On October 20, 2025, a short video quietly appeared on Ashley Biden’s Instagram story — no press conference, no political fanfare. Just a father, his family, and the sound of a hospital bell cutting through the silence of an oncology ward. That single, resonant clang carried more weight than any speech Joe Biden has ever delivered from a podium.
The former president had just completed a course of radiation therapy at Penn Medicine Radiation Oncology in Philadelphia CNN, marking a significant milestone in his battle against one of the most aggressive forms of prostate cancer. Ashley Biden posted the video of her father ringing the bell — a long-standing tradition for cancer patients upon completing a round of treatment — with the caption: “Rung the Bell! Thank you to the incredible doctors, nurses, and staff at Penn Medicine. We are so grateful!” CNN In a follow-up post, she added simply: “Dad has been very brave during his treatment. I am very grateful.”
It was, by any measure, a deeply human moment. But to understand just how significant it was, you have to go back to where this journey began.
A Diagnosis That Shocked the Nation
In May 2025, Biden’s personal office announced that the former president had been diagnosed with prostate cancer that had metastasized to the bone. NPR The diagnosis followed a finding of a prostate nodule after he experienced increasing urinary symptoms. He was diagnosed with prostate cancer characterized by a Gleason score of 9 — Grade Group 5 — with metastasis to the bone. Musc
The Gleason score drew immediate attention from the medical community. The Gleason score is a way of grading the severity of prostate cancer. The closer it gets to 10, the higher the risk. A score of 9 places Biden in the highest risk group — one with a high chance of developing further metastasis and a high risk of dying from the disease. Musc
Researchers were thrown by the timing of the diagnosis. One oncologist suggested Biden could have had the disease for up to a decade. “The vast majority of people identified as having prostate cancer have had it identified at a much earlier stage than this,” noted Herbert Levine, a Northeastern University professor who studies cancer progression. “To go from no concern or suspicion to full-blown metastatic cancer is unusual.” Northeastern Global News
Contributing to this uncertainty: without regular PSA testing, even an aggressive prostate cancer can progress without causing symptoms. Tumors often cause no urinary symptoms while confined to the prostate, and the first sign may be bone pain or unexplained weight loss once the disease has metastasized. Michigan Medicine
What the Diagnosis Really Means — and Why It Isn’t All Doom and Gloom
Public reaction to the news oscillated between despair and confusion. Metastatic cancer spreading to the bones sounds, and often is, devastating. But the medical picture is more nuanced than the headlines suggested.
Stanford urologist Geoffrey Sonn was clear in stating that while metastatic prostate cancer is not curable, it is highly treatable. “People can live for years on these hormonal therapy medicines,” he noted, pointing to a wave of newly approved drugs in the last decade that have extended survival. “This is very different than metastatic pancreatic cancer, where most patients are expected to survive only a few months. Prostate cancer can be managed for years.” Stanford Medicine
Biden’s cancer was confirmed to be hormone-sensitive, which allows for effective management. Treatment options include hormonal injections to suppress testosterone so that “the cancer stops growing quite as fast and can almost melt away from the bones,” as well as radiation therapy, which has been proven to extend life in patients with newly diagnosed metastatic prostate cancer. NPR
Life expectancy for metastatic prostate cancer has also improved dramatically. “With newer therapies directed at metastatic disease, survival is much longer than it was 20 years ago. Twenty or more years ago, it was two-and-a-half to five years. Now it’s five to ten or even more,” according to Dr. Eric Wallen of MUSC’s Hollings Cancer Center. Musc
Still, experts were measured in their optimism. When prostate cancer has metastasized to the bone, “it’s generally considered to be advanced and incurable,” according to Gerald Denis, a research professor at Boston University’s Shipley Prostate Cancer Research Center. “Generally, survival after prostate cancer metastasis to bone is only about 30 percent after five years” — though he emphasized that aggregate numbers often differ significantly from an individual patient’s experience. Boston University
Five Weeks of Treatment, One Defining Moment
The road between Biden’s May diagnosis and October’s bell-ringing was neither short nor easy. His office confirmed on October 11 that the former president had been undergoing radiation therapy in addition to hormone treatment, a course expected to span five weeks. CBS News Biden also underwent a Mohs surgery in September 2025 — a procedure that involves cutting away thin layers of skin until only cancer-free tissue remains — to address skin cancer lesions on his forehead. CBS News
Biden marked the conclusion of his radiation course by ringing the ceremonial bell alongside his radiation oncology care team. The ASCO Post ASTRO President Neha Vapiwala, the Eli J. Glatstein Endowed Professor of Radiation Oncology at the University of Pennsylvania, who led the team coordinating Biden’s treatments, stated: “President Biden’s bell-ringing milestone underscores the vital role of radiation therapy in modern cancer care and is a powerful reminder of how many lives it helps improve.” ASCO Post
What remains unclear is whether Biden will require additional treatment beyond the completed course. NBC News A spokesperson declined to detail future plans, and the medical team has stayed deliberately quiet on long-term prognosis. What his family made clear is something harder to quantify: courage.
A Personal Fight Made Public
The moment belongs to a man whose relationship with cancer is painfully personal. His son Beau died of brain cancer in 2015. As vice president, Biden led the Cancer Moonshot initiative, vowing to dramatically reduce the cancer death rate. He relaunched the program as president in 2022 with the goal of making a decade’s worth of progress in cancer prevention, diagnosis, and treatment in five years. NPR
It is one of the more striking ironies of his life that the man who staked much of his legacy on defeating cancer now finds himself staring down that very adversary. The fight is no longer policy. It is personal in the most fundamental sense.
Biden responded to his diagnosis with characteristic directness, writing on X: “Cancer touches us all. Like so many of you, Jill and I have learned that we are strongest in the broken places.” NPR
The bell at Penn Medicine rang once. Whether it signals an ending, a pause, or merely a waypoint in a longer journey remains to be seen. But the image of a former president, flanked by his daughter and grandchildren, reaching for that rope and pulling — that image has already said more than any press release ever could.
For now, the Biden family is grateful. And for now, that is enough.