By Navin C. Shah, MD
It is with great sorrow that I learned of former President Joe Biden’s diagnosis of advanced, aggressive prostate cancer with bone metastasis. As a physician who has spent decades treating and studying this disease, I find it heartbreaking that a man who served as both Vice President and President of the United States did not benefit from timely prostate cancer screening. His condition could have potentially been diagnosed at an earlier stage, when a cure is possible.
Prostate cancer remains the most common cancer in men and the second deadliest. The median age of diagnosis is 67. Yet, shockingly, more than half of primary care physicians in the United States do not offer routine screening with the PSA (prostate-specific antigen) blood test or the digital rectal exam (DRE). These two simple tools, used together, have saved countless lives when applied consistently and appropriately.
The roots of this failure trace back to the United States Preventive Services Task Force (USPSTF), which in 2012 and again in 2018 advised against prostate cancer screening in men over the age of 70. These guidelines, issued by a panel that did not include urologists, relied on studies that were flawed and statistically compromised. Notably, these studies featured disproportionately low participation from Black men, who are among the most vulnerable to aggressive form of prostate cancer and prostate cancer mortality.
Dr. Navin C. Shah: Prostate cancer screening: A vital necessity for men’s health (December 10, 2023)
Before these USPSTF recommendations were issued, prostate cancer screening had been in practice for over two decades and had succeeded in reducing mortality by nearly 50%. But since 2013, the American Cancer Society reports that prostate cancer deaths have been rising year after year. In 2024 alone, an estimated 35,250 men in the U.S. died from prostate cancer. Alarmingly, 60% of these deaths occurred in men aged 70 and older—the very demographic the USPSTF advised against screening.
These numbers reflect a tragic trend: prostate cancer is being diagnosed at more advanced stages and is proving more deadly, especially among older men, Black men, and those with a family history of the disease. Worldwide, 1.5 million new cases of prostate cancer were reported in 2022, with over 306,000 deaths.
Metastatic prostate cancer, which has spread beyond the prostate to other parts of the body such as bones, is incurable. Data shows that 79% of patients with metastatic prostate cancer die from the disease—60% of them within the first two years. These outcomes are not just grim; they are largely preventable with proper screening and early intervention.
Opponents of widespread screening often cite concerns about overdiagnosis and overtreatment. However, medical technology and practices have advanced significantly. The use of MRI of the prostate, PSMA PET/CT scans, genomic testing, and refined biopsy protocols have made it possible to better distinguish aggressive tumors from indolent ones. Moreover, active surveillance—a clinical approach in which low-risk prostate cancer is monitored rather than immediately treated—is widely practiced and helps avoid unnecessary procedures.
Yet, even with these safeguards, it is important to recognize that prostate biopsies can underestimate the severity of the cancer in about 50% of cases. Furthermore, nearly half of men under active surveillance eventually see their cancer progress to a more serious grade and require curative treatment. This means that withholding screening in older men, many of whom may still be active, healthy, and with a life expectancy of 14 or more years, is not just misguided—it is dangerous.
Financially, the burden is staggering. The Centers for Medicare & Medicaid Services (CMS) spent $11.8 billion on prostate cancer care in 2010 and that figure rose to $20 billion by 2020. The cost of treating metastatic prostate cancer alone can exceed $200,000 per patient. In contrast, early-stage treatment and monitoring is far less expensive—and far more effective. The five-year survival rate for localized prostate cancer is over 99%. For metastatic cases, that number drops to a mere 37%.
A paper I co-authored with Dr. Vladimir Ioffe, published in Trends in Urology in May 2024, cites over 50 studies and advocates for regular screening in healthy men over 70. This position is gaining traction among urologists and oncologists who witness the consequences of late-stage diagnosis firsthand. Thankfully, CMS does cover prostate cancer screening costs for Medicare beneficiaries, but current guidelines discourage many doctors from offering it to those over 70—even when the clinical logic supports doing so.
Today, over 3.3 million men in the U.S. are living after being treated for prostate cancer. This number stands as a testament to the value of early detection. Meanwhile, there are 24 million American men over the age of 70, many of whom can live well into their 80s and beyond. Denying them access to screening denies them a chance at life-saving intervention.
It is time to update our national guidelines to reflect medical reality. In my view, all men over 55 should be screened for prostate cancer regularly, especially those with risk factors such as family history or African ancestry. These guidelines should be issued and overseen by relevant medical specialty boards—such as the American Urological Association—not a generalized task force lacking specialty expertise.
Biden’s case should serve as a national wake-up call. His diagnosis is not just a personal tragedy—it is a symptom of a systemic failure in our approach to prostate cancer prevention. We have the tools to diagnose this disease early. We have the treatments to cure it when caught in time. What we need now is the will to act, guided by medical evidence and clinical experience.
We must not allow outdated policies to cost more lives. Prostate cancer is a silent killer, but with vigilance, science, and screening, we can give more men the gift of life.
(Dr. Navin C. Shah is a urologist based in the Washington, D.C., area. He has published six papers on prostate cancer and 15 letters to the editor commenting on other published papers on prostate cancer in various reputed US urology journals. His memoir, “Karma and Destiny of an Indian American Surgeon” (published by AB Books), was released in 2022. Dr. Shah is also a numismatist with a collection of thousands of ancient Indian coins.)