For many Americans, the first glimpse at Massachusetts Sen. John Kerry -- perhaps the frontrunner for the 2004 Democratic presidential nomination -- came on Tuesday evening when he announced that he had prostate cancer.
Wednesday morning, the senator announced, he would be undergoing surgery at Johns Hopkins University in Baltimore to remove his prostate, the walnut-sized gland that is crucial to the male reproductive system. Doctors say he has a 95 percent likelihood of being cured.
"They're going to take my 'aloof' gland out tomorrow, so I'm feeling better," Kerry joked to the throng of reporters who had assembled at the Senate Radio-TV Gallery, referring to one of the main criticisms political scribes and opponents have thrown his way. It's been a weird few weeks for Kerry; on Feb. 2, the Boston Globe reported that his paternal grandfather, apparently unbeknownst to the candidate, had been a Hungarian Jew who changed his name from Fritz Kohn to Frederick A. Kerry.
Of more consequence, perhaps, is Kerry's father, who died from prostate cancer in 2000. Second only to lung cancer as a cause of cancer-related death among men, prostate cancer kills about 40,000 American males a year; those with a family history of prostate cancer are at greater risk.
At Tuesday's press conference, Kerry, 59, voiced complete confidence in both his surgeon, Dr. Patrick Walsh M.D., urologist-in-chief at the James Buchanan Brady Urological Institute at Johns Hopkins Hospital, and his prognosis.
"I'm going to be cancer-free," Kerry asserted. Asked if he thought this health issue would have any effect on his presidential hopes, Kerry said: "I don't think it's going to have any impact at all." Kerry, a Vietnam veteran who later helped form Vietnam Veterans Against the War, was elected to the Senate in 1984.
Team Kerry took great pains to ensure that as much information as possible was available to reporters. His press office provided a packet of background information about Kerry's health, the disease, other prominent men diagnosed and treated for prostate cancer, and Dr. Walsh -- even going so far as to plug the surgeon's book, "Dr. Patrick Walsh's Guide to Surviving Prostate Cancer" (Warner Books, $16.95).
"Senator Kerry is a poster boy for early detection," Walsh said in a statement distributed by Kerry's staff. "He's a very active 59-year-old in overall great health who took to heart the advice we give to all men his age and insisted on regular checkups. We caught this very early and for that reason the prognosis couldn't be more optimistic."
On Wednesday at 6 a.m., according to Kerry's office, there will be a "Photo op of Kerry entering Main Entrance of Johns Hopkins Hospital" at the main entrance on Wolf Street.
Erring on the side of providing too much, rather than not enough, information is no doubt a politically savvy move. Health issues -- more specifically, questions about how open and honest the candidates had been about their health issues -- popped up in the campaigns of previous national candidates. In the throes of campaign for the Iowa Caucus and New Hampshire Primary, former New Jersey Sen. Bill Bradley was forced to admit that he hadn't disclosed information about his atrial fibrillation, in which the upper chambers of his heart contracted too rapidly. The administration of President George W. Bush has been accused of downplaying the severity of Vice President Dick Cheney's heart condition. The most glaring and tragic example, however, is former Sen. Paul Tsongas, D-Mass., who -- after being diagnosed with cancer of the lymph nodes and undergoing a bone marrow transplant -- did not completely level with reporters about his health during his 1992 presidential run. He died in January 1997.
Bearing that in mind, the Boston Globe -- which, like most hometown newspapers of presidential aspirants, is fairly aggressive in its Kerry coverage -- reported Tuesday that, thinking the senator particularly worn in appearance and noting that he drank a protein shake during a recent interview, a reporter asked Kerry 10 days ago if he was sick. "Why? Do I look bad?" Kerry replied. Asked again, Kerry denied being sick, as did several of his campaign staffers.
When accused by the Globe reporter, Glen Johnson, of not answering the question "truthfully" a week and a half ago, Kerry said that at the time he hadn't made up his mind about his medical treatment. More importantly, he said, "I believed members of my family deserved to learn not by reading the newspapers." He wanted, in short, to announce the decision on his own terms. "Sometimes, Glen, that's more important than a headline in a newspaper," he said.
Kerry said he hadn't told his sister about his cancer at that point. A source close to Kerry and his family adds that Kerry's daughter Vanessa hadn't been told at that point, either.
"I could parse the word 'sick,' but I'm not going to," he said.
According to Dr. James D. Brooks, an assistant professor of urology at the Stanford University School of Medicine, Wednesday morning Walsh and his team will give Kerry a spinal anesthetic that will not knock him out, but will keep him numbed during the operation. Walsh will make an incision from Kerry's navel down to his pubic bone, an up-and-down incision between the rectus muscles. Kerry's bladder will be pulled back, exposing the prostate, covered by the translucent pelvic fascia lining. Taking great care not to cut the nerves, Walsh will remove Kerry's prostate, reconnect his bladder with his urethra -- which normally runs right through the prostate gland -- and sew him back up. The procedure takes anywhere from two to three hours.
Kerry painted a whimsical picture of his recovery: He hoped to return to Washington on Saturday, he'd be busy next week with meetings and on the phone, and in two weeks would be making a campaign trip to California. However good his prognosis, it's obviously a bit more complicated than that. For two weeks or so, he will likely use a catheter tube to urinate. Dr. Brooks adds that there is usually a delay of "several months" before a patient can achieve an erection. Though "some are so potent they can have one virtually immediately after the operation," he added.
It all began last November, when Kerry started a series of medical exams for the purposes of his presidential run, the junior senator from Massachusetts said. A colonoscopy at Georgetown Medical Center "came up completely clean," Kerry said, using an unfortunate choice of words, but a blood test with the Senate physician indicated that his "protein specific antigen," or PSA, had risen from 2.7 nanograms per milliliter the year before to 3.2. Two years before it had been 2.0.
Kerry's wife, Teresa Heinz Kerry, noticed the elevated rates and became alarmed.
"Teresa is a hawk on health issues," says the source close to Kerry. "She just went through the whole dying process with her mother." Additionally, the friend said, while in the past Kerry might have been inclined to not visit a doctor, "Kerry's gone through this whole period of introspection anyway, with his run for the presidency, his father died a few years ago, his mother died a few months ago. So these kinds of issues had become important to him."
Because the earlier PSA test had taken place at a Massachusetts General Hospital lab, the Senate physician suggested that Kerry return to that lab for another test. He did, and that test reported on Dec. 19 that he had a PSA level of 3.4.
"The PSA is a marker that can indicate cancer," says Dr. Dorado Brooks, director of prostate cancer for the American Cancer Society. "But it can also be related to benign conditions." Brooks says that "that sort of rise over a relatively short period of time" is a red flag for possible cancer.
The next day, Kerry underwent a biopsy at Massachusetts General Hospital. Four days after that, on Christmas Eve day, Kerry was told that the biopsy tested positive. He was told, however, that because the cancer had been caught so early, a complete cure was possible. A Jan. 2, 2003, full-body scan indicated that the cancer had not spread, or metastasized.
Five days later, Kerry met with Dr. Walsh -- Kerry called him a "superb pioneering surgeon" Tuesday -- with whom he discussed the various treatment options.
There is no "clear and unequivocal evidence that one kind of treatment is better than another," Dr. Dorado Brooks says. Prostate cancer survivors like former presidential candidate and Sen. Bob Dole, R-Kansas, former Desert Storm Gen. Norman Schwarzkopf, FBI director Robert Mueller III, Yankees manager Joe Torre, and former 007 Roger Moore all have opted for surgery.
On the other hand, Nelson Mandela, Charlton Heston, Rupert Murdoch and former New York City Mayor Rudolph Giuliani chose radiation therapy instead.
Asked if he opted for surgery rather than radiation treatment because the former would presumably allow him to return sooner to the campaign trail, Kerry said: "For my age, for my level of detection, for my current analysis of what the slides look like, this is the best course of action." He took the facts about the surgery's potential side effects "and the extraordinarily enhanced recovery rate, and measured that against the outcome of the radiation and against my father's own outcome, and I made a judgment that it is better to get this thing out of me."
The source close to Kerry said he "wants to put it behind him, he wants to move on. And yes, he wants to campaign -- that's a factor."
Walsh is one of the leading prostate surgeons in the world. "He has broken through with what they call nerve- sparing surgery," Kerry said Tuesday, "which reduces bleeding and maximizes the long-term curable possibilities." But bleeding has little to do with the nerve-sparing surgery's raison d'etre -- it provides a great likelihood that the patient will be able to again achieve an erection.
The prostate gland, which lies under the bladder and just in front of the rectum, manufactures an alkaline fluid that makes up about a third of ejaculate. Radical prostatectomies used to be very bloody operations that carried with them great risk of long-lasting side effects -- namely incontinence and impotence. It was accepted as medical fact that the nerves that control erections ran through the prostate and prostate cancer surgeries would therefore always leave the patient impotent. Walsh began to wonder about this, however, after one of Walsh's patients reported that he had regained his ability to have an erection after his surgery. At a medical convention in the Netherlands in 1982, Walsh met a retired urologist named Pieter Donker, who invited him to join him in a dissection of a stillborn infant since Donker had discovered that stillborns were excellent subjects for prostate study because the nerves were easier to see. During this dissection, Walsh noticed that the nerve bundles were not inside but outside the prostate capsule. In April 1982, Walsh performed the first "nerve-sparing" prostatectomy on a 52-year-old man, who regained his ability to have an erection within a year. Walsh has since performed thousands of these operations, with the vast majority of patients experiencing neither incontinence nor impotence in the long term.
That is the option Kerry chose. "I am convinced the choice I made is the right choice for me," he said, before warning several men in the press gallery that they may have prostate cancer as well. "I don't want to shock anybody here, but for those men here, the probability is that some of you have it today and don't know it."