When Jill Biden sat down with Craig Melvin on the “Today” show recently, she shared something that caught a lot of attention. Her husband, former President Joe Biden, had been diagnosed with Stage IV prostate cancer that had spread to his bones. “Joe will live with cancer till the rest of his life,” she said.
It’s a devastating diagnosis, and it’s made a lot of people ask a uncomfortable question: How did we miss this?
The answer, according to reporting from HuffPost, is partly embedded in the way we think about prostate cancer screening in this country. And it might be time to rethink some of those assumptions.
The Symptoms That Weren’t Taken Seriously
Here’s what happened. During Biden’s last year in the White House, he kept waking up in the middle of the night to use the bathroom. His wife noticed. His doctors noticed too, but they weren’t alarmed—and honestly, who could blame them? Frequent urination in older men is incredibly common. It’s usually caused by benign prostatic hyperplasia, or BPH, a non-cancerous enlargement of the prostate that happens to just about every man as he ages.
“The prostate is getting bigger, and it’s interfering with your bladder, basically,” Dr. Herbert Levine, a professor at Northeastern University who studies cancer metastasis, told HuffPost. “But it’s not really necessarily a sign of cancer.”
The problem is that early-stage prostate cancer often has no symptoms at all. By the time symptoms like Biden’s show up, the cancer may have already spread. The only reliable way to catch it early is through a PSA blood test.
Why Many Doctors Stop Screening After 70
Biden’s last PSA test was in 2014, when he was 72 years old. His doctors followed standard guidelines from the U.S. Preventive Services Task Force, which recommends against routine PSA screenings for men over 70.
The reasoning isn’t unreasonable. The PSA test can produce false positives, leading to unnecessary biopsies and a lot of psychological stress. Prostate cancer is slow-growing in many cases, and older men are more likely to die with prostate cancer than from it. The task force’s position has been that for many men over 70, the harms of screening outweigh the benefits.
That logic makes sense on paper. But here’s where it gets messy.
When Guidelines Fail
Dr. Andrew Vickers from Memorial Sloan Kettering laid out the tradeoff in stark terms to HuffPost. “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 “one man is going to get harmed because the PSA test might have detected his cancer slightly earlier.”
Joe Biden, it seems, may be that one man.
His cancer had a Gleason score of 9, which is aggressive. By the time it was discovered, it had already metastasized to his bones. If caught earlier, treatment options would have been dramatically different.
“The metastasis process is not limited to prostate cancer,” Levine noted. “If you find a cancer early enough… then there are a number of different ways of treating it, which are relatively successful, especially for prostate cancer.” Once it spreads to the bones, “treating it becomes much more difficult.”
The Timing Couldn’t Be Worse
Here’s the really frustrating part. The debate over these guidelines isn’t new. The American Urological Association has pushed back against the USPSTF recommendations for years, pointing out that since screening declined after 2008, advanced-stage prostate cancer diagnoses have increased.
The American Cancer Society has been working on updated guidelines that may be released by the end of this year. The Cochrane collaboration, a global gold standard for medical evidence, published a review in May finding that PSA blood testing likely does reduce death from prostate cancer.
But here’s the kicker: USPSTF’s update to its recommendations has been on hold. Meetings were canceled by Health and Human Services Secretary Robert F. Kennedy Jr. between July 2025 and this past May. In May, he fired two members of the task force. In July, reporting indicated plans to dismiss the entire panel for being too “woke.”
So we’re stuck in a holding pattern at exactly the moment when this conversation is most urgent.
What Should Men Do?
This is where it gets personal. The experts HuffPost spoke with universally said the same thing: men who are healthy should talk to their doctors about whether continuing PSA screening makes sense for them, regardless of age.
“Frequent urination, having to wake up in the middle of the night, is typically caused during aging by enlarged prostate glands,” Levine said. “But the only reliable way to differentiate between BPH and cancer is through a PSA screening.”
That’s the uncomfortable truth here. The guidelines exist for good reasons, but they’re designed for populations, not individuals. Biden fell through the cracks not because anyone made a glaring error, but because the system is built to trade off some early detections for fewer false positives.
Whether that’s still the right tradeoff is a question we desperately need to answer—and soon.
