Biden’s prostate cancer is incurable, but it is treatable

With Joe Biden’s recent diagnosis of an aggressive form of prostate cancer, the former U.S. president joins a growing group of people newly coping with the disease.

Biden, 82, represents one of more than 300,000 new cases of prostate cancer estimated to occur in the United States in 2025. And the incidence of this disease, the most common cancer in males, is rising. From 2017 to 2021, the incidence of prostate cancer increased about 3 percent per year, researchers reported in the Annual Report to the Nation on the Status of Cancer released April 21.

The disease’s death rate, however, has been riding a slow decline of about 0.6 percent per year from 2012 to 2022, scientists found. In 2025, some 35,000 people in the United States will die from the disease, the American Cancer Society estimates.

Overall, survival rates for localized prostate cancer are among the highest for all cancers. Men with early forms of the disease are more than 99 percent as likely as men without the disease to live for at least five years after their diagnosis. With late-stage cancers like Biden’s, where the cancer has spread from its original site to distant parts of the body, that number drops to 37 percent.

“Metastatic prostate cancer is not curable, but it is very much treatable,” says Maha Hussain, a genitourinary medical oncologist at Northwestern University Feinberg School of Medicine in Chicago. Treatment includes two type of drugs that shut down male hormones, sometimes combined with chemotherapy.

But not all patients are getting the treatment they need, says Neeraj Agarwal, a genitourinary medical oncologist at the University of Utah Huntsman Cancer Institute in Salt Lake City. Nearly 70 percent of prostate cancer patients received just one drug, not a combo treatment, which is the standard of care, Agarwal and colleagues reported in JAMA Network Open in December.

What exactly causes prostate cancer isn’t known, though old age, family history and obesity are all factors that can affect a person’s risk.

Science News spoke to Hussain and Agarwal about Biden’s diagnosis and treatment options for people with metastatic prostate cancer. The interviews have been edited for length and clarity.

SN: Joe Biden has metastatic prostate cancer with a Gleason score of 9. What does that mean?

Hussain: Metastatic prostate cancer means the cancer has gone outside the prostate and traveled into other parts of the body. The most common locations tend to be lymph nodes and bone. This is essentially considered Stage 4 cancer.

A Gleason score is based on microscopic evaluation of the tissue, and it’s graded based on how aggressive the cells look. A Gleason 8, 9 and 10 are the most aggressive type of cancers.

SN: Why do you think it took so long to diagnose Biden’s cancer?

Hussain: Well, remember, the diagnosis is what was publicly released [on May 18]. We don’t really know if the cancer was actually diagnosed and treated before. But it’s quite possible for a late-stage diagnosis to happen. Prostate cancer, generally, is a disease of older men, and the risks increase as people get older.

Agarwal: Yes, about 10 percent of patients with a newly diagnosed prostate cancer present with metastatic disease, and they do not have any prior history of localized prostate cancer. It is not unusual.

SN: Why does the incidence of prostate cancer appear to be rising?

Hussain: It is probably driven by early screening and detection. I am not aware of any specific biological exposure that would potentially increase the risk.

SN: How do you screen for prostate cancer?

Agarwal: Prostate cancer is screened by detecting a protein which is made by prostate cells. The name of the protein is prostate-specific antigen, PSA, and if the level [in the blood] is higher than what you would expect, then it prompts other tests to diagnose prostate cancer, including a biopsy.

In men 70 years old and older, routine PSA screening is not recommended by the U.S. Preventative Services Task Force or the American Urological Association.

SN: Why not?

Agarwal: As we screen older patients, we expect them to have higher PSA levels, because PSA levels continue to go up with age, as the prostate enlarges. If we screened everyone over 70, then you are talking about thousands of patients who are going to be getting unnecessary biopsies because their PSA was high because of age. And biopsies are associated with other sets of problem, such as infection.

The bottom line is, the risk/benefit ratio does not justify, in general, screening patients who are 70 years old or older.

SN: Is prostate cancer curable?

Hussain: Early stage diagnosed cancer has a higher chance of being cured. At the stage when the cancer has spread, it’s not curable and certainly can shorten life. But we have different treatments for it.

SN: What treatments options exist?

Hussain: For metastatic cancer that has spread to other parts of the body, the backbone of treatment is androgen deprivation therapy, which basically means shutting down testosterone production. Testosterone is what feeds the cancer. In the old days, the testes used to be removed. Nowadays we don’t have to do that.

Agarwal: That was largely replaced by injections such as leuprorelin. These are given every three to four months and inhibit the production of testosterone from the testicles. And in 2018, we added a class of pills known as androgen receptor pathway inhibitors, or ARPIs. The pills block the androgen receptor, which is the docking site for testosterone. Blocking both testosterone and the androgen receptor is considered standard of care.

Hussain: Now, more recently, we’ve come up with triplet strategies, which add chemotherapy. I’ve given triplet therapies to men who are in their 80s, men who are active [and otherwise] in good health.

SN: What are the side effects of shutting down testosterone?

Hussain: I tell my patient this is sort of like menopause in women ­— andropause, as I call it. Of course, when women go through menopause, it takes years. With prostate cancer treatment, we’re doing it in a very short period of time. There could be issues of hot flashes, sweats and weight gain. So that’s why I usually advise a heart healthy diet, exercise and things like that. From my experience with patients, the first two or three months is the hardest, and then the body adjusts.

SN: What do you wish more people knew about this disease?

Agarwal: Anyone can be struck by metastatic cancer. Nobody is untouchable. For metastatic prostate cancer, the state of art treatment is injection plus second generation androgen receptor pathway inhibitors. It is imperative that everyone who has metastatic prostate cancer has the ability to be treated with those options.

Hussain: We’ve come a long way in terms of management of all cancers. Investment in research is what leads to new discoveries, and then those discoveries lead to new treatments. [Moving forward], the critical part is going to be more research to try and enhance outcomes and position cancer as more of a chronic disease that — hopefully — will not cause death.