The recent diagnosis of aggressive prostate cancer for former President Biden has sparked discussions about whether earlier warning signs might have been overlooked and if current screening guidelines need to be revisited.
Prostate cancer is notably one of the most prevalent cancers among older men, with statistics showing that one in eight men will face this diagnosis in their lifetime. The American Cancer Society reports that prostate cancer leads to approximately 35,000 deaths annually in the U.S., translating to a man losing his life from this disease every 15 minutes.
While Biden’s diagnosis is serious and treatment options exist, it is not considered curable. Prostate cancer specialists expressed uncertainty regarding the duration of Biden’s illness, indicating that even with regular screenings, it’s common for cancer to develop without noticeable symptoms.
“Cancer doesn’t play by the rules,” noted Alicia Morgans, an expert in prostate cancer at the Dana-Farber Cancer Institute and a board member of the Advocacy Group Zero Prostate Cancer Board. “This could have appeared out of the blue since cancer can be unpredictable.”
Biden was diagnosed with cancer that had spread to his bones after experiencing worsened urinary symptoms. It remains unclear if these symptoms were linked directly to the cancer or if the prostate nodule was found during a routine examination.
Morgans pointed out that even with regular screenings, there are gaps in our understanding.
“Our testing methods can fall short, and despite advances in blood tests and imaging, we can still miss important findings,” she explained.
Biden, being the oldest president in U.S. history, has often faced scrutiny over his health and mental acuity. Prior to his diagnosis, the last medical report in February 2024 labeled him as physically “fit to serve” after examinations at Walter Reed National Military Medical Center.
The summary of that visit included various tests performed but notably omitted the prostate-specific antigen (PSA) test, which Jeffrey Son, a urology associate professor at Stanford, found unsurprising.
“Honestly, there wasn’t much advocacy for active PSA screenings back in the ’80s,” he remarked. “Looking back, had he followed all the guidelines, they might have detected this earlier.”
The existing guidelines for cancer screenings are intricate, and Biden’s situation underscores some of the complexities. Early detection is generally advantageous; however, it’s also important to avoid unnecessary treatments.
While the American Cancer Society does not endorse routine screenings for men at any age, it does suggest discussions with healthcare providers about the potential benefits and drawbacks of screening, particularly for higher-risk men starting at age 40 and average-risk men at age 50.
The U.S. Preventive Services Task Force advises men aged 55 to 69 to make “individual” choices after consulting with health professionals. Recommendations for shared decision-making typically cease for those aged 70 and older, as prostate cancer tends to progress slowly and the benefits of screening often do not justify the risks for men with limited life expectancy.
“A reason we advise against screening older men is,” Otis Broly, a medical oncologist at Johns Hopkins University who treats men with metastatic prostate cancer, stated, “I’ve witnessed countless patients suffer mentally and physically from a diagnosis that really wouldn’t have affected them if left undetected.”
In a recent report from the White House, former President Trump mentioned that his PSA levels were tested in April and found to be normal. During a press interaction, he raised questions about why Biden hadn’t been tested earlier.
Befer Eidai, a urological surgeon at Memorial Sloan Kettering, mentioned that it’s challenging to make a precise prediction regarding Biden’s prognosis. Typically, men over 70 are not screened unless they display symptoms, as was the case with Biden and his frequent urination.
While Eidai hesitated to elaborate on Biden’s specific situation, he emphasized that even at 82, this type of cancer can be treated. “The primary aim is to identify it and address it early,” he added.
Queries regarding the last screening for Biden were left unanswered by his representative.
Politically, the timing of the announcement has raised eyebrows among both Democrats and Republicans. Some Democrats criticized the record voter turnout and suggested Biden’s team may have tried to obscure concerns about the implications of his age on his health.
A new book detailing Biden’s declining health, authored by CNN’s Jake Tapper and Axios’ Alex Thompson, is likely to deepen the political discourse around this issue.
Yet even the Democrats who were critical of Biden’s impact on Trump’s previous victory sought to advocate for him in a more respectful manner. “Joe Biden has done a lot for this country, and now is the time to allow him the focus and space he needs for his health,” said Democratic strategist Jamal Simmons. “This isn’t about politics right now.”
However, skepticism remains that this diagnosis could alter public narrative. “It’s politics. I hope they’ll manage expectations and utilize this situation for any potential advantages,” remarked a longtime ally, expressing uncertainty about the implications.
Since Biden’s diagnosis was disclosed last Sunday, Trump and his team have made attempts to steer the conversation toward sensitive topics surrounding health. Trump expressed sympathy for Biden’s condition and wished for a speedy recovery, but followed up with questions about the lack of early detection.
Earlier, Vice President Vance raised concerns about Biden’s fitness to serve. “We can wish for good health, but we must also recognize that if you’re not healthy enough to fulfill your role, perhaps you shouldn’t be in that role,” he stated.
Medical professionals not involved in Biden’s care cited no indications of a missed diagnosis. “I haven’t heard any claims suggesting a cover-up or delay in his case,” Morgans noted. “It appears to be simply an unfortunate situation of prostate cancer, one that has surfaced at a later stage.”
