Former President Joe Biden’s recent prostate cancer diagnosis raised a flurry of concern for his health — and suspicions about why the cancer hadn’t been discovered sooner.

Two experts on prostate cancer told The Baltimore Sun it is possible to have a sudden, serious diagnosis. Otis Brawley, former chief medical officer of the American Cancer Society, said he sees six to nine patients each year with newly diagnosed metastatic disease. Brawley is currently a professor of oncology and epidemiology at Johns Hopkins University.

“The last one, for example, was classic,” he said: “‘Hey, doc, I got screened every year for 25 years for prostate cancer, and now I got this pain in my hip, and they tell me I have metastatic prostate cancer. How could that happen?’”

The cancer diagnosis comes amid a swirl of discussion about the former president’s cognitive decline during his time in office. A new book is set to be released today, discussing the president’s mental acuity during his run for president in the 2024 election, written by CNN’s Jake Tapper and Axios’ Alex Thompson. And over the weekend, Axios released audio recordings of President Biden’s interviews with Special Counsel Robert Hur in October 2023, which showed the president sometimes slurring his words, muttering and struggling with his memory.

“What I want to know is how did Dr. Jill Biden miss stage five metastatic cancer or is this yet another cover-up???” wrote Donald Trump Jr. on X on Sunday.

There’s no indication that Biden or his staff were aware of his prostate cancer diagnosis during his first term or recent campaign for president. If they did know, that would raise ethical concerns, said Roger Hartley, dean of the University of Baltimore College of Public Affairs.

“If there had been any indication that he was aware that he was sick, and his team was aware that he was sick, and that was not relayed to the public, that … would have been a great concern to the public if he had won, because that would have been dishonest.”

Hartley noted that other politicians have battled cancer — including Former Republican Gov. Larry Hogan and Democratic Maryland Congressman Jamie Raskin — and “been deemed, I think, by most, to have done a really great job.”

Hogan was diagnosed with non-Hodgkins lymphoma in 2015, months after getting elected to his first term. He took chemotherapy treatments for six months and eventually became cancer-free.

“Cancer knows no politics,” Hogan said in an X post on Sunday. “I join with all Americans — millions of whom have faced a dreaded cancer diagnosis — in offering my prayers and support to former President Joe Biden and his family as they take on this fight. Yumi and I wish the former President and his family the strength and grace to face this battle and overcome it.”

Raskin overcame colon cancer after being diagnosed in 2010 and has recovered from diffuse large B-cell lymphoma, which he announced in 2022.

“Sending love, support and solidarity to President Biden and his family,” Raskin said on X on Sunday. “We know he’ll face this cancer fight with the same grace, tenacity and strength he has shown throughout a lifetime of public and private battles. This man shows us what character and courage are made of.”

Prostate screenings recommended

People are usually recommended to be screened between 50 and 55 years old and 70 and 75 years old, experts told The Sun. Screenings aren’t usually recommended past age 75 because the risks of treatment can possibly outweigh the benefits. Biden is 82 years old and doesn’t fall within the recommended time frame for screening.

“There’s no inherent harm in just having more information,” said Mohummad Siddiqui, director of urologic oncology and robotic surgery at the University of Maryland Medical Center. “However, when you add this up over the course of all the different diseases that are out there and all the different tests that you can do, you start over-medicalizing everyone.”

Siddiqui explained it’s estimated that around one in three men in their 80s probably have prostate cancer, but very few have problems arise because of it. “If you never told them, they would live their whole natural life and die … never having had to worry about and never having had to go through all the doctor visits and the treatments and the side effects and the complications.”

It’s possible that for prostate cancer to appear to be a “bland, non-aggressive” cancer during a screening, but then later suddenly “explode,” Siddiqui said. “That happens infrequently, but it can happen.”

When people are diagnosed with cancer between scheduled screens, it’s known as “interval cancer,” which is “more aggressive than screen-detected cancers,” said Brawley, the Johns Hopkins professor.

Maryland Gov. Wes Moore, a Democrat, posted on X Sunday following the news of Biden’s diagnosis. “Dawn and I carry @JoeBiden and his family in our hearts today, Moore wrote. “He stood with me during some of the toughest times in our state, and we stand with him today. We pray for his strength and a swift recovery.”

Contact Brooke Conrad at bconrad@baltsun.com, 443-682-2356 or @conrad_brooke on X.