Former first lady Jill Biden said she noticed her husband’s symptoms almost immediately. He kept needing to wake up and get out of bed in the middle of the night to use the bathroom during his last year in the White House. But doctors weren’t alarmed — and they were right not to be, since the symptoms are very common in aging men.
Except, former President Joe Biden’s symptoms indicated something much worse: Stage IV prostate cancer.
Jill Biden, who is on a press tour promoting her new book, “View from the East Wing,” spoke about her husband’s cancer prognosis with “Today” on Monday.
“He’s doing OK,” she told host Craig Melvin, adding that if her husband had been diagnosed with “just” prostate cancer, “that can be cured.” But since the cancer has metastasized to his bones, it “makes it a whole different story.”
“Joe will live with cancer till the rest of his life,” she said.
Joe Biden was diagnosed in May 2025 after reporting urinary symptoms to his doctors. His office said the cancer had metastasized — meaning it had spread to his bones. Prostate cancer is the second most common cancer among men in the U.S., with roughly 1 in every 8 men expected to be diagnosed with it at some point in their life, according to the National Cancer Institute.
The metastasis process is not limited to prostate cancer, Dr. Herbert Levine, a professor of physics and bioengineering at Northeastern University, told HuffPost. Levine’s research focuses on cancer progression, metastasis and interactions with the immune system.
“If you find a cancer early enough, such that it’s restricted to whatever place it emerged in the body … then there are a number of different ways of treating it, which are relatively successful, especially for prostate cancer,” he said. But when the cancer spreads to the bones, treating it “becomes much more difficult because now you’re dealing with it spreading over a much wider range with different parts of your bone system.”
MANDEL NGAN via Getty Images
President Joe Biden, seen here with first lady Jill Biden at the Democratic National Convention in 2024, has been diagnosed with prostate cancer that has metastasized to his bones.
It becomes a bigger problem if the cancer, once it spreads to the bones, starts to grow and evolve to the point where it becomes resistant to various therapies, Levine noted. For prostate cancer patients, this stage is called castration-resistant prostate cancer, the stage where hormone therapy stops working.
Joe Biden’s office said last May that the former president’s cancer, which has an aggressive Gleason score of 9, “appears hormone-sensitive which allows for effective management.” The Gleason scale ranks aggressiveness and ranges from 6 to 10.
This means the cancer can still respond to radiation and hormone therapy, which is necessary to help control prostate cancer.
“Prostate cancer cells are relying on androgen — the human male sex hormone — in order to grow,” Levine said. “You can present drugs, which basically reduce the supply of that hormone, and that will prevent the prostate from spreading rapidly.”
Joe Biden was seeing White House medical professionals for years. Why didn’t anyone catch the cancer sooner?
While promoting her memoir on MSNBC’s “Morning Joe” on Tuesday, Jill Biden said she was confused why her husband wasn’t diagnosed with prostate cancer sooner.
“We did have amazing health care in the White House, but somehow this was missed,” she said. The former first lady noted that doctors had followed all standard testing guidelines, which currently recommend discontinuing routine prostate cancer screenings for men over 70 years old.
Joe Biden’s last reported prostate-specific antigen (PSA) screening test was in 2014 when he was 72 years old, the former president’s spokesperson said in May 2025. There is no evidence that he, his family or his doctors were aware he had prostate cancer until his diagnosis.
“Frequent urination, having to wake up in the middle of the night, is typically caused during aging by enlarged prostate glands — enlarged doesn’t mean cancerous,” Levine said, referring to benign prostatic hyperplasia (BPH), which commonly happens to aging men. “Your prostate is getting bigger, and it’s interfering with your bladder, basically. … But it’s not really necessarily a sign of cancer.”
Early-stage prostate cancer often has no symptoms at all. The only reliable way to differentiate between BPH and cancer is through a PSA screening.
“It is possible to have prostate cancer, even with a very low PSA,” said Dr. Bill Dahut, the chief scientific officer for the American Cancer Society (ACS). “Changes in PSA over time, sometimes referred to as PSA doubling time, are often a clue to potentially concerning disease. Natural history studies show that most men over age 70 will have some evidence of prostate cancer.”
Old men die with prostate cancer, very few die of prostate cancer.
– Dr. Herbert Levine
However, for the last several years, the U.S. Preventive Services Task Force (USPSTF), a group of national experts in evidence-based medicine and primary care, has recommended against PSA screening for men over 70.
While Biden’s medical records are not public, Dr. Andrew Vickers told HuffPost that it is likely Biden passed his PSA screening in 2014 at 72 and was told by his doctor he didn’t need to continue taking these tests at his annual checkups.
“You don’t need another PSA test again if your PSA is completely normal,” Vickers, who specializes in prostate cancer screenings at Memorial Sloan Kettering’s Cancer Research Center, said. “If you have a PSA score that’s an abnormal result, then you need to continue monitoring.”
The argument is that the harms of these screenings — uncomfortable and invasive prostate biopsies and psychological stress of very common false-positive test results — can outweigh the benefits for patients. The group initially published this recommendation in 2008 and then shared an updated version in 2018, which recommended that men aged 55 to 69 should talk to their doctor about these tests.
“Because of concerns about over-treatment, most screening guidelines recommend shared decision-making, incorporating patient preferences when deciding whether to obtain a PSA blood test,” Dahut said. Essentially, instead of making the PSA tests a mandatory part of annual checkups for men of a certain age, it’s up to the patient to ask for one.
Doctors have relied on and followed USPSTF’s grading system and recommendations for preventive care for the last 40 years. However, some groups and doctors have not agreed with the recommendation for PSA screening. For example, the American Urological Association (AUA) noted that USPSTF’s 2018 guidelines were developed by primary care physicians rather than urologists. The AUA also pointed out that since these recommendations went into place in 2008, PSA screenings declined, and advanced-stage prostate cancer diagnoses increased. (Although this started to reverse a bit after USPSTF issued its 2018 update.)
NICHOLAS KAMM via Getty Images
Biden’s last reported public prostate-specific antigen (PSA) screening test was in 2014, a Biden spokesperson said. That was three years before this photo of him receiving the Presidential Medal of Freedom in 2017.
“Screening rates remain low in the United States, and there is a growing number of prostate cancer diagnoses driven by patients presenting with advanced disease at the time of the diagnosis,” Dahut said. “In the case of President Biden, it is likely that between the last screening test and the more recent diagnosis, the cancer was evolving and eventually spread outside of the prostate.”
Biden’s case could change PSA screenings for men.
USPSTF’s recommendation that men over 70 should not get annual PSA screenings is not necessarily dangerous or bad, Vickers said.
“A hundred people will benefit [from not being screened after 70] because they don’t end up getting diagnosed with a cancer,” he said. But, like in Biden’s case, it is possible “one man is going to get harmed because the PSA test might have detected his cancer slightly earlier, but we didn’t know.”
A new Cochrane review from May 15 found that PSA blood testing likely does reduce death from prostate cancer. Cochrane is considered the global gold standard for medical evidence and has helped shape many of the World Health Organization guidelines over the last 30 years.
The ACS’s prostate cancer screening guidelines may also be updated and released by the end of the year, Dahut told HuffPost.
“The ACS prostate cancer screening guidelines follow an extensive process that begins with a team of subject matter and screening experts, including experts from outside the ACS,” he said. “Work on these guidelines has been underway for some time.”
Biden’s diagnosis has added some urgency to USPSTF’s update of its recommendations, which have reportedly been in progress for some time. In 2023, it opened a public comment period to draft an update to its 2018 recommendation.
However, USPSTF’s updates have been on hold under Health and Human Services Secretary Robert F. Kennedy Jr. Its meetings were canceled by Kennedy between July 2025 and this past May. On May 20, Kennedy fired John Wong and Esa Davis from their positions on the task force, leaving only eight members. In July 2025, The Wall Street Journal reported that Kennedy planned to dismiss all of the panel members for being too “woke.”
For now, experts say men who are healthy should talk to their doctors about whether continuing PSA screening makes sense for them — regardless of age — because finding prostate cancer before it spreads is often the difference between a cure and years of treatment.
“Old men die with prostate cancer, very few die of prostate cancer,” Levine said.
