Former U.S. President Joe Biden has been diagnosed with an “aggressive form” of prostate cancer that has spread to his bones, his office said in a statement on Sunday.

Biden, 82, was diagnosed on Friday after experiencing urinary symptoms, and he and his family are reviewing treatment options with doctors, according to the statement.

“While this represents a more aggressive form of the disease, the cancer appears to be hormone-sensitive which allows for effective management,” his office said.

Cancers that have spread, or metastasized, are considered Stage 4, the most advanced. Most prostate cancers are detected at an earlier stage.

According to the Centers for Disease Control and Prevention, of the 236,659 cases of prostate cancer diagnosed in 2021, 70% were diagnosed before the cancer had spread beyond the prostate. About 8% of new prostate cancer diagnoses that year involved advanced-stage disease.

Biden’s physical health and mental acuity drew scrutiny during his 2021-2025 presidency. He abruptly ended his bid for reelection last July, weeks after a halting performance during a debate against Republican Donald Trump prompted panic among his fellow Democrats.

President Trump, who has repeatedly berated Biden since taking office in January, expressed sympathy on Sunday for Biden and his wife, Jill, in a post on his social media platform Truth Social.

“Melania and I are saddened to hear about Joe Biden’s recent medical diagnosis,” he wrote, referring to first lady Melania Trump. “We extend our warmest and best wishes to Jill and the family, and we wish Joe a fast and successful recovery.”

Biden’s office said the cancer scored a nine out of 10 on the Gleason score grading system, which is used to help determine the aggressiveness of prostate cancer.

Dr. Herbert Lepor, an urologist at NYU Langone, said a score of nine is “very high risk,” but added that many men can live “five to 10 years and beyond” even with metastatic prostate cancer.

“Over the last decade, there have been many advances in the treatment of advanced prostate cancer,” he said.

Dr. Chris George, the medical director of the cancer program for the Northwestern Health Network, said prostate cancer is no longer curable once it spreads to the bones but that there are treatments that can control it.

Biden was the oldest person to win the U.S. presidency at the time of his election in 2020. Trump, 78, broke that record when he defeated Vice President Kamala Harris last year.

Some prominent Democrats have recently acknowledged that it was an error to advance Biden as the 2024 nominee, given widespread concerns among voters about his age. Long before the debate last summer, Reuters/Ipsos polls showed a majority of Americans, including most Democrats, believed Biden was too old to serve a second term.

“It was a mistake for Democrats to not listen to the voters earlier,” Democratic U.S. Senator Chris Murphy told NBC News’ “Meet the Press” on Sunday morning, before Biden’s diagnosis was announced.

Biden has kept a low profile since leaving office, making only a handful of public appearances, including an April speech in which he defended the Social Security Administration against Trump’s planned cuts.

He has also defended his legacy in interviews and rejected reporting in two new books that he suffered from cognitive decline during his last year in office.

“They are wrong,” he said earlier this month on ABC’s “The View,” referring to the books’ authors.

Biden’s diagnosis triggered an outpouring of supportive statements on Sunday from Democrats and Republicans alike.

“Joe is a fighter — and I know he will face this challenge with the same strength, resilience and optimism that have always defined his life and leadership,” Harris said in a statement.

Biden lost a son, Beau Biden, in 2015 due to brain cancer.

In 2022, Biden revived an Obama-era program known as Cancer Moonshot, seeking to reduce the death rate from cancer by at least 50% over the next 25 years.

Russian and Ukrainian negotiators met in Istanbul on Friday at their first direct peace talks in more than three years, under pressure from U.S. President Donald Trump to end Europe’s deadliest conflict since World War Two.

Live television showed Turkish Foreign Minister Hakan Fidan addressing Russian and Ukrainian negotiators at the lavish Dolmabahce Palace on the Bosphorus. Half of the Ukrainian delegation wore camouflage military fatigues, sitting at a table directly facing their Russian counterparts, who were in suits, Reuters reported.

Fidan said it was critical to achieve a ceasefire as soon as possible. He said he was happy to see the will of both sides to open a new window of opportunity for peace, and it was important that the Istanbul talks form the basis for a meeting between leaders of the two countries.

“There are two paths ahead of us: one road will take us on a process that will lead to peace, while the other will lead to more destruction and death. The sides will decide on their own, with their own will, which path they choose,” Fidan said.

The warring sides had not met face-to-face since March 2022, the month after Russia’s invasion.

Expectations for a major breakthrough, already low, were dented further on Thursday when Trump, winding up a Middle East tour, said there would be no movement without a meeting between himself and Russia’s President Vladimir Putin.

The head of Ukraine’s delegation, setting out Kyiv’s priorities, said peace was only possible if Russia agreed to a 30-day ceasefire, the return of abducted Ukrainian children and an exchange of all prisoners of war.

Russia says it wants to end the war by diplomatic means and is ready to discuss a ceasefire. But it has raised a list of questions and concerns, saying Ukraine could use a pause to rest its forces, mobilise extra troops and acquire more western weapons.

Ukraine and its allies accuse Putin of stalling, and say he is not serious about wanting peace.

PUTIN STAYS AWAY

It was Putin who proposed the direct talks in Turkey, but he spurned a challenge from Ukrainian President Volodymyr Zelenskiy to meet him there in person, instead sending a team of mid-level officials. Ukraine responded by naming negotiators of similar rank.

U.S. Secretary of State Marco Rubio and Trump’s Ukraine envoy Keith Kellogg were also in Istanbul, where a flurry of separate diplomatic contacts took place earlier on Friday.

Rubio told reporters on Thursday night that, based on the level of the negotiating teams, a major breakthrough was unlikely.

“I hope I’m wrong. I hope I’m 100% wrong. I hope tomorrow the news says they’ve agreed to a ceasefire; they’ve agreed to enter serious negotiations. But I’m just giving you my assessment, honestly,” he said.

Russia said on Friday it had captured another village in its slow, grinding advance in eastern Ukraine. Minutes before the start of the Istanbul meeting, Ukrainian media reported an air alert and explosions in the city of Dnipro.

Russia says it sees the talks as a continuation of the negotiations that took place in the early weeks of the war in 2022, also in Istanbul.

But the terms under discussion then, when Ukraine was still reeling from Russia’s initial invasion, would be deeply disadvantageous to Kyiv. They included a demand by Moscow for large cuts to the size of Ukraine’s military.

Zelenskiy’s chief of staff Andriy Yermak said Russian attempts to align the current talks with the unsuccessful earlier negotiations would fail.

With Russian forces now in control of close to a fifth of Ukraine, Putin has held fast to his longstanding demands for Kyiv to cede territory, abandon its NATO membership ambitions and become a neutral country.

Ukraine rejects these terms as tantamount to capitulation, and is seeking guarantees of its future security from world powers, especially the United States.

MUTUAL HOSTILITY

Ukraine repelled Russia’s initial assault on the capital Kyiv in 2022 and recaptured swathes of land seized by Russians in the war’s first year. But since then Russian forces have slowly but relentlessly advanced for most of the past two years.

Hundreds of thousands of soldiers have been wounded or killed on both sides. Thousands of Ukrainian civilians have been killed, whole cities have been destroyed and millions of Ukrainians have been forced to flee their homes.

Moscow says it was forced to mount its “special military operation” in response to NATO expansion and the prospect that the western alliance would admit Ukraine as a member and use it as a launchpad to attack Russia. Any settlement of the conflict must address these “root causes”, the Kremlin says.

Kyiv and its allies reject that as a false pretext for what they call an imperial-style land grab.

Oleksandr Syrskyi, Ukraine’s army chief, said late on Thursday that Russia has about 640,000 troops in Ukraine at the moment and had “turned its aggression against Ukraine into a war of attrition”. He said there was active combat along the entire frontline, stretching many hundreds of miles.

U.S. President Donald Trump and Russian President Vladimir Putin indicated they would not attend what could be the first direct peace talks between Moscow and Kyiv in three years on Thursday, with the Kremlin sending instead a group of experienced technocrats, Reuters reported.

Putin on Sunday proposed direct negotiations with Ukraine in Istanbul on Thursday “without any preconditions”. Late on Wednesday, the Kremlin said the delegation would include presidential adviser Vladimir Medinsky and Deputy Defence Minister Alexander Fomin – but Putin’s name was not on the list.

After the Kremlin’s delegation announcement, a U.S. official said Trump, who is on a three-nation tour of the Middle East, would not attend. The U.S. leader had said earlier that he was considering the option to participate.

While Putin had never confirmed he would attend in person, the absence of the Russian and U.S. presidents lowers the expectations for a major breakthrough in the war that Russia started in February 2022.

Ukrainian President Volodymyr Zelenskiy had challenged Putin to attend the talks “if he’s not afraid,” in an apparent contest to show Trump who wants peace more, Ukraine or Russia.

While the Kyiv leader was on his way to Turkey late on Wednesday, a Ukrainian official said, he had said he would take part in the talks only if Putin attended.

In his nightly video address on Wednesday Zelenskiy said that Ukraine would decide on its steps for peace talks in Turkey once there was clarity on Putin’s participation.

“The answers to all questions about this war – why it started, why it continues – all these answers are in Moscow,” Zelenskiy said. “How the war will end depends on the world.”

Trump wants the two sides to sign up to a 30-day ceasefire to pause Europe’s biggest land war since World War Two, and a Russian lawmaker said on Wednesday there could also be discussions about a huge prisoner of war exchange, read the report.

Zelenskiy backs an immediate 30-day ceasefire, but Putin has said he first wants to start talks at which the details of such a ceasefire could be discussed.

Trump, who is growing increasingly frustrated with both Russia and Ukraine as he tries to push them towards a peace settlement, said he was “always considering” secondary sanctions against Moscow if he thought it was blocking the process.

U.S. officials have spoken about possible financial sanctions as well as potential secondary sanctions on buyers of Russian oil.

The U.S. delegation to Turkey included Secretary of State Marco Rubio and senior envoys Steve Witkoff and Keith Kellogg.

Ukrainian Foreign Minister Andrii Sybiha said early on Thursday he had met with Rubio to share Zelenskiy’s peace vision and “coordinate positions during this critical week.”

Medinsky and Fomin, part of the Russian delegation, took part in the last set of negotiations between the two sides in the first weeks of the war. Other senior military and intelligence officials were also part of the Thursday delegation.

Direct talks between negotiators from Ukraine and Russia last took place in Istanbul in March 2022, a month after Putin sent tens of thousands of troops into Ukraine in what he calls a “special military operation” to root out neo-Nazis, Reuters reported.

Ukraine and its allies say the invasion was an unprovoked, imperial-style land grab.

With Russian forces grinding forward in Ukraine and now controlling about a fifth of the country, the Kremlin chief has offered few, if any, concessions so far. In his proposal at the weekend, he said that the talks in Turkey would be aimed at a durable peace.

He specifically mentioned the 2022 talks and the failed draft deal.

Under that deal, among others, Ukraine would have agreed to permanent neutrality in return for security guarantees from the five permanent members of the U.N. Security Council: Britain, China, France, Russia and the United States, and other nations including Belarus, Canada, Germany, Israel, Poland and Turkey, according to a draft seen by Reuters.

But officials in Kyiv say agreeing to Ukrainian neutrality is a red line they will not cross.