Former U.S. President Joe Biden has been diagnosed with an aggressive form of prostate cancer that has metastasized to his bones. The diagnosis, announced on May 18, 2025, revealed a Gleason score of 9 (Grade Group 5), indicating a high level of malignancy.
The diagnosis followed reports of urinary symptoms from Biden, prompting further investigation. Doctors found a prostate nodule, with subsequent tests confirming prostate cancer that had already spread to the bone.
“While this represents a more aggressive form of the disease, the cancer appears to be hormone-sensitive which allows for effective management.” his office said in a statement on Sunday (May 18).
News of Biden’s diagnosis quickly spread across social media, with many public figures expressing support and concern.
“Melania and I are saddened to hear about @JoeBiden’s recent medical diagnosis. We extend our warmest and best wishes to Jill and the family, and we wish Joe a fast and successful recovery.” –President Donald J. Trump 🇺🇸 pic.twitter.com/6HjermTGK7
— The White House (@WhiteHouse) May 18, 2025
Understanding Prostate Cancer
Prostate cancer is one of the most common cancers among men, particularly those over the age of 65. It often develops slowly and may not show symptoms in its early stages, which means many men live with it without it becoming a major health issue.
But that does not mean it is harmless. Aggressive forms can progress rapidly and spread to other parts of the body, such as bones and lymph nodes.
What Does a Gleason Score of 9 Mean?
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The Gleason scoring system assesses the aggressiveness of prostate cancer based on how abnormal the cancer cells look under a microscope. Scores range from 6 to 10, with higher scores indicating more aggressive cancers.
A score of 9 suggests that the cancer cells are highly abnormal and likely to grow and spread quickly .
Metastatic Prostate Cancer
When prostate cancer spreads beyond the prostate gland, it is referred to as distant, or metastatic cancer.
In localised disease with low Gleason grades, patients are expected to have survival of >95% in 5 years. In contrast, those with metastatic disease may have survival rates as low as 13 months.
Hormone-Sensitive Prostate Cancer
When doctors describe prostate cancer as hormone-sensitive, they mean the cancer cells rely on certain hormones (specifically testosterone) to grow and survive.
Testosterone acts like fuel for many prostate cancer cells. If the body’s testosterone levels drop, these cancer cells can shrink or slow down. This is why hormone therapy (also called androgen deprivation therapy, or ADT) is often the first line of treatment for advanced prostate cancer.
It works by either:
Blocking the body’s ability to make testosterone, or
Preventing testosterone from reaching cancer cells
For men with hormone-sensitive prostate cancer, this treatment can be effective in controlling the cancer for years. While it does not cure the disease, it can delay its progression and reduce symptoms.
However, over time, some prostate cancers can stop responding to hormone therapy. When that happens, they are called hormone-resistant prostate cancers. They then require more advanced or aggressive treatment.
In Biden’s case, the fact that the cancer is hormone-sensitive gives doctors more options to slow its spread, even at its advanced stage.
The Importance of Early Detection
Early detection of prostate cancer significantly improves the chances of successful treatment. Regular screenings, such as the prostate-specific antigen (PSA) blood test and digital rectal exams (DRE), can help detect prostate cancer before symptoms appear.
Early PSA testing (baseline PSA followed by risk adapted follow-up) can be offered to well-informed men >50 years of age, in men >45 years of age and a family history of prostate cancer, and black-skinned men of African origin >45 years of age, with a life expectancy >10 years [III, B].
In Asia, prostate cancer screening guidelines generally recommend starting PSA testing around age 50, or earlier (45) for men with a family history of prostate cancer. Some guidelines also recommend PSA testing for men > 50 years of age, with a life expectancy > 10 years. A digital rectal examination (DRE) can also be part of the screening process.
Screening Recommendations in Asia
At present, there is a lack of evidence to support routine screening for prostate cancer for the general population. Nevertheless, selective screening is recommended for asymptomatic men with a family history, as early detection is important for better outcomes.
PSA blood tests and digital rectal exams (DREs) are commonly used for screening.
PSA Blood Test
This is the most common screening tool. It measures the level of prostate-specific antigen (PSA) in your blood – a protein produced by the prostate.
Elevated PSA levels can be a sign of prostate cancer, though they can also rise due to other conditions like an enlarged prostate or infection.
Digital Rectal Exam (DRE)
During a DRE, the doctor checks the prostate through the rectum to feel for any unusual lumps or changes. It may be awkward, but it can pick up abnormalities that a blood test might miss.
MRI
In some cases, especially if PSA levels are elevated but not definitive, doctors may recommend a prostate MRI. It gives a clearer picture of any suspicious areas and can guide whether a biopsy is needed.
It is important to discuss screening options with a healthcare provider, especially for those with risk factors such as a family history of prostate cancer or other cancers.
Conclusion
While prostate cancer can be a serious and life-threatening disease, early detection and treatment can significantly improve outcomes. The tools to detect prostate cancer early are readily available. For men at risk, you are encouraged to have open discussions with your doctors about the risks and benefits of prostate cancer screening.
So if you’ve been putting off that check-up, maybe it’s time to give the clinic a call?
