Powell has prostate cancer surgery

Secretary of State Colin L. Powell underwent prostate cancer surgery yesterday, with his physicians expecting a full recovery and a quick return to his post.

Powell's cancer had not spread beyond his prostate, said State Department spokesman Richard Boucher after surgeons removed the gland in a two-hour procedure yesterday morning. Until Powell's return to office, Deputy Secretary of State Richard Armitage will run the department.

"I just spoke to the secretary's doctor a few minutes ago. I'm happy to report that he's out of surgery, that everything went fine," Boucher said yesterday afternoon.

"They say he did extremely well. There are no complications, and a full recovery is expected," he added.

Powell's surgery underscored the heightened prostate cancer risk faced by black men in the United States: They get the disease nearly twice as often as whites, and die from it more than twice as often. The reasons remain a mystery.

"We've searched very hard, but we don't have the answer," said Massachusetts General Hospital's genitourinary cancer chief, Dr. Donald Kaufman.

Annual screening tests for prostate-specific antigens are recommended for black men 45 and older and for whites beginning at age 50. But the PSA test has not been proven to reduce the risk of death from the disease, and large-scale studies are underway to determine the extent of its usefulness.

Coincidentally, Boston Mayor Thomas M. Menino and state Representative Peter J. Koutoujian, a Waltham Democrat, plan today to file a bill that would grant all state employees four hours of annual paid leave to get cancer screening tests.

Powell will remain hospitalized at Walter Reed Army Medical Center in suburban Washington for several more days, followed by bed rest at home. He underwent regular prostate screening as part of the military's regimen of frequent checkups, said State Department officials. He has no family history of the disease.

President Bush was told of the planned surgery two weeks ago. Powell cleared his schedule, and has no overseas travel planned the rest of the year. But over the weekend, unexpectedly, Powell engaged in intense telephone diplomacy after Saddam Hussein's capture, speaking to 23 foreign ministers on Sunday alone, said State Department officials.

As a black man over age 45, Powell falls into a high-risk category for prostate cancer. According to National Cancer Institute data, between 1996 and 2000, 272 in 100,000 black men developed prostate cancer, compared with 164 in 100,000 whites. And they were more likely to die: 73 in 100,000 blacks died from the disease, compared with 30 in 100,000 whites. The risk increases with age. About 30,000 Americans die from prostate cancer annually, although the vast majority of those diagnosed survive for years.

No clear physical basis for the racial difference has been found.

"You should be able to point to a gene that is more common in blacks, but no one has been able to find it," said Dr. Timothy Gilligan, a prostate cancer specialist at the Dana-Farber Cancer Institute.

Gilligan said some speculation has centered on diets high in animal fat, common among Southern blacks, but the generalization is greeted with skepticism by many researchers.

"It's a controversial area," Gilligan said. "It's very politically sensitive."

Black men are less likely to undergo elective prostate cancer surgery, as Powell did, and less likely to get screened. But even when that is factored into statistics, blacks develop prostate cancer more often, earlier in life, and of a more aggressive variety.

Mass General's Kaufman said the only solution now is to encourage more frequent conversations on the topic between doctors and patients of all races.

"We're not screening as many men as we should be," he said.

Kaufman acknowledged the PSA screening test has not proved its value. Since the test became common a decade ago, US prostate cancer deaths have dropped by about 20 percent. But many tumors detected probably would have progressed so slowly that the patients would have died of other causes even if they hadn't had surgery. A national clinical trial is underway to assess PSAs, with results expected in about five years.

Raja Mishra can be reached at rmishra@globe.com