Biden's aggressive prostate cancer: what you need to know about the disease

Former President Joe Biden has been diagnosed with an aggressive form of prostate cancer that has metastasized to his bones, according to an announcement from his personal office on Sunday, May 18, 2025.

The 82-year-old former president received his diagnosis after experiencing worsening urinary symptoms. His cancer has been classified with a Gleason score of 9, placing it in the highest risk category, though doctors note it appears to be hormone-sensitive, which offers options for effective management. This factbox provides key information about Biden's diagnosis and prostate cancer in general, including risk factors, symptoms, treatment options, and prognosis.

Biden's Diagnosis and Current Status
Former President Joe Biden was evaluated last week for a newly discovered prostate nodule after experiencing increasing urinary symptoms. On Friday, May 16, he received a diagnosis of prostate cancer with a Gleason score of 9 (Grade Group 5) that has spread to his bones. The statement from his office indicated that "while this represents a more aggressive form of the disease, the cancer appears to be hormone-sensitive which allows for effective management".

Biden's Gleason score of 9 indicates that his cancer cells look very different from normal prostate cells and are likely to grow and spread rapidly. This places his cancer in Grade Group 5, the highest risk category, associated with a greater likelihood of metastasis and a more challenging prognosis. The former president, now 82 years old, and his family are currently reviewing treatment options with his medical team.

The timing of Biden's diagnosis comes only months after he left office in January 2025, having withdrawn from his reelection campaign in July 2024 following concerns about his health and cognitive abilities. His diagnosis represents a serious health challenge, though modern treatments offer pathways for managing even advanced prostate cancer cases.

Understanding Prostate Cancer
Prostate cancer is the most common cancer among men in the United States after skin cancer. According to the American Cancer Society, about 313,780 new cases of prostate cancer will be diagnosed in the United States in 2025, and approximately one in eight men will be diagnosed with prostate cancer during their lifetime.

The prostate is a gland in the male reproductive system located below the bladder that plays a role in producing semen. Prostate cancer develops when cells in the prostate begin to grow uncontrollably due to accumulated genetic mutations. These mutations affect genes involved in cell growth, replication, cell death, and DNA damage repair, which leads to the formation of tumors that can eventually spread beyond the prostate.

While prostate cancer incidence had declined sharply from 2007 to 2014, coinciding with fewer men being screened due to changes in screening recommendations, the rates have been increasing by approximately 3% per year since 2014. This trend has raised concerns among health organizations, with the American Cancer Society National Prostate Cancer Roundtable noting that the time has come to address this troubling trend.

Gleason Score and Cancer Grading System
The Gleason score is a critical grading system for prostate cancer that helps determine its aggressiveness and potential treatment approaches. Medical pathologists establish Gleason scores after studying tissue samples under a microscope, evaluating how abnormal the cancer cells appear compared to normal prostate cells.

Gleason scores range from 6 (low-grade cancer) to 10 (high-grade cancer), with higher scores indicating cancer cells that look very different from normal cells and are likely to grow and spread quickly. For calculating the score, pathologists identify the two areas of cancer that make up most of the tumor and assign each a grade from 1 to 5 based on how abnormal the cells appear, then add these numbers to determine the overall Gleason score.

Biden's Gleason score of 9 places him in Grade Group 5, the most severe category. According to the Cancer Research UK, cells with a Gleason score of 9 or 10 "look very abnormal" and "the cancer is likely to grow quickly". Dr. Benjamin Davies, a professor specializing in urology at a university medical center, explained that a Gleason score of 9 indicates the most aggressive form of prostate cancer.

Symptoms and Detection
Early prostate cancer typically causes no symptoms, which is why screening is important for early detection. As the cancer advances, like in Biden's case, it may cause urinary issues that include frequent urination, weak or interrupted urine flow, blood in the urine, and trouble either starting or holding in urination.

Biden's office reported that he was evaluated after experiencing "worsening urinary symptoms," which led to the discovery of a prostate nodule. It's worth noting that urinary symptoms are quite common in older men and are usually due to benign conditions like having an enlarged prostate, according to Dr. Celine Gounder, a medical contributor.

Advanced prostate tumors that have metastasized can cause additional symptoms including fatigue, unexplained weight loss, and back or bone pain that doesn't improve with rest. In some cases, growing metastases can compress the spinal cord, causing weakness in the legs and feet, or even limb paralysis. About a quarter of those with metastatic prostate cancer develop bone fractures due to bone damage caused by metastases.

Treatment Options for Metastatic Prostate Cancer
Given Biden's diagnosis of metastatic prostate cancer with bone involvement, his treatment options will focus on managing the disease rather than curative approaches. The primary treatment for metastatic hormone-sensitive prostate cancer is androgen deprivation therapy (ADT), which reduces the levels of male hormones (androgens) that fuel prostate cancer growth.

Androgen deprivation therapy can be administered through surgical removal of the testicles (orchiectomy) or more commonly through medications that block hormone production. While ADT alone was the standard treatment for many years, newer approaches combine ADT with other treatments for better outcomes.

More recent treatment protocols incorporate novel androgen receptor pathway inhibitors (such as abiraterone, apalutamide, darolutamide, or enzalutamide) alongside ADT. For patients with metastatic disease, chemotherapy with docetaxel may also be added to the regimen, creating what is sometimes called "triple therapy". Dr. Matthew Smith of Massachusetts General Brigham Cancer Center noted about Biden's case that "it's very treatable, but not curable".

The fact that Biden's cancer is hormone-sensitive is significant and positive for his treatment outlook, as his office statement noted that this characteristic "allows for effective management". Hormone-sensitive cancers typically respond well to hormone therapy, at least initially, though resistance can develop over time.

Prognosis and Survival Rates
Prostate cancer survival rates vary significantly depending on the stage at diagnosis. For localized prostate cancer (confined to the prostate), the five-year relative survival rate approaches 100%. For regional spread (cancer that has spread to nearby structures), five-year survival rates remain high at 60-80%.

However, for metastatic prostate cancer like Biden's, the prognosis is more challenging. The five-year relative survival rate for prostate cancer that has spread to distant parts of the body (Stage IV) is approximately 30-40%. Dr. Ryan Cleary, a urologist at MedStar Health, stated that "generally a third of patients will be alive five years after diagnosis of metastatic prostate cancer".

While these statistics provide a general framework, individual outcomes can vary based on numerous factors including age, overall health, response to treatment, and specific characteristics of the cancer. The hormone-sensitive nature of Biden's cancer may offer a more favorable outlook than some cases of metastatic disease.

Dr. Jeffrey Kuhlman, who served as White House physician during Barack Obama's presidency, estimated "10 to 15 years of function" for someone with Biden's diagnosis, considering aggressive cancer treatments, while emphasizing the importance of prioritizing treatments that maintain quality of life.

Risk Factors and Prevention
Prostate cancer risk increases significantly with age, with the average age of diagnosis being 67. At 82, Biden falls into a high-risk age category. Family history also plays a role, as those with a family history of any cancer are more likely to develop prostate cancer, particularly those who inherit cancer-associated variants of the BRCA2 gene.

Early detection through screening is crucial for identifying prostate cancer before it spreads. The American Cancer Society National Prostate Cancer Roundtable emphasizes that the number of advanced stage prostate cancer diagnoses is increasing, noting that "a simple blood test can help find prostate cancer early, when it may be easier to treat".

Screening typically involves blood tests that check for prostate-specific antigen (PSA) levels, with high PSA levels indicating increased risk for developing prostate cancer. The five-year survival rate when prostate cancer is diagnosed at an early stage exceeds 99%, highlighting the importance of early detection.

Conclusion
Former President Biden's diagnosis of aggressive, metastatic prostate cancer underscores the serious nature of advanced prostate cancer while also highlighting the treatment options available for management. With a Gleason score of 9 and bone metastasis, his cancer represents a significant health challenge, though its hormone-sensitive nature offers pathways for treatment.

Biden's diagnosis serves as a reminder of the importance of prostate cancer awareness and early detection. As the American Cancer Society noted in response to Biden's diagnosis, "This news is a reminder about the tragic impact of prostate cancer in the U.S." With prostate cancer incidence rising approximately 3% annually since 2014, medical experts continue to emphasize the critical role of screening and early intervention in improving outcomes for this common but potentially deadly disease.

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