Former President Joe Biden’s recent diagnosis of advanced prostate cancer with a Gleason score of 9 has sparked widespread concern and curiosity. Announced on May 18, 2025, this news highlights the seriousness of his condition and raises questions about what a Gleason score of 9 means. As someone who has seen loved ones face cancer, I know how overwhelming medical jargon can feel. Let’s break it down in a way that’s clear, human, and hopeful, while leaning on expert insights and data to guide us.
What Is Prostate Cancer?
Prostate cancer starts in the prostate, a small gland in men that produces fluid for semen. It’s one of the most common cancers among men in the U.S., affecting about 1 in 8 men during their lifetime. According to the National Cancer Institute, over 313,000 new cases are expected in 2025 alone. While many prostate cancers grow slowly and may not cause harm, some, like Biden’s, are aggressive and require immediate attention.
Biden’s diagnosis came after he experienced urinary symptoms, a common red flag. Doctors found a nodule during a routine exam, which led to further testing and a biopsy. This is a reminder that regular checkups can catch issues early, even for someone as high-profile as a former president.
Understanding the Gleason Score
What Is a Gleason Score?
The Gleason score is a tool doctors use to measure how aggressive prostate cancer is. Pathologists examine prostate tissue samples under a microscope and assign grades based on how abnormal the cancer cells look compared to healthy cells. They pick the two most common patterns of cancer cells, grade each from 1 to 5, and add them together. The result is a Gleason score, typically ranging from 6 to 10.
A score of 6 suggests a slower-growing cancer, while 8 to 10 indicates a high-grade, aggressive cancer. Biden’s Gleason score of 9 (often a 4+5 or 5+4 combination) places his cancer in Grade Group 5, the most severe category. This means the cancer cells are highly abnormal and likely to grow and spread quickly.
Why a Gleason Score of 9 Is Serious
A Gleason score of 9 signals that the cancer is poorly differentiated, meaning the cells barely resemble normal prostate tissue. Dr. Alexander Kutikov, a urologist at Fox Chase Cancer Center, described Biden’s case as a “very rare” form of prostate cancer, noting that only 5-8% of diagnoses involve metastasis at the outset. Biden’s cancer has spread to his bones, classifying it as Stage 4, which complicates treatment and prognosis.
To put this in perspective, my uncle was diagnosed with prostate cancer a few years ago. His Gleason score was 6, and his doctor recommended active surveillance because the cancer was slow-growing. Biden’s situation, however, is far more urgent, requiring immediate and aggressive intervention.
Metastasis to the Bone: What It Means
When prostate cancer spreads beyond the prostate, it often travels to the bones via the bloodstream. This is called bone metastasis, a hallmark of Stage 4 prostate cancer. For Biden, this means the cancer has formed new tumors in his bones, which can cause pain, weaken bones, and increase fracture risk. The Cleveland Clinic notes that bone metastasis can also lead to high calcium levels in the blood, causing nausea or confusion.
The American Cancer Society reports that the 5-year survival rate for metastatic prostate cancer is about 37%, compared to 97.9% for non-metastatic cases. While these numbers sound daunting, survival outcomes have improved significantly in recent decades. Dr. Matthew Smith from Massachusetts General Brigham Cancer Center told The Associated Press that patients with metastatic prostate cancer can live 4-5 years or more with proper treatment.
Hormone-Sensitive Cancer: A Ray of Hope
Biden’s office noted that his cancer is hormone-sensitive, which is a critical piece of good news. Prostate cancer often relies on male hormones (androgens) to grow. Hormone therapy, also called androgen deprivation therapy (ADT), blocks these hormones to slow cancer progression. This treatment can be administered through injections or tablets and is often effective for hormone-sensitive cancers.
Anne Savage, CEO of the Prostate Cancer Foundation of Australia, emphasized that new treatments, like PSMA therapy, are extending survival times. These therapies target cancer cells with radioactive molecules, offering hope even for advanced cases. However, hormone therapy isn’t without side effects, including fatigue, weight gain, and osteoporosis, which Biden’s care team will need to manage carefully.
Treatment Options for Biden
Given the cancer’s spread, surgery is unlikely to be an option, as it’s typically used for localized prostate cancer. Instead, Biden’s team is likely exploring a combination of treatments:
- Hormone Therapy: To slow cancer growth by reducing androgen levels.
- Chemotherapy: To target rapidly dividing cancer cells.
- Radiation Therapy: To relieve pain or target bone metastases.
- Emerging Treatments: Such as PSMA therapy or immunotherapy, which are showing promise in clinical trials.
Dr. Jamin Brahmbhatt, a urologist at Orlando Health, told the BBC that while these treatments aren’t curative, they can stabilize the cancer and improve quality of life. Biden’s active lifestyle and access to top-tier medical care will play a significant role in his treatment plan.
Why Early Detection Matters
Biden’s diagnosis underscores the importance of regular screenings, especially for men over 50. The American Cancer Society recommends discussing PSA (prostate-specific antigen) blood tests and digital rectal exams with your doctor. Early detection can catch prostate cancer before it spreads, dramatically improving outcomes.
Houman David Hemmati, MD, a former prostate cancer researcher, posted on X, “This is a moment to raise awareness: men over 50 should talk to their doctor about PSA screening.” His words echo the sentiment that proactive health checks can save lives.
A Personal Reflection
Cancer touches us all in some way. When my friend’s father was diagnosed with prostate cancer, the family rallied around him, learning about treatments and celebrating small victories. Biden, a fighter who has faced personal tragedies like the loss of his son Beau to brain cancer, is likely approaching this with the same resilience. His Cancer Moonshot initiative, aimed at reducing cancer deaths, shows his commitment to this fight on a larger scale.
Looking Ahead
Joe Biden’s Gleason score of 9 and Stage 4 prostate cancer diagnosis is serious, but it’s not the end of the story. With hormone-sensitive cancer and access to cutting-edge treatments, there’s hope for effective management. As we wish him strength, let’s also take this as a reminder to prioritize our health and support those facing similar battles.
For more information, visit the American Cancer Society’s website or call their 24/7 helpline at 1-800-227-2345. Stay proactive, stay informed, and keep hope alive.
