Can You Get To Stage 9 Cancer? What We Know
On May 18, 2025, it was announced that former President Joe Biden had been diagnosed with an aggressive form of prostate cancer. His diagnosis came after he was checked out by his physician because of worsening urinary symptoms and a prostate nodule (here are some other prostate cancer warning signs you shouldn't ignore). The statement revealed that his cancer was "characterized by a Gleason score of 9 (Grade Group 5)." It was further noted that the cancer appears to be hormone-sensitive, which means there are treatments that can manage it (via CNN).
Once news about Biden's diagnosis broke, many were curious to learn just what these numbers mean for the former president's prognosis, especially after President Donald Trump made an inaccurate statement that Biden has "Stage 9" cancer (it's actually Stage IV). Health Digest spoke with Dr. Justin Houman, a board-certified, fellowship-trained urologist, to gain a better understanding of what these scores mean.
The first thing Houman wanted to clear up was any confusion between "stage" and "Gleason score." "There is no such thing as 'Stage 9' cancer," he explained, going on to say that Biden's Gleason score of 9 relates to a grading system used specifically in prostate cancer.
What the difference is between stage and Gleason score
"Staging tells us how far the cancer has spread," said Houman, adding that a TNM (tumor, nodes, metastasis) system is used to stage cancer. This system looks at the size and extent of the primary tumor within the prostate, whether it has spread to nearby lymph nodes, and whether it has spread to other organs. "Prostate cancer is commonly grouped into Stage I to Stage IV, with Stage IV being the most advanced," he said. In Biden's case, it has been reported that his cancer has metastasized to the bones, placing it in the category of Stage IV. (Learn more about the four stages of prostate cancer, and what happens at the end.)
"Gleason Score, on the other hand, tells us how aggressive the cancer looks under the microscope," Houman said. This score starts at 6 and goes up to 10. Houman added that it's actually the sum of two numbers, which is why the score doesn't start at 1. "A Gleason 9 means the cancer is high-grade and aggressive, even if it hasn't yet spread beyond the prostate," he explained.
Why the stage and Gleason score are important to understand
Houman said it's important to understand what the stage and Gleason score are because the stage tells us where the cancer is, and the Gleason score tells us how it behaves. "So when we hear that someone has a Gleason 9, it means they have a highly aggressive form of prostate cancer, but not necessarily a widely spread (Stage IV) cancer," he explained.
Houman further noted that treatment decisions depend on both of these factors. "A high-grade cancer caught early (Gleason 9, Stage II) might still be curable," he said. "But a lower-grade cancer that has already spread widely (Gleason 6, Stage IV) could be much harder to treat."
While Houman didn't comment on Biden's prognosis specifically, the Wall Street Journal reported that, although Stage IV prostate cancer isn't curable, experts say the former president could "live for years."