Former President Joe Biden‘s late-stage prostate cancerdiagnosis has ignited debate about early detection protocols and whether the White House health team failed the former commander-in-chief.
Biden’s team revealed that he received a diagnosis last week following complaints of urinary issues. A growth was identified on his prostate, and further evaluation showed the disease had metastasized to his bones, according to the statement from his office. The 82-year-old’s last known prostate-cancer blood screening test was performed in 2014, a spokesperson confirmed on Tuesday.
Biden spokesman Chris Meagher didn’t offer any more insight into why the former president didn’t undergo a prostate-specific antigen (PSA) screening while in office. By comparison, President Donald Trump, now 78 and the second-oldest president, released his PSA test results last month, showing a normal reading. Former Presidents Barack Obama and George W. Bush also shared their scores during their presidencies.
Doctors have been debating for years about how often men should get screened for prostate cancer and when it might be time to stop. The test can catch cancer early when it’s easier to treat, but it can also lead to false alarms or find slow-growing tumors that wouldn’t actually cause problems, especially in older men. That means some men might end up getting treatments they don’t really need, along with the side effects that come with them.
Screening for prostate cancer in men in their 80s isn’t typically recommended. The U.S. Preventive Services Task Force, a government-supported panel of medical experts, advises against PSA screening for men 70 and older. Other medical organizations take a more individualized approach, suggesting that older men talk with their doctors to decide whether continued screening makes sense for them.
Dr. Otis Brawley, a prostate cancer and screening specialist at Johns Hopkins University in Baltimore, said he personally wouldn’t have recommended prostate cancer screening for Biden, citing his age, other health issues and limited life expectancy.
He emphasized that the tests have limitations and are not always effective. Citing a European study, Brawley noted that screening showed only a small benefit for men in the Netherlands and Sweden, but not in other European countries.
“There is literally no organization of medical experts that says men should get screened. They all say men should be informed of the potential risks and the potential benefits, and a decision whether or not to be screened should be made for men age 50 to 70,” Brawley said, speaking to the Washington Examiner.
Brawley said he wasn’t surprised by Biden’s advanced diagnosis, even if he had been screened, because he often sees patients who were tested regularly and still develop an aggressive form of prostate cancer.
“I only treat prostate cancer patients with metastatic disease, with disease that has spread,” Brawley explained. “In this past year, I have had at least five, maybe six people who were screen fanatics. They religiously got screened, but they ended up, despite the fact, they got screened every year, they ended up with the same thing Joe Biden has right now.”
He recalled a meeting of prostate cancer experts that occurred last fall where a clear divide emerged between those who are trained in screening and those who treat the disease. When asked who had undergone screening themselves, the screening experts mostly said no, while the treating doctors said yes, highlighting a fundamental disagreement.
“The truth of the matter is, the harms have actually been better documented than the benefits, but the benefits may exist,” Brawley said.
Dr. Ezekiel J. Emanuel, an oncologist who advised the Biden administration during the coronavirus pandemic, argued that presidents should be held to stricter health standards than the general public. He highlighted that this is especially critical for presidents over 70 years old and recommended a change in the approach to evaluating a president’s health.
“I would say it’s surprising he did not get this test, given the fact that the proclivity of presidential physicians is to test more rather than less,” Emanuel said during an interview on MSNBC’s “Morning Joe.”
“President Obama had this test,” Emanuel said. “President Bush had this test. It is a little surprising that the doctor didn’t take it. And if he took it and didn’t report it, and it was elevated, that is another case of doctors not being straightforward with us. And if that is true, that would be very troubling.”
Rep. Ronny Jackson (R-TX), who served as White House physician under Trump and former President Barack Obama, criticized Dr. Kevin O’Connor, Biden’s doctor, saying that if the president’s cancer had progressed without being identified, it would amount to serious negligence.
“I mean, it’s complete malpractice in my mind, to be honest with you,” Jackson said in an interview with the Washington Examiner on Monday.
“If you pick it up early, it’s curable, right? And just to have the President of the United States, who’s supposed to have access to world-class health care, whose White House medical unit is supposed to be the pinnacle of concierge medicine, executive medicine, and to not pick up on something like this,” Jackson continued. “I’m quite honestly shocked, and it’s just, it’s not good.”
Dr. Alicia Morgans, a genitourinary medical oncologist at the Dana-Farber Cancer Institute in Boston, hopes the U.S. Preventive Services Task Force will update their guidelines about testing so more men get screened.
“I take care of people who have very advanced prostate cancer, as well as some people who have curable prostate cancer,” she said, speaking to NPR, “so my perspective is really skewed by the fact that I really want to make that diagnosis when things are curable.”
As the GOP-led House Oversight and Government Reform Committee investigates whether senior White House officials concealed troubling signs of Biden’s health decline or whether the medical team overlooked key issues, allies of the former president are pushing back forcefully against the speculation.
“I think to respond to President Biden getting what is a very hard diagnosis by immediately leaping to conspiracy theories about who tested him and whether they tested him, it was, is one of the least humane and charitable responses I can imagine,” said Sen. Chris Coons (D-DE), one of Biden’s closest friends and allies on Capitol Hill.
Sen. Ron Wyden (D-OR) advised against making assumptions, noting that extensive medical studies advise against such screenings for aging men.
“First of all, it’s important to remember, there’s a considerable body of healthcare research that indicates for older men, it is not recommended that they have these tests. So I would just urge people not to jump to conclusions,” he said.
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Others emphasized that it wasn’t their role to speculate on the president’s medical background, pointing out their lack of medical expertise.
“I don’t really know what the protocol would be. I mean, you know, the only protocol I know is what my doctor tells me to do, and when he tells me to do stuff, I do it,” said Sen. Tim Kaine (D-VA). “I don’t know what the communication between Joe Biden and his doctor, and so I’m not going to opine about that.”
David Sivak, Naomi Lim, and Rachel Schilke contributed reporting.
