Former President Joe Biden was diagnosed on May 16, 2025, during a routine physical prompted by urinary symptoms, with Stage 4 prostate cancer that had already spread to his bones—confirmed by biopsy to be Gleason score 9 (Grade Group 5).
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His office stated that his last known PSA (prostate-specific antigen) test occurred in 2014, with no prior prostate cancer diagnosis before the May announcement.
2. Why wasn’t it detected sooner?
a. Guidelines discourage routine PSA screening after age 70
Current U.S. Preventive Services Task Force and other expert groups generally recommend against routine PSA screening in men over 70 or 75, due to risks of false positives and overtreatment in less aggressive cancers.
b. Aggressive prostate cancers can progress with low PSA
Some high-grade prostate cancers, especially Gleason 9, may not elevate PSA levels significantly until later stages, making them more difficult to spot early.
c. No obvious symptoms until it metastasizes
Prostate cancer often remains silent until it causes urinary issues or pain due to bone metastasis—precisely what led to Biden’s evaluation.
3. Why now—even with top-tier care?
a. Age-based screening cutoff
Even with world-class healthcare, standard practice stops PSA testing at age 70–75. Biden’s last documented screening in 2014 aligns with this practice, though it ended before his presidency .
b. Contrast with previous presidents
Presidents like Trump and Obama publicly shared regular PSA results. Biden’s tests ceased after 2014, a gap that critics say is surprising given his profile—but experts say it follows accepted norms .
c. Rare but known cancer behavior
Medical professionals note that sporadic aggressive cancers can emerge or escalate rapidly, potentially bypassing early detection protocols .
4. Was there a “cover‑up”?
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Speculation by critics—including former President Donald Trump and some GOP lawmakers—suggested possible concealment or failure to monitor his prostate health while in office.
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Biden’s office responded by affirming that there was no prior diagnosis, that the last PSA test indeed occurred in 2014, and that the cancer was only discovered recently following new symptoms—there was no deliberate withholding of information.
5. What do medical experts say?
| Observation | Expert Views |
|---|---|
| Lack of screening wasn’t unusual | “It is not unusual for a man of Biden’s age to skip prostate cancer screening” |
| Late-stage detection is common | “Without screening… almost no way to detect these cancers early” |
| Aggressive forms may evade tests | “Physicians were thrown by the timing… could have had the disease for up to a decade” |
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Once cancer metastasizes to bone, the 5-year survival rate drops to around 30–37%, though newer therapies, especially for hormone-sensitive tumors like Biden’s, can extend life significantly.
6. Treatment outlook & next steps
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Promising therapies: hormone (androgen deprivation) therapy, radiation, chemotherapy, immunotherapy—often in combination—can slow disease progression web.musc.edu.
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Patient prognosis: While Stage 4 metastatic prostate cancer is not curable, many patients now live 5 to 10+ years with quality life thanks to modern treatments .
Conclusion: Was it truly “unchecked”?
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Not necessarily—Biden’s last PSA test in 2014 fell within accepted medical practice for his age.
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Yes, it wasn’t caught early, but that is often due to guideline limits, silent progression, and unpredictable aggressiveness, not necessarily negligence.
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No credible evidence of a deliberate “cover-up”: his office clarified facts promptly once cancer was confirmed.
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Case highlights a broader issue: screening guidelines may miss aggressive cancers, especially in older adults. Biden’s case renews debate about balancing over‑diagnosis vs. early detection.
