Biden physicians failed him, in my opinion
I assumed that President Biden had his PSA checked while in office, but I now realize that he may not have. The guidelines were changed in 2018. Under the new recommendations, PSA screening is not advised for men aged 70 or older. Biden was 78 when he became president in 2021.
His office says he has not been screened since 2014, when he was 72. It typically takes about 10–15 years for a non-aggressive form of prostate cancer to reach stage four (Biden’s current status). In aggressive cases—determined by the Gleason score—it can happen in just 2–5 years.
The current guidelines for PSA testing need to be rethought. The guidelines, I fear, were a reaction to the over-diagnosis and over-treatment of early-stage prostate cancer. About 18% of men will be diagnosed with prostate cancer. It is generally a slow-growing cancer, and its incidence increases with age. Some suggest that your percent chance of having prostate cancer roughly equals your age. Most men will die with prostate cancer, not from it. But some will die from it. I hope Biden will not be one.
My own experience with being overly treated
When I was treated for prostate cancer in 1996, it was definitely being over treated. I had a PSA of 4.8 and a Gleason score of 6. I should never have been treated—and today, I likely wouldn’t be, at least not initially.
These days, a PSA level like mine would likely be monitored to track its rate of increase—assuming the elevation is actually due to cancer and not caused by something else. If the PSA continued to rise, a biopsy would eventually be performed. That would determine cancer is present and how aggressive it was. If it isn’t aggressive, a technique called active surveillance would be used: a combination of PSA tests and periodic biopsies every few years. This approach avoids aggressive treatment like prostate removal or radiation in most cases.
The idea of not testing men over 70 makes little sense to me. Half of men over 70 are expected to live to at least 85. With continued improvements in healthcare and lifestyle, I suspect that life expectancy will continue to rise.
Precise recommendations based on the person not the population
The current recommendations regarding PSA testing are designed for the general population. I would have expected that Biden, given his access to top-tier medical advice, would have received more personalized recommendations. For example, it is generally not advised to have a colonoscopy after age 75—but these guidelines also emphasize factoring in projected life expectancy. Being in excellent health myself, I had a colonoscopy at age 79. I may not have another one—my next would be at 89—but we’ll see how I’m doing then.
The invation of the Prostate Snatchers
I wrote in 2010 about the aggressive treatment of prostate cancer which I suspect the lead to the current recommendations.
Two Thirds Done 