When the news broke in May 2025 that former President Joe Biden had been diagnosed with Stage 4 prostate cancer, the first question everyone asked was: "How did we miss this?" He was the most watched man on the planet. He had the best doctors at Walter Reed. Yet, here he was, at 82, facing a Gleason score of 9—a very aggressive grade—and the cancer had already reached his bones.
Naturally, the conversation turned to screening. Specifically, the PSA test.
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Did Biden Get PSA Tests? The 11-Year Gap
The short answer is no, at least not recently. A spokesperson for the former president confirmed in mid-2025 that Biden's last recorded prostate-specific antigen (PSA) test was way back in 2014. He was about 71 at the time.
Think about that. For over a decade, the man at the helm of the country didn't have a simple blood test that screens for one of the most common cancers in men. It sounds like a massive oversight, right? But honestly, it’s not that simple.
Medical guidelines aren't always black and white. For years, the U.S. Preventive Services Task Force (USPSTF) has recommended against routine PSA screening for men over the age of 70. Why? Because most prostate cancers in older men grow so slowly that they won't actually kill them. Doctors often say more men die with prostate cancer than of it. The fear is that testing leads to "over-treatment"—painful biopsies and surgeries for a disease that might have never caused a problem.
Biden’s medical team followed these rules to the letter. His February 2024 physical, the last one he had as president, notably skipped the PSA test. The doctors focused on his heart, his gait, and his sleep apnea. They saw a "vigorous" 81-year-old and followed the standard protocol for his age bracket.
The Nodule That Changed Everything
Things took a turn in early May 2025. Biden started experiencing "increasing urinary symptoms." Basically, he was having trouble going, which is common for men his age but also a major red flag when it’s new or worsening.
He went in for a checkup, and this time, the exam wasn't just a blood draw. A doctor found a small nodule on his prostate during a physical examination. That finding "necessitated further evaluation," as the official statement put it.
What the Tests Revealed
Once that nodule was found, the medical team moved fast. They weren't just looking for an enlarged prostate (BPH) anymore, which Biden actually had been treated for in 2019. This was different.
- The Diagnosis: Grade Group 5 prostate cancer.
- The Gleason Score: 9 out of 10. This is the heavy-hitter range. It means the cells look nothing like healthy tissue and are prone to spreading fast.
- The Spread: Imaging, likely a PET scan or a PSMA scan, showed the cancer had metastasized to the bone.
It's a tough pill to swallow. If he had been getting those PSA tests every year, would they have caught it at Stage 1 or 2? Maybe. But here’s the kicker: aggressive cancers sometimes don’t even raise PSA levels that much. You can have a "normal" score and still have a monster growing inside. It’s a terrifying loophole in the screening process.
Why This Matters for the Rest of Us
The Biden situation has sparked a huge debate among urologists. Dr. Marc Dall’Era from UC Davis and other experts have pointed out that while the "don't screen over 70" rule makes sense for the general population, it can fail individuals with aggressive biology.
If you're a man—or you care about one—there are some real-world takeaways here that go beyond political headlines.
First, the PSA test is just one tool. It’s a protein check. High levels can mean cancer, but they can also mean you just went for a long bike ride or have a common infection.
Second, don’t ignore the plumbing. Biden’s diagnosis came because he finally sought help for urinary symptoms. If things change—if you’re up four times a night or the stream is weak—don't just blame "getting old." Get it checked.
Third, age isn't a hard cutoff. The 2025 diagnosis shows that if a man is "functionally active" and healthy, it might make sense to keep screening past 75. It's a conversation you need to have with a doctor who looks at you, not just a chart of national averages.
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What’s Next for the Former President?
The silver lining in the report was that the cancer appears to be hormone-sensitive. This is a big deal. It means doctors can use Androgen Deprivation Therapy (ADT) to essentially starve the cancer of the testosterone it needs to grow. It’s not a cure for Stage 4, but it can manage the disease and keep it at bay for years.
Biden is currently weighing these options with his family in Delaware. He’s the guy who launched the "Cancer Moonshot," so there's a certain irony—and a lot of hope—that the very research he championed might be what gives him more time now.
Your Actionable Next Steps
If this news has you thinking about your own health or your father’s, here’s how to handle it:
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- Ask for a Baseline: If you're between 45 and 50, get a baseline PSA test. It’s easier to spot a problem if you know what "normal" looks like for you.
- Discuss "Velocity": It’s not just about the number; it’s about how fast it rises. A jump from 1.0 to 2.5 in a year is more concerning than a steady 3.0.
- Inquire About mpMRI: If your PSA is high, ask about a multiparametric MRI before jumping straight to a biopsy. It’s a newer, clearer way to see if a nodule is actually dangerous.
- Listen to Your Body: New back pain, hip pain, or urinary changes in your 70s or 80s should never be ignored.
The "Biden protocol" of skipping tests was standard medicine, but standard medicine isn't always perfect medicine.