Did Asif Zardari suffer from prostate cancer?

By

Dr Ghayur Ayub

The other day, I was watching a well known TV talk-show whose guests were; the ex Director General IB, Col Iqbal Niazi along with a well-known columnist and an anchor person of another talk show. They were discussing Mr Zardari’s incarceration in the late 1990s, and how he was purportedly maltreated. I cannot comment about the physical torture AZ was allegedly exposed to or how an alleged attempt was made to assassinate him. But I found obvious twisting of the facts when it came to his medical condition. If I had their contact numbers, I would have called the show to set the record straight because I was privy to certain information on the matter.

I served as Director General of Health, government of Pakistan from December 1996 to October 1999.  I was selected in that position by the interim government of Meraj Khalid and was asked to continue when Nawaz Sharif’s government took over in 1997. One Sunday morning I received a call from my private secretary saying that Sen. Saif-ur-Rehman was looking for me and that he had given him my private telephone number so he could contact me. My PS could not tell me what the nature of the call was. Being the Chief of Ihtesab, the Senator was known for his bullying behaviour and scary techniques. I felt a slight twinge in my stomach and started wondering what I had done to warrant a call from him. An hour or so later he rang. That was my first contact with him. He spoke softly and politely and wanted to know if I knew of any cancer specialist. I answered in affirmative and told him that I myself had had training in the field at The Royal Marsden Hospital London. It is one of the most prestigious cancer hospitals in the world. I presumed he wanted to talk about a friend or a relative who suffered from cancer but I was wrong.

Instead, he told me that Asif Ali Zardari was admitted in Agha Khan Hospital where a specialist had diagnosed him with prostate cancer and had advised him to go abroad for further assessment and treatment. Senator Saif-ur-Rehaman wanted a second opinion. I asked him to send the medical records for me to study and if need be to discuss further with other specialists in the field. Three days later, I received a copy of his report. I studied it briefly, it made me smile. Although my main field of oncology training at The Royal Marsden Hospital was breast and colorectal cancers, I did also work in the Urology department from time to time, handling urological malignancies such as prostate cancer. The reason given in the medical report diagnosing Asif Zardari with cancer of prostate was not less than mirthful. I’ll come that later.

I contacted the Senator and gave my initial assessment based on the report but wanted more information so that I could discuss it further with other specialists before coming to a final conclusion. Sure enough, I received more reports. After going through them, it became clear that the reason for sending AZ abroad could be anything but cancer of prostate. The diagnosis was just a ploy. What happened was that the specialist found microscopic heamaturia (tiny amount of blood seen only under microscope) in his urine. This type of finding can be real or it can be adulterated. But this definitely does not mean a person has got cancer of prostate. The more ridiculous finding of the report was that they found ‘cancer cells’ in his urine and linked them with the prostate gland. It was ridiculous because cancer of prostate is not diagnosed with its cells floating in urine. Incidentally, and as a matter of fact, it is only recently the UCLA scientists have identified for the first time cell-of-origin for human prostate cancer, a discovery that could result in better predictive and diagnostics tools and the development of new and more effective targeted treatments for the disease. So, observing prostatic cancer cells in urine, at that time, as primary diagnostic tool was ludicrous. 

There are set investigative procedures to reach that diagnosis, such as; digital examination; prostate specific antigen (PSA), an Ultra Sound, a CT or MRI Scan of pelvis including prostate gland; cystoscopy and lastly biopsy. The last procedure could be done as part of open surgery or, alternatively, needle biopsy as preoperative diagnostic requirement. Some specialists avoid needle biopsy because of danger of spread of the disease and thus changing its classification stage. The notes did not show that any of these investigations were done. It, definitely, did not fare well for Agha Khan Hospital which, I personally knew, had the highest medical standards. Anyway, I took the report and discussed it with two of the top urologists of the country. They were as surprised by the findings as I was and one of them felt embarrassed as he knew the specialist who suggested the treatment abroad. 

Now, I had two choices; either to speak to the specialist or talk to the president of AKDN, Dr Shams Kassim-Lakha. Agha Khan University and the hospital came directly under him. I opted for the latter because I knew him personally. He was in France when I called him. I explained the situation. He apparently wasn’t aware that one of his specialists had recommended AZ’s treatment abroad. When I told him about the clinically weak ground his specialist based his diagnosis on and that it could bring a bad name to his prestigious institute, he realised its severity. He said he was going to take the next flight back to Pakistan and asked me to hold on to the reports.

Three days later, he was in Islamabad. After going through the papers, he understood my point. He, then, picked up his mobile, went out of the room and spoke to someone. I presumed it was the specialist involved. On re-entering the room, looking annoyed, he could only utter something like, ‘these politicians can go to any length.’ Obviously, the poor specialist was put under pressure by AZ or one of his friends to falsify medical report. Did they threaten the specialist; I didn’t know, neither did I ask. Dr Lakha promised that a false report could never be issued by Agha Khan Hospital no matter what the consequences. He stood by his promise. I was told later, when AZ was asked to go through proper investigative procedures to confirm the diagnosis, he declined. As far as Senator Saif-ur-rehman was concerned, he took a sigh of relief as he was also under tremendous pressure from powerful lobbyists both within and outside the country to send AZ abroad for his supposed cancer of prostate.

The end