That thrill soon tempered by the misuse of a test (PSA) never designed to be cancer detection specific and hence "opening the floodgates for a tsunami of routine nationwide testing" (p. 7). Dr. Ablin is adamant that the FDA made a "fateful error" to approve the PSA test as a means to detect prostate cancer. But as Ablin notes, PSA is even in healthy tissue and it can spike from all manner of external stimuli including: riding a bicycle, riding a horse, or after a rectal exam or colonoscopy. So what the hell use is it? Virtually none, as Dr. Ablin makes clear.
All it does, according to Ablin, is result in nearly a million risky biopsies a year - to the tune of billions of bucks for urologists- as well as tens thousands of unnecessary radical prostatectomies leaving most of those men mere shadows of their former selves. Often incontinent as well as impotent - even using Viagra every day and getting costly penile implants.
Ablin cites Dr. Alan Shapiro (p. 192) - once a promoter of the PSA- whose wake up call on the unnecessary harms caused by PSA testing arrived "when a 50 year old man came to his urology practice wearing a condom catheter - a flexible, condom -like sheath that fits over the penis and is attached to a tube that drains the urine into a storage bag."
As Dr. Shapiro put it (ibid.):
"This relatively young guy had a radical prostatectomy and now he couldn't get an erection or control his urine. He was crippled. "
This was five years before Ablin and Shapiro decided to make their documentary, 'Second Opinion', showing men who'd undergone the procedure recounting their experiences and later suffering. All the men lament the predictable trajectory that imprinted and ultimately altered the quality of their lives: the initial PSA test or tests, the advice to then get a biopsy because of a "spike" and finally the urging of the urologists to get treatment- usually radical prostatectomy because each one of those puts the biggest bucks into their pockets.
Hence, urology has become - thanks to PSA testing - one of the most lucrative branches of the medical industrial complex.
Ablin notes men are often pushed "to have it out" and so the initial reaction to a PSA spike or high level is an emotional response, often from their wives asking - "Can you really live with that cancer inside you?" Failing to realize that after their hubby follows her imperative he will no longer be able to have any kind of sex with her. Thus we behold the power of naked emotion to sway sound scientific judgment. Of course, there are exceptions - but these are not the "rule" - something its eager advocates forget or neglect.
Ablin essentially insists a man ceases to be a man in many vital respects, after this surgery. He writes for example (p. 36):
"A man can live without his prostate but once it is removed he suffers varying degrees of physical and psychological changes."
He goes on to quote one patient who actually wrote a book, 'I Want My Prostate Back':
"He wasn't the same man after the robotic surgery and pulled no punches talking about it. In an article in Men's Health, he wrote: 'Without any ejaculate I felt like a broken toy, like a water pistol that squirts jelly. Or nothing"
Harsh words but he cuts through the BS surrounding the test, just as Dr. Ablin does in his book, including all the flack he's taken from the nabobs who are trying to protect their profitable lives.
Perhaps the best chapter is Six:
"The Task Force has determined that PSA screening fails to meet the criteria for effective screening. The test lacks accuracy in detecting early stage disease. There is little evidence that early detection of prostate cancer improves patient outcomes and there is mounting evidence of the adverse effects of testing and treatment."
It took nearly 20 years of ongoing PR battles with the urologists - remember they pocket a pretty penny from biopsies as well as surgeries - before the Task Force recommendations became generally accepted and have now - in the past year- yielded for the first time fewer biopsies as well as cancers detected. While a segment of the pro-PSA bunch is still left to hair on fire screeching, blasting that "all those men not getting screened are playing with their lives" the evidence simply isn't there.
As Ablin notes, prostate cancer is an inevitable disease of aging. By age 65 nearly half of all man have some manner of "neoplasm" in their prostates. By age 85 it is nearly 95%. What? We're going to cut out all those cancers despite the fact they're all likely to die of anything but prostate cancer?
Let's also bear in mind that Richard Ablin's take on the PSA test is not new. Years before we beheld medical author Shannon Brownlee's take, in her book 'Untreated: Why Too Much Medicine is Making Us Sicker and Poorer' (2007, p. 202):
"The evidence suggests that PSA testing is not saving any lives, and even it is the large numbers of men who are treated unnecessarily are paying a terrible price. They're the equivalent of civilian casualties in our war on cancer.".
That take very nearly resembles Ablin's of havoc wrought across the years by this screening test which actually isn't cancer specific.
Yes, in the interest of full disclosure, I did have radiation therapy treatment myself - under pressure from my wife, my urologist, my primary doc and others. BUT......as a fellow Intertel member emailed me (soon after I wrote about the experience in the Intertel Regional Newsletter 'Port of Call') I might also have lived with only minor problems (the cancer stage was T1c) and croaked eventually of something else. This is because 97% of prostate cancers are slow growing. (Incredibly, 99% of males autopsied who are 80 years or older are found to have prostate cancer .....and most never knew about it!)
Even if you're an avowed and dedicated believer in PSA screening, you should try to get this book and at least see another point of view. Those who are in the age range for such tests, or have medical providers who recommend getting it, absolutely should read this book first.