Details of John
Kerry's Victory Over Prostate Cancer
By LAWRENCE K. ALTMAN
Senator John Kerry could become the first "cancer survivor" to be elected president, but he rejected the term as creating an unfair stigma. He is free of any vestiges of the cancer and characterized it as a nonissue in an interview in Las Vegas on Sept. 16. "I am cured, " he said. "I am cancer-free, and the percentages of me being cancerfree 10 years from now are about as good as they get."
Mr. Kerry's doctors said they had told him that he was cured. They based their optimism on an array of tests and concluded that he had a less than 3 percent chance of a recurrence in the next nine years. Even if the cancer came back, it could be treated without seriously interfering with presidential duties, Mr. Kerry's doctors and experts said.
The likelihood that he is going to have a significant problem with this cancer is infinitesimally small," said Dr. Patrick C. Walsh, the Johns Hopkins University urologist who performed the operation. The five-year death rate for the kind of prostate cancer that Mr. Kerry developed is virtually zero.
Mr. Kerry, in expressing confidence that he was cured of prostate cancer, pointed to former Senator Bob Dole of Kansas, 81, who underwent the same operation in 1991, five years before he lost the presidential election to Bill Clinton.
Mr. Dole "is doing great today," Mr. Kerry said. "There's your answer."
Since his surgery, blood tests performed every six months to check Mr. Kerry's prostate-specific antigen, or P.S.A., a marker for cancer, have indicated no recurrence. The latest test was performed Sept. 18 in a house call by Dr. Doyle.
Reasons for Concern
Mr. Kerry's P.S.A. was in the normal range when his cancer was detected during an annual checkup in December 2002. But because the figure had risen by 70 percent over two years, both Teresa Heinz Kerry, the senator's wife, and Dr. Doyle independently felt the need to check further.
The P.S.A. test was a normal 3.24 nanograms per milliliter. But Mrs. Heinz Kerry said she told her husband, "it's low, but high for you" and urged him to see Dr. Doyle in Boston and repeat the tests.
When the doctor examined Mr. Kerry on Dec. 17, 2002, it was his patient's first checkup in nearly two years. A standard digital examination and an ultrasound test found no nodules or other prostate abnormality that might signal cancer. His new P.S.A. level was a normal 3.4 nanograms per milliliter. Nevertheless, Dr. Doyle said he was concerned because the figure had crept up from 2.7 in Feb. 2001 and 2.0 in Dec. 1999 and Nov. 2000.
So Dr. Doyle consulted Dr. Alex F. Althausen, a urologist, who recommended a biopsy. "The rate of increase was what alarmed us both," Dr. Doyle said.
After learning that an ultrasound "isn't a fail-safe" test, Mr. Kerry decided he wanted a biopsy.
After fitting Mr. Kerry into his schedule between surgeries on Dec. 20, Dr. Althausen told Dr. Doyle that the biopsy specimens did not look suspicious to his naked eye, Dr. Doyle said.
But the real test was viewing the biopsied tissue under a microscope, and the pathology report showed cancer in five of the pieces that were removed.
Mr. Kerry was one of more than 200,000 men in the United States in whom prostate cancer is diagnosed each year. About 1 in 6 American men will develop the disease at some point, but only 1 in 33 will die of it, the American Cancer Society says. The reason is that prostate cancers often do not develop until men are in their 70's or older and often grow slowly; men who develop prostate cancer often die of other causes.
Dr. Doyle wanted to inform Mr. Kerry about the finding in person, as he usually does. "Most patients are overwhelmed when they first learn they have cancer, and many lose their focus," he said.
But for four days over the long holiday weekend, (Christmas was midweek) Dr. Doyle's attempts to leave messages for Mr. Kerry at his Senate and local offices failed because the voice mailbox was full. He finally reached Mr. Kerry on Christmas Eve at his home in Sun Valley, Idaho.
"To have to tell someone over the phone is difficult," Dr. Doyle said. "But I had to because we wanted to get things squared away as soon as possible."
When he delivered the news to his patient, Dr. Doyle said, "He didn't miss a beat and just asked all these appropriate questions right away as though it were someone other than himself."
"What does this mean?" Dr. Doyle said Mr. Kerry asked him. "What are my options? What is the time frame we are talking about here? How soon can we get moving on it?"
Mr. Kerry recalled, "A lot of things went through my mind," including memories of his father, who died of prostate cancer at age 85 in 2000. (Studies show that a family history of prostate cancer increases the risk of developing the disease but not the rate of its progression.)
"My dad had radiation, and I saw just how he lived at the end, and I didn't want to go through that," Mr. Kerry said.
After consulting with people who had different treatments for prostate cancer, Mr. Kerry said, "I knew what I wanted and needed to do."
"I made the decision, boom, and we booked the surgery, and 30 days later I did it," he said.
Mrs. Heinz Kerry said she had read about Dr. Walsh, who had developed a nerve-sparing prostate operation that preserves continence and potency for many patients, and suggested the couple call him.
The decision to have the surgery in Baltimore irked many doctors in his home, Boston. Mr. Kerry said he regretted that attitude, and that he preferred to recuperate near his office in Washington. The operation, removing the entire prostate gland, was performed on Feb. 12, 2003 and "went by the book," Dr. Walsh said. His patient, though, did not allow himself much time to recover.
"He needed to be at a major event out in California two weeks later," Dr. Walsh said. "So he shortened his recovery schedule by a little bit just to make it fit."
Mr. Kerry said, "It takes you a little longer to get back up to speed than you think because they put a bunch of stitches in you, and I was surprised at how many."
"The prostate slowed me down a little bit at a critical time," Mr. Kerry said. "It was an annoyance; it was aggravating."
The pathology report was the best that Mr. Kerry could receive: the cancer was confined to the left side of the prostate gland. And on the Gleason scale, a standard measure of the severity of prostate cancer, Mr. Kerry's score was 6 out of 10, considered a very favorable finding.
If Mr. Kerry had a recurrence, Dr. Walsh said, "he would be astonished, and so would I, and I am telling you this with the very conscious understanding of what happened to Senator Tsongas."
Dr. Peter T. Scardino, the chief urologist at Memorial Sloan-Kettering Cancer Institute in Manhattan, who is not connected with Mr. Kerry's case, said that while "there are no guarantees," he agreed with the prognosis given Mr. Kerry. "Something bizarre could happen as an exception to the rule, but it would be extremely surprising," Dr. Scardino said.
If Mr. Kerry's cancer did return, it could be controlled by radiation therapy over six weeks, Dr. Scardino said. "That would almost certainly not interfere with his functioning as president except" to limit travel during that period and for the fatigue that often follows radiation therapy, he said.