How long could Biden have left? Experts reveal bleak prognosis for men with advanced prostate cancer - yet there is hope
Former US president Joe Biden could have less than five years left to live because his prostate cancer is aggressive, has spread and was caught late, data suggests.
The 82-year-old's diagnosis was announced on Sunday, and revealed the disease had been given a Gleason score of nine and had already spread to his bones.
A Gleason score is a system which medics use to grade prostate cancer using samples taken from a biopsy that assess its aggressiveness, how likely it is to grow and spread.
The scale goes up to 10 meaning Biden has received the second-highest potential score.
A result of nine means the cancer looks like it will likely grow and spread at a 'moderately quick rate', according to Prostate Cancer UK.
Studies conducted on thousands of men with the disease show only about one in three of those diagnosed with a Gleason score of 9–10 were alive at the end of a 10-year follow-up.
Of the remainder, almost half had died from the disease, and nearly one in four from other causes like advanced age.
But Biden's cancer has already spread to his bones, implying it is at stage 4.
This is the later stages where the disease has spread to other parts of the body, also known as metastatic cancer.
While Biden's disease has been described as 'stage 5', this typically references a very advanced stage 4.
Data from Cancer Research UK show that only 50 per cent of men diagnosed with stage four prostate cancer are alive five years after their diagnosis.
However, there are overall statistics covering men of all ages who are diagnosed at this stage.
Biden, being in his 80s, will face additional challenges relating to his age.
Of all prostate cancer deaths recorded in the UK of all stages the vast majority (75 per cent) are among men aged 75 and over.
Ben Lamb, a consultant urological surgeon, Barts Health and University College London Hospitals NHS Foundation Trusts said cases of prostate cancer like Biden's account for the minority of cases.
'Most prostate cancer, around four fifths, in the UK is diagnosed before it is metastatic, with one fifth diagnosed with metastatic disease,' he said.
He added that most cases of late diagnosis are linked to 'deprivation, ethnicity and older men'.
Mr Lamb added that in cases like Biden's the go-to option for treatment is typically hormone therapy to stop the spread of the cancer.
'Prostate cancer depends on testosterone to grow, and by blocking testosterone production and action, the cancer can be effectively treated but not cured.
'Additional modern hormone drugs (known as ARTA's) are given in addition, and these are known to prolong survival. Chemotherapy can also be given.'
He added that, for most men the first symptom they notice is problems urinating, but this in the early stages.
Biden had recently reported urinary problems, a known red flag for the disease.
As the disease advances, patients like Biden will face additional problems caused by their growing cancer, Mr Lamb added.
'In later stage disease, some men may have symptoms from metastatic disease, such as fatigue, bone pain or weight loss,' he said.
'Lymph node spread can cause blockage of the kidneys with renal failure and leg swelling.
'If the prostate tumour is large, it can cause bladder symptoms, though in most men in general, these are from benign enlargement of the prostate as men age.'
Several medics have questioned how Mr Biden's cancer could have been caught so late, given his age means he is at advanced risk of the disease and it can be screened for by routine blood tests.
'It is inconceivable that this was not being followed before he left the Presidency,' wrote Dr Howie Forman, a professor of radiology and biomedical imaging, public health management and economics at Yale.
He noted that the test for prostate-specific antigen would have shown he had cancer 'for some time before this diagnosis', given how aggressive it is.
About 55,000 British men and more than 300,000 in the US are diagnosed with prostate cancer each year.
Survival from the disease has vastly improved over time thanks to screening, increased awareness of symptoms and better treatments.
In the 70s only a quarter of men were expected to survive a year after their diagnosis.
However, this has now increased to around 80 per cent.
Generally, cancer is easiest to treat if caught in the earlier stages and patients tend to have better outcomes.
Due to the prostate's location—the gland is situated below the bladder, and wraps around the urethra—it most commonly causes urinary symptoms.
If a man notices these, it;s important to speak to a GP and discuss whether something called a PSA test might be warranted.
PSA stands for prostate specific antigen, a hormone that's produced by the prostate in higher amounts if there is a problem with the gland.
One of the most common signs something is wrong with the prostate is a change in urinary frequency.
While the amount people urinate can vary widely—anything between four and ten or so times can be seen as normal—it's a noticeable increase that experts say men need to be aware of.
Sudden urges—needing to rush to the loo—may also be a sign of a problem.
This could be coupled with difficulty in starting to pee, known medically as hesitancy.
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Search her name on any social media platform and you'll see FoodBabe, with her hair curled and pink lipstick freshly applied, pointing out the bleached white flour 'contaminated with weed killer' and 'emulsifiers and gums that wreck your gut' in the products on supermarket shelves. She wishes that they would be 'wiped from this earth,' she wrote in a caption. These ingredients, often illegal in Britain, enrage Hari because they are 'harmful to the human body' and are there to 'improve the bottom line of the food industry', she says. She seems to have a point. The average American is more likely to be overweight than they are to be within a healthy weight range. More than one in ten are type two diabetic, heart disease accounts for one in every five deaths, and rates of colorectal cancer in young people have nearly doubled since 1995. It is no wonder that the average American's life expectancy is in decline, dropping to 76 years in 2021 from 79 years in 2019. 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She set up FoodBabe because 'people asked me why I try to avoid MSG in the soup at restaurants, or why I don't eat artificial food dyes,' she says, and her work is meant to help people navigate the 'unconventional lifestyle choice' of a diet free from processed foods. Her own rigorous attempts to avoid harmful ingredients are what have led to her fame. In 2012, Hari took a closer look at the ingredients used by a frozen yoghurt shop in her hometown of Charlotte, North Carolina. She discovered that the chain had been using artificial flavourings, despite claiming to be organic. Her post went viral, forcing the company's CEO to make a written apology. Hari then turned her attention to Starbucks. She convinced a barista to give her the recipe for a pumpkin spice latte and shared it online for the first time, along with criticisms of the ingredient list. Worst of all, she said, was an ammonia-based caramel-colour food dye. 'It's already brown, so in what world is that necessary?,' she asks, clearly recalling the outrage a decade on. Starbucks later pulled the dye from its drinks. Next came Subway. 'I thought I was eating fresh when I ate there, but when you look closer at what's in a Subway roll, there were nearly 60 ingredients in there, and one ingredient was azodicarbonamide. It's found in yoga mats and shoe rubber.' Another petition, hand-delivered, led to the ingredient's removal. Then it was Kellogg's: in 2015, the company said it would remove an additive called butylated hydroxytoluene from its American products after Hari launched a petition that attracted hundreds of thousands of signatures. The food dye ban announced earlier this year 'was a huge achievement' for Hari, she says. Greater still, though, she was invited back to the White House by the president himself just weeks later, to witness the release of the first Make America Healthy Again (Maha) report. Listed as problems were the things Hari has railed against for years: sweeteners, high-fructose corn syrup, seed oils and pesticides. 'Our food system is poisoning us, and we finally have leaders who want to make changes,' she wrote in her weekly newsletter. Her role in that has been to 'communicate different things to the public and make sure our leaders do what they say they're going to do,' she says. Hari has a legion of Maha moms behind her, who she calls her 'FoodBabe army'. She wasn't always so comfortable being a figurehead for additive-free living. 'I wanted to call the blog 'eat healthy, live forever', but my husband, the tech geek in the family, thought it was a terrible name,' she says. 'Foodbabe' was her husband's suggestion. 'People think that I was calling myself food babe, but I didn't think of myself as a babe at all. I had these cartoon characters that I hid behind for a year and a half, while I still had my corporate job. Describing myself in that way felt very foreign.' Growing up, in one of just a handful of Indian families in Charlotte, Hari ate a standard American diet. 'I grew up with two immigrant Indian parents, and when they came here to the United States, they really adopted the American food system and they were very trusting of it,' Hari says. Her parents wanted her and her older brother to fit in. 'My mom was cooking medicinal, Indian spiced cooking at home for her and my dad, but they didn't require me and my brother to eat it.' She ate fast food several times a week and 'as many processed foods as I possibly could'. Hari believes that this is why 'my brother and I both had severe health issues,' she says, 'but when they took me to the doctor, no one asked what I was eating'. She was put on nine different prescription drugs in her early twenties, shortly after she finished her computer science degree at the University of North Carolina. 'I hit rock bottom after that. I ended up having surgery to remove my appendix, when I got appendicitis, and I had to have surgery for endometriosis a few years later too.' Doctors told Hari that her appendix wasn't an essential organ, as our bodies have 'evolved not to need it'. She wasn't satisfied with that. 'It really baffled me that God would put this organ in your body that you don't need. I did my own research and found that your appendix is really there to populate your gut with good bacteria.' It was then that Hari 'started to investigate why this was happening to my body, what was causing those problems and what exactly I was eating,' she says. Processed foods were contaminated with dangerous chemicals, she found, so she 'decided to opt out of that system' and eat only whole foods. Hari also came off her medications. She lost weight, her eczema vanished, 'and I started to feel better and have better energy'. Ever since she began her work, Hari has been criticised as a scaremonger. As early as 2014, she was accused of generating controversy to drive traffic to her blog and sell copies of her healthy eating guide. Many of the chemicals she discusses are safe, if unnecessary, say some experts, like the bread ingredient that Hari's petition forced Subway to scrap. But people would understand if they 'put themselves in my shoes, and thought about how I had two surgeries in my early twenties,' she says. 'I deeply am passionate about helping Americans to avoid what I went through. I want them to know the truth about what they're eating, and that nature has provided everything we need.' In 2017, Hari set up Truvani, a food company that makes protein products. Her powders and bars are stocked in Whole Foods in the US. 'I became a mother, so instead of taking on the food industry full time, I kind of took a backseat to that, and decided to start my own thing, using ingredients that you would find in your own kitchen.' Her children are now four and eight. Then, in late 2024, Hari 'got out of retirement as a food activist', as she puts it. 'An old friend called me and asked me to help take on the food industry. When you really have a passion for something, it keeps calling.' There was another target in her sights, too: 'a really important issue that I didn't think was being addressed, which is that American companies are using better, safer ingredients in other countries and using dangerous ingredients here.' Last September, she spoke at a Washington roundtable about the issue, presenting flipcharts filled with comparisons between the American and British versions of different foods. It was this that put her on Kennedy's radar, she says. The health secretary, who unsuccessfully ran against Trump in the 2024 election (before dropping out and endorsing him), 'was really giving attention to the issues I've been working on, getting the food industry to be cleaner, use less ingredients and be more transparent, and he wanted to make that a primary focus of his mission,' Hari says. She first met the health secretary at a dinner the night before the Washington event in September, and has been there 'to support him' since. The two have 'a spiritual connection,' Hari says. Like her, he 'has been vilified for his ideas, and he's been called everything under the sun for the work he's done to try to protect citizens from the pharmaceutical industry and from the chemical industry.' Now, the state of Texas is behind them, too. A bill signed yesterday by the state's governor demands that warning labels are added where foods contain additives that are banned outside of America. Even though many nutritionists would agree with Hari that UPFs (ultra-processed foods) are bad for our health, she has joined the health secretary and a cast of other characters in a group that has been called anti-science, and that is certainly anti-convention. One such character is Dr Casey Means, the incoming surgeon general, who holds a PhD in functional (alternative) medicine rather than a traditional medical degree, and like Hari has a high profile on social media. Her brother Calley Means, now a special government employee, is an influencer, health startup entrepreneur, and former lobbyist for both major food and pharmaceutical companies. He is credited with encouraging the health secretary and the president to combine forces in the first place. Hari herself has no formal qualifications as a nutritionist. She doesn't see that as an issue. 'I don't know how many books you need to read or to write about eating healthy to make you eventually qualified to talk about this,' she says. Rather than being a Republican, however, Hari says she is an independent — and she used to be a Democrat. In 2008, she became a delegate for the Democrats, meaning that she was selected to represent her local area at the party's convention and could vote on their presidential nominee. Hari backed Barack Obama because he promised to force the labelling of genetically modified foods. In 2012, after this didn't come to pass, she sat in the first row on the convention floor and held a sign that read 'label GMOs!' during the then-agriculture secretary's speech. Going against her fellow Democrats was not a difficult decision. 'Poison is not partisan,' she says. 'When a child gets cancer, she doesn't know whether she's Democrat or Republican, or she doesn't care. Politics doesn't matter, because you have nothing other than your health.' Does Hari see a prime spot for herself in the White House, alongside Calley and Casey Means? She is a talented campaigner, with a powerful story, and the ability to communicate ideas about healthy living to a population that loves its fast food. 'It's unacceptable that we haven't had more clear communications and guidelines coming from our government, not until now, anyways,' she says. She hopes that Maha 'outlasts this President and continues to go on.' Future leaders are going to 'have to have these issues as part of their platform, or they're not going to get voted in, because Americans care about them,' Hari believes. But 'what I am first is a mom,' says Hari. 'I've got two small kids, so my business is being there for them, and then I'll continue to use my platform to inform Americans about the food industry and the food that they're eating. So I'm just going to keep doing that.'
