Deep Dive

Prostate Cancer, President Biden, and the Value of Screening After 75

The Guidelines Say Stop – But the Conversation Doesn’t End

Most prostate cancer screening guidelines suggest stopping routine PSA testing between age 70 and 75. 

The reasoning is based on averages: if a man’s life expectancy is under 10 to 15 years, the benefit of finding and treating prostate cancer early is less clear.

But for many men, that age doesn’t tell the whole story.

Some 76- or even 80-year-olds are healthy, active, and engaged. Others are managing medical conditions that would make cancer treatment a much tougher road. 

That’s why this isn’t just about numbers – it’s about context and conversation.

President Biden’s Diagnosis Highlights the Why

When news broke that President Joe Biden had been diagnosed with metastatic, high-grade prostate cancer, it raised an important question:

What’s the role of screening when you’re older?

The truth is, we want to catch prostate cancer before it spreads. That’s when treatment is most effective. 

But in older men, especially those over 75, screening has a different purpose – it’s not always about curing.

Sometimes we screen because a man is still healthy enough to benefit from treatment. 

Other times, we screen simply to understand what we’re dealing with, especially when symptoms like trouble urinating show up – as they did in President Biden’s case.

In that setting, a PSA test isn’t about checking boxes. It’s about checking in.

When Screening After 75 Still Makes Sense

Here’s what I often tell my patients:

Many prostate cancers in older men are slow-growing and won’t ever cause harm. In those cases, we may choose to monitor without treatment. 

But for some healthy men with years ahead of them, screening still helps us find the kinds of cancers we would treat – because leaving them alone could mean real trouble later on.

And yes, treatment in a healthy 76- or 78-year-old can still be curative. That’s why the decision to stop screening should never be automatic. It should be thoughtful.

What we shouldn’t do is screen everyone just to say we’re looking. The goal isn’t to find more cancers – it’s to find the ones that matter:

Cancers that, if left undiagnosed, could progress and compromise a man’s health and longevity.

We’re talking about clinically meaningful cancers – not just something under the microscope, but something that can impact how a man lives his life.

Biopsy Isn’t Always About a Cure – Sometimes It’s About Clarity

For a man in his late 70s or 80s, we don’t always recommend biopsy with the goal of treatment. Often, the reason is simpler:

Let’s find out what this is, so we’re not guessing.

If we discover a cancer that isn’t aggressive, we may continue to watch. But if it’s higher-grade, we can keep a closer eye or intervene if symptoms arise. 

Either way, we’re working with real information – not just assumptions.

And that helps us stay ahead of complications like urinary obstruction, fatigue, or cancer that quietly spreads to bones. 

Even when cure isn’t the goal, we can still protect function, independence, and quality of life.

What Metastatic, High-Grade Prostate Cancer Really Means

When prostate cancer spreads, or is classified as high-grade, it’s no longer considered curable in the traditional sense. 

But it is treatable.

Men can live for many years with metastatic prostate cancer – especially when it’s detected before it causes major problems. 

Treatment can slow the cancer’s progress, manage symptoms, and preserve quality of life. But it may also come with trade-offs like fatigue or sexual changes.

And not all metastatic cancers behave the same. Some move quickly.

Others progress very slowly. Knowing which kind you have helps guide the next step.

That’s why a diagnosis – even in later life – can still matter greatly.

Shared Decision Making Is the Point

If you’re over 75 and wondering whether to continue PSA testing, the answer isn’t yes or no – it’s:

Let’s talk about it.

Are you feeling well overall? Would you want treatment if we found something serious? 

Or are you more focused on staying informed, so you can make the best decisions if and when something does show up?

There’s no one right answer. But there is one wrong one: silence.

Because screening is never just about numbers. It’s about what we do with what we find.

And knowing – even if we don’t treat – can guide smarter care, protect dignity, and help a man and his family feel prepared.

It’s not always about doing more. It’s about knowing enough to do what’s right – for you.