sense that we now know there’s a lot of prostate cancers that will never cause a problem in a person,” Weizer said. “So you don’t really even want to find those cancers. You want to find the ones that are going to behave more aggressively.”
In recent years, he said, the pendulum has swung back in the direction of more screenings, as doctors have gotten better at knowing which cases to treat and which to monitor over time.
But Dahut said there’s still some lingering concerns among patients and physicians that the benefits of screening don’t outweigh the risks of overdiagnosis or overtreatment. Screening rates have steadily declined since 2012 — which Dahut said has contributed, in part, to a 5% annual increase in men being diagnosed with more advanced prostate cancer.
It’s unclear whether Biden has been screened for prostate cancer in recent years. His annual physical exam in February 2024 did not indicate that a screening had taken place, though it would not have been expected for his age. According to his physical exam from 2019, he had an enlarged prostate, but had not been diagnosed with prostate cancer by that point.
Dr. David Shusterman, a New York-based urologist, said Biden’s advanced diagnosis would be considered unusual for someone who was screened regularly.
“It’s rare to present with bone [metastasis] … in someone who’s checking with their urologist once a year,” he said. “I’ve been doing this 25 years and I’ve never had a patient like that.”
The diagnosis is more common in patients who don’t regularly see a doctor, he added. That was the case with Rick Gum, who had never been screened before he was diagnosed with prostate cancer in 2018. Gum, the 73-year-old owner of a trucking company in Big Rock, Illinois, originally sought care for a hernia, only to learn he had aggressive cancer that had spread to his bones.
“I learned the hard way,” he said. “I should have been going to the doctor.”
Gum said his cancer was too far progressed to receive standard treatments, so he participated in various clinical trials at Northwestern Medicine involving chemotherapy, radiation and a pharmaceutical drug containing radioactive isotopes.
“I’ve had seven good years since they diagnosed me,” he said. “They’ve been quality years. I ride motorcycles. We travel some. I love my job. I’ve been able to do it all.”
Around 37% of patients whose prostate cancer has metastasized survive at least five years after their diagnosis, according to the American Cancer Society.
Dr. Peter Nelson, vice president of precision oncology at Fred Hutch Cancer Center, said patients like Biden have a more than 90% chance of responding to therapies that lower testosterone — a hormone that can feed the cancer’s growth. These so-called hormone therapies often come in the form of an injection or pill.
“Most likely, he will get multiple medications at the initiation of his therapy, and could expect several years of response to that therapy before that cancer becomes resistant,” Nelson said. Some patients receive chemotherapy or radiation at the same time or following hormone therapy, he added.
Biden and his family are considering “multiple treatment options,” including hormone therapy, according to a source familiar with the family’s thinking.
