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Former President Joe Biden’s office announced on May 18 that he had been diagnosed with an aggressive form of prostate cancer two days earlier, following the discovery of a prostate nodule. President Donald Trump and others have suggested, without evidence, that Biden’s diagnosis had been known much earlier and hidden from the public.
We can only report what Biden’s office has said. However, the timing of the diagnosis is plausible, since the U.S. Preventive Services Task Force has recommended against routine prostate cancer screenings for men over age 70.
Trump wished Biden well in a May 18 Truth Social post, saying, “Melania and I are saddened to hear about Joe Biden’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.”
By the next day, however, Trump’s reaction had shifted. “I’m surprised that it wasn’t — the public wasn’t notified a long time ago,” Trump told reporters, suggesting that the condition had been concealed from the public during Biden’s presidency.
But there is no evidence that Biden was aware of the cancer before the May 16 diagnosis. A May 20 statement from a Biden spokesperson said his last known PSA, or prostate-specific antigen, test “was in 2014. Prior to [May 16], President Biden had never been diagnosed with prostate cancer.”
The PSA test measures the amount of a specific protein produced by cancerous and noncancerous tissue in the prostate, a small gland below the bladder in males.
Experts in prostate cancer told us it is likely that Biden’s cancer began growing years ago. But at age 82, he had not been tested since his early 70s. The diagnosis was made after Biden experienced urinary symptoms, the New York Times reported.
“It is almost certain that President Biden had prostate cancer for months if not many years prior to his diagnosis,” Dr. Daniel Spratt, chief of radiation oncology at University Hospitals Seidman Cancer Center and Case Western Reserve University, told us. “This does not mean he or his physicians were aware of his diagnosis.”
Biden’s cancer is Stage 4, meaning the disease has spread, in his case to bone, with a Gleason score of 9, which refers to a more aggressive cancer.
Trump told reporters, “To get to Stage 9, that’s a long time,” confusing the cancer stage with the Gleason score. “You have to say, why did it take so long?” Trump said, adding later, “somebody is not telling the facts. It’s a big, it’s a big problem.”
The president’s son Donald Trump Jr., in a post on X, wrote, “What I want to know is how did Dr. Jill Biden miss stage five metastatic cancer or is this yet another coverup???” Trump Jr. shared a post that claimed it was “highly likely” Biden’s diagnosis was known throughout his presidency.
Former First Lady Jill Biden’s doctorate is in education, not medicine, and Joe Biden’s cancer is Stage 4, not 5.
Leo Terrell, an official in Trump’s Department of Justice, reposted a baseless claim on X that Jill Biden knew about her husband’s health problems but still wanted him to seek a second term. “Elder Abuse! Criminal Charges??” Terrell wrote.
The timing of Biden’s cancer diagnosis also coincides with the release of a book by Jake Tapper and Alex Thompson, “Original Sin: President Biden’s Decline, Its Cover-Up, and His Disastrous Choice to Run Again,” which reports that Biden’s inner circle hid his deteriorating mental and physical health.
But, as we said, there is no evidence that Biden, his family or his doctors were aware of his prostate cancer before the diagnosis on May 16.
Recommendations on Testing
The latest guidelines from the U.S. Preventive Services Task Force advise against PSA screening for prostate cancer in men who are 70 and older. The group’s 2018 recommendations, which are in the process of being updated, were based on finding with “moderate certainty” that the potential benefits “do not outweigh the expected harms.” The USPSTF is an independent panel of medical experts that issues recommendations on preventive screenings and medications.
For men 55 to 69 years of age, the task force said the decision to get a PSA test “should be an individual one,” and recommended that men discuss the pros and cons of testing with a clinician.
“Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men,” the USPSTF recommendation for the younger group says. “However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction.”
Guidelines from other groups are broadly similar, often recommending that men only test after consulting with a health care provider, although some do not provide an age cut-off after which testing is advised against.
High PSA levels “may indicate the presence of prostate cancer. However, many other conditions, such as an enlarged or inflamed prostate, also can increase PSA levels. Therefore, determining what a high PSA score means can be complicated,” according to the Mayo Clinic.
Men with prostate cancer may also have normal PSA levels. “Some types of prostate cancer don’t cause elevated PSA levels. You may have prostate cancer even if a PSA test says your levels are normal,” the Cleveland Clinic explains.
Reconsidering Testing Guidelines
“Most prostate cancers are asymptomatic for a very long time,” Dr. Isaac Kim, chief of urology at Yale School of Medicine, told us. “When patients develop very large disease locally or extensively disseminated, symptoms develop. In general, it is considered that prostate cancer will become symptomatic when the disease is very very advanced.
“It appears that President Biden became symptomatic recently,” he added, which would explain why the cancer was diagnosed so late.
Doctors might have detected Biden’s cancer earlier if he had been tested, Kim said, “but it is very complicated. In many circles among doctors, prostate cancer screening is discouraged. This is true especially for men in their 70’s” and older, he said.
Some have argued that the standard guidelines should not always apply to a president. At the same time, deviating from them could mean subjecting a president to unnecessary risks or procedures.
Dr. Ezekiel J. Emanuel, a breast oncologist and vice provost for global initiatives at the University of Pennsylvania, told the New York Times that the way a president’s health is monitored, particularly one of Biden’s age, should be reassessed. “We have to have confidence that their health condition is not intervening,” he said.
In a May 19 interview on MSNBC, Emanuel, who was on a COVID-19 advisory board for the Biden administration, said that Biden likely had cancer “at the start of his presidency in 2021.” This was interpreted by some as an admission that a cancer diagnosis was hidden from the public. Emanuel, however, later told the Washington Post that he was only saying that the cancer was present during Biden’s presidency.
“I didn’t say that there was a conspiracy,” he said, adding that he “should have” clarified that he wasn’t saying Biden knew he had cancer. “I was very clear that he did have cancer, that’s a fact. That he knew or didn’t know, I don’t know and they don’t know.”
Dr. Jeffrey Tosoian, who specializes in early diagnosis and management of urologic cancers at Vanderbilt University Medical Center, told us in an email that PSA testing became widely used for prostate cancer screening in the 1990s. That resulted in “a large reduction in the number of deaths caused by prostate cancer in the U.S. But PSA testing also led to a number of unnecessary prostate biopsies” and “detection of non-aggressive prostate cancers.”
The USPSTF then decided to recommend against PSA testing. “Unfortunately, but not unexpectedly, the reduction in PSA testing has been associated with an increase in diagnoses of metastatic prostate cancer in the U.S. … To many, the USPSTF decision to recommend against PSA screening was an example of throwing the baby (i.e. reducing death from prostate cancer) out with the bathwater (i.e. risk of negative outcomes from PSA testing),” Tosoian said.
“In the past decade-plus, several advances have improved the risk vs. benefit balance of PSA screening.” Tosoian said. “Based on these crucial improvements, many of us that care for patients with prostate cancer are hopeful that PSA screening will be better supported by forthcoming policy changes.”
Spratt, of Case Western Reserve, noted that “older men in studies consistently are more likely to harbor more aggressive prostate cancer. Thus, PSA screening should continue past 70 years old, but what doctors do with that information must be individualized to each patient to avoid over diagnosis and overtreatment.
“Fortunately, President Biden has many effective therapies to treat his prostate cancer, including image guided radiotherapy and various forms of therapy that can inhibit or block testosterone,” Spratt said. The hormone testosterone propels the growth of prostate cancer cells.
Gerald Denis, a research professor at the Shipley Prostate Cancer Research Center at Boston University’s medical school, said that prostate cancer that has spread to the bone is “generally considered to be advanced and incurable.” Survival after prostate cancer metastasis to bone is “only about 30 percent after five years,” Denis told BU Today.
“Generally speaking, there are many treatment options available to strengthen bones and slow tumor growth and spread, even if the bones are involved. In short, he can still be treated, and the progress of the cancer slowed, even if it is regarded as incurable,” Denis also said.
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