It’s been a heavy road for the Biden family lately. Honestly, seeing a former president—especially one who made the "Cancer Moonshot" his life’s mission—face a Stage IV diagnosis feels like a cruel twist of irony.
In May 2025, just months after leaving the White House, Joe Biden’s office dropped a bombshell. He wasn't just dealing with the "aches and pains" of being 82. He was facing an aggressive form of metastatic prostate cancer.
People had questions. Lots of them. Was he sick while he was in the Oval Office? How did it spread so fast? Why didn't we know sooner?
The Anatomy of the Diagnosis
Basically, it started with a nodule.
During a routine check-up in early May 2025, doctors found a small lump on his prostate. Further tests, including a biopsy, confirmed every patient's nightmare: prostate adenocarcinoma with a Gleason score of 9.
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In the world of urology, a 9 is high. It’s Grade Group 5. That's the most aggressive category there is. It means the cells don't look like normal prostate cells anymore; they look like they’re in a hurry to grow and move.
And move they did.
The scans showed the cancer had already reached his bones. This officially classified it as Stage IV metastatic prostate cancer.
Dr. Celine Gounder, a medical contributor who has followed the case closely, noted that this kind of spread—known as bone metastasis—places a patient in the "high-risk" management group.
But here’s where the nuance comes in: Biden’s team also shared that the cancer was hormone-sensitive.
That’s a big deal.
It means doctors can use drugs to starve the cancer of the testosterone it needs to grow. It’s not a "cure" in the traditional sense, but it’s a way to keep the disease at bay for a long time.
Why the Gleason Score Matters
If you’ve ever looked at a pathology report, you know it’s mostly Greek. A Gleason score is essentially a "grade" for how aggressive the cancer looks under a microscope.
- Gleason 6: Low-grade, slow-growing.
- Gleason 7: Intermediate.
- Gleason 8-10: High-grade, fast-moving.
At a 9, Biden’s cancer was behaving like a sprint, not a marathon.
The Treatment Timeline
Biden didn’t just sit around after the news broke. He went to work.
By the fall of 2025, he was deep into a multi-modality treatment plan. We’re talking Androgen Deprivation Therapy (ADT), which is basically chemical castration to drop testosterone levels, combined with targeted radiation.
He spent weeks at Penn Medicine Radiation Oncology in Philadelphia.
Then came the moment that went viral in October 2025.
His daughter, Ashley Biden, posted a photo of him on Instagram. He was at the clinic, smiling, and he finally "rang the bell." It’s a tradition in cancer wards. You ring it when you finish your final round of radiation. It was a rare moment of public celebration in what has been a very private battle.
The Second Front: Skin Cancer
As if one cancer wasn’t enough, the former president had to go under the knife again in September 2025.
You might have seen the photos of him leaving church with a fresh scar on his forehead. His spokesperson, Kelly Scully, later confirmed he had Mohs surgery to remove basal cell carcinoma.
This wasn't his first dance with skin cancer. He had a similar lesion removed from his chest back in 2023 while he was still in office. Basal cell is rarely life-threatening, but for an 82-year-old already fighting Stage IV prostate cancer, it was another weight on the scale.
Did He Have Cancer in the White House?
This is the question everyone is arguing about.
Medical experts like Dr. Ezekiel Emanuel and Dr. William Dahut have been crunching the numbers. They look at the doubling time of aggressive prostate cells and the extent of the bone spread found in May 2025.
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Their estimation? The cancer likely started years ago—possibly as far back as 2015 to 2020.
If that’s true, it means Joe Biden was likely living with undiagnosed cancer during the entirety of his presidency.
It’s a "medical mystery," as some have called it. How did it stay silent?
Well, prostate cancer is famously "quiet" until it isn't. You don't always feel it. Biden’s 2024 physical declared him "fit for duty," and his neurological exams were normal. But those physicals don't always include the deep-dive imaging required to find a hidden, aggressive tumor if the PSA (Prostate-Specific Antigen) levels don't raise a red flag.
The PSA Controversy
Some urologists were actually surprised Biden was being screened at all.
Standard medical guidelines for men over 75 are... messy. Many doctors stop routine PSA screening at that age because they assume something else will get you before the prostate cancer does.
But Biden wasn't a "standard" 82-year-old. He was functionally active. When he started showing "increasing urinary symptoms" in early 2025, his doctors knew they couldn't just ignore it.
The Reality of Living with Stage IV
So, where does he stand now, in early 2026?
He’s finished the heavy lifting of radiation. He’s likely still on hormone therapy, which can cause significant fatigue, muscle loss, and "brain fog."
But by all accounts, he’s staying active.
He’s been spending time in the Santa Ynez Valley in California and his home in Delaware. The narrative has shifted from "Is he fit to lead?" to "How will he spend his remaining years?"
It’s worth noting that the five-year survival rate for metastatic prostate cancer is around 28% to 30%. Those aren't great odds, but they aren't a death sentence for next week, either. With the kind of "gold-standard" care a former president gets, many patients live for several years with a high quality of life.
Actionable Insights for You
If you or a loved one are navigating a similar diagnosis, Joe Biden's case actually offers some practical lessons.
Don't ignore the "small" symptoms.
Biden’s diagnosis came after he reported "increasing urinary symptoms." Don't just chalk up frequent bathroom trips to "getting old." It's worth a conversation with a urologist.
Understand your Gleason Score.
If a biopsy is performed, the Gleason score is the most important number on that page. It dictates the entire treatment strategy. Ask your doctor specifically where you fall on the 6-to-10 scale.
Ask about "Multimodal" Therapy.
For aggressive cases, a single treatment usually isn't enough. Biden used a combination of hormone therapy, radiation, and surgery. If your doctor only suggests one path, ask why others aren't being considered.
Screening is a personal choice.
The debate over whether men over 75 should get PSA tests is real. If you are healthy and active, you might choose to continue screening. If you have other major health issues, the risks of treatment might outweigh the benefits.
The story of Joe Biden’s recent diagnosis isn’t over. He’s still "ringing the bell" in more ways than one, proving that even with a Stage IV label, there’s still a lot of life to be lived.