As a urologist, the revelation that a former U.S. president has been diagnosed with widespread high-grade metastatic prostate cancer five months post-presidency raises critical questions. Prostate cancer is the most prevalent cancer among males, recognized for its gradual advancement from the prostate to metastatic stages, especially within the axial skeleton. Such an advanced condition suggests that cancer was present long before it became publicly disclosed, likely during the president’s time in office.

The diagnosis indicates that, despite having access to top-tier medical care, the president may not have received sufficient PSA screenings, particularly after reaching the age of 70, even though many opt to continue these screenings. Only a minor fraction of prostate cancer patients present with metastatic disease, rendering this situation less credible for someone with his level of resources.

Prior to the broad implementation of PSA testing, prostate cancer was identified through rectal examinations and indicators such as alkaline phosphatase. The occurrence of widespread bone disease is generally accompanied by severe symptoms like bone discomfort, which would have necessitated further examination via X-rays or bone scans, likely uncovering the metastasis.

The absence of disclosure regarding this condition during the president’s tenure indicates either a failure in medical duty or a conscious decision to withhold information. Medical professionals, bound by ethical obligations, must be forthcoming, especially when treating individuals in such influential roles. Should the president’s physician have concealed such vital information, it would signify remarkable negligence, warranting significant professional repercussions.

This situation highlights the necessity for transparency and accountability in the healthcare of public figures, ensuring public trust and upholding high ethical standards within the medical field.