**The great prostate cancer ‘hoax’: A call to arms for Cancer icd 10

Originally on Urology times May 5, 2014

PSA TEst

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) (cancer prostate icd 10) 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 rechecking 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. 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 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.

Another approach, from cognitive psychologist Hal Arkes: Picture two auditoriums with 1,000 men in each. Auditorium One is filled with men who had PSA tests. In Auditorium Two, no one had a PSA test. Eight men in each room will die of prostate cancer.

The upside of a PSA test is small to nonexistent. But let’s not forget about the huge downside. A man who falsely believes he is about to die of prostate cancer and goes along with a surgeon’s recommendation that the gland be removed may pay a devastating price. Incontinence and impotence are bland sounding words but imagine your quality of life if you were forced to wear a diaper forever and could never have sex again. A radical prostatectomy robs a man of much of what made him himself. And these complications are exceedingly common: The prostate is located amid a tightly strung nest of important nerves that is difficult to keep intact during surgery.

Ablin’s book is a gripping disaster tale about how hype, profit-chasing, hysteria, and intransigence to reality reinforced one another in producing a horrendous mass medical error.

When the protein called PSA was first discovered (T. Ming Chu of the Roswell Park Cancer Institute was also involved), with higher quantities of it possibly linked to cancer, the medical community had hopes that a PSA test might turn out to be the male equivalent of a pap smear, which is a highly effective means of detecting pre-cancerous cells in the cervix.

But the PSA protein is present in every prostate, and though a reading above four (nanograms per millilitre) is often called a warning sign, you could have a reading of 0.5 and have cancer, or a reading of eleven and be cancer-free.

Even if the test could reliably inform you whether you have cancer, it’d still be more or less useless. Prostate cancer is both extremely common (by the time a man is in his 40s, he already has a 40% chance of having prostate cancer, and the odds increase from there) and extremely likely to be harmless. Think of prostate cancer as existing in two entirely different forms. It can be either a rabbit eager to burst out of its box (and into other parts of the body) or a turtle that just sits there, barely moving at all. You should worry about the rabbit, not the turtle. The PSA test won’t tell you which kind you have. Yet a huge industry swung into action behind the PSA. One expert cited by Ablin says perhaps half of the urologists in the United States would go bankrupt without the gold rush of prostate-removal surgery that followed the PSA discovery.

Now that the worth of the PSA test has been questioned, the industry is looking for a follow-up version, but Ablin is wary of whatever replacement is found.

*“When a 50-year-old man went for his yearly physical,” explains Ablin, “he routinely had a PSA test, quite often without his knowledge. The level of his PSA could propel him into the prostate cancer industry . . . the prostate gland is at the epicenter of a worldwide trillion-dollar industry and the PSA test as its kingpin. Think of PSA as oil. If the test were made irrelevant, an industry would crumble.

*“You don’t have to be a conspiracy theorist to grasp what the stakeholders will do to keep this Prostate Cancer Hoax industry booming.” (cancer prostate icd 10)

*****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.

I marked the last paragraph because the medical system is motivated by greed, however, it is not motivated by doctors as much as it is by the big pharmaceutical companies, the researchers who have no morals and the lobbyists who see only money. We must always remember that we, as people searching for alternatives….they do NOT work in our best interests! The natural cures that I will present, in the next chapters, will highlight the cheap alternative drugs that are widely available, that work better most times than the Chemotherapeutics and Radiotherapy they push, and are far cheaper than the ‘Wonder Drugs” they push on us. The problem is that these alternatives cannot be patented so there is no money to be made, and they then quash the idea that we can heal ourselves, they direct the research, and they publish only research that fits their agenda of making $$Billions off our illnesses.

I have decided to not play their game, and I am in the process of healing myself and ensuring that my cancer will not come back. It is a conscious choice that I made after much research, thousands of hours in fact, followed by thousands of hours in putting this book together. I wanted a quality of life that the doctors, specialists, and pharmaceutical companies could not guarantee me.

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