Former President Biden’s last known prostate cancer screening was in 2014, a spokesperson for the former president said Tuesday. 

The acknowledgement that Biden hasn’t been screened in 10 years fills in some details regarding his diagnosis with aggressive, stage 4 prostate cancer that’s spread to the bone. 

Prostate cancer is extremely common in older men, and Biden’s announcement fueled public speculation about why a man with access to some of the best medical care in the country could be surprised with such a late-stage cancer diagnosis. 

“President Biden’s last known PSA was in 2014. Prior to Friday, President Biden had never been diagnosed with prostate cancer,” the spokesperson said. 

Many prostate cancers in the U.S. are detected with a blood test that measures prostate-specific antigen (PSA). But doctors for years have debated about the benefits of screening for prostate cancer, especially in older men.  

It’s best if the cancer is caught early, but there needs to be a balance between early detection and overtreatment for slow-growing cancer that doesn’t become life-threatening. 

When Biden was last tested in 2014, the U.S. Preventive Services Task Force, a volunteer panel of experts that makes preventive-health recommendations, recommended against any screenings regardless of a person’s age.

Guidelines have since shifted, and in 2018 they were updated to suggest men ages 55 to 69 make an “individual” decision after first discussing it with their provider.  

The panel continues to recommend against screening in older men because of limited benefit, as do most other organizations. Biden turned 72 in 2014. 

A medical report released in 2019 from then-candidate Biden showed he was once treated for “Benign Prostatic Hyperplasia BPH,” otherwise known as an enlarged prostate. But BPH is not cancer, and research shows it does not lead to cancer.