The revelation of former President Joseph Biden’s prostate cancer diagnosis left me on unfamiliar footing. As a medical oncologist, I find most celebrity disclosures humbling yet rarely moving. But for someone whose uncle is in the midst of a very similar cancer journey, the particulars of Biden’s disease are inescapable.
In a statement released Sunday, Biden’s office disclosed that he had Stage 4 prostate cancer with “metastasis to the bone.” The disease was noted to be an “aggressive form” with a Gleason score of 9 (on a scale of 6 to 10), which reflects the heightened abnormality of the cells. The former president is now exploring treatment options with his doctors.
According to the CDC, 8% of prostate cancers are first diagnosed when the cancer has already spread so widely.
Not long ago, my 74-year-old uncle found himself in the same place. In 2023, his prostate-specific antigen (PSA) blood test — which measures a protein produced by both normal and cancerous cells of the prostate gland — was 1.5, well below the age-appropriate normal of 4.0. But within a year, despite only vague urinary symptoms, his level spiked to 104.
An MRI of the prostate and biopsy duly followed, and confirmed cancer with a high Gleason score. Shortly after, a PET scan showed that the disease had already spread to various bones and lymph nodes. Like Biden, in other words, my uncle’s malady was Stage 4 at the time of diagnosis — controllable but incurable.
Because prostate cancers are often slow-growing and assessed regularly with PSA levels, the vast majority (70%, per the Centers for Disease Control and Prevention) are first detected at an early stage, still localized to the prostate. But while such advanced presentations are unlikely at the time of initial detection, they are not impossible. According to the CDC, 8% of prostate cancers are first diagnosed when the cancer has already spread so widely.
After my uncle’s unexpected diagnosis, I had to provide space for him and his immediate family to absorb the news. And though I would not be the primary doctor for his treatment, I did reassure him that regardless of the advanced cancer, an effective treatment plan did exist.
The former president will receive the same treatment plan my uncle has: an individualized strategy that accounts for his disease specifics, physical ability, co-morbidities and quality of life. And crucially, my uncle could start this journey with optimism, thanks not only to his personal faith but to the burgeoning potential of current prostate cancer treatments — hormone therapy, chemotherapy, radiation and others.
“Cancer touches us all,” Biden posted Monday on social media. For me, this holds true both personally and professionally.
“Over the past decade, treatment for advanced prostate cancer has evolved significantly,” said Bilawal Ahmed, an oncologist at the University of Tennessee Health Science Center and a panel contributor on the National Comprehensive Cancer Network’s guidelines for prostate cancer. “While Stage 4 prostate cancer is not curable, it is very often treatable and manageable as a chronic disease. This helps shift the focus from fear to a long-term care plan rooted in hope and ongoing support.”
This is where Biden, and others like my uncle, stand to potentially benefit from the bounties of the former president’s own “moonshot” mission to reduce cancer deaths through significant investment in research. Such efforts, which are threatened by the Trump administration’s ongoing budget cuts, are the mainspring to expand our arsenal against a disease whose incidence and death toll remain substantial.
“Cancer touches us all,” Biden posted Monday on social media. For me, this holds true both personally and professionally. My uncle has made incredible progress on his cancer journey: His PSA has cratered on treatment and scans show no active disease. While no two cancers are ever alike, I hope the former president’s path meets equal success.