Close friends of former President Joe Biden express growing concern about his visible fatigue as he continues treatment for aggressive stage 4 prostate cancer that has spread to his bones.

Friends Notice Increased Tiredness

Four individuals who spoke with Biden in recent months told The Washington Post they observed increased fatigue during their conversations. The friends attributed his tiredness to the demanding cancer treatment regimen he undergoes for prostate cancer with a Gleason score of 9, indicating one of the most aggressive forms of the disease. While these friends received no formal health updates, they noted the visible changes in Biden’s energy levels over several weeks.

A fifth source provided a contrasting perspective, describing the 83-year-old as remaining active, engaged, and positive about his treatment response. Biden’s official aides maintain he continues working on his memoir and preparing for scheduled public appearances. He plans to travel to South Carolina on February 27 to commemorate the sixth anniversary of his primary victory in that state.

Aggressive Cancer Diagnosis and Treatment

Biden’s office announced his stage 4 prostate cancer diagnosis in 2025, revealing the cancer had metastasized to bone tissue. Medical experts classify this advanced stage as incurable, though treatable. The former president underwent radiation therapy at Penn Medicine Radiation Oncology in Philadelphia while receiving hormone therapy in pill form. On October 20, 2025, Biden celebrated completing his radiation treatment course by ringing the ceremonial bell, with daughter Ashley describing the moment as a meaningful milestone.

Continued Public Engagement

Despite his diagnosis, Biden maintains an active public schedule. He attended several high-profile events in 2025, including Pope Francis’s funeral in April and former Vice President Dick Cheney’s funeral in November. In January, he appeared at Tatiana Schlossberg’s funeral. Biden also underwent surgery in September 2025 to remove skin cancer lesions from his head, adding to his medical challenges while continuing his public duties and personal projects.