Iran’s Supreme Leader Ayatollah Ali Khamenei was released from hospital on September 15, a week after undergoing prostate surgery. Following the surgery, Dr. Alireza Marandi, head of his medical team, said he would be kept in hospital for a further three to five days. He also advised the ayatollah to take it easy, not take on a heavy workload, and avoid certain tasks. Khamenei’s website, however, reports that the Supreme Leader has made a full recovery.
According to Dr. Marandi, Khamenei’s prostate surgery was straightforward, taking only half an hour under local anesthesia. Marandi said the surgery was a routine procedure: “Old or middle-aged men’s prostates often become enlarged, so surgery is quite common among this age group.” He added that Khamenei had a pre-existing condition but provided no further details.
Mehdi Khalaji, an Iranian-American Islamic studies scholar and political analyst, pointed out that rumors about Khamenei having cancer are nothing new. “Iran’s political system means that the physical condition of the leader is treated as a national security issue,” he told IranWire, and this was as true for the Shah as it has been for Iran’s Supreme Leaders.
In the past, the public has had very little access to information about Khamenei’s various ailments. But recently, the Persian-language newspaper Keyhan of London published parts of an interview that referred to Khamenei’s medical condition. During the interview, which was recorded in 2012, the son of former president Hashemi Rafsanjani, Mehdi Hashemi, was asked whether Khamenei had cancer. “His cancer is cured,” he said.
It’s not just the press and the general public who have raised the subject of Khamenei’s medical situation. Dr. James J. Elist, former Honorary Co-Chairman of the Physician Advisory Board of the US Congress and a Diploma of the American Board of Urology, tells IranWire it’s been a topic of conversation among medical experts and physicians, many of whom have questioned whether Khamenei might have cancer.
Dr. Elist says that since there’s a lack of accurate medical information about the Supreme Leader available, outside medical analyses remains at the level of speculation and conjecture. However, judging from what Khamenei’s medical team has said, it’s reasonable to assume that the surgery could be related to prostate cancer.
According to Dr. Elist, if Khamenei has had prostate cancer in the past, he would have most likely undergone one of two kinds of surgery. The recent procedure most likely addressed complications resulting from a previous operation. “The two types [of procedures] are open surgery on the prostate and resection of the prostate,” he explains. “In both cases, one of the frequent complications can be the stricture of the urethra”. Based on comments from Khamenei’s doctors, it has been suggested that the Supreme Leader underwent a surgical procedure to reopen his urinary tract, and this could have been done under local anesthesia. “But it is also possible that he has had this operation before and his prostate cancer has recurred,” Dr. Elist says. “They will want to know if this is indeed the case, so they will have taken sample tissues. Sampling tissues can be done under local anesthesia as well.”
An Issue of National Security
Dr. Elist does suggest another possibility. “If Ayatollah Khamenei did not have prostate cancer before and has not undergone surgery before, it is possible that recently they found out that the prostate had been enlarged or his PSA [prostate-specific antigen] levels have gone up.” The blood’s PSA level often increases in men with prostate cancer. “In this case, the half an hour his doctors mentioned was to verify whether he has prostate cancer or not,” says Dr. Elist. “If the test results are positive then he will need to have an operation in the next few months.”
“Except in these two cases I have mentioned, there are no other situations in which the prostate can be operated on in half an hour unless the problem is a urinary tract obstruction or hematuria [blood in the urine],” Dr. Elist says. “In these two cases, the problem can be resolved with a catheter.”
The fact that Dr. Marandi told Ayatollah Khamenei to lighten his workload and avoid strenuous tasks could suggest complications. From Dr. Elist’s perspective, it’s possible that “either the urinary tract has developed strictures or the cancer has recurred.”
“It is quite possible that Ayatollah Khomeini has undergone prostate surgery before,” he says.
The potential political consequences are hugely important. Mehdi Khalaji points to Ayatollah Khomeini’s ailments and Mohammad Reza Shah’s cancer, both of which were kept secret for a long time. “Ayatollah Khomeini had a stroke in 1986 and became comatose,” he says. From 1986 to 1989, a number of crucial historical events took place, “from the conclusion of the war [between Iran and Iraq] to the removal of Ayatollah Montazeri [as heir apparent to Khomeini], to the fatwa against Salman Rushdie and the revision of the constitution. But later, when the evidence came to light, we realized that in 1986 Khomeini was actually on death’s doorstep.”
In the case of the Shah, Khalaji points out, even Queen Farah did not know about his cancer until a few months before leaving Iran. “The Shah’s cancer affected his decisions; it made him a passive decision-maker,” Khalaji says. “If the Shah did not have cancer, major events could have gone in another direction.”
Dr. Elist also points to the possibility of a “change of direction” as a result of illnesses. In addition to Mohammad Reza Shah’s cancer, he cites other figures who have suffered from prostate cancer: Former Secretary of State Colin Powell, former presidential candidate Bob Dole, General Norman Schwarzkopf and Nelson Mandela. “Who knows how this illness affected decision-making and changed people’s lives?”
“The wrong diet, especially fatty foods; genetic factors; race and age are all important in prostate cancer,” Dr. Elist says. “But there are other factors too, like tension, anxiety, constant stress and sleep deprivation, which can affect the body’s defense system and lead to sudden trouble such as cancer or the spread of cancer.”
But Mehdi Khalaji has another scenario in mind. “I do not think the operation was really prostate surgery,” he says, “and I do not think Ayatollah Khamenei was hospitalized the day that they say he was. It could be that all of it was staged and we have no idea how serious the operation was.”
He is only certain about one thing: “The physical condition of the Leader is a national security issue.”