President Biden Had Followed Bad Prostate Cancer Screening Guidelines -- Here are Better Ones
The connection with life expectancy misinformation
Some people were incredulous when they saw this news, but I was not:
ABC News, 20 May 2025: Biden last had a PSA blood test in 2014, following medical guidelines
A representative for former President Joe Biden said he last took a prostate-specific antigen blood test, commonly used to screen for prostate cancer, in 2014.
Although the exact date of the test wasn't disclosed, Biden was around 72 years old at the time, which falls in line with current medical guidance and recommendations on who should take a test.
Current screening recommendations suggest men age 55 to 69 should discuss the benefits and harms of a PSA test with their doctor and make an individual decision when or if they need it. Men 70 and older should not receive PSA-based screening because of the risk of false positives, according to the United States Preventive Services Task Force.
"Prior to Friday, President Biden had never been diagnosed with prostate cancer," the spokesperson said in a statement.
Here are my main points, and I will get into them below:
Yes, the current “official guidelines” are that men over the age of 70 shouldn’t get the PSA test regularly for prostate cancer screening.
THESE GUIDELINES ARE CRAP … and have had repercussions
These guidelines are also currently under review
There are better, risk-based guidelines at cancer.org
One of the bad part of the guidelines people misinterpret has to do with life expectancy — that one has only 10 years of expected life left, and how one determines that. It is not at 70 years for American nonsmoking men of average health.
Let’s get into these points.
The current “official” prostate cancer screening guidelines: a political document
Here are the current “official” prostate cancer screening guidelines:
U.S. Preventive Services Task Force
Final Recommendation Statement
Prostate Cancer: Screening
May 08, 2018
Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
This topic is being updated. Please use the link(s) below to see the latest documents available.
Update in Progress for Prostate Cancer: Screening
Oh wait, this is independent of the government? Really?
Task Force members are appointed by the Secretary of HHS to serve 4-year terms. Members are screened to ensure that they have no substantial conflicts of interest that could impair the scientific integrity of the Task Force's work.
While the HHS may not provide direct pressure on these members while they’re on the task force, these are political appointments. They’re generally going to come from professional organizations and may be concerned about subsequent appointments should they anger anybody…. because I remember the kerfuffle over the attempt to change breast cancer screening recommendations in a way similar to prostate cancer screenings.
Anyway, let’s look at these recommendations.
Notice those grades to the right. I do not know who is grading these things, but I agree with these grades.
The “Men 70 years and older”, at least, is clear.
The “Men aged 55 to 69 years” recommendation is full of crap that has a bunch of “keep giving the guys an out not to get screened!”
People should not be made to fear a cancer diagnosis, if the cancer can be found at a very early stage and easily treated.
The treatment approaches for early prostate cancer are much less likely to affect sexual function, for instance, which is one of the fears often preyed upon. Let us not try to make Medicare cheaper by having men die younger.
Quick Facts on Prostate Cancer
Prostate cancer is the most common cancer men will contract in their lifetimes, with about 1 in 8 American men being diagnosed with it.
Age is a key risk factor.
[P]rostate cancer is more likely to develop in older men. About 6 in 10 prostate cancers are diagnosed in men who are 65 or older, and it is rare in men under 40. The average age of men when they are first diagnosed is about 67.
Prostate cancer currently has a very high survival rate, when caught at early stages. When caught at the earliest stages, the survival rate (relative rate against baseline mortality, at 5 years after diagnosis) is over 99%.
Back to Cancer.org:
The prostate cancer death rate declined by about half from 1993 to 2022, most likely due to earlier detection and advances in treatment. In recent years, the decline in the death rate has slowed, likely reflecting the rise in cancers being found at an advanced stage.
I BLAME THAT CRAP “RECOMMENDATION” ABOVE.
Okay, maybe it’s not just that crap recommendation. But, still.
There has been some evidence that the change in recommendations (and it did not merely happen in 2018) caused the shift to prostate cancer being found at more advanced stages:
UPI, 28 Oct 2022: Drop in screenings linked to increase in advanced prostate cancer cases
Researchers found that across 128 U.S. veterans health centers, the rate of PSA screening for prostate cancer declined between 2008 and 2019 -- a period where guidelines came out recommending against routine screening.
But patterns varied among the individual centers, with some maintaining high screening rates.
And in subsequent years, the study found, a trend emerged: VA centers with higher PSA screening rates had fewer cases of metastatic prostate cancer, while more cases were diagnosed at centers with lower screening rates.
It’s better to find the cancer earlier, where it’s not just treatable, but curable.
A Better Screening Recommendation from Cancer.org: Risk-Based
American Cancer Society Recommendations for Prostate Cancer Early Detection
Last updated November 2023
[I added some italicization]
The American Cancer Society recommends that men have a chance to make an informed decision with their health care provider about whether to be screened for prostate cancer. The decision should be made after getting information about the possible benefits, risks, and uncertainties of prostate cancer screening. The discussion about screening should take place at:
Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years
Age 45 for men at high risk of developing prostate cancer. This includes African American men and men who have a first-degree relative (father or brother) diagnosed with prostate cancer at an early age (younger than age 65).
Age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age)
After this discussion, men who want to be screened should get the prostate-specific antigen (PSA) blood test. The digital rectal exam (DRE) may also be done as a part of screening. (See Screening Tests for Prostate Cancer.)
If, after this discussion, a man is unable to decide if testing is right for him, the screening decision can be made by the health care provider, who should take into account the man’s general health, preferences, and values.
If no prostate cancer is found as a result of screening, the time between future screenings depends on the results of the PSA blood test:
Men who choose to be tested who have a PSA of less than 2.5 ng/mL may only need to be retested every 2 years.
Screening should be done yearly for men whose PSA level is 2.5 ng/mL or higher.
Because prostate cancer often grows slowly, men without symptoms of prostate cancer who have less than a 10-year life expectancy should not be offered prostate cancer screening, because they aren’t likely to benefit from it. Overall health status, and not age alone, is important when making decisions about screening.
This is a much better set of recommendations than the first one quoted. Notice that the age of 70 is nowhere mentioned but the “live at least 10 more years” or “10-year life expectancy” [yes, I will be getting to that].
I am happy they specifically mentioned African-American men having higher-than-normal risk for prostate cancer.
I covered that in a few posts:
April 2024: OJ Simpson Dead: Let's Review Racial Gap in Prostate Cancer Mortality
Nov 2023: Movember 2023: Racial Gap in Prostate Cancer Mortality
It is important to take a risk-based approach in these screening recommendations. Even if there were a significant false positive risk (which I deny in this case), the elevated risk for black men in the U.S. means the trade-off is such that they should test more often than other racial/ethnic groups in the U.S.
Life Expectancy: Where is the 10-year cut-off? How can I know?
The problem with the age 70 cut-off is I bet I know what a bunch of doctors did: took the life expectancy FROM BIRTH and subtracted 10.
There’s a problem with doing that.
Let’s say the life expectancy from birth in the year 2018 for males was 76.2 years (and it was, I have the stats). You want life expectancy from age 70, so you subtract off 70, the life expectancy is 6.2, easy-peasy!
Okay, what’s the life expectancy from age 80?
Negative 3.8 years?
The point is with life expectancy from a specific age is that you can’t have died at all the ages before that specific age. So, for life expectancy from age 70, you can’t have died before age 70… but for life expectancy from birth, that statistics includes all the probabilities of dying from age 0 through 70. That skews things a lot.
So, if you’re not an actuary like me, how can you find out?
To the Actuaries Longevity Illustrator! (I last used this to figure out how long Pope Leo might be around for)
As my base case, I did a person, Joeat70, a nonsmoking male, age 70, starting from age 70, of average health.
The tool can give you output at specific number of years for probability of survivorship: [this is supposed to help with retirement planning]
You also get output of specific probabilities, and the number of years that represents:
So here’s the deal: a 70-year-old man of average health would, on average (from a median perspective), expect to live to be about 86 years old.
But he’d also have about a 25% chance of living to 91.
70 seems awfully young to stop screening for prostate cancer.
I played around with the tool a bit, and even at 75 years, there’s a median expectation of at least 12 more years.
I would think catching a cancer young, at 75? I would take the test, if I were a 75-year-old man. That’s my opinion.
Again, there are trade-offs in cancer screening and treatment. I agree with that in terms of recommendations. However, early cancer treatments are not as harsh as they used to be.
What is very harsh is having advanced prostate cancer, also known as metastatic prostate cancer. In our current state of affairs, it is treatable, but not curable. The five-year survivorship for advanced prostate cancer has improved, but it’s still low compared to finding prostate cancer early. Also, the treatment for advanced prostate cancer can be harsh. I will have more to say (as in, podcast) about that later.
But for now, I am sorry for former President Biden that he got bad advice for prostate cancer screening. Many have.
I hope the “official” recommenders look to the American Cancer Society for at least clearer communications, if they do not decide to just wholesale use their recommendations.