How Could Biden Have Aggressive Prostate Cancer Despite Top Medical Care?
An Oncologist Explains How Cancer Can Develop Rapidly Even with Regular Screening
Former President Joe Biden's recent prostate cancer diagnosis has raised questions about how someone with access to the best medical care could develop an aggressive form of cancer seemingly without earlier detection. As announced on Sunday, May 18, 2025, Biden has been diagnosed with an aggressive form of prostate cancer that has metastasized to his bones. This diagnosis, coming shortly after his presidency, has prompted a flood of questions from concerned citizens wondering whether something was missed in his medical care.
Is it possible Biden was just diagnosed with aggressive cancer after receiving regular care? While we do not know all the details of his specific case, medical science offers explanations for how this can happen.
We have been receiving tons of questions about this situation, including this one:
"I need a doctor's opinion on how an 83-year-old man who was President of the United States with access to the best medical care went from a clean bill of health last year to aggressive Prostate Cancer. Aren't his PSA levels checked routinely? Can someone go from perfectly healthy to this?"
To address these important concerns, I consulted with Dr. Alex Morozov, an oncologist, who shared his expert medical insights. While we cannot comment with certainty about what happened or what was known versus not communicated in Biden's specific case, Dr. Morozov's expertise helps provide context for understanding this situation. Let’s discuss…
The Nature of Biden's Diagnosis
According to Biden's personal office statement: "Last week, President Joe Biden was seen for a new finding of a prostate nodule after experiencing increasing urinary symptoms. On Friday he was diagnosed with prostate cancer, characterized by a Gleason score of 9 (Grade Group 5) with metastasis to the bone."
The Gleason score rates prostate cancer cells from 6 to 10 based on how abnormal they appear under a microscope, with higher numbers indicating more aggressive cancer likely to grow and spread quickly. A score of 9 indicates a highly aggressive cancer requiring more urgent treatment.
Media Response and Public Questions
Some media outlets, including Fox News, have already begun spreading claims that the diagnosis was "missed," with White House correspondent Peter Doocy asking: "White House doctors may have missed the early stages of his prostate cancer. So is President Trump worried about the quality of care that presidents get here?"
These types of questions reflect broader public concerns about how such a serious diagnosis could seemingly appear suddenly. Let's examine what medical science tells us about this situation.
So, Did Biden's Doctors Miss Something?
According to Dr. Morozov, the answer is simple: "Does this mean Biden or his doctors did something wrong, like not get routine PSA testing? Absolutely not."
Here's why:
PSA Testing Recommendations and Age Considerations
Is routine PSA testing recommended for everyone? No. Dr. Morozov explains that many men die with prostate cancer, not of prostate cancer. Unnecessary biopsies could lead to tests, surgeries, and side effects but not impact survival. It's very reasonable to stop PSA testing at a certain age.
Medical guidelines vary by organization:
The National Comprehensive Cancer Network (NCCN) recommends PSA testing up to age 75, and then "only in very healthy" patients over 75
The American Urological Association suggests clinicians may personalize the re-screening interval or decide to discontinue screening based on patient preference, age, PSA, prostate cancer risk, life expectancy, and general health
The U.S. Preventive Services Task Force (as of their 2018 guidelines) does not recommend PSA testing for men 70 or older
Biden's medical history: Before his presidency, Biden had been treated for an enlarged prostate. Medical records do not mention a PSA test during his final presidential physical in February 2024, which aligns with standard age-based recommendations.
How Aggressive Cancer Can Evade Detection
Dr. Morozov emphasizes that even with regular PSA testing, someone can still be diagnosed with metastatic disease. A large study compared 3,000 men who underwent PSA testing with 3,000 who did not. Even in the PSA testing group, approximately 2% of patients were diagnosed with stage IV disease.
How can this happen? Dr. Morozov provides three key explanations:
Sometimes prostate cancer presents with metastatic disease from the beginning, so there is no period of localized disease when it can be detected before it spreads
The period before it spreads can be short and fall between PSA checks
About 1% of prostate cancers do not produce PSA at all, making them undetectable through standard PSA screening, according to research
Additionally, the PSA test has significant limitations as a screening tool - about 15% of men with prostate cancer will have normal PSA results (false negatives), and normal PSA ranges increase with age — what's concerning at 50 might be acceptable at 80.
What Does "Hormone-Sensitive" Mean for Biden?
Dr. Morozov notes that "hormone-sensitive" is not a commonly used description for prostate cancer. In Biden's case, it likely means that he has the common type of prostate cancer (adenocarcinoma) for which hormone treatment will be indicated, as opposed to a very rare type, such as small cell prostate cancer, for which hormones would not work and chemotherapy would be indicated.
This distinction is significant for treatment options, as experts have noted: "Most men diagnosed with prostate cancer do not die of it. And that Biden's cancer is hormone-sensitive suggests he will respond to treatment."
Treatment Options and Prognosis
For advanced prostate cancer like Biden's, doctors typically use hormone treatments to block testosterone (the fuel that helps cancer grow). These hormone therapies are often paired with drugs like abiraterone that enhance their effectiveness.
When the cancer eventually stops responding to hormones, treatments shift to chemotherapy or targeted therapies that exploit the cancer's vulnerabilities, such as PARP inhibitors, which kill cancer cells while preserving healthy cells.
While advanced, metastatic prostate cancer is generally not considered curable, it can often be effectively managed for extended periods, particularly when it's hormone-sensitive, as Biden's appears to be. These treatments help slow cancer's spread, ease symptoms like bone pain, and extend patients' lives — usually through a personalized combination of approaches.
Key Takeaways for the Public
This case highlights several important points:
Age-appropriate screening: Medical guidelines call for a discussion between the patient and the provider to determine whether PSA testing is needed to balance the risks of overdiagnosis and overtreatment with the benefits of early detection in elderly patients.
Aggressive cancers behave differently: Even with optimal medical care, some prostate cancers can progress rapidly or evade detection through standard screening methods.
Symptoms warrant evaluation: Biden's diagnosis came after he experienced "increasing urinary symptoms," underscoring the importance of promptly evaluating new urinary symptoms in older men, even when routine screening isn't recommended.
Medical care has limits: Even the best medical care available cannot prevent or detect all cancers at early stages. This is not necessarily a failure of care but reflects the biological reality of aggressive cancer and the limitations of current screening methods.
In a nutshell…
There is no evidence that Biden's doctors missed or overlooked his cancer. The progression of his disease aligns with what medical professionals know about aggressive prostate cancers and the limitations of current screening methods, especially in older patients. While questions about the timeline and specifics of his medical care may persist, focusing on blame is misplaced and unproductive.
Biden's diagnosis highlights the continuing need for robust funding of cancer research. Despite significant medical advances, cases like this demonstrate that we still have much to learn about early detection, prevention, and treatment of aggressive cancers. This situation underscores why continued investment in cancer research is vital—to develop better screening tools, more effective treatments, and ultimately, to save more lives.
As Biden himself posted on Monday, "Cancer touches us all. Like so many of you, Jill and I have learned that we are strongest in the broken places."
Stay Curious,
Unbiased Science
P.S. Want to support our work? The best way is to subscribe to our Substack and share our content. While all our articles are always completely free to read, paid subscriptions help sustain our in-depth reporting on public health and science topics. Thank you for considering it!
 | A guest post by
|
My brother was diagnosed with stage 4 metastatic prostate cancer, with tumors at 10 bony sites, one year after a normal PSA. So yes, it’s possible and it happens.
Medical oncology here and I agree.
Gleason 9/10 tumors are more likely to have low PSA levels and are generally not held in check with hormone therapy as long as Gleason 6-8 tumors.
The problem with PSA testing is what you do with it. With noninvasive MRI monitoring and the new radiation techniques, I don’t believe that a blanket approach to stop all screening at 70 is correct. But this is a nuanced and extensive topic of discussion.