“The vast majority of people who are identified as having prostate cancer … have had it identified at a much earlier stage than this,” says Herbert Levine, who studies cancer progression.
Former President Joe Biden’s Stage 4 prostate cancer diagnosis has raised questions about when the former president knew he had an aggressive form of the disease — and whether those surrounding him kept that information out of view of the public.
At least, physicians and cancer researchers were thrown by the timing. One oncologist, appearing on MSNBC’s Morning Joe, suggested that Biden could have had the disease for up to a decade.
“I was also surprised,” says Herbert Levine, a Northeastern University distinguished professor of physics and bioengineering who studies cancer progression, metastasis and its interaction with the immune system.
Biden’s office released a statement on Sunday noting that the former president was evaluated by doctors after they discovered a small nodule on his prostate. His cancer is noted as having a Gleason score of 9, and has progressed to Stage 4.
Levine notes that patients who keep to annual check-ups and screening protocols typically wouldn’t miss such an aggressive cancer.
“The vast majority of people who are identified as having prostate cancer, which is not so uncommon for men this age, have had it identified at a much earlier stage than this,” Levine tells Northeastern Global News.
A Stage 4 cancer means the disease has already successfully metastasized, Levine notes.
“While this represents a more aggressive form of the disease, the cancer appears to be hormone-sensitive, which allows for effective management,” the statement reads. “The president and his family are reviewing treatment options with his physicians.”
“To go from no concern or suspicion to full-blown metastatic cancer is unusual,” Levine adds. “It doesn’t mean it doesn’t happen, but it certainly isn’t the normal course for most people.”
One way to test for prostate cancer is through a prostate-specific antigen (or PSA) test, which detects a specific protein that can be produced by malignant cells in the prostate gland.
Levine notes that the test can produce false positives, but that patients will typically pursue further testing to rule out more advanced forms of cancer.
“It’s much more unusual to have a negative reading and then discover that, in a short period of time, you have this aggressive metastatic cancer,” Levine says.
Prostate cancer is the second-most frequent cancer diagnosis for men, and the fifth-leading cause of death worldwide, according to the National Institutes of Health. Early screening for the disease is a part of standard care for men as they age.
“The reason why everybody goes through prostate and breast cancer screening is that, if you catch it at an earlier stage, like Stage 1 or 2, it’s really treatable,” Levine says.
The prognosis for late-stage prostate cancer isn’t especially good, with an average five-year survival rate of around 28%.
“The Gleason score that he has suggests that it is extremely severe,” says Saeed Amal, a Northeastern bioengineering professor. “Although it’s a hormone-sensitive cancer, the chances he can overcome this are really low.”
“Prostate cancer, along with uterine and breast cancers, are a family of cancers affected by hormones,” Amal says. “What that means is that the cancer is usually initiated by higher or abnormal levels of hormones.”
A readout from Biden’s most recently available physical in 2024, when he was still in office, “identified no new concerns.”
Biden’s doctor at the time wrote then that: “He continues to be fit for duty and fully executes all of his responsibilities without any exemptions or accommodations.”