Prostate cancer awareness in 2025: A human imperative in the wake of President Biden’s diagnosis

Former President Joseph R. Biden’s recent diagnosis of metastatic prostate cancer has put prostate health back into the national spotlight. His courage in sharing his diagnosis, particularly at age 82, reminds us that prostate cancer does not discriminate. It’s a disease that touches families across race, class, geography, and political lines. As clinicians, researchers, and advocates, this moment invites us to reflect on how far we’ve come—and how much further we must go.

Michael S. Cookson, MD, MMHC, FACS

Prostate Cancer Awareness: Not Just a Month

Prostate cancer awareness isn’t just about blue ribbons in September. As I’ve often said, “Cancer doesn’t take a holiday or a weekend.” Prostate cancer screening is an everyday opportunity to save a life. Prostate cancer awareness is about ensuring that men, their families, and their physicians have year-round access to meaningful conversations about risk and prevention.

Since the introduction of prostate-specific antigen (PSA) screening in the early 1990s, prostate cancer mortality has declined by more than 50%. During that same time, US male life expectancy has increased from 71.8 years to over 76 years. These gains reflect not only medical progress but also the courage of men who chose screening, diagnosis, and timely treatment.

Yet, disparities remain stark. Black men are 70% more likely to be diagnosed with prostate cancer and more than twice as likely to die from it than White men. Americans who live in rural communities also often face geographic and economic barriers to care. Your zip code or skin color should never determine your survival odds—but in 2025, they still do. Changing that is no longer optional; it is both a medical and moral obligation.

Screening Guidelines in 2025

Screening remains one of the most debated issues in prostate cancer care. The key is not to detect every tumor but to identify the aggressive cancers early enough to intervene—without subjecting men to unnecessary biopsies, imaging, or treatment for indolent disease.

Current recommendations from national guidelines include the following:

• American Urological Association: PSA screening for men aged 55 to 69 years with shared decision-making; earlier for high-risk individuals¹
• National Comprehensive Cancer Network: Baseline PSA at age 45; further screening intervals based on risk²
• American Cancer Society: Discussions at age 50 (average risk), 45 (high risk), or 40 years (very high risk)³
• US Preventive Services Task Force: Grade C recommendation for men aged 55 to 69 years; against routine screening after age 70⁴

These guidelines are a product of the data available in the late 1980s. However, almost 4 decades later, the health of the population has changed, which argues for extending the upper age of screening in healthy men.

Shared Decision-Making: Beyond Guidelines

Shared decision-making is where medicine becomes most human. It’s the space where guidelines meet values. A man asking about PSA screening is asking whether he will live to retire, to see grandchildren, to fulfill his future plans. Our job is to provide the facts: PSA screening may reduce the risk of prostate cancer death, but it also carries risks—false positives, biopsies, and treatment adverse events. The clinician’s role is not to dictate but to guide.

Life Expectancy: Context Is Everything

Life expectancy plays a pivotal role in screening and treatment. Screening may not offer a meaningful benefit for men with less than 10 years of expected life, but it may be life-extending for healthy, active men in their 60s or even 70s. We must individualize care based on health status, not just age alone. The mere fact that men are living longer than when initial studies on screening were conducted argues for moving the goal posts for men beyond the age of 70 years.

Advanced and de Novo Metastatic Prostate Cancer

Although early detection is critical, treatment options for advanced prostate cancer have evolved dramatically:

• Androgen deprivation therapy remains foundational.

• Docetaxel and/or second-generation androgen receptor inhibitors (abiraterone acetate [Zytiga], enzalutamide [Xtandi], apalutamide [Erleada], darolutamide [Nubeqa]) improve survival. This has led the way for treatment intensification and improved survival with combination therapy.

• Prostate-specific membrane antigen–targeted therapies and PARP inhibitors offer options for resistant or genetically driven cancers. Imaging coupled with treatment and a greater understanding of germline and somatic mutations has opened the door for precision medicine in prostate cancer therapy.

• Treatment intensification—initiating potent therapy combinations early—is key to improving both survival and quality of life. There is also a keen awareness of the need for deintensification in the appropriate setting and proactive adverse effect management for both disease and treatments.

Conclusion: A Call to Action

President Biden’s strength in facing cancer adds a powerful voice to the broader conversation on men’s health. But awareness and progress should not rely on headlines. As urologists, oncologists, primary care providers, and community leaders, we must normalize conversations, reduce disparities, and expand access to care. Prostate cancer is not just a medical issue—it is a deeply human one.

REFERENCES

1. Early detection of prostate cancer: AUA/SUO guideline (2023). American Urological Association. Accessed May 28, 2025. https://www.auanet.org/guidelines-and-quality/guidelines/early-detection-of-prostate-cancer-guidelines

2. NCCN. Clinical Practice Guidelines in Oncology. Prostate cancer early detection. Accessed May 28, 2025. Htts://www.nccn.org

3. Prostate cancer early detection, diagnosis, and staging. American Cancer Society. Accessed May 28, 2025. https://www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging.html

4. US Preventive Services Task Force, Grossman DC, Curry SJ, et al. Screening for prostate cancer: US Preventive Services Task Force statement. JAMA. 2018;319(18):1901-1913. doi:10.1001/jama.2018.3710