Former President Joe Biden Diagnosed With Prostate Cancer: Here Is What We Know

Former President Joe Biden has been diagnosed with prostate cancer, according to a statement released by his office. The cancer has spread to his bones. Doctors have confirmed a Gleason score of 9, one point shy of the most severe possible rating. The Gleason system grades how abnormal prostate cancer cells appear under a microscope, with higher scores reflective of more aggressive and fast-growing tumors.

Bone metastases in prostate cancer are a known marker of late-stage disease and are associated with a higher risk of complications, including fractures and severe pain. According to 2023 research in Oncology Letters, some 80% of patients who have late-stage prostate cancer can develop metastases of the bone. Statistically, prostate cancer that has spread to the bones carries a poor prognosis. The American Cancer Society (ACA) places the five-year survival rate below 3%.

Despite the gravity of the diagnosis, former President Biden's medical team has indicated that the cancer is hormone-sensitive, which, per the statement, "allows for effective management." That means it may respond to hormone therapy, which works by depriving prostate cancer cells of the growth signals that they need to multiply. As of press time, Biden and his family are said to be "reviewing treatment options with his physicians."

Prostate cancer is one of the most common cancers to affect older men, with age being the strongest risk factor. At 82, the former president falls well within the demographic most vulnerable to both the development and progression of the disease. The vast majority of cases occur in men over the age of 65, with those over 70 more than four times as likely to have advanced disease — and significantly more likely to die from it — compared to younger men.

In most cases, the disease progresses slowly and remains confined to the prostate. Many men live with the disease for years without serious complications. But when the cancer is aggressive, it may not cause noticeable symptoms until it has already spread. Among the most common signs are difficulty urinating, urinary frequency, blood in the urine, fatigue, weight loss, and pain in the back, hips, and pelvis. These are just some of the warning signs of prostate cancer that should alert men to schedule an appointment with a doctor.

What makes prostate cancer particularly insidious is that it often grows silently. In Biden's case, recent urinary issues prompted him to seek medical attention. This led to further investigation, which revealed both the primary tumor and the bone metastases. For high-risk individuals (including those in Biden's age group), regular screening can mean the difference between curable disease and late-stage cancer. (Here are the 4 stages of prostate cancer, explained.)

The Gleason score is a vital tool doctors use to assess the abnormality of prostate cancer cells. This prostate cancer scale is named for Dr. Donald Gleason, who developed the grading system to categorize cancers as either less or more aggressive. It's based specifically on the way the patient's prostate tissue samples appear under a microscope. Pathologists assess the appearance of the two most common cell patterns found in the patient's cancer and assign each of them a grade between one and five. Those two numbers are then added together to arrive at the total Gleason score. The higher the number, the more abnormal and aggressive the cancer cells.

President Biden's reported Gleason score of 9 (out of 10) places his cancer in what's known as Grade Group 5. This is the most severe category, suggesting that the cancer cells are both highly abnormal and more inclined to spread quickly. While the clinical outlook changes dramatically when the score is higher, Biden's cancer is hormone-sensitive.

This means that there is a chance that it may respond to androgen deprivation therapy (ADT), which is a treatment geared towards slowing the growth of androgens, including testosterone and dihydrotestosterone (DHT). If the therapy is successful, it could slow the growth of the cancer or potentially help them shrink. ADT can be administered prior to radiation or alongside it, but for patients with non-curative, aggressive cancer, it may be used to extend life while managing the disease.