Austin kept prostate cancer, surgery complications a secret from everyone, even Biden

WASHINGTON (AP) — Defense Secretary Lloyd Austin has prostate cancer, and his recent secretive hospitalization was for surgery and later to treat a urinary tract infection related to that operation, his doctors said Tuesday.

The cancer revelation answers the main question about Austin’s hospitalization, which has now lasted eight days. But it may only add to questions of accountability, since President Joe Biden only learned about the cancer diagnosis on Tuesday, even though it was made about a month ago.

“Nobody at the White House knew that Secretary Austin had prostate cancer until this morning," said John Kirby, the National Security Council spokesman. "And the president was informed immediately after.”

The 70-year-old Austin was admitted to Walter Reed National Military Medical Center on Dec. 22 and underwent surgery to treat the cancer. He developed the infection a week later. Biden and other senior administration officials were not told for days about his hospitalization or his cancer.

According to the doctors, the cancer was detected when Austin had a regular screening in early December. They said he “underwent a minimally invasive surgical procedure” and went home the next day. But on Jan. 1 he reported nausea and severe abdominal, hip and leg pain due to the infection.

They said his prostate cancer was detected early, and his prognosis is excellent.

The cancer revelation comes after days of persistent questions about Austin’s hospitalization and the delays in notifying key leaders. And it raises more questions about the transparency and truthfulness of the Defense Department, which for the past four days said he was initially at Walter Reed for an "elective medical procedure,” and not prostate surgery.

Asked about that choice of wording, Maj. Gen. Pat Ryder, Pentagon press secretary, said in a briefing on Tuesday that it was developed in consultation with Austin’s doctors.

When pressed on the delays in public notification, Ryder said, “Despite the frequency of prostate cancer, discussions about screening, treatment and support are often deeply personal and private ones." It was still not clear Tuesday how this will affect Austin's job, travel or other public engagements going forward. Deputy Defense Secretary Kathleen Hicks is expected to take on some of his day-to-day duties as he recovers.

The lack of transparency about Austin's hospitalization —- including the failure to tell Biden and other top officials about it or the reason for it for days — has triggered sharp criticism.

Austin spoke with Biden on Saturday, the same day he issued a public statement saying he recognized he could have done a better job insuring the public was informed about his hospitalization, and said “I commit to doing better.” He did not, however, tell the president in that phone call that he had cancer.

Several Republican lawmakers even said Austin should be ousted. Rep. Mike Rogers, R-Ala., the chairman of the House Armed Services Committee, launched a formal inquiry into the situation. And, earlier Tuesday, the White House chief of staff ordered Cabinet members to notify his office if they ever can’t perform their duties.

Dr. John Maddox, trauma medical director, and Dr. Gregory Chesnut, director of the Center for Prostate Disease at Walter Reed, provided the first details of Austin's prognosis in a statement put out by the Pentagon. They said he was under anesthesia during the initial surgery, and when he went to intensive care on Jan. 2 the infection had triggered an intestinal backup and his stomach had to be drained with a tube in his nose.

Medical experts said it’s likely Austin had urine leak into his abdomen, a rare complication of prostate surgery, and that led to a bowel problem.

“All of this is temporary and reverses relatively quickly,” said Dr. Benjamin Davies, a professor of urology at the University of Pittsburgh School of Medicine.

“We anticipate a full recovery, although this can be a slow process,” Maddox said. They noted that prostate cancer is the most common cancer among American men, and it affects 1 in every 8 men — and 1 in every 6 African American men — during their lifetime.

The doctors said Austin underwent a surgical procedure called a prostatectomy. That is a common procedure to remove all or part of the prostate gland and is often used to treat prostate cancer, but is not the only option. Some men and their doctors choose radiation treatment or actively monitoring the disease, which involves watching it closely but no immediate treatment.

Prostate surgery can be done with small incisions and the aid of a tiny camera. It’s not minor surgery, experts said, but “it’s not as big a deal as it once was,” said Dr. David Penson, who chairs Vanderbilt University’s urology department. “It’s not all that different than, say, having your gallbladder removed with a laparoscope.”

Meanwhile, the Biden administration, reeling from learning of Austin's surprise, is mounting a policy review. And the Pentagon has also begun its own review.

Chief of staff Jeff Zients sent a memo to Cabinet secretaries directing them to send to the White House by Friday any existing procedures for delegating authority in the event of incapacitation or loss of communication.

Biden and other top officials weren’t informed for days that Austin had been hospitalized and had turned over power to his deputy. A Pentagon spokesman blamed the lapse on a key staffer being out sick with the flu.

“Agencies should ensure that delegations are issued when a Cabinet Member is traveling to areas with limited or no access to communication, undergoing hospitalization or a medical procedure requiring general anesthesia, or otherwise in a circumstance when he or she may be unreachable,” Zients said in the memo. He also directed agencies to document when any such transfer of authority occurs and that the person serving in the acting role promptly establish contact with relevant White House staff.

A copy of the memo was obtained by The Associated Press.

During Austin's two hospitalizations, he transferred some of his authorities to Hicks, but she was not told why. The White House was not informed Austin was in the hospital until Jan. 4, and the public and Congress didn't learn of it until a day later.

The Pentagon issued a memo Monday on its internal review, and broadened the circle of leaders who would be informed of any delegation of authorities by the defense secretary to ensure that, in the future, “proper and timely notification has been made to the President and White House and, as appropriate, the United States Congress and the American public.”

Going forward, any time authority is transferred, a wider swath of officials will also be notified, to include the Pentagon’s general counsel, the chair and vice chair of the Joint Chiefs of Staff, the combatant commanders, service secretaries, the service chiefs of staff, the White House Situation Room, and the senior staff of the secretary and deputy secretary of defense.

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Associated Press writers Zeke Miller and Seung Min Kim contributed from Washington, D.C.; AP Medical Writer Carla K. Johnson contributed from Washington state.