Men are getting unnecessary treatment for prostate cancer because of greed in the urology community and the drug industry, University of Arizona immunobiologist Richard J. Ablin says in a new book “The Great Prostate Hoax.”
The book, recently released by Palgrave MacMillan, is subtitled “How big medicine hijacked the PSA test and caused a public health disaster.”
Ablin was 30 years old in 1970 when he was part of a research team that discovered PSA — prostate-specific antigen, which is a protein produced by the cells of the prostate gland. A high level of PSA could indicate prostate cancer.
Other scientists developed the PSA test several years later, and the U.S. Food and Drug Administration approved it in 1986. In the 1990s, the test became the norm for millions of men.
Ablin has always maintained the test is ineffective. It’s a battle cry he reiterates in his book, written with New York science writer Ronald Piana. The book says the PSA screening test is “slightly better than flipping a coin.”
Many of the 160,000 American men who undergo radical prostatectomies each year as a treatment for prostate cancer end up with complications, like impotence and incontinence. The tragedy is that such traumatizing effects are unnecessary in many cases, Ablin writes.
Nearly 240,000 men in the United States were diagnosed with prostate cancer last year, which is 14 percent of all diagnosed cancers, the National Cancer Institute says. The five-year survival rate is 99 percent. There were nearly 30,000 deaths from prostate cancer in the U.S. last year, which is 5 percent of all cancer deaths.
Ablin’s father died of prostate cancer at the age of 67, and family history is a major risk factor. Yet Ablin, who is 73, has always refused to have his own PSA tested, he writes in his book.
Ablin quotes Canadian urologist Dr. Michael Greenspan, saying that, without radical prostatectomies, “more than half of all the urology practices in the U.S. would go belly-up.”
As one case, the book cites a 51-year-old man named “John” whose blood work in conjunction with an annual physical examination reveals a slightly elevated PSA. John’s doctor sends him to a urologist in a move that Ablin calls “the doctor-to-doctor handoff that can inadvertently turn men into unwitting victims of a system that may do more harm than good.”
John has no family history of prostate cancer. He gets a biopsy under local anesthesia, which reveals cancer confined to the prostate gland. John and his wife want the cancer out. So he has surgery, and ends up incontinent and impotent.
“There was no question that John had prostate cancer, a disease that kills almost 30,000 American men every year,” Ablin writes. “However most localized cancers never leave the prostate gland and men that have them usually die of other causes, like old age.”
Ablin dedicates his book to “the countless millions of men and their families who have suffered needlessly because of the misuse of the PSA Test.”
The book has already received attention from The Economist, the New York Post, and New Scientist, among other publications. And Ablin’s opinions have landed him on the pages of the New York Times.
Some of his opinions are consistent with critics of the American health system who are becoming increasingly vocal about overscreening, overdiagnosis and overtreatment.
To an extent, the medical community has already backed off the PSA test. In 2011, the U.S. Preventive Services Task Force issued a policy recommendation against routine PSA screening, and last year the American Urological Association followed with new clinical practice guidelines that do not recommend using PSA screening on average-risk men under the age of 55.
“There is general agreement that early detection, including PSA screening, has played a key part in decreasing prostate cancer mortality,” officials from the association wrote in response to a question from the Star. “Nonetheless, optimal PSA-based screening needs to target men who are most likely to benefit from testing (such as those at a higher risk).”
Ablin acknowledges the association’s moderated recommendations in the first chapter of his book, but dismisses the changes as “too little and far too late.”
The PSA is the “best tool we have right now” for prostate-cancer screening, says Jamie Bearse, chief executive officer of ZERO, a nonprofit charity that has an aim of fighting prostate cancer. He stresses that the test is just one piece of information that doctors use.
There are several components to assessing men for prostate cancer besides the PSA test — their age, a digital rectal exam, and, if necessary, a biopsy.
Bearse’s group supports the American Urological Society’s testing guidelines, and he says his group would like to see more focus on a solution and less time on criticism.
Bearse has not read Ablin’s book, but does not agree with Ablin’s statement that PSA testing is “nothing short of a national health disaster.”
He says what’s really needed is more research to figure out how to identify aggressive cancers as opposed to indolent ones.