Former President Joe Biden announced he has stage 4 prostate cancer that has spread to his bones
“That’s generally not considered a curable situation,” Dr. Christopher Wee, a genitourinary medical oncologist with the Cleveland Clinic, tells PEOPLE
Patients with prostate cancer often have no signs, as symptoms can vary and tests are “imperfect”
Former President Joe Biden has “aggressive” prostate cancer and released a statement that offered medical details about his diagnosis, explaining it has metastasized to his bones.
His cancer has a Gleason Score of 9, which means that it is an aggressive form that is likely to grow quickly, according to the Cleveland Clinic.
As Dr. Christopher Wee, a genitourinary medical oncologist with the Cleveland Clinic, explains, “The higher the number, the more abnormal the cells are. And so when something is a Gleason 9 or a Gleason 10, that translates to Grade Group 5. Generally speaking, people think that reflects a more aggressive behavior of the cancer.”
However, he clarifies, it doesn’t mean stage 5 cancer — that classification doesn’t exist. “The highest it goes to is 4, and his is stage 4 because it has spread outside of the prostate,” Dr. Wee tells PEOPLE.
Cancer touches us all. Like so many of you, Jill and I have learned that we are strongest in the broken places. Thank you for lifting us up with love and support. pic.twitter.com/oSS1vGIiwU
— Joe Biden (@JoeBiden) May 19, 2025
While it is “generally not considered a curable situation” at stage 4, it is still “treatable,” Dr. Wee says. “The goal of treatment is to slow progression or growth, maintain quality of life, and extend life expectancy. Prognoses can vary significantly.”
Biden’s statement offered more details about how his cancer might be treated: “The cancer appears to be hormone-sensitive, which allows for effective management,” the statement said.
Lee explains that drugs and not surgery are the standard treatment at this stage. “The backbone of that is hormone therapy, also known as androgen deprivation therapy. The idea of this is that prostate cancer cells are fueled by testosterone, so we lower the testosterone generally with medicines, either shots or pills.”
Dr. Wee also says a patient can “absolutely” not know they have prostate cancer.
“A lot of times patients can have prostate cancer and not have any symptoms,” he says, adding that while blood work can check for a prostate-specific antigen (PSA), it still has limitations.
“The challenge with the PSA is that there are things that are not prostate cancer that can also make a PSA go up. And then not every prostate cancer will make the PSA go up, so it’s an imperfect test.”
Diagnosing the disease, he says, “is challenging sometimes because the symptoms can be very vague and nonspecific to the actual disease.”
SAUL LOEB/AFP via Getty
Former President Joe Biden with Former First Lady Jill Biden and dog Commander in 2021.
“Oftentimes patients will not have any symptoms, and they’ll be caught just based on a rising PSA. Urinary symptoms can happen, especially as men age, that can be assigned to get evaluated … there are some patients in whom their PSAs are fine, and then the next year it just goes up really fast. And there are some people in whom it’s brewing a long time.
“Everyone’s case is different. It’s a very variable course of how this can go.”
“You know your body the best, and anything that’s changing, such as urinary symptoms, should be discussed with your doctor,” Dr. Wee says. “Every patient is unique. And there’s not a one-size-fits-all rule.”
Biden and his wife Jill shared an emotional statement on X on May 19: “Cancer touches us all. Like so many of you, Jill and I have learned that we are strongest in the broken places. Thank you for lifting us up with love and support.”
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