Close associates of Joe Biden remain divided over his health following his advanced prostate cancer diagnosis, which medical experts consider incurable. The oldest president to leave office, the 83-year-old Biden announced last May that he was diagnosed with Stage 4 prostate cancer that had metastasized to the bone.
However, some of his friends and former officials have expressed concern about Biden’s increased fatigue in recent weeks, noting he has appeared more tired during private interactions, reported the Washington Post on February 23.
These worries stem from the physical toll of the metastatic prostate cancer and the related treatment, which carries a Gleason score of 9 on a scale of 6 to 10. A score of 9 is among the most aggressive forms of cancer and is more likely to spread quickly, particularly to the spine, which is fatal.
Biden's friends attribute his observable fatigue to the strain of cancer he is dealing with and his treatment regimen, while another source told the Post that he still is active and engaged and remains "encouraged and positive about his prognosis given his positive response to treatment."
Biden's aides and family members publicly claim that he is well enough to work on his ongoing projects, including writing his memoirs, working on his presidential library, and attending public appearances, like the upcoming event in South Carolina on Feb. 27.
His trip to South Carolina is meant to assist the state's bid to keep its first-in-the-nation Democrat primary, which the former president lobbied for in 2024, after his primary win there in 2020 led him to gain his party's nomination. Twelve states are now fighting to hold the first Democrat primary for the 2028 elections, which formerly belonged to New Hampshire prior to 2024, right after the Iowa caucuses.
The average five-year survival rate for his aggressive cancer diagnosis is 34% to 38%, according to the American Cancer Society, which noted that advancements in cancer treatments have significantly improved the former president's chances. According to the Washington Post, oncologists believe that some men with metastatic prostate cancer can live for years with effective treatment, while others deteriorate rapidly.
Despite these concerns, Biden’s aides insist he is doing well, staying active, and responding positively to treatment. Biden completed a round of radiation therapy at Penn Medicine Radiation Oncology in Philadelphia on October 20, marking the occasion by ringing a ceremonial bell, a common tradition for cancer patients.
He also previously underwent surgery last September to remove skin cancer from his head. The former president has made few public engagements since leaving the White House in January 2025.
He attended Tatiana Schlossberg’s funeral in January, traveled with his family to St. Croix during the Christmas holidays, and was spotted last week traveling on Amtrak from Washington to Delaware, where he took pictures with passengers.
Meanwhile, experts like Boston University’s Gerald Denis have described the stage of illness as "very painful and difficult," and warn of serious risks such as spinal fractures from minor movements.
"If the spine has been degraded by the tumor metastasis, it's entirely possible to break your back simply by getting out of bed the wrong way," Denis told the Post.
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