Former US President Joe Biden’s recent diagnosis of advanced prostate cancer, which has already spread to his bones, has sparked debate among doctors and users on social media about how quickly the disease could have progressed.

The announcement described the illness as aggressive, with a Gleason score of 9, indicating a high-grade cancer known to grow and spread rapidly.

However, some experts have expressed doubts about whether such an advanced stage could have developed in a short span of time without earlier signs.

Following the former President’s diagnosis, criticism has surfaced on social media targeting his wife, Dr. Jill Biden from Donald Trump Jr., the eldest son of President Donald Trump.

He questioned how the First Lady, who holds a doctoral degree in education, could have missed signs of such an advanced illness.

“What I want to know is how did Dr. Jill Biden miss stage five metastatic cancer or is this yet another cover-up?” Trump Jr wrote in the post on X.

‘STAGE 4 PROSTATE CANCER DOESN’T HAPPEN OVERNIGHT’

Dr. Steven Quay, a US-based physician and researcher, raised concerns about the timeline in a post on X that went viral.

“Stage 4 prostate cancer doesn’t happen overnight,” he wrote, suggesting that the former President’s medical team may have known about the cancer much earlier than publicly disclosed.

“For even with the most aggressive form, it is a 5-7 year journey without treatment before it becomes metastatic. Meaning, it would be malpractice for this patient to show up and be first diagnosed with metastatic disease in May 2025. It is highly likely he was carrying a diagnosis of prostate cancer throughout his White House tenure and the American people were uninformed,” Quay added.

Biden had who demitted the White House in November last year. Earlier, in August 2024, the 82-year-old bowed out of the US presidential race amid feverish speculation surrounding his health that was exacerbated by near-daily videos drawing scrutiny over his physical health and mental acuity.

Biden abruptly ended his bid for re-election and proposed his deputy and then Vice President Kamla Harris as the Democrats’ candidate for the presidential election.

Doctors typically recommend routine screening for men over 50 through PSA (prostate-specific antigen) blood tests and digital rectal exams, which can help detect prostate cancer before symptoms arise.

While high-grade cancers like Biden’s can spread faster than average, experts say it’s still unlikely for the disease to reach Stage 4, involving metastasis to bones, in just a few months.

NOT CURABLE, BUT CAN BE CONTROLLED FOR YEARS

Dr. Chris George, medical director of the cancer program for the Northwestern Health Network, clarified that once prostate cancer spreads to the bones, it is considered incurable.

“When the cancer has spread to the bones, that makes it Stage 4. That means that the cancer is not curable. There’s no treatment available that can cure the cancer,” he told Reuters.

However, he noted that it can still be controlled for extended periods. “Two or three years is very realistic, and some lucky patients get control for four, five, six and even longer,” he said.

Dr. George also dismissed suggestions that Biden’s cancer might explain his physical decline during public appearances in recent years.

“I don’t think he had cancer over the last two years and that’s why we saw physical decline on television. I think probably that happened from something else and this cancer just happened to be diagnosed,” he said.

Dr. Jamin Brahmbhatt, a urologist with Orlando Health Medical Group, said Biden is likely to undergo androgen deprivation therapy.

“In a lot of patients that get diagnosed with metastatic prostate cancer, the treatment usually starts the day of the diagnosis,” he told Reuters.

“So patients may get started, may start on their androgen deprivation therapy, which is pretty much like hormone castration. So we’re trying to like slow down the cancer which can be fed by hormones or testosterone. So the treatment starts there, and then as more evaluations are being given and as they see more specials as we’re expanding the team, more things may be added based on what that specific patient needs,” said Dr. Brahmbhatt.

CANCER PROGRESSION OFTEN SILENT IN EARLY STAGES

In India, oncologists say many cases go undetected until the disease has significantly advanced.

Dr. Prashant Jain, Associate Director of Urology at PSRI Hospital, New Delhi, said, “The majority of patients do not seek medical attention early, and by the time they do, the disease has often progressed significantly. Many are surprised to learn they have cancer because it tends to remain silent in its early stages.”

He explained that the cancer typically starts in the prostate and may then spread to nearby structures like the bladder, and eventually to distant organs, especially the bones and liver, leading to fatal outcomes.

“A biopsy is used to confirm the diagnosis. MRI scans are often recommended, especially when PSA levels are under 4 but clinical suspicion remains,” he said.

TREATMENT EVOLVES WITH DISEASE PROGRESSION

Prostate cancer tends to evolve over time.

Dr. Mandeep Singh, surgical oncologist and co-founder of the Art of Healing Cancer centre, noted that initially, prostate cancer often responds well to hormonal therapy, which works by lowering testosterone or blocking its action.

“However, resistance to hormonal treatment can develop, which complicates management,” he said.

At that point, treatment often shifts to personalised medicine based on biopsy results. While chemotherapy is not typically effective in early stages, it becomes more relevant in advanced or resistant cases.

LACK OF ROUTINE SCREENING IN INDIA

Dr. Jain also highlighted a major gap in India’s healthcare approach.

“Prostate cancer progresses very slowly in most cases, but the lack of patient awareness and routine screening means early detection is often missed. In India, health check-ups are not streamlined or done regularly unless symptoms arise, unlike in Western countries,” he said.

According to guidelines by the American Urological Association, men over 50 should consider regular PSA tests to catch malignancies early.

Though PSA testing is not diagnostic on its own, it offers a crucial lead, especially since most prostate cancers begin around this age.

The Biden family has not addressed speculations about when the cancer was first detected. However, his doctors have confirmed that the cancer is hormone-sensitive, and treatment is currently under way.