Health exam shows small nodule on Biden’s prostate. Now what?

Former President Joe Biden was hospitalized overnight last Friday in Philadelphia for “further evaluation” of a small nodule found on his prostate during a physical exam.

Biden’s spokesman told The New York Times he would not be providing any additional information about the former president‘s care. But prostate issues are not uncommon in older men.

Biden is 82 and was the oldest serving president when he left office in January.

A number of issues can be found in older prostates, including benign prostatic hyperplasia (called simply BPH and very common), prostatitis and prostate cancer. The National Institute on Aging explains that the prostate is a small gland that helps men make semen. It wraps around the tube that carries both semen and urine from the body and the prostate naturally tends to enlarge as men age.

Treating prostate issues

BPH requires “watchful waiting” to see if symptoms such as urination frequency and pain or lower back and groin area pain and stiffness get worse. Medication can also be given to shrink the prostate or provide pain relief by relaxing the muscles. Other, less common approaches include surgery or use of radio waves or lasers.

Acute bacterial prostatitis usually starts with a bacterial infection, so the institute recommends men visit their doctor if the symptoms of prostate trouble are accompanied by fever, chills or pain. It‘s typically treated with antibiotics.

There are two other degrees of prostatitis — the “itis” part in medicine means inflammation — including chronic bacterial infection and “chronic prostatitis,” which is chronic pelvic pain syndrome. That, like the treatments for BPH, can require medicine, surgery or lifestyle changes to provide relief.

After screening tests including a digital exam and blood work, a person with a nodule or enlarged prostate may be referred to a urologist for a biopsy, which takes small tissue samples to look for cancer.

Even if cancer is detected, treatment may be watchful waiting because prostate cancer is often, though not always, slow-moving. Other treatment options include surgery, radiation therapy and hormone therapy or a combination.

How common are prostate issues?

The concern on everyone’s mind is, of course, prostate cancer, which is relatively common for older American men. Risk goes up with age after 50, family history, regularly consuming a high-fat diet and race, as prostate cancer is most common in Black men, followed by white, Hispanic and Native American men. Asian American men have the lowest risk.

ABC News reported it‘s not the first brush with potential cancer for Biden. “In February 2023 during his presidency, Biden had a lesion removed from his chest that was cancerous and, before entering office, Biden had several non-melanoma skin cancers removed with Mohs surgery.”

Mohs is a tissue-sparing procedure that takes cancerous tissue but as little noncancerous tissue as possible by checking tissue margins for cancer cells.

Basal cell carcinoma, which is the type of cancer he had, does not typically “spread” to other parts of the body.

Prostate cancer is the most common cancer for men in the U.S., aside from non-melanoma skin cancer, impacting nearly 115 men per 100,000, according to the Centers for Disease Control and Prevention. That‘s more than twice as many as the number of men who get lung and bronchus cancer, colon and rectum cancer or urinary bladder cancer, which are the next most common.

In 2021, close to 237,000 new cases of prostate cancer were diagnosed.

While most older men who do have prostate cancer die with the disease, rather than of it, prostate cancer can kill. It is one of the leading causes of cancer deaths for men, behind lung and bronchus cancer. In 2022, 33,363 men died of prostate cancer in the U.S., per the CDC.

According to Newsweek, Biden was declared “fit to serve” in February 2024 after a physical at Walter Reed National Military Medical Center.