News of former President Joe Biden’s advanced prostate cancer has elicited sympathy – and shock – from doctors, like me.
Over my 25 years as a board-certified urological surgeon, I’ve come to know the pain – physical and emotional – that such a life-changing discovery has on a patient and their family.
This must be a very difficult time for the Bidens, indeed. However, as a medical professional, it’s difficult to overlook the odd circumstances and severity of the president’s diagnosis.
According to the president’s office, doctors detected an ‘aggressive form’ of cancer after a ‘small nodule’ was found on his prostate during a ‘routine physical exam’ last week. But the statement suggests that the president was cancer-free prior to this screening and I find that very hard to believe.
Of course, I have never evaluated the president, I do not know his medical history and he deserves some degree of privacy when it comes to his health. Yet he has now made his diagnosis public – and I have reason to suspect that he had cancer even while serving the country and presenting himself as healthy and capable of fulfilling the duties of the office.
Biden’s last publicly available health report, from February 2024, makes no mention of a routine prostate cancer screening. But five years prior to that, his doctor noted that the former president ‘never had prostate cancer,’ while treating him for an enlarged prostate.
Now, his physicians report that he has a highly aggressive form of the disease that has metastasized – or spread to his bones – though curiously, such proliferation of the disease typically takes at least five years.
Furthermore, doctors use a method to determine the potential lethality of cancer, called a Gleason score that rates the severity of the disease on a scale of one to 10 – with a score of six being a slowly-spreading cancer and 10 being the most aggressive case.
Biden’s aggressive cancer diagnosis, which has spread to his bones, was revealed on Sunday.
Dr David Shusterman is a board-certified urologist and urological surgeon who diagnoses and treats urologic cancers, including of the prostate.
Biden’s Gleason score is nine.
This abrupt presentation defies any typical case that I’ve ever seen. In my experience, prostate cancer of this severity doesn’t develop overnight. In fact, I’ve never treated a patient (including those who have avoided regular checkups) whose cancer has progressed from no detectable trace to an aggressive stage.
Additionally, I find it implausible that cancer was never detected by routine screening.
Doctors often begin testing men for prostate cancer at the age of 50, or younger if they have a family history of cancer. It is among the most common cancers in men and when detected early, it is easily treatable.
The most common form of screening is a simple blood analysis called a Prostate-Specific Antigen (PSA) test that measures a protein produced by the prostate. If a man is found to have elevated PSA levels, they may undergo a rectal exam. In the instance that lesions on the prostate are found, the patient will likely have a biopsy of the abnormal tissue, as that is the only way to confirm a cancer diagnosis. If a malignant tumor is found, it will be treated.
Some have suggested that President Biden, now 82, may not have received regularly prostate screenings, but I find that, too, to be unlikely.
The US Preventive Services Task Force (USPSTF) – an independent panel of doctors – does not advise PSA testing in men over 70 years old due to the risk of over-diagnosis and unnecessary treatments, but I perform these tests on patients up to 80 years old. And while USPSTF guidelines may be suitable for the ordinary citizen, the President of the United States is certainly extraordinary.
His health is a matter of national concern. And Biden – who also served as vice president and a US senator for decades – has had access to the best health care the country has had to offer.
There is also the possibility that Biden declined prostate screenings during his White House physicals and opted for private doctors whose findings would be shielded from the public by the Health Insurance Portability and Accountability Act (HIPAA), a federal law that protects the privacy of patient health information. But if that was the case then the President wasn’t being forthright with the public.
It’s very possible that the cancer could have weakened his bones contributing to his worsening mobility issues over the years.
Biden posted a selfie of him and his wife, Dr Jill Biden, on Monday, thanking people for ‘lifting us up with love and support’ after his diagnosis.
It’s also plausible that the former president has already received some sort of medical treatment for his cancer and kept it a secret, but that the treatment has since become ineffective.
His spokesperson announced that, while aggressive, Biden’s cancer ‘appears to be hormone-sensitive, which allows for effective management.’ Biden would likely have been given a synthetic hormone, called Lupron, that lowers testosterone level and slows the growth of the tumor.
The medicine works well – however it is only effective for two years and then the effects wear out.
Finally, if the president was truly unaware of his condition, or if he chose to ignore it, that is tragic.
It’s very possible that the cancer could have weakened his bones contributing to his worsening mobility issues over the years. And, sadly, his diagnosis has a five-year survival rate of between 30 and 40 percent.
No matter the truth of the former president’s health, we can all agree that is deeply unfortunate. If any positive lesson can be gleaned from this news, it is that all men should be screened for prostate cancer early and regularly.
Dr David Shusterman is a New York-based, board-certified urologist and urological surgeon with a distinguished career in diagnosing and treating urologic cancers, including prostate, bladder and kidney cancers.
