Part II: The shocking case of DOD Secretary Gen. Austin’s prostate and government policy

He called in drone strikes in the Red Sea from his hospital bed at Walter Reed

(See Part I “Presidents, politics, prostate cancer, policy debates, transparency, the Constitution and taking the Fifth.” This is a recap of of how public policy was influenced by a case of prostate cancer—that of former Defense Secretary Gen. Lloyd Austin tried to keep his cancer and subsequent surgery secret and how that led to a Congressional hearing and an investigation by the Inspector General of the Department Defense—heady study for the “walnut” gland—HW)

By Howard Wolinsky

Former Secretary of Defense Gen. Lloyd Austin withheld his prostate cancer diagnosis and surgery from his boss, Commander-in-Chief Biden, his top deputy, and the American public

He should have handed over his duties and taken a break, but he was in his hospital bed-command post watching a big screen as he called in attacks in real time on terrorists in the Red Sea off Yemen. I pictured him in a shorty camo hospital gown, a remote-control Rambo at Walter Reed. Here’s how AI portrayed the scene:

(AI rendition of Gen. Austin calling in the drones in the Red Sea as he recuperates from a radical prostatectomy. Notice the camo hospital gown.)

Austin appeared before Congress and fessed up to, took responsibility for and apologized for mismanagement of information about his case. He said he had been “gut punched” by the disease and should have been transparent.

In essence, Gen. Austin went “rogue,” violating the rules of the Pentagon and those of military discipline and protocol. Check the account in The Active Surveillor.

So the prostate gland impacted federal policies.

The Austin case resulted in the Biden administration implementing new guidelines for Cabinet secretaries regarding transparency and delegation of authority. Cabinet members must now inform the White House Chief of Staff and the Office of Cabinet Affairs when they plan to or have delegated their authority.Departments are required to maintain written documentation of when authority is delegated and rescinded. Authority must be delegated in situations where a Cabinet member is unreachable, such as during travel with limited communication, hospitalization, or medical procedures under general anesthesia.

At the time, Biden said Austin showed a lapse in judgment but expressed confidence in Austin’s competence.

As the Biden administration left office in January 2024, the Pentagon Inspector General investigation called out Austin, saying his desire for privacy drove notification failures within government, and that he took medication that could have affected his cognitive functions while still in sole command.

The report found that Austin failed to meet requirements under The Federal Vacancies Reform Act to notify the U.S. government about his incapacitation during this incident. He underwent a hush-hush radical prostatectomy in December 2023 after a routine health screening identified prostate cancer, according to the U.S. Department of Defense. He was later readmitted to the hospital on January 1, 2024, due to complications from the surgery.

"Secretary Austin received several different medications during the morning of January 2 that had the potential to affect cognitive functions," the Pentagon's independent Inspector General wrote.

Austin's authorities were not transferred to his deputy until 2:22 p.m. on Jan. 2, according to the report. She did not learn he was hospitalized until Jan. 4, the report said.

The Pentagon had previously denied Austin was under any medications that could have impacted his judgment before a transfer of authority. Spokesperson Major General Patrick Ryder said on Jan. 9: "I have no indications (of) anything that would affect his decision making."

About 4% of U.S. Senators known to be diagnosed with PCa. None on Active Surveillance. Time for a Senate investigation?

By Howard Wolinsky

Of the 94 male members of the current U.S. Senate, four have publicly disclosed they have prostate cancer.

That’s roughly the 4% incidence you’d expect in this group of oldish men—average age 64.

All claimed early detection of the cancer and all underwent radical prostatectomy.

I am compelled to ask: If the cancers detected so early, why did none go on Active Surveillance. About 315,000 U.S. men will be diagnosed with prostate cancer—and well over half will be candidates for Active Surveillance.

Why is the U.S. Senate defying the odds that show 60% of men with low-risk prostate cancer go on AS? I’d call for a Senate investigation as if that would do any good.

A-listers, as far we can tell, generally seem to avoid Active Surveillance and apparently head straight for radiation or surgery, suggesting that “platinum/VIP medicine” may not be the best choice.

It’s possible that some Senate members have gone on AS and kept it secret. That happens in the general population. Here’s a bit of a history of the cancer in the Senate.

Here’s a PCa roll call of Senators who have been diagnosed and treated:

• Senator Michael Bennet (D-Colo.): Underwent surgery in April 2019 for prostate cancer, according to his office. The surgery was reported to be successful, and he required no further treatment. He had been a Presidential candidate. More here from The Active Surveillor:

• Senator Bob Casey (D-Pa.): Was diagnosed with prostate cancer in late 2022 and underwent surgery in February 2023. His office stated that the procedure went well and he was not expected to require further treatment. More here.

• Senator Angus King (I-Maine): Also faced prostate cancer and underwent surgery in 2015 to remove the prostate gland and some surrounding tissue. In January 2019, he underwent a round of radiation therapy to treat residual cancer.

• Senator Thom Tillis (R-N.C.): Announced in March 2021 that he would undergo surgery for prostate cancer, reports PBS News.

  Also, for the record, there’s Mitt Romney, a former GOP Presidential contender and Senator from Utah and Governor of Massachusetts: In January 2018, it was revealed that Mitt Romney had been treated for prostate cancer the previous summer. The diagnosis was a slow-growing prostate cancer, and it was successfully removed surgically, with the cancer found not to have spread beyond the prostate. His prognosis was reported as good. The treatment took place at UC Irvine Hospital in California.

Why not share your Active Surveillance story with your male U.S. Senator and help him avoid aggressive treatment?

FDA grants Artera AI-powered software for prostate cancer 'Breakthrough Device Designation' to help drive innovation

By Howard Wolinsky

I have heard several times in the past week from men who received reassurance about going on Active Surveillance from ArteraAI Prostate software, which makes predictions of outcomes based on AI analysis of digital images of pathology slides.

40=60% of patients avoid biopsies from their results from ArteraAI Prostate, an AI precision medicine tool intended to assist clinicians with risk-based decisions for patients with localized prostate cancer.

Now, the Food and Drug Administration has granted Breakthrough Device Designation” to ArteraAI Prostate. Breakthrough Device Designation may expedite the FDA authorization process for the ArteraAI Prostate software. The FDA’s Breakthrough Devices Program is designed to accelerate the development and review of medical devices that offer more effective diagnosis or treatment for serious conditions, while maintaining rigorous standards for safety and effectiveness.

ArteraAI Prostate can prognosticate long-term outcomes, such as 10-year risk of distant metastasis and prostate-cancer specific mortality, to help clinicians determine the most appropriate treatment option. It can help men avoid Androgen Deprivation Therapy and whether AS would be a good fit.

Timothy Showalter, MD, medical director of Artera AI, said: “"We’re honored to receive Breakthrough Device Designation from the FDA and look forward to working closely with the agency as we pursue clearance for the ArteraAI Prostate device. This designation reflects our shared commitment to improving access to innovative tools that support timely, personalized treatment decisions.

Andre Esteva, CEO of Artera, said: “Our goal is to empower patients and clinicians with actionable insights at the point of diagnosis—helping to eliminate unnecessary delays and reduce uncertainty during a critical moment in the cancer journey

“This designation is a powerful validation of our software's potential to transform how we treat cancer,” said “We’re proud that the FDA has recognized our innovative technology platform, and we’re excited to be advancing the frontier of oncology by delivering differentiated and clinically relevant tools that can help save more lives.”

Artera notes that a man is diagnosed with prostate cancer every 2 minutes in the U.S. While it is the second leading cause of cancer death among American men, there are also 3.5 million men in the U.S. living with the disease today.

Come to the ASPI webinar on genetics—and respond to a couple surveys, please

ASPI (Active Surveillance Patients International) has assembled a panel of genetics experts to address genetic and prostate cancer.

The session will run from noon to 1:30 pm Eastern time on Saturday, July 26.

Please register for the meeting here.

There will be a Question-and-Answer session following remarks by the panel. Please send questions in advance to: contactus@aspatients.org

Please respond to my confidential survey on genetic testing and PCa. Click here: https://forms.gle/Uv9d5gaZYHadZ5Qh9

I’m closing out this survey soon.

Also:

Please answer this questionnaire on transperineal vs. transrectal biopsies: https://forms.gle/GShpHwegEPtAVgTs9 I have a relevant story coming, and you can take a few minutes and help if you haven’t already.

Please respond to my survey on your experience with MRIs: https://forms.gle/kuQVP4bDhEsm3RLV9