Former President Joseph R. Biden Jr. had never been diagnosed with prostate cancer before last week, his spokesman said on Tuesday, pushing back against speculation that there had been some sort of coverup around the illness.
The spokesman, Chris Meagher, also said Mr. Biden’s last-known prostate-specific antigen test, the most common way to screen for prostate cancer, was in 2014. Mr. Biden would have been 71 or 72 years old at the time.
The new details help provide some clarity about Mr. Biden’s health records, but they still do not directly give an answer on why Mr. Biden was not regularly screened for prostate cancer throughout his presidency.
Mr. Meagher did not respond to that question, and Kevin O’Connor, Mr. Biden’s doctor in the White House, did not respond to inquiries. But allies of Mr. Biden, 82, and medical experts point to guidelines that advise against P.S.A. screening for men over the age of 70. The guidelines vary slightly across different medical organizations, but doctors generally agree that men of an advanced age should not automatically be screened for prostate cancer.
But Mr. Biden was not just the average American man, and his diagnosis of stage 4 prostate cancer has raised the question: Should the oldest president in American history have gone beyond those guidelines? Mr. Biden, until July, was also running for a second term in office, and had he won, he would have been 86 at the end of his second term.
Some men over 70 do choose to have the test despite the guidelines. President Trump, 78, has been regularly screened for prostate cancer, according to his medical records from the last decade. Mr. Trump’s medical report from his physical last month showed his P.S.A. level was normal.
And prostate cancer experts caution that some men suddenly find out they have advanced prostate cancer even after being screened regularly year after year and told they have a clean bill of health.
Dr. Ezekiel J. Emanuel, an oncologist who served as an adviser on the coronavirus pandemic for the Biden administration, said presidents should be held to a higher standard than the average American. He emphasized that should especially be the case for presidents when they are above the age of 70, and he suggested changing the way the president’s health is assessed.
“We have to have confidence that their health condition is not intervening,” Dr. Emanuel said. “We need a committee of doctors who are not chosen in a political manner who are making an independent evaluation of the president and making it public.”
In announcing his diagnosis on Sunday, Mr. Biden’s office said his cancer has a Gleason score of 9, which means it is among the most aggressive forms of prostate cancer. Mr. Biden’s office also said the cancer has spread to his bones, which means it is incurable though it can be managed.
On Monday, Mr. Trump seem to suggest Mr. Biden’s cancer diagnosis was hidden from the public and questioned why it took so long for doctors to discover it.
“It can take years to get to this level of danger,” he said. “So it’s a — look, it’s a very, very sad situation, and I feel very badly about it, and I think people should try and find out what happened.”
The U.S. Preventive Services Task Force, an independent, volunteer panel of national experts, issued guidance in 2018 that recommended against P.S.A. screening for men over 70 years old. In explaining their recommendation, the task force said many men develop prostate cancer with no symptoms and often die with the disease without knowing it.
The American Urological Association advises medical professionals to consider a range of factors before screening for prostate cancer in men above 70.
“It doesn’t surprise me that he wasn’t being screened because honestly the data don’t really support screening in someone that age,” Dr. David Penson, the chair of urologic oncology at Vanderbilt University Medical Center and the secretary of the American Urological Association, said about Mr. Biden.
“Some people they worry and they have regrets and they’ll ask their doctor to do it and a lot of doctors will do it just because it makes the patients feel better,” he added. “But sometimes you find something that you didn’t need to find because they weren’t going to die of it anyway.”
Ultimately, experts say decisions about screening should be made after discussions between doctors and their patients.
“Guidelines on P.S.A. screening for prostate cancer have been evolving, and they do vary somewhat,” said Dr. Jason Efstathiou, a professor of radiation oncology at Harvard Medical School. “There is broader agreement on the importance of shared decision making between the patient and their doctor.”
It is unclear how much, if any, discussion Mr. Biden had with his doctors when his P.S.A. screening stopped in 2014.
Gina Kolata contributed reporting.
Tyler Pager is a White House correspondent for The Times, covering President Trump and his administration.
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