The case of the mysterious prostate operation and the San Diego Padres’ skipper

Cancer ruled out? So what was it? Padres have no more to say.

By Howard Wolinsky

When it comes to prostate cancer, high-profile sports figures, pols, aging rockers, actors, and entertainers are different from the rest of us.

Sir Ian McKellen a few years back blurted out to a reporter that he was on active surveillance for low-risk prostate cancer. Then, he lied and said he didn’t have prostate cancer. And once again, he reversed himself.

Prostate disease is a touchy subject for those with images of vitality, health, youth, and zillion-dollar contracts to maintain.

Fireman’s Fund laid out nearly $2 million for delayed production when actor Robert De Niro was being treated with for a radical prostatectomy. The insurer said De Niro allegedly lied, committing insurance fraud, for signing a certificate of health that did not acknowledge the prostate issue. Ultimately, a court tossed the suit.

Another chapter of the Annals of the Prostates of the Rich and Famous was added earlier this week. It related to a high-profile figure in San Diego, the manager of the Padres baseball franchise.

Padre’s new skipper Bob Melvin told the sports media Tuesday in a dugout briefing that he was undergoing “prostate surgery” the next day. 

I started to hear about the news from men with diagnosed prostate cancer who couldn’t figure out what Melvin was talking about when he described his health situation. I can tell you they weren’t alone. Several medical experts I talked to were left scratching their heads as well.

A friend from Detroit with low-risk prostate cancer sent me an ESPN story on Melvin and commented: “Some odd quotes in this article.”

The skipper, in street clothes, gearing up for a serious medical intervention, mentioned he was having surgery, almost in passing.

Like a pitcher trying to brush a batter off the plate, while briefing reporters, Melvin attempted to simultaneously raise and avoid his personal health issue: “Real quickly, let's minimize this. I'm going to have surgery tomorrow. It’s' going to be prostate surgery,” he said.

He then plunged into details on who was going to fill in for him and how long he was going to be gone.

The reporters didn’t have any hardball questions.

One reporter said he wasn’t sure what he was hearing and asked: “Bob, just so we're reporting it accurately. You say prostate … is it cancer? Or is it something else?”

Melvin downplayed the prostate cancer angle and responded: “I don't think so but they won't know until they get in there.”

Huh? That’s when things started to not add up for me as a veteran medical reporter and as a patient on active surveillance for low-risk prostate cancer for the past 12 years.

Melvin was not specific about his symptoms. But he was specific about surgery and about the prostate. What was going on?

I’m not a doctor of course. But my first suspicion was he must be experiencing frequent urination from an enlarged prostate. But he didn’t say so, and the reporters, more accustomed to stats such as RBIs and ERAs didn’t know enough to ask key questions about the prostate Gleason scores, PSAs, PI-RADS, and prostate density.

They shouldn’t feel bad. Sports reporters, entertainment reporters, and political reporters, who often cover this kind of story, typically are at a loss when it comes to an inside baseball topic such as prostate cancer. 

I found it unusual that surgeons would in effect be doing exploratory surgery on the prostate to look for cancer. I never heard of exploratory surgery for prostate cancer. MRIs and targeted biopsies usually do the trick.

 My impression is that prostate surgery is planned after the presence of cancer is verified in pathology. Prostate surgery wouldn’t be performed because of a suspicion of cancer.

Leading prostate experts told me my instincts were correct.

One said,  “This makes absolutely zero sense. You are of course correct--we know ahead of time if we are doing a cancer surgery or a BPH (benign prostatic hyperplasia) surgery. This really has to be a BPH surgery, such as TURP. Yes, there is a chance of finding some incidental cancer, but it's weird to even mention cancer in this setting.”

He added: “I’m thinking more likely he has a cancer diagnosis and doesn’t want to talk about it. Would think if a BPH procedure he’d just wait until the off-season.” In other words, the fact that Melvin was rushing into surgery suggested something major was amiss--though that didn’t seem to be what unfolded later. 

Brian Helfand, MD, PhD, chief of urology, NorthShore University HealthSystem, outside Chicago, one of the top prostate docs in the country, told me this puzzled him, too. I happened Thursday to have my annual visit with him--this year via a telehealth call--so I peppered him with questions.

He agreed with my other source: “We, as surgeons, know what we are planning on doing. However, the way the information is reposted to media can be to protect a patient’s wishes or privacy. Having said that, there can always be surprises with pathology.”

One of those surprises can be the discovery of incidental cancers, he said. “Most of the time GG1 (Gleason Group 1, or Gleason 3+3) during BPH surgeries,” Helfand said.

If by chance, some sports reporter is reading this:  Gleason 3+3=6 is about the best news you can get with prostate cancer. These patients potentially can live out their lives without any prostate cancer treatment. So surgery or radiation are not on deck in most cases.

Meanwhile, the San Diego Padres medical team posted on social media an update on manager Melvin, three-time winner of Manager of the Year.

Darren Feeney, the Padre’s spokesman, on Friday gave me the latest update on Melvin: “Bob is out of the hospital, recovering at home, and in good spirits. He’s very thankful that cancer was not found during his surgery.”

That’s good news. But I still feel Melvin and the Padres owe the public a comprehensive explanation about what happened.

I suggested to Feeney that Melvin make his doctors available for an interview to clarify matters. I said I knew this was a private matter, but the skipper could help his fans out by explaining what had transpired with his medical care, and that he potentially could save some lives and educate the public.

Come on, guys. Prostate cancer is the most common form of non-skin cancer found in men, making it a true public health concern.

But that was a non-starter.

Feeney said, “Bob’s medical information is private and confidential, so we won’t be able to provide any additional information.” He gave me the update and said, “We won’t be commenting any further.”

I hope this isn’t the end of it. I hope the sports media tackle this with follow-up questions to get at the truth to inform the public. And if they’re not up for it, how about setting loose some medical writers loose in San Diego?

Howard Wolinsky: I was on the medical beat at the Chicago Sun-Times for more than 25 years. I frequently was called on to write about health aspects of sports stories. The Sun-Times was and is a great “sports paper.” And the biggest reactions I got on stories were when I wrote for the sports section about such topics as the Chicago Bulls’ Michael Jordan’s having a fungal infection that took him out of the game as fans and sports writers ridiculed what was a potentially serious, even deadly infection.  Or when I got attacked for criticizing in an article the Chicago Bears punk quarterback Jim McMahon and his very public chewing tobacco habit. 

Sorry, sports fans, gotta call ‘em as I see them