Biden's cancer battle highlights need for early prostate-cancer diagnosis

News that former US President Joe Biden's prostate cancer has spread to his bones has drawn attention to a disease that is frequently diagnosed at an advanced stage among Kenyan men.

In an interview broadcast by the BBC, Hunter Biden said his father's cancer had metastasised to the bones and described the illness as painful and debilitating.

Biden, 83, was diagnosed in May 2025 with aggressive, hormone-sensitive prostate cancer and bone metastases. Public statements have indicated that he subsequently received hormonal treatment and completed a course of radiotherapy.

In Kenya, prostate cancer is the most frequently diagnosed cancer among men. Current national reporting estimates that about 3,601 new cases are diagnosed annually, representing 25.9% of cancers diagnosed in men.

What it means when cancer reaches bone

Dr Catherine Nyongesa, Consultant Clinical and Radiation Oncologist and Director of Medical Services at Kenyatta National Hospital, explains that bone metastasis means the cancer is no longer confined to the prostate gland.

“Cancer cells have broken away from the prostate, travelled through the bloodstream or lymphatic system, and settled in the skeleton, most commonly the spine, pelvis, ribs, upper thigh bones and skull,” says Dr Nyongesa, who is also President of the African Radiation Oncology Group.

Disease that has spread to a distant organ is classified as metastatic, or Stage IV, prostate cancer. Bone is the commonest distant site involved. Studies suggest that bone metastases develop in up to nine in 10 men during the course of advanced metastatic disease.

Prostate-cancer deposits in bone are commonly osteoblastic, meaning that they stimulate abnormal new bone formation. However, bone destruction and mixed changes can occur as well. The affected area may look unusually dense on an X-ray, but the new bone is disorganised and may remain painful and structurally weak.

Patients may develop persistent bone pain, fractures, anaemia or reduced mobility. If cancer in the spine compresses the spinal cord, it can cause severe back pain, leg weakness or numbness, and loss of bladder or bowel control. This is an oncological emergency requiring immediate hospital assessment.

Spread does not always mean delayed or inadequate care.

Dr Nyongesa cautions that bone  metastases may be associated with late diagnosis, but do not automatically mean that a patient delayed seeking care or received inappropriate treatment.

“Prostate cancers do not all behave in the same way. Some grow slowly and remain confined to the prostate for many years. Others are biologically aggressive and can spread relatively early. Cancer may also recur or progress years after apparently successful initial treatment,” she says.

There is therefore no fixed period within which prostate cancer reaches bone. Metastatic disease may already be present when an aggressive cancer is first diagnosed, while in other patients progression may occur several years later.

“The important public message is that bone metastasis is not the end of treatment. Modern care can control the disease for prolonged periods, relieve pain, protect the bones and preserve quality of life,” she adds.

Accurate diagnosis is essential

Experience from the KNH patient-navigation programme highlights the importance of complete diagnostic and staging information in prostate-cancer care.

“Accurate staging helps the clinical team select the most appropriate treatment for each patient. We must strengthen diagnostic services, ensure that investigation results accompany patients during referral, and improve cancer registries and referral data,” says Dr Nyongesa.

Complete staging allows clinicians to determine whether the disease is confined to the prostate, has spread to nearby tissues and lymph nodes, or has reached distant organs such as the bones.

It also helps prevent unnecessary repeat investigations, reduces delays and ensures that patients are directed to the appropriate specialist and treatment pathway.

Why prostate cancer favours the skeleton

Several factors help explain prostate cancer's tendency to spread to bone. Veins draining the prostate connect with a network of veins running alongside the spine, providing one possible route to the vertebrae and pelvis.

Bone marrow also contains growth signals that may support tumour cells. Once established, cancer cells disturb the normal balance between bone formation and breakdown. This interaction can create a cycle in which changes in bone release further signals that support tumour growth.

Treatment is available

Although metastatic prostate cancer is generally not considered curable, it remains treatable. Many men can live for years with appropriate treatment and supportive care.

Treatment usually begins with androgen-deprivation therapy, which reduces or blocks testosterone, the main hormonal driver of most prostate cancers. This may be achieved with injections or by surgical removal of the testes.

“Where appropriate and available, we now combine androgen-deprivation therapy with a newer androgen-receptor-targeted medicine or chemotherapy because combination treatment improves survival compared with hormone treatment alone,” Dr Nyongesa explains.

Selected patients may also receive bone-modifying medicines to reduce fractures and other skeletal complications. Dental assessment is recommended before medicines such as zoledronic acid or denosumab are started because of the small but important risk of damage to the jawbone.

Radiopharmaceuticals and targeted treatments may be considered in selected patients. PSMA PET-CT scanning and lutetium-177 PSMA therapy are available at selected specialist centres in Kenya, although eligibility depends on the cancer's characteristics, previous treatment, blood counts, kidney function and the patient's general condition.

Radiotherapy can relieve pain

Radiotherapy is a highly effective treatment for painful bone metastases. For uncomplicated painful deposits, one treatment session can provide pain relief comparable to longer courses, although some patients may later require retreatment.

“For a patient who has travelled from a distant country, completing palliative radiotherapy in one visit can make an enormous difference,” Dr Nyongesa says.

Spinal-cord compression requires urgent multidisciplinary assessment. Treatment may include corticosteroids, surgery and radiotherapy, depending on the location of the compression, the patient's neurological condition and overall health.

Pain control and palliative care should begin when they are needed and should be provided alongside cancer-directed treatment, not reserved only for the final days of life.

“No Kenyan man should remain at home in uncontrolled pain because his disease is considered too advanced to help. There is almost always something we can do to relieve suffering and support the patient and family,” she says.

What makes prostate cancer aggressive?

Aggressiveness is assessed using several factors. Pathologists examine how abnormal the cancer cells look under a microscope and assign a Gleason score and Grade Group. A high score indicates a cancer that is more likely to grow and spread quickly.

Doctors also consider the prostate-specific antigen level, how rapidly it is changing, the amount and location of disease, and whether the tumour carries high-risk molecular features. Inherited alterations in genes such as BRCA2 may be associated with more aggressive disease and can influence treatment decisions.

Public information about Biden's diagnosis described a Gleason score of 9, Grade Group 5, with bone metastases. Dr Nyongesa declined to speculate about his prognosis or individual care.

“A patient's prognosis depends on far more than one score. It is a private matter that should be discussed by the patient and the treating team,” she says.

Early discussion and assessment

Early prostate cancer may cause no symptoms. Urinary symptoms are common and are often caused by non-cancerous prostate enlargement, but they should still be assessed. Persistent unexplained back or bone pain, weight loss, weakness or worsening urinary problems also warrant medical review.

Dr Nyongesa advises men to discuss prostate-cancer screening with a qualified  healthcare professional from about the age of 50. Those at higher risk, including men of African ancestry and men with a father or brother who developed the disease, should begin the conversation earlier, often from around age 45.

“Early diagnosis provides more treatment choices and the best opportunity for cure. When back pain is caused by metastatic disease, treatment is usually aimed at long-term control rather than cure. We must encourage men to seek assessment before symptoms become severe,” she says.