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Early detection can save lives, yet outdated screening advice still puts too many men at risk. Here’s how modern tools and smarter choices can change that.
By: Dr. Manuj Agarwal
In May 2025, former President Joe Biden was diagnosed with metastatic prostate cancer. The announcement was made promptly and transparently, serving as a sobering reminder of how silently prostate cancer can progress—often without symptoms until it has spread. Even with access to world-class health care, his cancer was not detected early.
This high-profile case brought renewed attention to an urgent issue: prostate cancer remains one of the most curable cancers when caught early, but a combination of outdated screening practices and age-based cutoffs continues to delay diagnosis for too many men.
As a physician who specializes in prostate cancer, I’ve spent the past decade helping men navigate this deeply human disease. I’ve witnessed firsthand how impersonal, overly rigid policies have led us away from a thoughtful, individualized approach to health—one that honors not only the body but the mind and soul.
I Was There When the Shock Waves Began
In 2012, while training as a resident in radiation oncology, I remember the day the U.S. Preventive Services Task Force (USPSTF) issued a now-infamous grade D recommendation against prostate-specific antigen (PSA) screening—a simple blood test that measures prostate-specific antigen levels and can signal prostate cancer.
Overnight, the message to millions of men became: “You don’t need to check.” Yet we knew this wasn’t true for everyone. We knew lives would be lost. And we knew that by ignoring the wisdom of personalized care, we were taking away not just years from a man’s life but potentially his vitality, purpose, and sense of security.
That fear has proven correct. Over the past decade, we’ve watched early-stage prostate cancer diagnoses drop while late-stage, incurable diagnoses rise.
The Data Tell the Story–But So Do Our Patients
A 2022 study reported a 41 percent increase in metastatic prostate cancer in men aged 45 to 74 between 2011 and 2018. Among men aged 55 to 69, the increase was over 50 percent.
Another study published in JAMA Oncology confirmed what we’ve felt in practice—too many men are now being diagnosed when cure is no longer possible.
In a large Veterans Health Administration cohort, PSA screening rates fell from approximately 50 percent to 37 percent between 2005 and 2019. This decline in screening was statistically associated with a higher incidence of metastatic prostate cancer five years later, highlighting the delayed but profound effect that reduced screening has on disease progression and curability.
This isn’t just a statistical concern—it’s an emotional one. I’ve seen patients react not just with fear but with frustration—because they didn’t know. Because they trusted the system and were never offered a test that could have changed everything.
And often, the regret isn’t just theirs. It belongs to their partners, children, and loved ones—those who would have gladly traded one conversation for more time, more memories, more peace.
An Update That Came Too Quietly
In 2018, the USPSTF softened its stance, upgrading its recommendation to a grade C and encouraging shared decision-making. However, the revision barely made a ripple. The damage had been done. Screening rates remained low. Trust remained shaken.
From what I’ve observed in practice, many clinicians never returned to recommending PSA screening. The caution became habit. And the inertia cost us precious time in catching this disease early.
The Hidden Age Bias in Modern Medicine
Today’s guidelines still recommend stopping PSA screening around age 70. But this is based on averages—not people. And none of us is average.
I care for many vibrant, high-functioning men in their 70s and even 80s—men who exercise, travel, work, and contribute to their families and communities. They are not statistics. They deserve individualized care.
Biden’s case underscores this flaw in our system. His last publicly known PSA test was in 2014, at age 72. After that, no screening appears to have been done until 2025—when the cancer was metastatic. Had his PSA been monitored, his cancer might have been detected when it was still curable.
If you are over 70 and in good health, do not assume screening no longer matters. Ask your doctor to continue PSA testing. Advocate for yourself. You are more than a number.
Who’s Most at Risk?
While prostate cancer is common, certain groups face far greater danger:
Black men are 1.7 times more likely to develop prostate cancer and more than twice as likely to die from it compared to white men.
In absolute terms, about 1 in 6 black men will be diagnosed with prostate cancer in their lifetime, and about 1 in 23 will die of it. For comparison, about 1 in 8 white men will be diagnosed with prostate cancer, and approximately 1 in 44 will die of it.
Men with a family history—especially those with a father or brother diagnosed before age 65—face increased risk.
Men with inherited mutations such as BRCA2 are also more likely to develop aggressive prostate cancer at a younger age.
Lifestyle factors including poor dietary habits, high in red meat and dairy, a sedentary lifestyle, obesity, and chronic inflammation possibly linked to environmental exposures and pollution further raise risk.
For these groups, screening should begin at age 40—and should not stop at an arbitrary age cutoff.
We Have Better Tools Than Ever
Critics of PSA screening often cite false positives, unnecessary biopsies, and overtreatment. However, this concern reflects an outdated understanding of how we now approach prostate cancer.
Modern screening is precise, adaptable, and safe:
Using advanced imaging, including multiparametric magnetic resonance imaging (MRI) before biopsy, to target suspicious areas and avoid unnecessary procedures.
Performing transperineal biopsies, a technique where samples are taken through the skin between the scrotum and anus rather than through the rectum, to improve accuracy and reduce infection risk.
Conducting genomic testing to distinguish between aggressive and slow-growing disease.
Choosing active surveillance, a strategy of closely monitoring prostate cancer with regular PSA tests, MRIs, and biopsies instead of immediate treatment, to spare men with low-risk cancer from overtreatment.
PSA is not the endpoint—it’s the starting point for a modern, nuanced, and individualized diagnostic process.
Treatment Success Stories: Healing Is Possible
A 43-year-old African American man—well outside the typical screening age—presented with urinary symptoms and was diagnosed with high-risk prostate cancer. I treated him with radioactive seed implantation (brachytherapy). This is an outpatient procedure where small radioactive seeds are placed directly inside the prostate gland. Today a decade later, he has no evidence of disease and full function. If he was not diagnosed and treated then, he likely would have metastatic disease now.
A 78-year-old man had his PSA checked as part of an elite rowing performance evaluation. He was found to have intermediate-risk, nonmetastatic prostate cancer. Given his excellent health and longevity potential, this was a cancer likely to affect him within his lifetime. He also underwent brachytherapy and remains cured five years later—another example of life-saving detection and treatment beyond conventional screening age.
These cases are not anomalies. They’re reminders that early detection saves lives and that age or perceived low risk should never disqualify a man from the care he needs.
What You Can Do Now
Here’s what I recommend to all men—and their loved ones:
Know your risk: If you’re over 50, black, have a family history of prostate cancer, or a genetic predisposition, get screened.
Don’t let age stop you: If you’re over 70 and healthy, talk to your doctor. Screening still matters.
Push for clarity: If your PSA is rising, ask for an MRI or see a specialist. Don’t wait.
Understand your options: Not everyone needs treatment—but everyone deserves to know what’s going on.
Include screening in your wellness plan: Treat it as routine, like checking blood pressure, cholesterol, or scheduling a colonoscopy.
Biden’s diagnosis reminds us why this matters. He may not have belonged to a traditionally high-risk group, but he was a healthy older man—still active, engaged, and contributing. His case underscores the flaw in age-based cutoffs. Screening decisions should be based on health and life expectancy, not just birthday candles.
Daily Habits That Can Lower Your Risk
While screening is critical, lifestyle also plays a role in prevention. Here are simple, actionable steps:
Eat a plant-forward diet: Focus on leafy greens, cruciferous vegetables, tomatoes rich in lycopene, and healthy fats like olive oil.
Limit red and processed meats: These are associated with higher cancer risk.
Exercise regularly: Aim for 150 minutes of moderate exercise per week, such as brisk walking.
Maintain a healthy weight: Excess body fat is linked to more aggressive disease.
Reduce inflammation: Avoid smoking, limit alcohol, and manage stress with sleep, social connection, and mindfulness.
In 2012, a single policy decision changed the trajectory of prostate cancer care in the United States. It created confusion, pulled back on prevention, and shifted us away from life-saving early detection. The 2018 revision, though well-intentioned, came too quietly to reverse the harm.
The surge in advanced disease isn’t just about statistics—it’s about fathers, brothers, and friends. Biden’s case is a powerful reminder that even a man with access to the best care can be affected when screening guidelines are too rigid. His diagnosis should galvanize us to take a more individualized approach—guided by health, not age.
This is our moment to change course—before it’s too late for the next generation of men. Let’s not waste the opportunity.