Former President Joe Biden has been diagnosed with metastatic prostate cancer at age 82. The former president’s office said he has an “aggressive form” of the cancer, which has spread to his bones.
His cancer was categorized as having a Gleason score of 9, which places him in Grade Group 5, the most severe category.
Here’s what to know about the disease, its symptoms and treatments:
Prostate cancer symptoms
Most men are diagnosed with prostate cancer before they start showing symptoms, as early warning signs of prostate cancer are rare, according to Johns Hopkins Medicine. The severity of symptoms can depend on the location of the cancerous cells and how advanced the disease has become.
Symptoms can include urinary issues, such as frequent urination, weak or interrupted flow, blood in urine and trouble either holding in or starting urination, according to Johns Hopkins. Other symptoms can include difficulty getting and maintaining an erection, painful ejaculation and pain or stiffness in the lower back, hips or upper thighs, Johns Hopkins says.
Urinary symptoms, such as frequent urination or difficulty urinating, are quite common in older men and are usually due to benign conditions like having an enlarged prostate, CBS News medical contributor Dr. Celine Gounder says.
But in this case, Biden’s office said his symptoms led to a prostate exam that resulted in the discovery of a small nodule. Further testing determined it was cancerous.
Some urologists were surprised that the 82-year-old underwent prostate cancer screening at all, according to Dr. Gounder, because routine screening in men over 75 is controversial. Many prostate cancers at that age are slow-growing, and overtreatment can do more harm than good, she said.
Prior to the diagnosis, Biden had received a clean bill of health during a February 2024 physical, in which he was declared “fit to serve” while still in office.
His situation underscores the importance of tailoring medical decisions to the individual, Dr. Gounder says. The former president had new symptoms and is functionally active, which justified a closer look.
Gleason score and what bone metastasis means
Gleason scores are a grading system for prostate cancer, according to the Cleveland Clinic. Pathologists grade each tissue sample on a 1 to 5 scale. The lower the grade, the more cancer cells look like normal cells.
Each area of prostate cancer may have a different grade, so pathologists pick the two areas that make up most of the cancer. They add the two areas’ grades to come up with a Gleason score, according to the Cleveland Clinic.
Biden had a Gleason score of 9 (Grade Group 5), which is determined by the pathologist who looked at cells under a microscope.
A score of 9 is the second highest on the scale, which goes to 10. For scores 8, 9 and 10, the “cells look very different from healthy cells, which is called poorly differentiated or undifferentiated,” the Cleveland Clinic said.
The categorization suggests a poor prognosis without intervention, according to Dr. Gounder.
Moreover, Biden’s prostate cancer diagnosis came with the presence of bone metastases, meaning the disease has spread. It places him within the high/very high-risk management group.
Is prostate cancer curable?
Prostate cancer is often curable if it’s identified and treated early, according to the Mayo Clinic.
In Biden’s case — given his age and health — the goal isn’t to cure the disease but to control it, to slow progression and preserve quality of life, Dr. Gounder says. Since the former president is reportedly in good functional health, more aggressive treatment is on the table. But these decisions always weigh the benefits against the potential risks and side effects, based on the individual’s overall condition and priorities.
While Biden’s diagnosis represents a more aggressive form of prostate cancer, his office said the cancer appears to be hormone-sensitive. This means the cancer should respond to testosterone-blocking treatment, since testosterone fuels prostate cancer growth, according to Dr. Gounder.
Based on what is known about his diagnosis, the primary treatment would be to block testosterone with a medication like Lupron, Dr. Gounder says. This might be combined with other hormone therapies like Zytiga, or even chemotherapy, depending on the specific case.
Bone-targeted treatments are also part of the strategy when the cancer has spread to the skeleton, according to Dr. Gounder.
Biden is among an estimated 313,780 new cases of prostate cancer will be diagnosed in the U.S. this year, according to the American Cancer Society’s Cancer Facts & Figures. Approximately 35,770 of them (11%) will die from the disease this year, the organization said.
Dr. Céline Gounder
contributed to this report.
