Early Detection Disaster
How the rush to diagnose and treat prostate cancer devastated the lives of millions of men
Because conventional medicine has largely failed at finding cures for all major diseases, the focus has shifted to early detection and quick intervention to save lives. Nowhere is this approach more prevalent than in treating cancer. We all know someone who’s alive today because the doctors “caught the cancer in time.”
All cancer awareness organizations like to share the survival percentages of those who get regular screenings and receive early intervention to promote the process.
Today, the so-called fight against cancer has largely become a race game. Unfortunately, we’re finding that the early detection screening methods we once held up as the gold standard are seriously flawed, and in some cases, entirely inaccurate.
This is exactly the situation with the prostate-specific antigen (PSA), the test that since 1994 has been the premier screening for prostate cancer. Now, more than two decades of rushing into treatment is revealing how the lives of tens of millions of men were ruined, fortunes were created, and a healthcare disaster exploded.
A Runaway Mistake
In 1970, Dr. Richard J. Albin, PhD, was a researcher at The State University of New York College at Buffalo. He was attempting to discover an antigen (protein) that was specific to prostate cancer that could be used in diagnosing the condition.
Unfortunately, what he found, the prostate-specific antigen (PSA), was present in both the benign (normal) and malignant prostate. There was no way to tell if a man had prostate cancer using the PSA, but with some additional analysis, it was found to be helpful for tracking the prostate for a recurrence of cancer but only after it had already been diagnosed and treatment administered. As an initial diagnostic tool for cancer, it was useless.
In 1986, the FDA approved the PSA test as a tool to track the recurrence of prostate cancer. The biotech representatives present at the meeting were really after getting approval for cancer detection, because it would have bolstered their efforts in developing immunotherapy drugs. But it didn’t happen.
Although only one biotech lab, San Diego based Hybritech, was authorized to make the PSA test kit, several other labs almost immediately began producing their own off-label versions.
The urology market was instantly flooded with PSA test kits that doctors began using indiscriminately to test men, who’d never been officially diagnosed with prostate cancer, for the disease. The practice became so widely accepted, that by 1994, the FDA officially approved the PSA test for the detection of prostate cancer in men through regular testing beginning at age 50.
In a 2010 op-ed article in the New York Times entitled, “The Great Prostate Mistake,”1 Dr. Albin poured out his regret over the entire tragic process. He explained that the 1994 approval process hinged on a so-called study that showed PSA could detect a dismal 3.8% of prostate cancers. This happened to be a higher rate than the standard method at the time — the digital rectal exam.
In his book, The Great Prostate Hoax: How Big Medicine Hijacked the PSA Test and Caused a Public Health Disaster,(2) Dr. Albin describes how the 1994 FDA approval committee meeting disintegrated into chaos.
Some physicians pointed fingers and screamed that blood would be on the hands of those who voted in favor of PSA being approved for prostate cancer detection.
On the other side of the table were those who knew the test didn’t work but yelled back that “millions of men were dying” and the American medical establishment had to do something. As it turned out, there would be a lot of blood on a lot of hands because in the words of the man who invented the test, “With the 78% false positive rate and being wrong 80% of the time, I don’t know how the test was approved.” (3)
In the end, in spite of the habitual misuse, the profit-hungry corporations that wanted to sell a prostate cancer prevention scam won. It was the tens of millions of American men who lost.
The truth is that the PSA, which was once so revered and trusted as the definitive test for prostate cancer, has no cutoff for detecting the disease. Men have shown a PSA level as low as 0.5ng/mL and had prostate cancer, while those with a level as high as 11ng/mL have been cancer free.
Still, in the early years of screening, any man whose test showed as little as 4ng/mL was immediately sent for a painful biopsy, regardless of the fact that the test couldn’t decipher between benign or malignant cells. If there was any sign of cancer at all, he was quickly pushed into surgery, with radiation to follow, along with other harmful treatments. This so-called early detection and quick response happened almost without exception.
Loss and Profit
Considering the fact that the PSA is wrong 80% of the time, and that approximately 30 million men (4) each year for the last 22 years have had the test, the number of men who have had their lives ruined is staggering.
With prostates entirely removed or damaged beyond repair by radiation and chemotherapy, they’ve suffered through decades of urinary incontinence, impotence, hormonal imbalance, and the intense depression that comes with such abrupt and severe biological changes.
The tragic truth is that with very rare exceptions, prostate cancer is extremely slow-growing. It’s so slow, in fact, that the vast majority of these men could have lived full, happy lives and never died of prostate cancer. Most men don’t.
If you tell a lie long enough, people will believe it. Author, Mark Twain once said, “It’s easier to fool someone than to convince them they have been fooled.”
That’s the story of the PSA. Even now, when what has always been known about the PSA has finally become common knowledge, hordes of brainwashed doctors still don’t want to let go of the test. They still recommend that men get their yearly PSA screening starting at age 50.
Maybe it speaks to the power of habit, or profit, but it’s just inexplicable and certainly inexcusable. Maybe they believe the test still has some efficacy and they don’t want to be sued by patients who don’t get the PSA and then develop cancer at a later date. Perhaps they haven’t read Dr. Ablin’s book or the New England Journal of Medicine study that recently showed PSA screening does not reduce death rates in men age 55 and over. (5)
Many patients and their families still defend the PSA, claiming that it saved their lives or the lives of their husbands, fathers and grandfathers. It’s certainly understandable that someone would choose to believe this, especially when the thought that one’s life has been so unnecessarily and irrevocably damaged is just too much to bear.
To find out who’s still pushing routine PSA screenings, all you have to do is follow the money. The PSA became so widely used, it created its own mini-industry within the healthcare industry.
PSA screenings led to millions of unnecessary procedures that benefited surgeons, labs, radiology, pharmaceutical companies, a robotic surgical equipment market specifically for prostate procedures, and proton beam development firms. Why else would we, in Albin’s words, “…spend $3 billion [a year] on PSA screening in asymptomatic men using a test that doesn’t do what it’s supposed to do.”(6)
Albin himself has spoken directly to the CEOs of biotech companies explaining why the PSA test doesn’t work for detection. He describes their consistent response this way, “Dick, this is very interesting, but nobody is going to be interested in your story. Too many people are making too much money to stop this.” (7)
The Turning Tide
It’s no surprise that the mainstream media has been largely silent on this crucial healthcare development. Even with the release of his book in 2014, the press wasn’t exactly knocking down Albin’s door.
The media sources that weren’t silent did what they tend to do best, confuse the whole issue in the public’s mind by running articles on why the PSA still mattered, and the so-called risks of not having a regular screening.
What does seem to be changing minds is an official statement originally made by the United States Preventative Services Task Force (USPSTF) in 2009, which was reinforced as their final judgment, and published in 2012 in the Annals of Internal Medicine. The national organization of preventative health experts stated:
“There is convincing evidence that PSA-based screening programs result in the detection of many cases of asymptomatic prostate cancer. There is also convincing evidence that a substantial percentage of men who have asymptomatic cancer detected by PSA screening have a tumor that either will not progress or will progress so slowly that it would have remained asymptomatic for the man’s lifetime. The terms ‘overdiagnosis’ or ‘pseudo-disease’ are used to describe both situations….The precise magnitude of overdiagnosis associated with any screening and treatment program is difficult to determine, but estimates from the 2 largest trials suggest overdiagnosis rates of 17% to 50% for prostate cancer screening.”
And, “…the USPSTF now recommends against PSA-based screening for prostate cancer in all age groups.” (8)
According to the Prostate Cancer Foundation, after the USPSTF made their final recommendation, PSA screenings dropped by up to 50% in some primary care clinics across the country.
The biggest drop was in men aged 50–70 and yet, some urologists are still wringing their hands with worry. The fact that 8 out of 10 doctors surveyed in Massachusetts said the PSA offered more harm than benefit suggests the tide may be turning. (9)
Awareness Agencies Weigh In
Meanwhile, some major health organizations are choosing a less decisive position, even in light of the overwhelming evidence. The American Cancer Society now urges “more caution” when pursuing the PSA screening. The American Urological Association does not recommend PSA screenings for men younger than 54.
African-American men, who naturally have a higher risk of prostate cancer, and men with a family history of the disease should make individual decisions as to what’s best for them.
Men 55–69 should participate in “shared decision-making” and consider screenings every two years. No screening for men 70 and older. The American College of Preventative Medicine has stated there is insufficient evidence to warrant regular screenings. The National Cancer Institute states that any man considering a PSA screening should be informed of the risks and benefits beforehand.
Watch and Wait
My recommendation is to watch and wait. Because prostate cancer is so slow-growing, most men will live happy lives and never die of the disease. In the meantime, we can use other, non-invasive, forms of treatment. If the cancer changes in anyway, we can address those issues when the time comes. This is the wisest and most humane approach, especially since American men have only a 16% chance of developing prostate cancer over their lifetime and just a 3% chance of actually dying from it. (10)
Pass this article on to someone you love.
National health organizations have a strong influence on the minds of Americans, and it will take time to reverse the blind belief in yearly early detection screenings like the PSA test. With the each-one-teach-one approach, we can save millions of lives. Consider nationally-recommended preventative healthcare routines very carefully. Everyone’s body, state of health and lifestyle are different. Standardized recommendations to have a particular test at repeated intervals beginning at a specific age don’t work for many people, can be very harmful and are often profit-driven.
Decisions like these should be made between the two people who know your body best, you and your doctor. In the meantime, practice the early detection of fear-based healthcare recommendations that promote regular testing and fast follow-up treatment, because what you’ll actually be preventing is a decision you might later regret.
Footnotes:
[1] Albin, R. (2010) March 9. The New York Times, The great prostate mistake.
[2] Ablin RJ, Piana R. The Great Prostate Hoax: How Big Medicine Hijacked the PSA Test and Caused a Public Health Disaster. New York: Macmillan Publishers; 2014.
[3] Topol, Eric. (August 8, 2014). PSA test is misused, unreliable, says the antigen’s discoverer. Medscape: news & perspectives. http://www.medscape.com/viewarticle/828854_3.
[4] Mahar, Maggie. (2010). The doctor who invented psa test calls it “a profit-driven public health disaster” . . . Why this is good news — see more at: http://www. Healthbeatblog. Com/2010/03/the-doctor-who-invented-psa-test-calls-it-a-profitdriven-public-health-disaster-why-this-is-good-new/#sthash. 0nrm87cj. Dpuf. . Health beat, (), http://www.healthbeatblog.com/2010/03/the-doctor-who-invented-psa-test-calls-it-a-profitdriven-public-health-disaster-why-this-is-good-new/.
[5] Andriole, G et al. (2009). Mortality results from a randomized prostate-cancer screening trial. New England Journal of Medicine. 360(13), 1310–1319.
[6] Topol, Eric. (August 8, 2014). PSA test is misused, unreliable, says the antigen’s discoverer. Medscape: news & perspectives. http://www.medscape.com/viewarticle/828854_3.
[7] Ibid.
[8] Moyer, Virginia. (2012). Screening for prostate cancer: U. S. Preventive services task force. Annals of Internal Medicine. , 157(2), 120–134.
[9] Thompson, Dennis. (May 17, 2015). Prostate cancer testing drops off following controversial guidelines. Research News: Prostate Cancer Foundation. , http://www.pcf.org/site/c.leJRIROrEpH/b.9283333/k.9A1F/Prostate_Cancer_Testing_Drops_Off_Following_Controversial_Guidelines.htm.
[10] Mahar, Maggie. (2010). The doctor who invented psa test calls it “a profit-driven public health disaster” . . . Why this is good news — see more at: http://www. Healthbeatblog. Com/2010/03/the-doctor-who-invented-psa-test-calls-it-a-profitdriven-public-health-disaster-why-this-is-good-new/#sthash. 0nrm87cj. Dpuf. . Health beat, (), http://www.healthbeatblog.com/2010/03/the-doctor-who-invented-psa-test-calls-it-a-profitdriven-public-health-disaster-why-this-is-good-new/.
Dr. Sadeghi is the founder of Be Hive of Healing, an integrative medical center, publisher of MegaZEN Wellbeing Journal, and the author of The Clarity Cleanse. You can read more of his exclusive articles on medical research, mind/body healing, and entelechy medicine at Patreon.
