The Great Prostate Mistake

[FarCenter]

By RICHARD J. ABLIN - Published: March 9, 2010 - Tucson

EACH year some 30 million American men undergo testing for prostate-specific antigen, an enzyme made by the prostate. Approved by the Food and Drug Administration in 1994, the P.S.A. test is the most commonly used tool for detecting prostate cancer.

The test’s popularity has led to a hugely expensive public health disaster. It’s an issue I am painfully familiar with — I discovered P.S.A. in 1970. As Congress searches for ways to cut costs in our health care system, a significant savings could come from changing the way the antigen is used to screen for prostate cancer.

Americans spend an enormous amount testing for prostate cancer. The annual bill for P.S.A. screening is at least $3 billion, with much of it paid for by Medicare and the Veterans Administration.

Prostate cancer may get a lot of press, but consider the numbers: American men have a 16 percent lifetime chance of receiving a diagnosis of prostate cancer, but only a 3 percent chance of dying from it. That’s because the majority of prostate cancers grow slowly. In other words, men lucky enough to reach old age are much more likely to die with prostate cancer than to die of it.

Even then, the test is hardly more effective than a coin toss. As I’ve been trying to make clear for many years now, P.S.A. testing can’t detect prostate cancer and, more important, it can’t distinguish between the two types of prostate cancer — the one that will kill you and the one that won’t.

<SNIP>http://www.nytimes.com/2010/03/10/opinion/10Ablin.html?th&emc=th

[unc70]

1. Ablin is known for publishing that AIDS not caused by HIV

I just posted in a similar thread in the Health forum about Ablin. He has a lot of credibility from being first to isolate the PSA forty years ago, but I am sceptical of his claims and statements.

He published in Lancet, April 1985, and elsewhere that HIV did not cause AIDS but rather they were each sympoms of other diseases.

See my posts in the Health forum for more detail.

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=222x83917

[Supersedeas]

4. Yes, thanks for posting that.

[The Genealogist]

2. Glad he is talking some science

and seems to have good points, but I don't care for how flippant he is with those numbers. I am still not too happy with losing my father to prostate cancer, which spread all over, particularly into his bones, and which lead to a drawn out couple of years of real suffering for him, physically and emotionally and for those he left behind emotionally.

I would have loved for him to have had back, in his last 18 months on earth, all the money he threw down the drain on saw palmetto and other "herbal products" that did him no good. Too, if you are wondering if he went to the doctor, he did regularly (he had Parkinson's Disease) but his primary care physician, a D.O., apparently didn't bother to do screenings of any sort.

Sorry to go so off subject, still a sore spot for me. In short, if the science is not backing up the value of P.S.A. testing, then stop wasting money that could go to other things on it! One last thing...my father's P.S.A. numbers after his diagnosis were at times so far off the range for normal that it was mind boggling.

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3. There are serious problems with the science in those studies.,

First, I am sorry about your father and his suffering. That is why I find Ablin, et al so reckless in arguing against PSA screening.

The two studies I think he references are seriously flawed. I posted about them when they came out (see my journal and archives). The US study is not between groups screened and not screened, but between a group screened 100% compared with a group that continued making their own decisions, with a high percentage being tested every year or two and others tested after symptoms or surgery. So "more aggressive" screening versus "current practice", not "less aggressive" screening.

The German study is limited to those 55 and older. While it has some issues, it is a useful study for that population. But it should not be used in deciding anything about testing on younger men, where early detection has the greatest impact.