Hello and welcome. Today we’re talking about former President Joe Biden’s recent metastatic prostate cancer diagnosis and what it tells us about illness, aging, and responsibility. As doctors remind us, metastatic prostate cancer is “treatable, but usually not curable,” and in an 82-year-old patient with frailty—an “accumulated loss of resilience”—both disease and treatment become harder to withstand.

What does this mean for prognosis? We simply don’t know yet how long this cancer has been growing or exactly how it will progress. We do know that older, frail patients often face tougher side effects, even from gentler therapies like testosterone blockers, which can worsen fatigue and cognitive decline. Yet many patients live for years—what physicians call dying “with cancer, not from cancer.”

In palliative care, we often say: “hope for the best, plan for the worst.” Hope is a conscious act, distinct from denial, which blocks planning. Planning for the worst isn’t about giving up—it’s about weighing risks, setting priorities and ensuring the people and causes we love are protected if time becomes short.

For leaders and all of us, confronting reality with compassion and clarity is an act of responsibility—and of hope.
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