Joe Biden’s office announced Sunday that the former president has metastatic prostate cancer. The diagnosis is tragic and may have been completely avoidable, but the question now is whether Biden’s medical team was negligent or lied about his cancer. Either way, the American people deserve to know.
Prostate cancer is a “gut punch” diagnosis for any man to receive, and unfortunately, it is becoming more prevalent. Except for skin cancer, it is the most common cancer in men in the U.S. and the second-leading cause of cancer mortality. About 1 in 8 men will get prostate cancer, with two-thirds of these cases in men aged 65 and older.
Early detection is the key to survival, and prostate-specific antigen (PSA) is a vital screening test that millions of men have every year during their annual physical exams. A quick needlestick and a tube of blood sent to the lab with same-day results — it’s that simple. Clinical studies have shown that this type of screening may reduce the risk of prostate cancer death.
As for Biden’s diagnosis, it is a sad postscript to a long life in politics and a presidency fraught with other major health concerns. Many unanswered questions remain, specifically, how did he develop such an aggressive cancer just a little over a year since his last physical exam?
Biden underwent detailed examinations in 2021, 2023, and 2024, performed by the physician to the president, Dr. Kevin O’Connor. And there was no mention of any prostate abnormalities, such as enlargement, nodules, or elevated PSA levels. There was no record of a urology consultation, although evaluations by several other specialists were prominently noted. We know more about Biden’s seasonal allergies and his teeth than his prostate health. This is in sharp contrast to President Donald Trump’s physical examination reports from 2018 and 2025, where PSA levels were specifically called out and reported as normal.
What happened? Prostate cancer tumors are typically slow-growing and do not usually present at the most severe stage, as has happened with Biden. While a PSA level can be normal in a person with advanced prostate cancer, it is not a common occurrence. Was the PSA test intentionally omitted by O’Connor?
If he strictly followed the U.S. Preventive Services Task Force (USPSTF) recommendations, the test would not have been done because Biden was over age 70. These recommendations have been a moving target in the past and tend to err on the side of not testing, presumably to spare patients from the risks of “overdiagnosis and overtreatment.” In 2012, the USPSTF recommended against any PSA testing in men, but as previously declining prostate cancer rates increased, they partially reversed themselves with their 2018 recommendations. Unfortunately, men age 70 and older, like Biden, were left with a recommendation for no testing.
When key personnel such as CEOs and senior executives undergo executive physicals, however, testing frequently goes above and beyond USPSTF recommendations, considering the high value these employees have to the corporations and stockholders they work for. In fact, the renowned Mayo Clinic Executive Health Program includes PSA testing for all male patients age 50 and older. Considering the quantity and quality of physicians and health care facilities at the disposal of the president, he should have received this same level of service or better.
What if Biden’s PSA level was abnormal, and the public was not informed about it? That possibility must also be considered, given the issues with his previous examinations, which glossed over significant concerns about his thought processes, memory, speech, and ability to walk.
Could this omission have been deliberate to avoid additional attention to Biden’s diminished faculties and concerns about his ability to run for a second term? This would be consistent with the White House actions at the time to push back on questions regarding cognitive testing, which might have discovered damning information that would have sunk his hopes for a second term.
Rep. Ronny Jackson, R-Texas, a former White House physician to Presidents Obama and Trump and current chair of the House Intelligence Committee’s Subcommittee on Oversight and Investigations, has gone on record that O’Connor will soon be questioned about “medical information that the American people don’t have.” O’Connor should be made to disclose everything he did (or didn’t do) with regard to Biden’s prostate evaluations.
Former Secretary of Defense Lloyd Austin’s prostate cancer AWOL episode underscored the vital importance of medical transparency for key government officials. Austin dropped out of sight for days while he was receiving treatment for prostate cancer at Walter Reed National Military Medical Center. He informed neither the president nor Congress, and there seemed to be no public consequences for this behavior. Perhaps Biden’s own prostate issues at the time may have tempered his response.
What does the future hold for Biden? He will most likely start hormonal therapy, and depending on his response to treatment, radiation therapy and chemotherapy may also be needed. Unfortunately, surgery is not helpful when prostate cancer has spread to other parts of the body, as has happened in this case. Even with aggressive treatment, this type of advanced prostate cancer only has a 37 percent five-year survival rate.
Whether Biden was the victim of substandard care or a willing participant in a coverup remains to be seen. In hindsight, if Biden had only undergone PSA testing, like Trump did, he might not have found himself in this situation. Ultimately, the American public must receive full disclosure so neither scenario can ever happen again with our nation’s chief executive and one of the world’s most powerful people.
Dr. Williams is a board-certified occupational medicine physician and Fellow of the American College of Occupational and Environmental Medicine who has performed thousands of examinations to determine workers’ fitness for duty. He has a consulting practice and has also served as a corporate medical consultant. Find him on X @MedicusOmnibus.
