Former President Biden, 82, Faces Critical Treatment Decisions Amid ‘Aggressive’ Prostate Cancer Battle – Here Are Some Treatment Options

Cancer touches us all. Like so many of you, Jill and I have learned that we are strongest in the broken places. Thank you for lifting us up with love and support. pic.twitter.com/oSS1vGIiwU

— Joe Biden (@JoeBiden) May 19, 2025

RELATED: Check Out SurvivorNet’s Digital Guide to Prostate Cancer

Biden’s diagnosis reminds us how critical it is for men to undergo regular prostate cancer screening, and to be aware of potential symptoms, which could include:

• Urinating more often
• Waking up in the middle of the night to pee
• Blood in your urine
• Trouble getting an erection
• Pain or burning when you urinate
• Pain in your back, hips, thighs, or other bones
• Unexplained weight loss
• Fatigue

The former president underwent prostate cancer tests, including a protein-specific antigen (PSA) test. This test screens for prostate cancer by looking for larger amounts of protein-specific antigen in the blood. An elevated PSA test does not always mean prostate cancer. The results of the PSA test provide a Gleason Score. This score ranges from 6 to 10. The higher the score, the more aggressive the cancer. This score, along with other test results, helps doctors determine if cancer is “low risk,” “intermediate risk,” or “high risk.”

Biden’s Gleason Score was a 9.

Watch: Coping emotionally after a prostate cancer diagnosis

“He was diagnosed with prostate cancer, characterized by a Gleason score of 9 (grade Group 5) with metastasis to the bone,” Biden’s office said. Biden’s cancer has spread beyond the prostate and into his bone, which makes it more advanced and aggressive.

Biden’s office added, “The cancer appears to be hormone-sensitive, which allows for effective management.”

Hormone-sensitive cancer means Biden’s prostate cancer is influenced by a hormone such as testosterone. Hormone therapy is an option Biden may consider for treatment.

RELATED: Adjusting to your new normal after a prostate cancer diagnosis

Hormone Therapy and the New Treatments Available for Late-Stage Prostate Cancer

Hormone therapy is used when patients are unable to have cancer surgically removed because it has spread to other parts of the body.

Although hormone therapies do not cure stage 4 prostate cancer, they may help keep it from growing and spreading further.

“The traditional standard of care for metastatic prostate cancer is androgen (male sex hormone) deprivation therapy or hormone therapy,” explains Dr. Jeff Tosoian, a urologic oncologist.

Androgen deprivation therapy is a type of hormone therapy that works by inhibiting androgen production, including testosterone, or blocking androgen receptors, which can slow down tumor growth.

“Prostate cancer feeds off testosterone,” explains medical oncologist Dr. Mary O’Keeffe. “When you lower testosterone with androgen deprivation therapy, it’s no longer feeding the cancer.”

As metastatic prostate cancer progresses, the cancer cells can adapt and become resistant to therapy.

According to Dr. O’Keeffe, this is true for most cancer treatments. “You have some men that are on it for many years, and some men can progress in less than a year if they have a more aggressive type of cancer.”

Two newer androgen deprivation therapies for late-stage prostate cancer include:

Xtandi (enzalutamide)

• FDA-approved to treat non-metastatic (nmCRPC) and metastatic castration-resistant prostate cancer (mCRPC) and metastatic castration-sensitive prostate cancer (mCSPC)
• It’s a once-daily oral pill that can be taken with or without food
• The most common side effects include fatigue, weakness, hot flashes, back pain, joint pain, changes in bowel habits, high blood pressure (hypertension), and decreased appetite

Erleada (apalutamide)

• FDA-approved to treat metastatic castrate-sensitive prostate cancer (mCRPC)
• It’s a once-daily pill taken by mouth
• The most common side effects include rash, hot flashes, high blood pressure, itching, and joint pain

RELATED: Promising Data on Drug Nubeqa Could Mean Better Targeted Treatments for Men With Advanced Prostate Cancer

Targeted Cancer Therapy Options

Targeted therapy is a developing treatment option for prostate cancer. Unlike cytotoxic chemotherapy, which also damages healthy cells as it attacks cancer, targeted therapies interfere with specific molecular pathways.

These drugs can target and destroy specific cancer cells with fewer side effects than traditional chemotherapy.

Targeted therapy has three major mechanisms of action:

• Blocking the growth factor that encourages tumor cells to grow
• Interfering with the synthesis or function of DNA
• Disrupting cell signaling pathways essential for the survival and growth of cancer cells

Pluvicto is part of a newer class of targeted cancer therapies called radioligand therapies (RLTs). It delivers a small but powerful dose of radiation directly to prostate cancer cells that express a protein known as PSMA (prostate-specific membrane antigen). This protein is found on most prostate cancer cells but not on normal tissues — making it a valuable target for treatment.

Before receiving Pluvicto, patients must undergo a PSMA PET scan using an approved imaging agent, such as Locametz, to confirm that their cancer cells express PSMA.

This treatment is now approved for men with mCRPC — which means the cancer has spread beyond the prostate and is no longer responding to hormone therapy — who have already been treated with one ARPI (like abiraterone or enzalutamide) and who are not yet ready for chemotherapy. At this time, it is too soon to know if this would be a treatment option for Biden.

Pluvicto has potential side effects, which may include:

• Dry mouth
• Fatigue
• Nausea
• Constipation
• Decreased appetite
• Anemia

Other Treatment Options

There are an array of treatment paths Biden’s medical team may choose to take, each with their own risks and benefits.

Here is a breakdown of the options:

• Chemo: The goal of this therapy is not to cure prostate cancer but rather to slow its growth and reduce symptoms.
• Radiation Therapy: This therapy uses high-energy rays or particles that are focused on prostate cancer cells to damage or destroy them. This treatment is effective for helping to ease symptoms related to prostate cancer, but it’s not used as a cure.
• Surgery: Surgery isn’t common in late-stage prostate cancer. However, sometimes, doctors may surgically remove the testicles (called an orchiectomy or surgical castration) in order to stop the production of testosterone.
• Clinical trials: Clinical trials are being conducted for many types of advanced prostate cancer. Participation can give patients access to new drugs and treatments.
• Cancer vaccine: Provenge, an immunotherapy treatment given over the course of one month, is the first FDA-approved vaccine for metastatic castration-resistant prostate cancer (mCRPC). It helps the patient’s immune system attack prostate cancer cells that have been growing and dividing throughout the body. Common side effects include fatigue, chills, fever, back pain, nausea, joint pain, and headaches.

WATCH: Genetic testing can help doctors tailor advanced prostate cancer treatments

Each of these treatment options involves careful considerations Biden and his medical team will take into account, including the former president’s age, past health history, and current health status.

Bone Therapy

Biden’s metastatic prostate cancer has spread to his bones. Metastatic cancer can destroy bone tissue and release substances that cause additional bone damage.

Doctors often manage bone loss with treatment to stop or slow bone destruction (such as bisphosphonate drugs), reduce pain, and prevent fractures.

New drugs available to prevent bone loss and fractures in those whose cancer has already spread to the bones include Xgeva (denosumab), which is FDA-approved for preventing skeletal complications in men with advanced prostate cancer who are at high risk for fracture.

It’s an injection given under the skin every four weeks. The most common side effects include shortness of breath, fatigue, nausea, and low phosphate levels in your blood.

Finding Support After Cancer Diagnosis

“Cancer is something that affects not just the person who’s diagnosed, but the family, whether that’s your partner, whether that’s your kids, whether the community,” Dr. Kysa Christie, a clinical oncology psychologist at the West Los Angeles VA, tells SurvivorNet.

WATCH: The power of emotional support for men handling prostate cancer

During the early stages of your diagnosis, your team of supporters can be most helpful. Your supporters can include close family members and friends. Your support group can also include people outside your inner circle.

One of the benefits of having supporters includes helping alleviate stress and anxiety following your diagnosis. Supporters can also help advocate on your behalf during treatment.

When to Screen for Prostate Cancer

The United States Preventive Services Taskforce recommends men at average risk between the ages of 55-69 years old should talk with their doctor about the pros and cons of prostate cancer screening. Most doctors agree that men over the age of 70 do not need screening.

WATCH: When should I get tested for prostate cancer?

SurvivorNet experts suggest that men consider factors such as their family history, genetics, and age when deciding whether and when to undergo screening.

Questions To Ask Your Doctor

If you have experienced symptoms associated with prostate cancer or have a screening coming up, here are some questions you may ask your doctor:

• If I have elevated PSA levels, what could be causing that besides cancer?
• How long will it take to learn if my PSA levels warrant further testing?
• What are the treatment options that are best suited for me based on my risk level?
• What financial resources exist to help me with the costs associated with treatment?
• How long will my potential treatment prevent me from working or continuing normal activities?

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