President Joe Biden's prostate cancer diagnosis has raised questions over medical screening practices and presidential transparency after officials confirmed his last known prostate-specific antigen (PSA) test was conducted in 2014, seven years before he entered the White House.
Biden, 82, was diagnosed on May 16 with stage 4 prostate cancer that had metastasized to the bone. The diagnosis followed urinary symptoms that led doctors to detect a nodule on his prostate. His cancer was characterized by a Gleason score of 9, grade group 5, indicating aggressive growth potential and high risk of rapid spread.
A spokesperson confirmed Tuesday that Biden underwent PSA screening in 2014, during his tenure as vice president, but subsequent annual physicals during his presidency did not include the test. According to current U.S. Preventive Services Task Force guidelines, routine PSA screening is not recommended for men over 70 due to concerns over overdiagnosis and the potential harms of unnecessary treatments.
"He could be receiving the best medical care that we have to offer as a nation and not be screened for prostate cancer," said Dr. Michael Morris, a prostate cancer specialist at Memorial Sloan Kettering Cancer Center. "Excellent care means not under-testing. It also means not over-testing."
Still, some experts have expressed concern over the timing of Biden's diagnosis. "It is a bit unusual in the modern era to detect cancers at this late stage," said Dr. Herbert Lepor, a urologist at NYU Langone Health.
The White House released Biden's most recent physical report in February 2024. It described him as a "healthy, active, robust 81-year-old male who remains fit to successfully execute the duties of the Presidency," according to his physician Dr. Kevin O'Connor. The exam included evaluations of Biden's sleep apnea, arthritis-related gait stiffness, and heart and neurological function-but not a PSA test.
The PSA test measures levels of prostate-specific antigen in the blood, a protein produced by both cancerous and noncancerous prostate tissue. While elevated PSA levels may indicate cancer, they can also be caused by benign conditions such as an enlarged or inflamed prostate, making interpretation complex.
Because Biden's cancer is described as hormone-sensitive, it may be more responsive to hormone therapy, which remains a standard treatment for advanced prostate cancer.
The diagnosis has ignited political scrutiny. "There are things going on that the public wasn't informed of," said President Donald Trump on Monday. "I think somebody's going to have to speak to his doctor."
"This is no longer politically correct. This is dangerous for our country," Trump added. "Somebody is not telling the facts."
