Political leaders from across parties in the U.S. extended their sympathies to Democratic former President Joe Biden, 82, after his office announced Sunday that he was diagnosed with an “aggressive” form of prostate cancer.

“Last week, President Joe Biden was seen for a new finding of a prostate nodule after experiencing increasing urinary symptoms,” his personal office said in a statement. “On Friday he was diagnosed with prostate cancer, characterized by a Gleason score of 9 (Grade Group 5) with metastasis to the bone.”

How was Joe Biden’s cancer not caught earlier? The news that the former president is battling an aggressive, stage-4 prostate cancer that has spread to the bone ignited a public debate about why a person with peerless access to medical care was diagnosed at such an advanced stage with a disease that is quite common in men his age.