I Understand Why Defense Secretary Austin Kept His Prostate Cancer Quiet

Derick Alison
Derick Alison
8 Min Read

When the news broke in early January that Defense Secretary Lloyd Austin was hospitalized for unrevealed reasons, my first thought was: “Aha, prostate cancer.” Turns out I was right.

A Black man like him has a higher risk than the majority white population of being diagnosed with prostate cancer, getting a more aggressive cancer, and of dying from the cancer. Austin is also 70 years old, close to the average age (66) of a prostate cancer diagnosis.

Shortly after, the Pentagon confirmed that Austin had been hospitalized on New Year’s Day at Walter Reed National Medical Center for complications from a prostatectomy done on December 22.

On January 15, Austin was released from the hospital and sent home to recuperate and perform his duties from home. In a statement, Austin expressed thanks to the Walter Reed medical staff, adding, “I’m eager to fully recover and return as quickly as possible to the Pentagon.”

Walter Reed doctors said in a statement that Austin was treated early and his prognosis is “excellent.” They said he had “progressed well throughout his stay and his strength is rebounding.”

The Defense Department’s inspector general will be reviewing Austin’s actions. I suspect his prostate care won’t be directly evaluated, similarly to how the mainstream press has primarily investigated whether Austin had informed his boss, Commander-in-Chief President Joe Biden, about his hospitalizations. There’s been a clear focus on policy and protocols rather than the prostate.

But the health matter at hand — prostate cancer — naturally raised questions in the prostate cancer community, which refers to itself symbolically as the brotherhood of “Reluctant Warriors.” (Not everyone likes the warrior analogy.)

Our group ranges from those like me with non-aggressive Gleason 6 disease that may never be treated (and is not even considered cancer by some) to those with deadly metastatic disease that can kill. The extremes are contrasted as the Sleeping Lion versus the Snarling Tiger. Many are in between.

We don’t know — and may never know — where Austin falls on the spectrum. It’s up to him what he chooses to share.

But as a patient, an activist, and a medical journalist, I always advocate for openness to inform the public at large about this disease. It also offers Austin a new avenue to show his leadership. Many other celebrities and politicians, such as the late senator Bob Dole (R-Kan.) and the late singer and actor Harry Belafonte, have shone a light on this disease and helped the public understand it.

Some of Austin’s fellow patients wonder about the details of his disease: what is his Gleason score? What are his prostate-specific antigen (PSA) blood levels? What is his PI-RADS score from an MRI? What about his family history and the results of any genetic testing? Inquiring minds want to know.

Of course, however, that is all very personal information. The prostate cancer community understands that. And, despite the fact that Austin is a high-profile public figure, he is not compelled to share his medical data or history.

Although I have low-risk prostate cancer and have been on active surveillance for 13 years, I know a bit about the sort of journey of body and mind ahead for Austin. It isn’t necessarily going to be easy.

After being diagnosed with prostate cancer, you undergo an identity change, transforming into a “cancer patient,” no matter the kind of tumor you have. You make some of the most important decisions you will make in your life about treatment — hopefully with the help of your family and a knowledgeable physician.

For many, it is a time of emotional distress (anxiety and depression) and uncertainty — the potential for decisional regret or cognitive dissonance. You may have to choose between several options and may face serious side effects, including temporary or permanent incontinence, impotence, or worse. You may ask again and again: Did I make the right choice?

There is denial and stigma with any cancer, especially one linked with your sexual organs, and the possibility you could be in diapers or pads temporarily or permanently. This may be tough in the macho world of the military.

Through my newsletter, I ran a survey of men with prostate cancer and found that 25% of respondents hid their cancer from their family, friends, and bosses. Many use a fake name — a “nom du cancer” — while attending support groups. Some fear losing their jobs because their bosses think they will be unable to handle the stress of cancer treatment (even those on surveillance) while juggling job responsibilities.

Rick Davis, who founded the AnCan Foundation, a major support platform for prostate cancer and other diseases, wrote: “No Defense for Secretary Austin: For those of us living with prostate cancer, Secretary Austin’s crime was not failing to keep his boss informed — it was hushing up his prostate cancer as something to be ashamed of. Many of our peers have voiced the same reaction.”

“This was an opportunity to promote public awareness and to save lives as a result, especially within the vulnerable African-American population. Generals Powell and Schwarzkopf were bigger men and chose the right path when diagnosed with prostate cancer; General Austin was defeated by his own ego.”

Austin initially kept his diagnosis from his boss. Biden agreed Austin had a “lapse in judgment” but added that he still had faith in his Defense secretary. Some members of Congress went on the warpath against Austin being secretive about his cancer treatment. Time will tell whether Austin keeps his job.

Putting on my advocate hat as a co-founder of support groups for men on active surveillance, I organized fellow patients, support organizations, and medical experts to “welcome” Austin the warrior to our brotherhood of “Reluctant Warriors.”

It appears to be the early days for Secretary Austin on his healing journey. We fellow patients and expert physicians offer our support to Austin. We have his back if he needs us.

Howard Wolinsky is a Chicago-based medical writer. He now is in his second semester working on an MPH from the University of Illinois School of Public Health.

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