Former President Joe Biden Completes Radiation Therapy for Metastatic Prostate Cancer

Joe Biden completes round of radiation therapy for prostate cancer | Joe Biden | The Guardian

A Case Study in Advanced Prostate Cancer Management

FOR THE INFORMED PROSTATE CANCER SUPPORT GROUP (IPCSG) NEWSLETTER

Introduction

Former President Joe Biden, 82, has completed a course of radiation therapy as part of his treatment for aggressive metastatic prostate cancer, marking a significant milestone in his journey with the disease. His case offers valuable insights into the diagnosis, staging, and treatment of high-risk prostate cancer that has spread to the bones.

The Diagnosis

In May 2025, Biden's office announced that he had been diagnosed with prostate cancer after experiencing increasing urinary symptoms and the discovery of a prostate nodule during medical evaluation. The diagnosis revealed several concerning factors:

Gleason Score of 9 (Grade Group 5): This places Biden's cancer among the most aggressive forms of prostate cancer, indicating rapidly growing cells with significant potential for metastasis

Bone Metastases: Imaging confirmed that the cancer had already spread beyond the prostate to his bones

Hormone-Sensitive Classification: Importantly, the cancer was determined to be hormone-sensitive, which allows for more effective management options

The Gleason scoring system, which ranges from 6 to 10, assesses how abnormal cancer cells appear under microscopic examination. Scores of 8 to 10 are classified as high-risk cancers. Medical experts note that Biden's Gleason score of 9 represents "probably the worst version" of prostate cancer a patient can receive, according to Dr. Ben Davies, a professor of urology at the University of Pittsburgh School of Medicine.

Understanding the Clinical Picture

Prevalence and Risk Factors

Prostate cancer remains the most common cancer among men in the United States after skin cancer. The American Cancer Society estimates approximately 313,780 new cases and 35,770 deaths from prostate cancer in 2025. About one in eight men will be diagnosed with prostate cancer during their lifetime.

Late-Stage Detection Challenges

Biden's case highlights a common challenge in prostate cancer detection, particularly in older men who may have discontinued routine PSA screening. According to Dr. Todd M. Morgan, urological surgeon and chief of urologic oncology at the University of Michigan Health, if Biden followed guideline-concordant care, he likely discontinued PSA testing several years ago, as current guidelines often recommend stopping screening in men over 70-75 years old.

This creates a diagnostic dilemma: without regular PSA monitoring, even aggressive prostate cancers can progress without causing symptoms. Dr. Tudor Borza, assistant professor of urology at the University of Michigan, explains that tumors often cause no urinary symptoms while confined to the prostate, and the first signs may only appear as bone pain or unexplained weight loss once metastasis has occurred.

Diagnostic Advances: PSMA PET Imaging

Biden's case likely benefited from recent advances in prostate cancer imaging. Over the past two years, medical professionals have increasingly adopted prostate-specific membrane antigen (PSMA) PET scans, which Dr. Al Barqawi of the University of Colorado Cancer Center describes as highly sensitive tests that can accurately depict metastatic disease throughout the body.

"It lights up like a candle on the scan, and it very accurately depicts metastatic disease," Barqawi explained. This technology represents a significant advancement over traditional bone scans and CT imaging in identifying the extent of cancer spread.

Treatment Approach: Multi-Modal Therapy

Biden's treatment plan reflects current evidence-based approaches to managing metastatic hormone-sensitive prostate cancer, incorporating multiple therapeutic modalities:

1. Androgen Deprivation Therapy (ADT)

As the foundational treatment for hormone-sensitive metastatic prostate cancer, ADT works by blocking testosterone production in the body. Dr. Barqawi explains that this hormonal blockade essentially amounts to medical castration, using injections that mimic testosterone and biochemically shut down its production.

The majority of prostate cancers, even when advanced, are hormone-sensitive, meaning they respond to testosterone suppression. This treatment often results in significant tumor shrinkage and slowed cancer growth. However, experts caution that this is not a cure—most prostate cancers will eventually convert to a hormone-resistant status, typically within six months to five years.

2. Radiation Therapy to the Prostate

Biden completed several weeks of external beam radiation therapy at Penn Medicine's Radiation Oncology clinic in Philadelphia. On October 21, 2025, he "rang the bell"—a symbolic gesture marking the completion of this phase of treatment—alongside his wife, Dr. Jill Biden, daughter Ashley Biden, and grandchildren.

The role of radiation therapy in metastatic prostate cancer has evolved significantly based on landmark clinical trials, particularly the STAMPEDE trial conducted in the UK and Switzerland. This research demonstrated that adding radiation therapy to the prostate in patients with newly diagnosed metastatic prostate cancer can extend survival, particularly in those with low-volume metastatic disease.

According to recent NCCN (National Comprehensive Cancer Network) guidelines, radiation therapy has seen dramatic increases in indications for prostate cancer treatment. Dr. Daniel Spratt, a radiation oncology expert, notes that radiation therapy now has category 1 evidence for high-risk prostate cancer, making it "the only local therapy that has randomized evidence showing it improves survival over hormone therapy alone."

Prognosis and Long-Term Management

Survival Expectations

Despite the aggressive nature of Biden's cancer, medical experts remain cautiously optimistic. Dr. Davies noted that with current treatment options, Biden "can easily live 10 years with this disease." However, the five-year survival rate for distant-stage prostate cancer is approximately 38 percent, compared to nearly 100 percent for early-stage disease—underscoring the importance of early detection.

Quality of Life Considerations

Treatment side effects represent a significant consideration in managing metastatic prostate cancer. Dr. Eric Wallen, chair of the Urology Department at the Medical University of South Carolina, emphasizes that androgen deprivation therapy can produce substantial symptoms, particularly in elderly patients who may already be experiencing age-related changes.

"When we take away testosterone or block testosterone in a man that way, they tend to get a lot of symptoms," Wallen explained. "Almost half the patients can have cognitive decline from the treatment." Other common side effects include fatigue, hot flashes, loss of muscle mass, decreased bone density, and sexual dysfunction.

Ongoing Research and Clinical Trials

The field of metastatic prostate cancer treatment continues to evolve rapidly. Several promising areas of investigation include:

Metastasis-Directed Therapy

Trials such as STOMP and ORIOLE have evaluated stereotactic body radiation therapy (SBRT) directed at individual metastatic sites in patients with oligometastatic disease (limited number of metastases). This approach, also called stereotactic ablative radiotherapy, aims to delay disease progression and potentially extend the time before systemic therapy becomes necessary.

Combination Approaches

Research is exploring combinations of:

• ADT with advanced anti-androgen agents like abiraterone acetate
• Radiation therapy with immunotherapy agents
• Radionuclide therapies such as Radium-223 and Lutetium-177 PSMA-617, which deliver targeted radiation directly to cancer cells

Treatment Intensification Strategies

Studies are investigating when and how to intensify treatment for patients with high-risk or metastatic disease, including optimal timing and combinations of chemotherapy, hormone therapy, and radiation.

Implications for Screening and Early Detection

Biden's case reinforces critical lessons about prostate cancer screening:

1. Individualized Screening Decisions: The American Cancer Society recommends that men aged 50 and over (45 for Black men and those with family history) have conversations with healthcare providers about screening benefits and risks.
2. Continued Surveillance in High-Risk Patients: Some experts suggest that screening cessation ages may need reconsideration for men with higher baseline risk factors.
3. Symptom Awareness: Urinary symptoms, while common in older men due to benign prostatic hyperplasia, should prompt medical evaluation, particularly if new or progressive.

Additional Health Considerations

In addition to his prostate cancer treatment, Biden underwent Mohs surgery in September 2025 to remove skin cancer lesions. This procedure, which involves progressively removing layers of skin until no cancerous cells remain, successfully removed all cancerous tissue according to his physician.

Public Health Impact

Biden's openness about his diagnosis continues his long-standing advocacy for cancer research and treatment. As vice president, he led the Cancer Moonshot initiative following his son Beau's death from brain cancer in 2015. He reignited this project as president, vowing to dramatically reduce cancer death rates.

Political figures from across the spectrum expressed support for Biden following his diagnosis, with President Donald Trump, former Vice President Kamala Harris, and former President Barack Obama all offering well-wishes. Obama noted that "nobody has done more to find breakthrough treatments for cancer in all its forms than Joe."

Key Takeaways for Patients

1. Early Detection Matters: While Biden's case demonstrates that advanced prostate cancer can be managed, early detection significantly improves outcomes.
2. Multiple Treatment Options Exist: Even with metastatic disease, combination therapies including hormone therapy and radiation can provide meaningful disease control and quality of life.
3. Hormone Sensitivity is Crucial: Determining whether cancer is hormone-sensitive guides treatment decisions and affects prognosis.
4. Treatment is a Marathon: Managing metastatic prostate cancer requires ongoing adjustment of treatment plans over months to years, with attention to both disease control and quality of life.
5. Research Continues to Advance: New imaging technologies, targeted therapies, and combination approaches continue to improve outcomes for patients with advanced disease.

Looking Forward

Biden is scheduled to receive a lifetime achievement award at the Edward M. Kennedy Institute in Boston, demonstrating his continued public engagement despite his diagnosis. His treatment journey continues with ongoing hormone therapy and monitoring.

For patients and families navigating similar diagnoses, Biden's case illustrates both the challenges and possibilities in managing advanced prostate cancer. While the disease requires serious, sustained treatment, modern therapeutic approaches offer meaningful opportunities for disease control and extended survival.

Sources and References

1. Neff, C. (2025, October 21). Joe Biden completes round of radiation therapy for prostate cancer. The Guardian. Retrieved from https://www.theguardian.com
2. Borza, T., & Morgan, T. M. (2025, May 19). What does Joe Biden's prostate cancer diagnosis mean for older patients? Michigan Medicine Health Lab. https://www.michiganmedicine.org/health-lab/what-does-joe-bidens-prostate-cancer-diagnosis-mean-older-patients
3. Davies, B. (2025, May 19). How treatable is prostate cancer? A doctor reacts to Biden's diagnosis. NPR Morning Edition. https://www.npr.org/2025/05/19/nx-s1-5403446/biden-metastatic-prostate-cancer-diagnosis-survival-rate
4. Biden diagnosed with 'aggressive form' of prostate cancer. (2025, May 18). CNN Politics. https://www.cnn.com/2025/05/18/politics/joe-biden-prostate-cancer
5. Barqawi, A. (2025, May 22). What Joe Biden's prostate cancer reveals about diagnosis, treatment. University of Colorado Cancer Center News. https://news.cuanschutz.edu/cancer-center/joe-biden-prostate-cancer
6. Joe Biden completes radiation treatment for prostate cancer at Penn. (2025, October 21). The Philadelphia Inquirer. https://www.inquirer.com/politics/joe-biden-penn-prostate-cancer-treatment-health-20251021.html
7. Joe Biden diagnosed with aggressive prostate cancer. (2025, May 18). NPR. https://www.npr.org/2025/05/18/g-s1-67544/joe-biden-prostate-cancer
8. Joe Biden prostate cancer treatment update after weeks of radiation therapy. (2025, October 20). Newsweek. https://www.newsweek.com/joe-biden-prostate-cancer-treatment-update-after-radiation-therapy-10910294
9. What to know about Biden's prostate cancer diagnosis. (2025, May 19). The Washington Post. https://www.washingtonpost.com/health/2025/05/18/biden-prostate-cancer-diagnosis/
10. Wallen, E. (2025, May 20). Hollings Cancer Center urologist on what Biden's cancer diagnosis means. Medical University of South Carolina News. https://web.musc.edu/about/news-center/2025/05/20/hollings-cancer-center-urologist-on-what-bidens-cancer-diagnosis-means
11. Former US President Joe Biden diagnosed with 'aggressive' prostate cancer. (2025, May 18). Al Jazeera. https://www.aljazeera.com/news/2025/5/18/former-us-president-biden-diagnosed-with-aggressive-prostate-cancer
12. American Cancer Society. (2025). Key statistics for prostate cancer. Retrieved from https://www.cancer.org/
13. Parker, C. C., et al. (2024). Radiotherapy to the prostate for men with metastatic prostate cancer in the UK and Switzerland: Long-term results from the STAMPEDE randomised controlled trial. PLOS Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC9173627/
14. The role of radiotherapy in metastatic prostate cancer. PMC - National Center for Biotechnology Information. https://pmc.ncbi.nlm.nih.gov/articles/PMC6526359/
15. Spratt, D. (2025, September 17). Metastasis-directed radiotherapy represents significant advancement in prostate cancer. OncLive. https://www.onclive.com/view/metastasis-directed-radiotherapy-represents-significant-advancement-in-prostate-cancer
16. National Comprehensive Cancer Network. (2025). NCCN Guidelines for Patients: Advanced-Stage Prostate Cancer. https://www.nccn.org/patients/guidelines/content/pdf/prostate-advanced-patient.pdf
17. Prostate cancer treatment & management. Medscape. https://emedicine.medscape.com/article/1967731-treatment
18. Parker, C., et al. (2020). Prostate cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 31(9), 1119-1134. https://www.annalsofoncology.org/article/S0923-7534(20)39898-7/fulltext

This article was prepared for the Informed Prostate Cancer Support Group (IPCSG) newsletter to provide comprehensive, evidence-based information about advanced prostate cancer diagnosis and treatment based on the recent public case of former President Joe Biden. Information is current as of October 21, 2025.