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Urologist William Lynes discusses his article “A urologist’s perspective on presidential health transparency.” William examines the medical plausibility of a former president being diagnosed with widespread metastatic prostate cancer just months after leaving office. He explains why the slow growth of this disease means it almost certainly existed during the presidency and challenges the narrative that it went undetected despite world-class health care. The discussion covers the standard of care regarding PSA screening and hormonal therapy while highlighting how symptoms like bone pain would likely have been obvious to any competent medical team. William ultimately questions the ethics of Dr. Kevin O’Connor and argues that concealing such a diagnosis constitutes a severe violation of the physician’s code of conduct. Listen to understand the grave implications of medical transparency at the highest levels of government.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back William Lynes. He is a urologist. Today’s KevinMD article is “A urologist’s perspective on presidential health transparency.” William, welcome back to the show.

William Lynes: Hey, thank you for having me here on the first day of the year, Kevin.

Kevin Pho: All right. And a Happy New Year to you too. This episode will probably go out later this month. OK. Tell us what this article is about.

William Lynes: I am a urologist, and I am particularly interested in prostate cancer. In May of last year, it was announced that President Biden had widespread high-grade adenocarcinoma of the prostate metastatic to bone. It really opened my ears.

If you recall, President Biden was in office and left office in January of last year. When he left office, he was said to be basically healthy. In February of 2024, which would have been ten months before he left office, Kevin O’Connor, his primary doctor, released a press release that said that all of his medical conditions were stable. He listed atrial fibrillation as a problem with a normal echocardiogram. He listed other minor things like some peripheral neuropathy in his feet. He has sleep apnea like I do, but that was it.

Fast forward to May of last year. President Biden presented to a hospital on the East Coast and was found to have a prostate nodule. He underwent a prostate biopsy which showed a Gleason score 9 adenocarcinoma of the prostate. Again, a Gleason score is two numbers when you add them up, and 10 is the maximum number. So he had high-grade adenocarcinoma of the prostate.

I think the reason he went to the hospital reportedly was because of bone pain. He was shown to have widespread metastatic bone disease. Now here is the issue. In the United States, people do not really present with metastatic disease anymore since the advent of PSA. Before that, maybe 30 to 50 percent of people with metastatic prostate cancer presented with metastatic disease. It is now 3 to 5 percent. So it is very unusual for somebody to walk into a hospital in America and really unusual for the President of the United States to do that and be found to have metastatic prostate cancer.

As you mentioned, I am a urologist and I am not really an expert on anything except urology and especially prostate cancer. I practiced during my residency for 22 years. I saw essentially thousands of people with prostate cancer. Before I left my practice in 2003, I actually did a survey of my practice because I was wondering how many men in my practice had prostate cancer. I pulled about 200 charts and I found that over 50 percent of them had prostate cancer in some form or another. A lot of them were occult, but many of them had metastatic disease and so forth.

I lived and breathed prostate cancer. Let me just tell you that you do not have metastatic prostate cancer just for five months. It predated that way back. You do not have prostate cancer in just five months. You do not even have metastatic disease just for five months. So I make the case that I think it is pretty clear that President Biden had prostate cancer in the White House and that it was metastatic.

In addition, let’s say that they knew that. Over 90 percent of Americans who have metastatic prostate cancer are actually treated in this country nowadays. We have evolved into early hormonal therapy, and definitely he would have been treated.

The argument has been that President Biden, as many people do, elected when he was 70 and had a normal PSA to not have any PSAs during the rest of his life. Now he is 81, so that is 11 years. I think it is probably unlikely he did not have a PSA. However, let’s say he did not. People say that they would not have known he had prostate cancer. No. Let’s just go back to the late 1980s and early 1990s before the advent of PSA. How did we detect prostate cancer?

The mainstay was rectal examination. The majority of prostate cancers are detectable on rectal examination if you know how to do a rectal exam. Now, President Biden specifically is known to have had a prostate nodule. That is why he had a prostate biopsy reportedly. So he should have been picked up on rectal examination. That would have been something that should have been done multiple times during his lifetime.

Now blood tests. Let’s say he did not have a PSA. What are the other blood tests used to detect prostate cancer? There are two of them. One is commonly drawn, and one is not. The one that is not is acid phosphatase. It is elevated in almost all patients who have metastatic prostate cancer. But it is very unusual because it is only used for prostate cancer. So probably he did not have one of those.

Alkaline phosphatase is the second one. However, it is almost always elevated again in metastatic prostate cancer. It is something that he would have had multiple times during the course of his White House administration because it is on all liver function test panels and so-called health panels. It measures bone disease and liver disease. If you have metastatic disease, especially prostate cancer, it shows up. So the argument does not hold water.

In addition, I have heard that he has quite pronounced arthritic problems and he would have had X-rays. They do not have a lot of sensitivity for picking up prostate cancer, but in the axial skeleton, they do. If he had a lot of arthritis, he would have had a bone scan. A bone scan is almost 100 percent diagnostic in metastatic prostate cancer. So when you put all this together, this argument that President Biden walked into a hospital in May of 2025 and lo and behold had widespread high-grade prostate cancer undetected before just does not hold weight.

Kevin Pho: Give us a sense of the typical progression for prostate cancer to get to the stage where it was diagnosed in President Biden. In order for a prostate cancer to become high-grade metastatic, what kind of time course are we talking about?

William Lynes: First of all, autopsy series will find a tremendous incidence of prostate cancer, and a great majority of them are occult. So it is very, very long. It is hard to come up with these numbers, but I would say from the onset or the localized process of prostate cancer to widespread metastatic disease is usually five to ten years.

Like I said, I have a real sense of prostate cancer. I had one patient in my entire career who had a prostate nodule and elected not to have a biopsy. I think he was 70, and he said that was fine. He was dead in six months. That is the only person I have ever seen who had this rapid progression. Like I said, I have treated thousands. It is usually five to ten years.

Kevin Pho: So, as you know, PSA screening sometimes can be controversial. There are various guidelines that are conflicting in terms of when to recommend it. Let’s say if President Biden was your patient when he was 65 years old. What would your recommendation for PSA screening be to him if he was 65 years old?

William Lynes: Let’s say 70. OK, sure. I sort of use that cutoff between people who should be treated with prostate cancer or not, but it is not a simple issue. I would have explained the pluses and minuses. I would explain the fact that a great majority of people who are above 70 who have prostate cancer never die of prostate cancer. I wasn’t a big advocate for screening people, especially in that age group, so I wouldn’t have recommended it.

Especially to a president, he should have been aware of that. Almost everybody in that situation, especially a president, says: “I want a PSA. I’ve had them every year for the last six or seven years. Why don’t I continue?” So I would have not told him what to do, but said that I think he probably shouldn’t. But it would have been up to him.

Kevin Pho: Just to be clear for the listeners in terms of the downsides of PSA screening, just clarify and synthesize what are some of the downsides of PSA screening in that age group of their 70s?

William Lynes: False positives are not the problem. I think that when that is elevated, it is very likely a very good test for prostate cancer. The main problem is overtreatment. So many people are never going to die of prostate cancer, but yet they are committed to treatment such as hormonal therapy or surgical therapy. That is a real problem. I have done radical prostatectomies on many people who in retrospect should not have had that procedure. Yet it carries significant morbidity. So the main thing is over-detection and overtreatment.

Kevin Pho: So assuming that President Biden got first diagnosed, and we will take their reports at face value, with metastatic prostate cancer in his early 80s. Assuming let’s say he did get a PSA screening in his 70s, in all likelihood would they have been elevated in order for that time course for him to be diagnosed with metastatic cancer in his early 80s?

William Lynes: I have to assume it wasn’t. That would be 11 years. It is very likely that somebody who was 70 had a normal PSA. But when they are 81, I guarantee you he has a very elevated PSA now. So that is not questionable in my mind.

Kevin Pho: But some of these indirect tests, like you said, perhaps a bone scan or some of these secondary blood markers, most likely would have diagnosed it earlier than they disclosed it.

William Lynes: A bone scan would have picked him up when he had metastatic disease. Alkaline phosphatase would have picked him up when he had metastatic disease. Acid phosphatase as well. Like I said, you have to get axial skeletal X-rays and really sort of be thinking about prostate cancer for X-rays to make that diagnosis. But rectal examination was abnormal for many, many years in his life. I guarantee that.

Kevin Pho: In your article, you questioned some of the decisions that the doctor made, Dr. Kevin O’Connor. So what do you think he should have done in this circumstance?

William Lynes: Let’s just say that he counseled President Biden on the issues of PSA and didn’t do them. He should have done a rectal examination on a regular basis. He should have picked that nodule up during the White House times, perhaps before that. And he should have been looking at his abnormal alkaline phosphatases. So Dr. O’Connor is either negligent or incompetent, or he is more likely part of a significant medical coverup.

Kevin Pho: How sensitive is the rectal exam for prostate cancer? You mentioned that Biden had a history of a prostate nodule. My understanding is a rectal exam has a variable sensitivity for picking that up. So if he did do a rectal exam, isn’t it not out of the realm of possibility that he simply missed it or it wasn’t picked up just because of that low specificity?

William Lynes: Really just a urologist knows how to do a digital rectal exam. I am not talking about rectal exam for other things. I am talking about examining the prostate. It is not an easy thing to do. It is also not an easy thing to convince a president to have that done. And so I can sort of say, “OK.”

Maybe he didn’t do one. But the guy had arthritic pains. He should have had alkaline phosphatases. He was 81. Now, Kevin, in autopsy series there is occult prostate cancer in 80 percent of people who are 80. So you should have a high index of suspicion. No, I do not let him off the hook because he didn’t know how to do a rectal exam. He should have known how.

Kevin Pho: Tell us more about the high alkaline phosphatase, because sometimes I see that isolated in my own patients and elderly men. So are we talking just an isolated alkaline phosphatase should potentially lead to a suspicion of a subtype of bone disorder, and in this case, potential metastatic bone disorder?

William Lynes: There are two reasons for having an elevated alkaline phosphatase. One is liver disease and the other is bone disease. I mean, you probably see it all the time. But if you can get the tests, do the workup for it. They should have looked at his liver. If the other ones were normal, so forget about alkaline phosphatase? No. You start questioning whether or not there is bone disease. PSA is a great test, but alkaline phosphatase, I guarantee it is elevated now, Kevin.

Kevin Pho: So if this was picked up earlier, let’s say President Biden had a PSA in his 70s that was elevated and potentially picking this up earlier, tell us what kind of options a man at that age typically would have. You mentioned a few earlier.

William Lynes: An elevated PSA in elderly people does not always precipitate biopsy. MRIs now are used because of the thing that I mentioned. A lot of people with prostate cancer might say, “Well, it is elevated. President Biden, you probably have prostate cancer, but you are probably going to elect to not be treated.”

Some people elect not to have a biopsy, MRI, et cetera. I do not think the president would have done that. I think that if he had an elevated PSA, he would have had a biopsy. The majority of people in the United States do, and he is the president with world-class quote-unquote medical care his entire life. I don’t know if that answers your question.

Kevin Pho: And earlier you inferred a potential medical coverup. So are you saying that it was covered up because of course he was going for reelection and news like a diagnosis of prostate cancer could certainly derail his campaign?

William Lynes: Well, see, it is mixed into this cognitive decline coverup. I think prostate cancer is really important, but his brain and his ability to think were issues. There is just no question he was not qualified to be president during his administration, in my opinion. Why they covered that up? You are mentioning some of it. He wanted to be a president for two terms, not one. The people around him wanted to be the pseudo-presidents, in my opinion.

I am not a politician, but I am a urologist. I sort of have pulled this out. I think it is a travesty. I think that the medical coverups concerning President Biden really are worse than President Wilson because he had the nuclear football. So yeah, it is a travesty.

Kevin Pho: So what options does President Biden have now in his current health state?

William Lynes: I can almost guarantee you that he is on hormonal therapy now. If what I am saying is true, which is that he was already treated during the White House years, he may have castrate-resistant metastatic prostate cancer. That means he is not just on androgen deprivation, usually Lupron, but he is on other things like chemotherapy and other hormonal agents. But right now, let’s just say he presented with this. He is on hormonal therapy, 99.9 percent, and that most likely involves drugs like Lupron.

Kevin Pho: We are talking to William Lynes. He is a urologist. Today’s KevinMD article is “A urologist’s perspective on presidential health transparency.” William, let’s end, as we always do, with take-home messages to the KevinMD audience.

William Lynes: Thank you, Kevin. President Biden presented with metastatic high-grade prostate cancer, and this does not hold water. It is extremely likely that he had prostate cancer, and probably metastatic prostate cancer, while he was president. I argue that he probably was treated during his administration. I think it is a travesty. I think that Kevin O’Connor, as his primary doctor, is primarily responsible for this. I think that his license should be revoked. I think that the AMA and other organizations should sanction him, and I think he should receive public humiliation.

Kevin Pho: Thank you so much for sharing your perspective and insight. Thanks again for coming back on the show.

William Lynes: OK, Happy New Year, Kevin.

Kevin Pho: Happy New Year. Thank you so much. Bye.