Two POV's on Defense Secretary's dilemma: the 'emasculating journey' and prostate cancer privacy vs. public right to know
Plus see Dr. Anne Katz's column addressing a "loss of sensitivity."
(Embattled Defense Secretary Lloyd Austin)
Editor’s note: The case of Defense Secretary Lloyd Austin and his prostate cancer rhas aised so many questions. Congress and the media questioned why Austin withheld information about his operation and hospitalization for complications from his boss, Commander-in-Chief and President Joe Biden. Reporters asked few questions about the cancer itself. The New York Times suggested that Austin had a rising PSA and was rushed for surgery. There had to be more to it than that, right?
A group of patients and doctors raised more serious questions such as what was Austin’s Gleason score, PSA levels, and PI-RADS score, In an open letter, we offered him support and urged him to help raise the profile of this disease, which has a significant impact on Black men like him. I also wrote a personal opinion in MedPage Today.
In the newsletter today, we get two POVs for the price of one.
First, my former Chicago Sun-Times colleague Mary Mitchell shares insights on Defense Secretary Austin and his prostate cancer what one expert calls the “emaculating journey.” Mitchell is an award-winning journalist who has covered social justice issues for the Chicago Sun-Times since 1991. She now writes a weekly column, "Starting Over," that examines aging issues. Her column is reprinted with The Sun-Times’ permission.
Second, Catherine Diamond, MD, an infectious disease expert from the University of California Irvine shares her thoughts on the Austin case. She granted permission to reprint this piece from KevinMD.com. Please share your thoughts.—Howard Wolinsky)
‘(There’s a) lot that men don’t like to talk about—prostate cancer is one of them’
By Mary Mitchell/Chicago Sun-Times
I haven’t met Secretary of Defense Lloyd J. Austin III. But his recent photographs capture the look of a Black man with a lot on his mind.
And there’s something else etched on Austin’s face. He has a look my father had late in life — stoic.
Mary Mitchell (Ashlee Rezin/Chicago Sun-Times)
Even when my dad’s health began to fail, he never complained. I didn’t know he had been treated for prostate cancer until my stepmother mentioned it after my father’s death from heart-related issues.
He didn’t talk about prostate cancer — not with his daughters, not even with his sons.
There are things that a lot of men don’t like to talk about, and prostate cancer is one of them.
The secrecy that surrounded Austin’s surgery for prostate cancer highlights the sad fact that the ailment is still stigmatized.
Austin, 70, had surgery Dec. 22 and was hospitalized a week later with a urinary tract infection, and apparently no one at the White House was aware of his whereabouts.
On Jan. 8, a news item — “Austin Continues Recovery” — was posted on the Department of Defense website. It said that Austin “resumed full duties and remains in contact with senior advisers while continuing to recover from experiencing complications from an elective medical procedure.”
It wasn’t until Jan. 9 that the Defense Department revealed Austin was in the hospital recovering from complications after prostate cancer surgery.
President Joe Biden wasn’t told about the prostate cancer surgery until Jan. 9, according to a National Security Council spokesperson.
For whatever reason, Austin chose to keep his medical diagnosis private.
Austin must have known his departure from protocol was unacceptable as a military leader. But he did it anyway.
Despite the controversy among Republicans over that decision, I’m sure many men have the same view on why Austin didn’t share the diagnosis.
“Many people with prostate cancer experience stigma and shame,” Dr. Russell Z. Szmulewitz, director of the genitourinary oncology program at the University of Chicago, said in an interview on Healthline, a health and wellness website. “Some view the disease as an ‘emasculating journey,’ while others are reluctant to speak about their concerns or diagnosis in their homes and communities.”
Szmulewitz said the “biggest stigma is the perception of diminished or damaged masculinity.”
Many men in Austin’s shoes would have made the same choice.
For the rest of the story, go to: https://chicago.suntimes.com/2024/1/12/24035826/lloyd-austin-cancer-diagnosis-prostate
‘Men fear appearing weak’
By Catherine Diamond, MD
First, a disclaimer. I do not know Secretary of Defense Lloyd Austin, and I am not involved in his medical care. As an academic infectious disease physician, I am ignorant of the internecine hierarchy of the Defense Department. However, I listen to the news and thus am aware of his recent prostate cancer diagnosis and treatment.
(Catherine Diamond, MD, UCI)
On National Public Radio, reporters were discussing why the secretary of defense did not reveal his prostate cancer diagnosis. In summary, he was diagnosed with prostate cancer, underwent surgery, and developed the complication of a urinary tract infection requiring hospitalization and intensive care, all without notifying some of his most important colleagues. Why is this notable? It drew attention because the executive and legislative branches of government were unaware of his illness, and the delegation of authority during his incapacitation was unclear.
Reporters kept repeating the same question, “Why did the secretary of defense hide his diagnosis and treatment?” The secretary is known to be an unusually private man, which provides a partial explanation.
As a doctor with expertise in sexual health, I thought there might be more to his behavior than meets the eye. I hesitate to speculate and do not want to be likened to the psychiatrists who attempted to diagnose Donald Trump via media posts rather than through a standard medical interview. Thus, I would ask the reader to consider my musings as almost regarding a generic patient, an Everyman, rather than a specific individual. I claim no special insight into the secretary’s thought process.
What would be the rationale for avoiding disclosure of a medical condition? The patient may have been ashamed. Was he ashamed of being ill? Was he ashamed of having cancer? Was he ashamed of having prostate cancer in particular?
The prostate is a walnut-sized organ in the male pelvis that releases seminal fluid during ejaculation. Prostate cancer is a disproportionate cause of death among African American men. There is controversy regarding screening for prostate cancer, with some arguing that the small cancers detected would not result in death and that aggressive treatment results in erectile dysfunction and urinary incontinence. Others counter that prostate cancer remains a leading cause of death and is easily treated when caught early. This is a man who is a four-star Army general who served in Iraq and Afghanistan. Yet perhaps he was afraid to reveal his condition.
Men fear appearing weak, and our culture views illness as a sign of weakness. This bias may influence a leader’s decision-making in a male-dominated military. In addition, there remains a stigma attached to a cancer diagnosis, even if the malignancy is limited and responsive to treatment.
(For the rest of the story, go to: https://www.kevinmd.com/post-author/catherine-diamond)
Q: I was diagnosed with low-grade prostate cancer a decade ago. I have been lucky enough to follow an AS path. Within the last year, I have noticed a growing difficulty in reaching ejaculation.
I have also noticed a growing loss of sexual sensitivity in various areas of my body. For example, my nipples are no longer as sensitive as they used to be.
The bottom line here is that this loss has made reaching ejaculation even harder.
Have you encountered any meds or other reasons for this loss of feeling, and is there anything you could recommend to regain it? As I have stated, I have not had any PCa treatment other than periodic PSA tests. In the early years of this disease, I did allow four or six biopsies. Several of them were “blind.”
Looking for any information you might be able to share.
79 and Butch from Nebraska
Dr. Katz: I am happy to hear that you have stayed on active surveillance this long – all the while protecting your quality of life.
In answer to your questions. Firstly, when you say you have difficulty reaching ejaculation, is it safe to assume that what you mean is you have difficulty achieving orgasm. Ejaculation, the release of fluid (often called emission) usually occurs with orgasm. The volume of ejaculate or fluid does decrease as men age and the intensity of orgasm and/or ejaculation is reduced. Men also report that the sensation of ejaculate moving down the urethra and out of the penis also decreases.
Being on androgen deprivation therapy reduces skin sensitivity as does some of the medications to treat depression and/or anxiety. The short answer is that aging affects orgasms, ejaculation, and of course erections. Using a vibrator anywhere on the shaft of the penis, on the scrotum, or on the area between the scrotum and anus (called the perineum) may increase the intensity of orgasm but if you’re looking for a medication…remember my column addressing the sad fact that age is not a friend to the penis:
'Age is not a friend to the penis'--Dr. Anne Katz in her debut 'Sex & Surveillance' column
By Howard Wolinsky Recently, an attendee to a support group for men on Active Surveillance (AS) spoke about his experiences following a radical prostatectomy for Gleason 7 cancer. He was very frank about how he regained his sexuality. It was a rare moment—and fellow attendees hung his every word.
(Please send questions about sexuality, urology, pathology, radiology, and lifestyle to mailto:pros8canswers@gmail.com)
Why wait? Sign up for the ZERO support group on AS in March
By Howard Wolinsky
For the past three years, I have run a special Active Surveillance support group for ZERO. Last year, our virtual support meeting drew 60 patients to talk about AS. By far, it was the biggest session of any at the annual ZERO Summit.
I’m hoping we can beat that record at 11 a.m. Eastern on March 12, 2024.
I’ve set up the meeting and figured why not put out the word early.
It also will help in planning. If we get over 100 sign-ups, I’ll have to convert to a webinar so no one gets turned away.
So sign up now an in advance for this meeting:
https://us02web.zoom.us/meeting/register/tZUsfuqgrjIoG9AWf7voMhzT_UjdqbQQbQPA
Testimonial from a U.K. reader for TheActiveSurveillor.com
"Knowing a low-risk prostate cancer is neither aggressive nor likely to kill me before something else does is a comfort of sorts, but it doesn’t stop me from stressing over what those rogue cells are doing inside of me – especially in the lonely small hours when it really tends to prey on my mind.
“What I need to put my mind at rest is trustworthy information on the latest thinking on all aspects of a Gleason 6 diagnosis: on Active Surveillance, PSA tests, MRIs, biopsies and emerging genetics and biomarket theories for example.
“And that’s what The Active Surveillor newsletter provides in spades: Instead of my own web searches – which often turn up info of questionable relevance and importance – I know I can trust Howard Wolinsky’s deep subject knowledge and enduring journalistic curiosity to tell me what really matters. As a result, I cannot recommend a subscription to The Active Surveillor highly enough: To me, it’s become absolutely essential reading."—UK reader
In 3 words... "Get over it!"
As a 16-year 'Veteran' of Prostate Cancer Advocacy, it's hard to make excuses for a public figure staying silent. It appears to place personal considerations above the public good, and that is especially telling when perpetrated by a highly visible public servant.
Disclosing his PCa diagnosis should be a no-brainer for Secretary Austin if it can lead to saving lives - especially African American lives, for whom Secretary Austin is a shining example. It was a no-brainer for General Powell, and for General Schwarzkopf who admittedly was not African American.
I have heard others defend Sec. Austin's actions based on his privacy and/or DoD considerations. Maybe Austin planned to make a big disclosure later, albeit he never told his boss at the time while subject to a major surgery, so I would doubt that.
A famous Aussie cricketer recently went through a PCa disclosure, His disease was evidently a lot more serious and he went public after a considerable amount of time - but the impact is significant, and the ego is clearly placed to one side. Watch it at https://twitter.com/7cricket/status/1747804336950755701?s=42&t=3N2nHf39VyK_R1jYZVrhaA
An adage to military life is the culture. I had 15 years experience working with mid and higher level officers. The culture is definitely hierarchical and questioning authority is abnormal. You cannot engage in conflict with analysts; orders must be followed. Force may be critical in conflicts. How does this pertain to SOD Austin? Perhaps, as I was not present nor am aware of all of the events as we have read or heard only in the media, people in the know in DC were following the military culture. In this case, respect authority in the organization. People in the military are willing to take a bullet to protect our national security. It is unusual for anyone in a hierarchical culture to step out of line. Perhaps there are facts in this case we are not aware of? All things as said, I appreciate your and guest writers POV.