In a significant health update in May 2025, former United States President Joe Biden, then 82, received a serious diagnosis: aggressive, metastatic prostate cancer. Medical reports confirmed a Gleason score 9 tumor, classified as grade group 5, representing one of the most severe forms of the disease. The cancer had already spread to his bones but was identified as hormone-sensitive, meaning it could respond to therapies that block testosterone. The discovery was made during a routine check-up prompted by urinary symptoms.
Decoding the Early Warning Signs: From Urinary Changes to Pelvic Discomfort
Prostate cancer often develops silently over many years, particularly in men over 65. For President Biden, the initial indicators were subtle changes in urination patterns—a common but frequently overlooked red flag. These symptoms include a noticeably weaker urine stream, hesitancy or straining to begin urination, and a flow that stops and starts. Many men also experience nocturia, or frequent nighttime urination, leading to sleep disruption and daytime fatigue.
More alarming signs can include hematuria, or blood in the urine, which may appear pink, red, or cola-colored. Pain or a burning sensation during urination can also occur as a tumor irritates the urethra. It is critical to note that roughly 70% of prostate cancers initially present with no symptoms or mimic benign prostate enlargement, a condition affecting half of all men over 50. This underscores the importance of proactive screening through PSA tests and digital rectal exams.
As the tumor grows within the prostate, symptoms can localize in the pelvic region. A persistent feeling of incomplete bladder emptying, frequent urination of small volumes, and a constant pressure or dull pain in the pelvis or perineum (the area between the scrotum and anus) may develop. Erectile dysfunction affects up to half of all cases, as cancer impacts the necessary nerves and blood vessels. Painful ejaculation or blood in semen are further possible indicators. Because these signs are often mistaken for normal aging, diagnosis can be dangerously delayed.
When Cancer Spreads: Understanding Metastasis and Systemic Effects
In President Biden's case, the high-grade Gleason 9 cancer progressed rapidly to metastasis, reaching stage IV and spreading to his bones. Bone metastases cause a deep, relentless pain typically felt in the lower back, hips, thighs, pelvis, or spine. Unlike ordinary joint pain, this discomfort often worsens at night or with weight-bearing activity and can be severe enough to wake a person from sleep.
The spread of cancer to bones carries serious risks, including easy fractures from minor falls due to bone weakening. In about 10-12% of cases, spinal cord compression can occur, leading to leg weakness, numbness, tingling, or loss of bowel and bladder control—a medical emergency requiring immediate treatment. Systemic effects of advanced cancer include severe fatigue from anemia, unexplained weight loss, loss of appetite, and nausea. Hypercalcemia, resulting from bone breakdown, can cause confusion, excessive thirst, vomiting, and constipation.
Biden's Treatment Journey and the Modern Outlook for Prostate Cancer
Following his diagnosis, Biden began immediate hormone therapy, known as Androgen Deprivation Therapy (ADT). This treatment uses pills to lower testosterone levels, effectively starving the hormone-sensitive cancer cells. For 80% of responsive cases, ADT can significantly relieve bone pain. In October 2025, Biden completed a five-week course of precise radiation therapy at Penn Medicine in Philadelphia, targeting both the prostate and bone metastases to kill cancer cells while sparing healthy tissue.
Publicly, Biden has maintained an active schedule and expressed optimism. In a statement to CNN, he said, "We are going to be able to beat this. It's not in any organ, it's in my bones strong, hasn't penetrated. So I'm feeling good." His hormone-sensitive status offers a favorable potential for disease control with current therapies.
The treatment landscape for high-risk prostate cancers like Gleason 9 has evolved considerably. While metastatic prostate cancer remains serious, the five-year survival rate has improved to approximately 36% in recent decades, a marked increase from the past. Combining ADT with radiation has shown success rates comparable to surgery. Newer drugs, such as enzalutamide, and advanced PSMA-targeted therapies provide renewed hope for managing the disease effectively.
Key Takeaways for Men's Health: Awareness, Screening, and Stigma
President Biden's candid disclosure of his diagnosis plays a vital role in dispelling the stigma often associated with prostate cancer and men's health issues. The statistics are sobering: one in eight men will develop prostate cancer in their lifetime, with risk peaking after age 65. The disease is more prevalent among Black men and those with a family history.
His case delivers several crucial lessons for men globally, including in India:
- Be vigilant about symptoms: Do not ignore persistent changes in urination, blood in urine or semen, pelvic pain, new erectile dysfunction, or unexplained bone aches.
- Prioritize regular screening: Men over 50, or earlier for those with risk factors, should discuss PSA testing and digital rectal exams with their doctors.
- Understand that metastatic disease can be managed: Modern medicine offers multiple treatment pathways that can control advanced cancer and maintain quality of life.
At 83, Joe Biden's resilience in his fight against prostate cancer, supported by his family, serves as a powerful reminder. His journey demonstrates that with timely detection, advanced treatment, and a proactive approach, even an aggressive, metastatic diagnosis can be confronted with strength and hope.
