Posted on 07/11/2014 10:59:41 AM PDT by KeyLargo
Why the prostate cancer test is useless
By Kyle Smith
March 1, 2014 | 11:15pm
“The Great Prostate Hoax: How Big Medicine Hijacked the PSA Test and Caused a Public Health Disaster” by Richard J. Ablin and Ronald Piana
Middle-aged men know the story: the PSA (prostate-specific antigen) test is an essential early-warning system for cancer. Elevated PSA levels mean cancer, which in turn means you should probably make the gutsy but necessary decision to prolong your life by having your prostate removed.
Except this story is rubbish. Says who? Says the pathologist who first observed the PSA, back in 1970.
Despite losing his own father, agonizingly, to prostate cancer at age 67, Richard J. Ablin (who is in his 70s) hasn’t had a PSA test done on himself, and doesn’t intend to. There is, he says, no reason to do so on a healthy man, he explains in his book “The Great Prostate Hoax.” Because PSA, contrary to what you’ve been told, doesn’t work as a cancer indicator.
That’s why a New England Journal of Medicine joint study of results from the US and Europe concluded, “PSA-based screening results in small or no reduction in prostate cancer-specific mortality.” Two years later the US Preventive Services Task Force declared that healthy men should not have a routine PSA test.
Look at it this way: If you had a PSA test in 2009, and it led to a biopsy, a cancer diagnosis and treatment for that cancer, there is, according to Dr. Peter Bach, a health-care policy specialist at Sloan-Kettering Cancer Center, a 1 in 50 chance that by 2019 or later, you will have been saved from dying of prostate cancer. But there is a 49 in 50 chance that you will have been treated unnecessarily.
Read at: http://nypost.com/2014/03/01/why-the-prostate-cancer-test-is-useless/
Why the prostate cancer test is useless
By Kyle Smith
March 1, 2014 | 11:15pm
“The Great Prostate Hoax: How Big Medicine Hijacked the PSA Test and Caused a Public Health Disaster” by Richard J. Ablin and Ronald Piana
Middle-aged men know the story: the PSA (prostate-specific antigen) test is an essential early-warning system for cancer. Elevated PSA levels mean cancer, which in turn means you should probably make the gutsy but necessary decision to prolong your life by having your prostate removed.
Except this story is rubbish. Says who? Says the pathologist who first observed the PSA, back in 1970.
Despite losing his own father, agonizingly, to prostate cancer at age 67, Richard J. Ablin (who is in his 70s) hasn’t had a PSA test done on himself, and doesn’t intend to. There is, he says, no reason to do so on a healthy man, he explains in his book “The Great Prostate Hoax.” Because PSA, contrary to what you’ve been told, doesn’t work as a cancer indicator.
That’s why a New England Journal of Medicine joint study of results from the US and Europe concluded, “PSA-based screening results in small or no reduction in prostate cancer-specific mortality.” Two years later the US Preventive Services Task Force declared that healthy men should not have a routine PSA test.
Look at it this way: If you had a PSA test in 2009, and it led to a biopsy, a cancer diagnosis and treatment for that cancer, there is, according to Dr. Peter Bach, a health-care policy specialist at Sloan-Kettering Cancer Center, a 1 in 50 chance that by 2019 or later, you will have been saved from dying of prostate cancer. But there is a 49 in 50 chance that you will have been treated unnecessarily.
Read at: http://nypost.com/2014/03/01/why-the-prostate-cancer-test-is-useless/
Men with a family history of Prostate cancer should get both PSA and digital checks each year. It's just common sense. Most doctors don't worry till the number hits above 10. It's wise to watch it. Elevated PSA numbers may or may not mean it is the aggressive type which the doctors do need to treat ASAP.
This is like telling women with family history of Breast Cancer not to do early preventative screen {mammogram} at an earlier age. I have a niece who would probably be dead had she not insisted. Yeah you bet your bottom dollars insurers would like to have that test limited also.
Myself along with my doctor should be the ones to determine if I need treatment or a preventative screening and not a bunch of Board Apes in the pockets of HMO's writing papers of their opinions trying to make such policy.
I do find it odd {sarcasm} that dad's Oncologist and Urologist both tested his PSA levels to monitor his cancer along with bone density test. Testing them told them when they needed to change type of treatment. There is a large movement going on in the HMO's & private insurers to re-write protocols & eliminate as many screenings as possible and they'll pay anyone to say anything. If Richard J. Ablin wishes to chance it that is his right. His rights end when he tries to impose this own actions or change protocols for others.
I’m also suspicious that a doctor is against the PSA test. But, as it turns out, the National Cancer Institute also is warning against the PSA test:
http://www.cancer.gov/cancertopics/factsheet/detection/PSA
Their argument is that sometimes radiation is unnecessary to kill the cancer, but the rads could harm the patient.
Still, I’m in favor of the PSA test. What the patient and his doctor decides to do is up to the patient.
During my radiation treatments, there was a man with prostate cancer scheduled for radiation at the same time of day. He told me that, at first, his doctors caught the cancer very early. He didn’t receive radiation or chemo - only surgery. After surgery, they told him he had nothing more to worry about.
Now, here he was again, this time receiving radiation because they found that the cancer spread to a nearby lymph node. So, you just can’t tell what will happen. I hope he’s OK.
The headline of the NY Post article is deceiving and the writers opinion only. The author of the book would disagree with such a headline.
I am about a 30 pages into the book now, which you can get at your local library. Anyway the author is the doctor that came up with the PSA test. From what I have read so far he is saying that the PSA test was basically designed only for patients with PC to determine treatment progress and not as a tool for the urology business to recruit more patients. His father died of PC and he knows that heredity plays a part in PC. The doctor says that his PSA test cannot diagnose PC.
I certainly do not endorse all of the authors’ opinons but, Like anything regarding a persons health I believe that it is important today to learn as much as possible from both sides before making irreversible decisions about surgery.
You can read some book reviews by scrolling down the Amazon webpage at the link.
AMAZON
The Great Prostate Hoax: How Big Medicine Hijacked the PSA Test and Caused a Public Health Disaster Hardcover – March 4, 2014
by Richard J. Ablin (Author), Ronald Piana (Author)
“Every year, more than a million men undergo painful needle biopsies for prostate cancer, and upward of 100,000 have radical prostatectomies, resulting in incontinence and impotence. But the shocking fact is that most of these men would never have died from this common form of cancer, which frequently grows so slowly that it never even leaves the prostate. How did we get to a point where so many unnecessary tests and surgeries are being done? In The Great Prostate Hoax, Richard J. Ablin exposes how a discovery he made in 1970, the prostate-specific antigen (PSA), was co-opted by the pharmaceutical industry into a multibillion-dollar business. He shows how his discovery of PSA was never meant to be used for screening prostate cancer, and yet nonetheless the test was patented and eventurally approved by the FDA in 1994. Now, doctors and victims are beginning to speak out about the harm of the test, and beginning to search for a true prostate cancer-specific marker.”
Editorial Reviews
Review
“The Great Prostate Hoax boldly exposes the profit, politics and fraud behind PSA screening, and the serious harm done to countless men. This is a must-read for every man, and the women who care about them.” —Margaret I. Cuomo, M.D., author of A World Without Cancer
“Dick Ablin, the discoverer of PSA, provides the inside story of how it became P$A, a veritable public health disaster, harming millions of men. The Hoax is a unique and provocative look into big medicine and why we desperately need a better way forward.” —Eric J. Topol, MD, Director, Scripps Translational Science Institute, Chief Academic Officer, Scripps Health and Professor of Genomics, The Scripps Research Institute; Author, The Creative Destruction of Medicine
“An intriguing story of how strong financial interests can trump weak data. And it goes well beyond the usual suspect – the manufacturer of the PSA test – to those who gain from more prostate cancer treatments and from cleaning up the resulting mess.”—H. Gilbert Welch MD, MPH, author of Overdiagnosed: Making People Sick in the Pursuit of Health
“The Great Prostate Hoax is the answer to my prayers, finally getting the message out to millions of men in jeopardy of undergoing unnecessary and debilitating treatments. Hoax sends a clear message that those who profit from PSA testing are doing so at the expense of countless men. A must read.” —Alvin Cox, prostate cancer survivor who defied a nationally renowned urologist.
About the Author
Richard J. Ablin, PhD, DSc (HON) is a professor of Pathology at University of Arizona College of Medicine. In 1970 he identified PSA—the prostate specific antigen that is used as a test for prostate cancer. For decades he has fought against the misuse of his discovery, including a 2010 New York Times op-ed titled “The Great Prostate Mistake.” He lives in Tucson, AZ.
Ronald Piana is a science writer specializing in oncology. He has published more than 400 bylined articles in leading medical journals.
http://www.amazon.com/The-Great-Prostate-Hoax-Medicine/dp/1137278749
>> is relative to that 16 out of 1,000.
I read that as being an affirmation of the previous sentence, not a dismissal suggesting an evidential insignificance of 1.6%.
>> it is important today to learn as much as possible from both sides before making irreversible decisions about surgery.
True for life changing surgery and health in general.
I agree completely. And, when the man who actually discovered PSA starts recommending against the PSA test, people should hear about it. Thanks for bringing this to our attention.
When we hear both arguments, we're empowered to make the decision that's right for us. I'm not a man, but the same goes for the tests given to us women. These days, I tend toward the more conventional tests/treatments myself, but that might not be the right course for everyone.
Quite frankly I find the PSA test far more preferable than the other test done. I'm used to shots I get six shots every six weeks and three shots every three for allergies. But I get both exams for Prostate cancer. Cancers can be slow growing or aggressive and it requires monitoring once detected or suspected.
If I had to have cancer and had a pick of which one I would pick Thyroid Cancer as it is the slowest growing and easiest to fully eradicate. Thanks to blood work, and digital exam of the glands, along with an ultrasound, if a mass or enlargement is noted cancer can be headed off early with a near 100% survival rate.
In that respect there is aggressive Thyroid cancer and the slow growing type. My wife had a goiter for several years our doctor was watching it. He did an ultrasound every year. Two years ago the radiologist must have saw something he didn't like because an biopsy was ordered. It was cancer and it likely had left the area. It was detected in July and her Thyroid removed in about November. She had the I131 in Jan or Feb. The Endocrinologist told her in 20 years time he had only seen one patient die from it and that patient waited too long to see a doctor to start with. This week she is undergoing a follow up scan to see if any Thyroid remains.
I do know this much about Prostate Cancer. If I had it and it had spread I know which route I would likely go as far as treatment and the doctor would not be operating on the Prostate itself. That surgery can leave a person incontinent. The more sure way if it had spread is to simply starve it to death from it's food source. Remission can last up to a decade and the ill effects of prostate removal avoided. That was the route my dad went. Prostate Cancer must have Testosterone to feed on. Radical surgery? Yea, but not as many ill effects as Prostate removal.
In all cancers as far as I know only a biopsy can diagnose it for certain and as to the type and it's aggressiveness. PSA can show the aggressiveness or red flag hey something is out of whack here. A good indicator would be three digit readings instead of say a reading of 10. That would definitely warrant a biopsy IMO. I would think any doctor and patient would want to know as much.
Prostate Cancer wasn't as much of an issue before because most men generally didn't live long enough to die from it and that has changed due to advances in medicine.
The author writes that he had intended to create a test similar to the Pap Smear which does its job of cancer detection, but his PSA test was highjacked early on and used by those wanting to get a test to the market in order to make high profits quickly.
Prostate cancer screenings.
Physicians conduct the prostate-specific antigen (PSA) screening to detect prostate cancer early and allow for early treatment. It is commonly assumed that early detection saves lives.
But two large clinical trials show no overall benefit from mass screening for prostate cancer. And the United States Preventive Services Task Force recommends against PSA-based screening, finding that for every 1,000 men screened, at most 1 man avoids prostate cancer.
Certainly, the thought of saving one human life is reason enough to give such an exam, right? Not so fast. Of that same 1,000-man sample, up to 120 men walk away with e a false-positive test result – wrongly indicating the presence of cancer.
A positive PSA test is typically followed by a biopsy to confirm the presence of cancer with a major risk of a complication.
And even when the set of tests rightly identifies a patient with cancer, rarely does the cancer lead to health problems.
Unfortunately, in most cases, doctors can’t differentiate between cancer that will become harmful and cancer that won’t. So, when tests suggest the presence of prostate cancer, most men pursue treatment.
The most common treatment options are surgery, radiation therapy, hormone therapy and chemotherapy. Each option exposes men to possible surgical complications, along with erectile dysfunction and incontinence.
All of this might be worth it if the outcome was an increased cure rate. But that has never been shown. Instead, the impact on survival and life expectancy remains unchanged based on the largest research studies.
Once again, more is not better.
http://www.kevinmd.com/blog/2014/06/think-care-better-us.html
I have no problem with the author making HIS own choices. When these so called studies skew the choices of others then I protest. I heard my dad talking to his friend who also had it but his was contained and had Prostate surgery. He had problems. My dad told him he had no regrets as to the treatment he chose. Why? Because his Prostate wasn't touched and his Urologist told him which offered his best option for increasing his time left. His doctor was right and that is where the decision process needs to be done and not in some obscure "Panel" study findings. Remember this as well. Our health care system is changing over to a RATIONING system. Thus expect to see many more such cough cough discoveries.
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