Biden’s Prostate Cancer Diagnosis: What It Means for BRCA Risk

Jennifer Thompson, MS, CGC
May 21
4 min read

President Joe Biden was recently diagnosed with aggressive prostate cancer, an announcement that has captured national attention. Prostate cancer is the most common cancer in men after skin cancer – affecting 1 in 8 men in their lifetime.

Most prostate cancers are slow-growing, but Biden's diagnosis reminds us that not all prostate cancers are the same. Some forms are fast-moving, harder to treat, and may carry implications not just for the patient but for their entire family.

Let’s unpack what this means, especially through the lens of hereditary cancer risk and BRCA genetic testing.

Aggressive Prostate Cancer: What Makes It Different

Most prostate cancers are slow-growing and remain confined to the prostate gland. They often pose little threat and are discovered incidentally. In Biden's case, the diagnosis was aggressive prostate cancer – specifically, a Gleason score of 9, which means the cancer cells look very abnormal under a microscope and are more likely to spread. In Biden’s case, his cancer has already spread beyond the prostate, meaning it is metastatic.

This isn’t the slow-growing prostate cancer most people are familiar with. And that distinction matters, because aggressive, metastatic prostate cancer raises the question: Could there be a hereditary cause?

BRCA1 and BRCA2: More Than Breast Cancer Genes

You may have heard of BRCA1 and BRCA2 in the context of breast and ovarian cancer. But these genes do much more. They help repair DNA damage in our cells. When these genes are working correctly, they help prevent cancer. When there is a mutation, the risk for several cancers increases.

A mutation in BRCA1 or BRCA2 can significantly raise your risk for several cancers – not just breast and ovarian. This includes:

Female breast cancer: up to a 72% lifetime risk
Ovarian cancer: up to 58% lifetime risk
Prostate cancer: up to a 61% lifetime risk, often more aggressive in BRCA2 carriers
Male breast cancer: up to 7% lifetime risk
Pancreatic cancer: up to 10% lifetime risk

These mutations can be passed down from either parent and can affect both men and women.

Why President Biden Meets Criteria for BRCA Genetic Testing

According to the National Comprehensive Cancer Network (NCCN) guidelines, all men with metastatic prostate cancer or a Gleason score ≥7 meet criteria for genetic testing, including BRCA1 and BRCA2 testing. President Biden's Gleason score of 9 and metastatic status both qualify him.

Genetic testing can be done to determine if a person carries a BRCA1 or BRCA2 gene mutation. This type of testing can have implications for the patient – including treatment and future cancer risks – and also for their family members.

Why This Matters for Treatment – And for Family Members

If President Biden were found to carry a BRCA mutation, it could influence his treatment plan. PARP inhibitors, for example, are a class of targeted therapies that are more effective in patients with BRCA-related cancers. Knowing about a BRCA mutation could unlock access to these personalized treatments.

A BRCA mutation doesn’t just affect one person – it can have life-saving implications for the entire family. Family members can pursue their own genetic testing, and if they also have the BRCA gene mutation, they can take action – long before a diagnosis occurs. That could mean enhanced screening, preventive surgeries, or lifestyle changes.

For women in the family, this may lead to:

Earlier and more frequent breast cancer screening (like breast MRI starting in their 20s or 30s)
Consideration of risk-reducing mastectomy and oophorectomy (removal of ovaries and fallopian tubes)
Screening for pancreatic cancer

For men, knowing about a BRCA mutation may lead to:

Earlier prostate cancer screening (starting at age 40)
Screening for male breast cancer and pancreatic cancer

When to Suspect a Hereditary Cancer Syndrome

Family history is a powerful tool, and can give you clues about your cancer risk. If you have a father, brother, uncle, or grandfather who had prostate cancer – especially if it was aggressive or diagnosed before age 60 – that may suggest a hereditary pattern.

Additional red flags for an inherited BRCA mutation include:

Breast cancer diagnosed at age 50 or younger
Ovarian cancer diagnosed at any age
Breast cancer diagnosed in a male
Multiple people in the family with breast, ovarian, prostate, and/or pancreatic cancer

Remember: you don’t need to have a personal cancer diagnosis to qualify for genetic counseling or testing. Being proactive may help you avoid a future diagnosis altogether.

Take the First Step: A Personal Risk Assessment Consultation

If you're wondering whether you or your family may be at risk for a hereditary cancer syndrome like BRCA, a Personal Risk Assessment Consultation is a great first step. In just 30 minutes, you’ll speak with a certified genetic counselor who will: