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    The great prostate cancer ‘hoax’: A call to arms

    Henry Rosevear, MD

    Henry Rosevear, MD

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    Dr. Rosevear is in private practice at Pikes Peak Urology, Colorado Springs, CO

    For a response to this blog post by "The Great Prostate Hoax" co-author Richard J. Ablin, PhD, DSc (Hon), click here.

    I recently read a very disturbing book that I wanted to share with everyone, as it presented a point of view that I, as a urologist, do not commonly encounter. “The Great Prostate Hoax: How Big Medicine Hijacked the PSA Test and Caused a Public Health Disaster,” by Richard Ablin and Ronald Piana (Palgrave Macmillan) was only recently published, but a quick Google search shows just how much publicity it is receiving.

    Note that this blog is not a review of the book. For that I recommend reading either the review by The Economist (“Prostate cancer: Help or harm,” March 8, 2014) or the one by The New York Post (“Why the prostate cancer test is useless,” March 1, 2014). The first is a balanced review while the second is less balanced but informative in its own right.

    The book was brought to my attention by a patient sent to me for evaluation of an elevated PSA. He seemed an ideal patient to have his PSA checked: He had a family history of prostate cancer, was in his mid-60s, and was very healthy. His primary care doctor had been checking PSAs yearly and when the value jumped from about 3.5 to over 5.0 ng/mL (even after recheck a month later), he was sent to me. During our conversation regarding what to do next (I highly recommend Dr. Hollingsworth’s excellent Urology Times article on talking about PSA to patients), he asked me about this book. While not buying into the book’s conspiracy theories, he was very alarmed at the limitations of the test that the book highlights.

    “The Great Prostate Hoax” begins with a historical perspective on the discovery of PSA and its acceptance by the FDA and the urology community, first in 1986 to monitor those with prostate cancer and later in 1994 to screen for the disease. Unfortunately, the book quickly leaves historical reality and begins to make unfounded, usually illogical comparisons between PSA screening and, among others, the tobacco industry. This passage summarizes the remainder of the book: “But in a large sense, the situation dramatized by John [a patient described earlier as having been harmed by PSA screening] illustrates the grim reality of the health care system itself: encouraged by perverse incentives, many of the tests and procedures that doctors do are unnecessary, and quite a few are downright harmful.”

    The authors paint a picture of doctors, motivated by greed and malevolence, diagnosing patients with prostate cancer simply so they can be treated. Clearly, Ablin and Piana have never seen a man expire from metastatic prostate cancer.

    Next: "There appears to be a great deal of misunderstanding regarding PSA."

    More from Dr. Rosevear

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    Online reputation management: Lessons from ‘Googling’ myself

    Lessons learned after a year in urology’s ‘real world’

    Henry Rosevear, MD
    Dr. Rosevear, a member of the Urology Times Clinical Practice Board, is in private practice at Pikes Peak Urology, Colorado Springs, CO.

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    • Dr. Roger Tall
      CMS, a group of healthcare administrators who have never diagnosed or treated prostate cancer, along with the 'natural' and family medicine types who also do not treat and diagnose prostate cancer but are at the forefront of PSA criticism, seem worried about over detection and offer nothing better than burying their heads in the sand --- the ostrich medicine model. I stand with PSA testing, remember the days without PSA and remain firmly committed to worrying about under detection for me and my patients. I just diagnosed prostate cancer in a man who had been talked out of further PSA's about five years ago in California by his FP who thought PSA testing was dangerous. Let me see, which is more dangerous, PSA testing or advancing prostate cancer? In Idaho prostate cancer wins the danger debate hands down.
    • Dr. Robert J. Cornell
      A very dangerous and unfortunate precedent has been set here and we've done little as a urologic community to combat it. At issue is the expense of prostate cancer treatment, not the morbidity of its diagnosis or treatment. Politically, it is untenable to deny cancer treatment (even for men). It is much easier, if not devious, to somehow distort the natural history of the disease and revise the historical success we've earned in controlling this condition, nearly preventing prostate cancer death through regular screening. This is what the politicization and rationing of health care looks like. It is dangerous, it is deceptive, and it will cause unnecessary morbidity and mortality. Where's the cry of "War on Men"?
    • Anonymous
      While the PSA does have limitations, it is the only test that has lowered the death rete from Prostate Cancer. That is the inconvenient truth that the insurance industry, including Uncle Sam, doesn't want the public to hear.
    • ChuckGallagher
      The PSA test saved my life. While I understand that there are those who believe in over diagnosis, I am alive because of a simple test. As a speaker, author and radio host what I do know is the author of this book is attempting to capitalize on fear knowing that fear sells books. Such a shame. Great post Dr. Rosevear!

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