Lloyd Austin's Mystery with Prostate Cancer

The events surrounding Defense Secretary Lloyd Austin's secret hospitalization are just starting to emerge. Physicians at Walter Reed National Military Hospital have disclosed that he was diagnosed with prostate cancer in December and underwent a surgical prostatectomy (removal of the prostate) on 12/22/23. As is usual for that surgery, he was discharged home the following day, only to be readmitted on 1/1/24 with a urinary tract infection and probable ileus bowel obstruction. These can be known complications from surgery. He remains in the hospital, apparently stable.

Of course there are major concerns that the Pentagon and President Biden were unaware of all of these events until a couple of days ago and even now, information is scant. Protocols were not followed and over the next few weeks we will hear more about the mistakes that were made. Certainly a public official has a right to medical privacy, but his key staff and the President should have been informed every step of the way for the security of the USA.

This gives us an opportunity to talk about prostate cancer, the most common type of cancer and the 2nd cause of cancer death for men in the US. In early stages, prostate cancer has no symptoms. Later on it can cause dull pelvic pain, difficulty urinating, blood in the urine, weight loss, bone pain or urinary frequency. When diagnosed it is usually staged as "Early", Stage I or II, and confined to the prostate. "Locally advanced" is stage III, spread to nearby tissue. Stage IV is cancer that has spread through the lymph nodes to other parts of the body like bones, liver or lungs.

The cause of prostate cancer is unknown. It occurs in men over the age of 50 as the DNA in the prostate changes. The most common risk factor is aging but men with a relative with prostate cancer are at higher risk as are African-American men. Being overweight in your 50s is a risk for later development of prostate cancer.

The PSA (prostate specific antigen) blood test has been available for decades as a screen for prostate cancer. PSA is a protein made only by the prostate that leaks into the blood stream. It has fallen in and out of favor over the years depending upon the results in each new study. It is not a very accurate test and 3 of 4 men with a raised PSA test will not have cancer. But it is a simple screening test and currently we do test men starting at age 50 and age 45 for African-American men. It is not diagnostic for cancer and an elevated level would need to be followed up by ultrasound and a biopsy. Other things like prostate enlargement, prostatitis and urinary infections can raise the PSA also. Testosterone supplements can also raise the PSA level but they do not in themselves cause prostate cancer.

We used to do digital rectal exams on all older men as a screening test for prostate cancer, but it is no longer recommended by the US Preventive Task Force because of lack of benefit. It's just not very good. Keep in mind that preventive screening is different from exams when a man is having a concern or symptom. In those cases a digital rectal exam is done.

Prostate cancer prevention includes limiting red meat, and processed meats. Avoiding saturated fats and dairy products. Drinking green tea and coffee may prevent it as well as eating foods high in antioxidants like all berries, tomatoes, cruciferous vegetables, nuts, garlic, turmeric and legumes.

Prostate cancer can be cured when detected and treated early. More than 90% of prostate cancers are detected in the early stages. Gleason scores are pathology ratings of the prostate cells from 1-5, depending upon how aggressive they appear to be. These scores help determine treatment options like surgery, radiation, hormone therapy or watching over time for very slow growing tumors.

General Lloyd Austin is entitled to privacy about his cancer and treatment. The public does not need to know any medical details. Had he notified his close staff and the President, it could have been kept quiet and he could recover in peace. Unfortunately it is now a media circus and being used for political gain.

I wish him a speedy recovery.