Former President Biden’s Prostate Cancer Diagnosis: A Wake-Up Call on Screening Access and Affordability

Naga Vivekanandan, Esq.

Former President Joe Biden’s recent diagnosis of aggressive prostate cancer has brought national attention to the critical issues surrounding prostate cancer screening, particularly its accessibility and affordability. Biden, 82, was diagnosed with a high-grade form of the disease, characterized by a Gleason score of nine and metastasis to the bone. Despite the severity, the cancer is hormone-sensitive, allowing for potential management through hormone therapies and other treatments.

The Importance of Early Detection

Prostate cancer is the second leading cause of cancer death among men in the United States. According to the American Cancer Society, early detection significantly increases the chances of successful treatment, with there being a nearly 100% five-year survival rate when caught early. Conversely, this rate drops to approximately 37% for advanced-stage diagnoses. However, Biden’s case illustrates the challenges in early detection for older men, considering that routine PSA (Prostate-Specific Antigen) screening is not universally recommended for men over 70 due to potential risks of overdiagnosis and overtreatment. Biden’s diagnosis at age 82, after the typical screening window recommended by the United States Preventive Services Task Force (USPSTF), illustrates how current guidelines may not account for cancers in older men who are still at significant risk.

Financial Barriers to Screening

While prostate cancer screening can be life-saving, significant financial barriers persist that limit access — particularly for low-income, uninsured, and underinsured populations. The PSA test is relatively inexpensive, with costs typically ranging from $20 to $80. However, this is only the beginning of the diagnosis. If a PSA test result is elevated or otherwise raises red flags, additional and much more expensive diagnostics are often necessary. These may include:

• Digital rectal exams (DRE)
• Multiparametric MRIs, which can cost $500-$2,000
• Prostate biopsies, which can exceed $1,000
• Genomic testing or advanced lab work, potentially amounting to another $300

For individuals without adequate health insurance, or with high deductibles or cost-sharing responsibilities, these costs can quickly become a barrier. Although the Affordable Care Act (ACA) mandates coverage for certain preventive services with no cost-sharing, prostate cancer screening is not uniformly covered. This is largely because the USPSTF assigns PSA screening a “C” rating for men aged 55 to 69, meaning insurers are not required by the ACA to cover it without cost-sharing. For men over 70, like Biden, there is generally no recommendation for screening at all, meaning Medicare and private plans may not cover it unless deemed medically necessary. This leaves a significant number of older adults, who are also at high risk for prostate cancer, potentially facing out-of-pocket expenses that deter them from getting tested. Moreover, because prostate cancer is often asymptomatic in its early stages, many are unlikely to pursue screening unless it is both recommended and affordable.

The financial barriers to screening disproportionately affect:

• Black men, who face a 70% higher prostate cancer incidence rate and more than double the mortality rate compared to white men.
• Men in rural areas, where both provider access and insurance coverage may be limited.
• Low-income populations, who are less likely to have stable insurance or funds to cover out-of-pocket expenses.

Without comprehensive insurance coverage or a safety net program, these groups are at higher risk of receiving a late-stage diagnosis, when treatment options are more limited and survival rates are lower. Financial barriers are compounded by a lack of public awareness about what insurance covers and how to navigate the system to obtain testing. Many avoid the healthcare system altogether due to perceived or actual costs, leading to missed opportunities for early detection.

Legislative Efforts to Improve Access

In response to these inequities, bipartisan legislation known as the PSA Screening for HIM Act was introduced in 2023 in the United States Senate. This bill aims to eliminate cost-sharing requirements for prostate cancer screening among high-risk groups, including Black men and those with a family history of the disease. By removing financial barriers, the legislation seeks to promote early detection and reduce mortality rates associated with prostate cancer.

Why Self-Funded Plans Should Pay Attention

For self-funded plans, excluding coverage for prostate cancer screening may save a few dollars upfront, but it exposes the plan to significantly higher claims liability later. When cancer is diagnosed late, treatment often involves extended hospital stays, oncology drugs, radiation therapy, and specialist care – all of which the plan must pay for directly, often resulting in large, unpredictable claim spikes. Treating late-stage prostate cancer is significantly more expensive than catching it early through PSA testing and follow-up diagnostics. Meanwhile, because these plans are not bound by USPSTF recommendations, they have flexibility to cover screenings for older or high-risk members. Doing so can prevent large claims and support better health outcomes, making early detection not just a clinical priority, but a financial one, too.

Moving Forward

Biden’s diagnosis serves as a poignant reminder of the importance of accessible and affordable prostate cancer screening. It highlights the need for policy reforms to address the financial barriers that prevent many men from seeking early detection services. As the nation reflects on this development, it is imperative to advocate for comprehensive healthcare policies that prioritize preventive care and equitable access for all individuals. By addressing these systemic issues, we can work towards a future where early detection of prostate cancer is accessible to everyone, regardless of age, race, or socioeconomic status.