Look closely: who is that cranky person writing on the New York Times Op-Ed page that the commonly used PSA test for prostate cancer has led this country to a "profit-driven public health disaster." Turns out it's Richard J. Ablin, the urologist and researcher who discovered PSA in 1970. Ablin, who now thinks routine screening is a very bad idea, points out the two largest studies of PSA testing have revealed that 1. over a period of 7 to 10 years, screening did not reduce the death rate in men 55 and over, and 2. PSA testing led to a small decline in death rates, but 48 men would need to be treated to save one life. "That’s 47 men who," Ablin writes, "in all likelihood, can no longer function sexually or stay out of the bathroom for long."
The main reason the test is still used, says Ablin is that "drug companies continue peddling the tests and advocacy groups push
“prostate cancer awareness†by encouraging men to get screened." Finally, Ablin leaves us with this:
I never dreamed that my discovery four decades ago would lead to such a
profit-driven public health disaster. The medical community must
confront reality and stop the inappropriate use of P.S.A. screening.
Doing so would save billions of dollars and rescue millions of men from
unnecessary, debilitating treatments.
Read the entire Op-ed in the New York Times.
I’ve interviewed Ablin and find him to be far from “cranky.” He is enlightening and delightful.
The government site has been saying this for at least 10 years. Well, maybe not as loudly but if you read their analyses carefully, they were saying most men died with prostate cancer, not from it.
Ablin, I am sure is a very good scientist. But saying his test “…lead to such a profit-driven public health disaster…” is disingenous. He put that test out there. I don’t know the tehnical background. But I get a test and the results indicate a problem. Now he seems to be saying, or so I understand it with my geezer brain, that the test doesn’t really mean what we think and it is all because of the profit motive. I think the misunderstanding goes a little deeper than that and he is doing the CYA dance.
Peter, the doctor is saying that you get a test because there is a noticable problem that needs to be dealt with then rather than having the test when nothing is noticabley going wrong simply beacuse your doctor gets paid by the insurance company and the pharm companies to push the test.
It is as simple as don’t fix it if it isn’t broken.
If it’s working, leave it alone.
America, with the ever growing and ridiculous love of “new and improved” which usually means changed for the worse so we can make a bigger profit, has a difficulty understanding such.
namaste
Peter,
I think what he means is that prostate cancer is not a killer that is worth chasing with great effort. The “cure” can be worse than the disease, and in most cases it should be left alone. It most likely will not be the prostate cancer that kills, but if it’s treated, there will almost certainly be unpleasant side effects that will render the man’s life less than it could have been. It seems to me that because the “C” word is involved, everyone’s first reaction is “we must fight.”
My PSA was elevated over time to 5.2 My doctor suggested that I see a urologist. He recommended a biopsy and cancer was found in three out of twelve samples. I opted for Proton Therapy and now my PSA is.05 with no side effects. Without the PSA, you won’t know until it’s too late but then some people like to play Russian roulette with their lives.
I’m 74, my PSA. went up and down; now up to 7 or 8, I forget which. I have had two prostate biopsies, and both came back negative. A Uroligist, who did the second one, wanted to do a third biopsy. Before he suggested the third one, he had told me that if the PSA goes down as well as up then it is not cancer. My primary care Physican told me the same thing, so when the Urologist said he wanted to do a third biopsy, I said “No thanks”, and then I looked for another Urologist.
I was certainly the one out of 50. I think if someone is in their 70s or 80s odds are no test. My doctor said guidelines were to start a test at 50. At 52 my PSA was in the normal range but because I had it checked the increase from 2 to 3 was suspicious at age 51. They did a biopsy, found small slow growing cancer. I decided to fight and remove it and found that it was an agressive cancer that just begun to spread out of the prostate. Another 3 months and it would have gone to other areas. I think every man needs to look at a baseline of PSA. THere are many studies. More than hitting a number, the PSA rise % over a year is the best indicator of an agressive cancer that should be treated. So PSA is a must for all men. Treatment based on age and PSA rise over time is what really matters when u go to specialists who understand how to use PSA. I am cancer free for 2 years (knock wood).
Great explanation from someone with first hand experience. Thanks.
I’m 84.. My PSA was up to 18 before I got a biopsy.
That came up with cancer with a Gleason rating of 7.
They give me shots every 78 days and it has knocked the PSA to 0.84. The treatment is a killer when you get the shots.(trelstar) You get heavy hot flashes like women only worse. I’ve had as many as 8 a day. Plus at least 4 during my sleep period at night.
You wake up tired at times and they thought the hot flashes would go away. After one year, they appear to be getting worse at times. One thing good. I can still play with the grand kids. P.s I still work every day and run a small company.
From someone in the Medical Device and testing industry, one of our products is used for the PSA screen (blood samples), I can personaly speak to the neccessity of the testing.
I was being tested from age 40 – 44, and as a result of my family doctor monitoring the results – he noticed the trend up – to 5.2 finally. I did see a urologist, was tested, and was diagnosed with Prostate Cancer in Stage 1. Due to early detection – I was able to get treatment. I choose to have IMRT radication treatment and Seed implants. I have been cancer free for 8 years now. MY PSA is less than 0.1
I support early testing. And have recommended men I know to get the test. No profit or other reason – I did that as a life saving measure and care about others. Sorry to think a researcher isn’t wise enough to realize the lives he has impacted over the years. I’m grateful for his discovery – he just needs to learn to accept his place in time and responibility to live with the results.
It’s not the test that’s costly, the treatment is. The key is to determine whether you have a aggressive cancer or not. Treating low grade cancers may not be necessary depending on age and etc. There is a saying that the accident happens to the other guy but to you I’m the other guy. It appears that the 1 guy out of 48 is not worth saving.
I agree with Bill. I am a 10 year prostate cancer survivor, which was discovered as a result of slightly elevated PSA score. I find, as with most issues discussed in today’s world, emotionalism and irrationality seem to prevail over logical, rational, actions. Are men so stupid, ill-informed, and timid that they cannot review the scenario and make an informed decision?
For thirty years my PSA has been between 10 and 20.
I have had 4 biopsies and ultra sounds. No cancer.
I do have an enlarged prostate. Age 84.
My prostate cancer was found at age 58 in 2005. My daughter was an RN working for a Urologist and new I was have problems and advise me to see the Doctor she was working for. When he did a DRE he immediatelly scheduled me for a biopsy. I retreived my records from my family Doctor who was supposed to be montoring my PSA results. In three years my PSA levels went from 1.26, 2.8, 5.8. Luckly they caught it at the 5.8 level and gleason score was 8. The cancer had spread into my lymph nodes. I went to Sloan Kettering in New York and had my prostate removed and found 2 lymph nodes with cancer which were also removed. After my surgery I took Eligard for 1 year to keep the testosterone levels low ( hated it ). At the moment I am cancer free.
I think that dealing with Non specialists they do not really understand the meanings of a PSA test. My doctor should have sent me to a specialist on the 2nd PSA test at 2.8 and did not. The rise in PSA over time is the key and not the magic #4