EDITOR’S NOTE: Dr. Jamin Brahmbhatt is a urologist and robotic surgeon with Orlando Health and an assistant professor at the University of Central Florida’s College of Medicine.
President Joe Biden’s diagnosis of metastatic prostate cancer has understandably raised concerns and questions: How long has he had cancer, how will he be treated, and what is his prognosis?
As a urologist, I regularly diagnose prostate cancer in my patients, and each time I share the diagnosis with them and their family, it’s never easy. Over time, I’ve learned the importance of keeping conversations simple and straightforward — avoiding sugar-coating and instead using data, statistics and personal experience to help patients begin their cancer journey.
As his public announcement draws attention to this type of cancer, it’s a reminder to regularly check on your own health. Here’s what you need to know about metastatic prostate cancer: how it’s detected, what treatments look like, and why early screening remains essential for men’s health.
How Biden’s cancer was diagnosed
The former president’s diagnosis began after he experienced “increasing urinary symptoms,” his office said, and a prostate nodule was discovered.
The detection of a prostate nodule likely happened during a digital rectal examination (DRE). During a DRE, a doctor gently inserts a finger into the rectum to examine the prostate gland, located directly in front of the rectal wall. A healthy prostate typically feels smooth and symmetrical. A prostate nodule, however, feels firm, raised, and irregular — similar in texture to your knuckles.
Not all prostate nodules indicate cancer — many are benign and associated with conditions enlarged prostate (BPH), or prostate stones (calcifications). However, in Biden’s case, further testing — likely including a prostate-specific antigen (PSA) blood test, imaging and biopsy — confirmed prostate cancer. Additional scans revealed that his cancer had spread to his bones, classifying it as high-risk, aggressive metastatic prostate cancer.
Understanding metastatic prostate cancer
“Metastatic” means the cancer cells have spread beyond the original location (the prostate gland) into other areas — most commonly bones and lymph nodes. Biden’s cancer has specifically spread to his bones, placing him among the 5% to 7% of prostate cancer cases in the United States that are metastatic at initial diagnosis. While this percentage seems small, it represents a significant number given that over 300,000 men in the US and approximately 1.5 million worldwide are diagnosed with prostate cancer every year.
Early-stage prostate cancer carries an excellent prognosis, with nearly a 100% five-year survival rate. However, when prostate cancer is metastatic at diagnosis, the five-year survival rate drops sharply to around 37%. Importantly, these survival rates are statistical averages, and individual outcomes vary considerably based on overall health, age, cancer aggressiveness, and how well a patient responds to treatment.
For Biden — and all prostate cancer patients — this diagnosis marks the beginning of a highly personalized journey. It remains impossible right now to accurately answer the question, “How long do I have?” Which of course is the question everyone wants answered.
Why your Gleason score matters
Prostate cancer severity is graded using a Gleason score, which ranges from 6 to 10. Lower scores (6–7) indicate slower-growing, less aggressive cancer cells, while higher scores (8–10) represent aggressive cancers more likely to spread quickly.
Biden’s Gleason score of 9 signifies a highly aggressive prostate cancer that usually requires immediate and comprehensive treatment.
In my clinic, the moment of diagnosing advanced prostate cancer is always difficult, evoking fear, uncertainty and many questions. At that moment, I ask the patient to take a deep breath, slow down and work together as we build a care team.
This multidisciplinary team may include specialists from urology, medical oncology, radiation oncology, radiology and supportive care services. Each specialist contributes a unique perspective, helping to create a treatment plan that has the best interest of the patient and their life goals.
Prostate cancer treatment options
Localized prostate cancer can often be cured with treatments such as robotic-assisted prostate removal (prostatectomy) or radiation therapy. However, metastatic prostate cancer treatment shifts from cure to managing symptoms, controlling disease progression and maintaining quality of life. Common treatments for metastatic prostate cancer include:
- Hormone therapy (androgen deprivation therapy, ADT): Blocks testosterone, essential for prostate cancer cell growth.
- Chemotherapy: Drugs to slow cancer growth, particularly when hormone therapy alone is insufficient.
- Radiation therapy: Targets metastatic lesions, reducing pain and symptoms, especially in bones.
- Immunotherapy and precision medicine: Treatments leveraging the immune system to attack cancer cells or therapies targeting specific genetic markers.
- Supportive care: Symptom relief and quality-of-life enhancement.
Advanced treatments effectively control metastatic prostate cancer but often come with side effects affecting daily life. Common side effects include fatigue, changes in sexual function, hot flashes, mood swings, and loss of muscle mass.
Treatment for metastatic prostate cancer depends on several factors: the patient’s overall health, age, other medical conditions and personal preferences. President Biden’s medical team will carefully personalize his treatment, aligning it closely with his unique health circumstances and quality-of-life goals.
How to take care of my prostate health?
A common question emerging from Biden’s diagnosis is whether his cancer could have been detected sooner or if it impacted him during his presidency. The President of the United States gets excellent medical care, and the truth is that we may never know.
Instead of getting stuck on these unanswerable questions, I recommend we refocus on something we can control: our own health. Biden’s diagnosis is a powerful reminder of our responsibility and opportunity to proactively manage our health.
As a urologist, I experience daily how unpredictable prostate cancer can be. Some patients show clear signs of the disease, while others surprise even me with aggressive or unexpected cases. Cancer doesn’t discriminate, and its trajectory can be uncertain. But one factor we can all control is our approach to prevention and early detection.
Symptoms to watch for are blood in the urine or semen; needing to urinate more often, including waking up at night to urinate; and trouble getting started when urinating. Signs of more advanced disease can also include accidental leaking, pain in the back and bones, fatigue, weight loss and weakness.
Former President Biden’s experience should be a call to action for us: Schedule regular health checkups, discuss prostate screening with your health-care provider, pay attention to your body’s signals, and prioritize overall health.
By shifting the conversation from speculation about someone else’s journey to actively engaging in your own, you’re investing in the most priceless and valuable asset you have — your health.