The great prostate hoax : how big medicine hijacked the PSA test and caused a public health disaster

Every year, more than a million men undergo painful needle biopsies for prostate cancer, and upward of 100,000 have radical prostatectomies, resulting in incontinence and impotence. But the shocking fact is that most of these men would never have died from this common form of cancer, which frequently grows so slowly that it never even leaves the prostate. How did we get to a point where so many unnecessary tests and surgeries are being done? In The Great Prostate Hoax , Richard J. Ablin exposes how a discovery he made in 1970, the prostate-specific antigen (PSA), was co-opted by the pharmaceutical industry into a multibillion-dollar business. He shows how his discovery of PSA was never meant to be used for screening prostate cancer, and yet nonetheless the test was patented and eventurally approved by the FDA in 1994. Now, doctors and victims are beginning to speak out about the harm of the test, and beginning to search for a true prostate cancer-specific marker.

Author Notes

Richard J. Ablin, PhD, DSc (HON) is a professor of Pathology at University of Arizona College of Medicine. In 1970 he identified PSA--the prostate specific antigen that is used as a test for prostate cancer. For decades he has fought against the misuse of his discovery, including a 2010 New York Times op-ed titled "The Great Prostate Mistake." He lives in Tucson, AZ.

Ronald Piana is a science writer specializing in oncology. He has published more than 400 bylined articles in leading medical journals.

Reviews (3)

Kirkus Review

The scientist who discovered the prostate specific antigen in 1970 explains emphatically why he considers use of the PSA test for routinely screening healthy men for cancer to be a profit-driven national disaster. With the assistance of science writer Piana, Ablin (Pathology/Univ. of Arizona Coll. of Medicine) pulls no punches in this attack on what he sees as the misdeeds of the urology community, the biotech industry and the Food and Drug Administration. The author explains that PSA is not a cancer-specific biomarker, and he asserts that the use of the PSA as a diagnostic test has crippled millions of healthy men, afflicting them with incontinence and impotence. A high PSA number leads to a biopsy, which leads to surgery. The author charges the FDA with negligence for allowing the profit-motivated biotech industry to market the PSA test as a cancer test and greedy urologists in directing frightened men to undergo unnecessary biopsies and prostatectomies. Ablin's account is replete with names of specific individuals, companies, agencies and organizations, and he provides excerpts from documents and letters to back up his charges. Conversations with men who have undergone prostate surgery put a human face on the alarming statistics he provides. In addition to the human suffering that their stories reveal, the cost to Medicare of prostate surgery is hefty. While misuse of PSA is Ablin's central theme, he sees this situation as representative of a larger problem: science for sale. Citing the revolving door between the FDA and big medicine, the author asserts that those charged with protecting American health care consumers are often in tacit collusion with those who come before them for approval of their products. Serious charges voiced in strong language, certain to be met with rebuttals from those whose ox has just been gored, and a must-read for any man concerned about his prostate.]] Copyright Kirkus Reviews, used with permission.

Choice Review

Ablin (pathology, Univ. of Arizona), discoverer of the prostate-specific antigen (PSA), provides a very well- written argument against the reliability and validly of the PSA as a diagnostic test for cancer. In doing so, Ablin, along with science/medical writer Piana, outlines the potential negative psychosocial impact that such a test can have on the public health system. While orchestrating their argument(s), the authors provide a catalyst to other concerns-as the conflicts and challenges presented in this text reflect a myriad of other problems that exist in the current health care (or rather care-less) system. In short, the book eloquently describes a system that is rooted in fear-based, procedure-dependent, and profit-driven marketing that has ultimately contaminated the doctor-patient relationship. This is an excellent read for a wide-ranging audience, including health care practitioners and patients who are seeking alternative explanations in complicated diseases and who are fed up with the current (profit-centered) standard of care model. Summing Up: Highly recommended. All academic, general, and professional health sciences collections. --Shawn Williams, York College/CUNY

Library Journal Review

In a well-documented and introspective account, Ablin (pathology, Univ. of Arizona Coll. of Medicine) and science writer Piana examine the fallacies associated with detecting prostate cancer through PSA screening. Although Ablin takes credit for discovering the prostate-specific antigen (PSA) in 1970, he vehemently argues against its use in screening men for the condition. According to Ablin, and many other physicians he has interviewed, PSA is not a good screening marker. However, many urologists continue to convince male patients to undergo procedures that are risky and that have a high probability of doing more harm than good. The author incorporates his 40-plus years of experience in the field of immunotherapy along with supportive medical opinion. -Attempting to set the record straight, he does not hold back in pinning blame on the greedy actions of two primary stakeholders: big medicine and doctors, particularly urologists. References made to unnecessary treatment, wasteful spending, and the collusion between business and medical interests support abuses revealed in Norton M. Hadler's The Citizen Patient. VERDICT Wary medical consumers-men in particular-and health-care reformers alike should not overlook the wisdom that this title offers.-Chad Clark, Lamar State Coll. Lib., Port Arthur, TX (c) Copyright 2014. Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.

Acknowledgments	p. ix
Introduction	p. 1
1 The Jungle	p. 9
2 A Decision I Thought I Could Live With	p. 17
3 What The Bleep Just Happened?	p. 31
4 The Color of Money	p. 91
5 Unintended Consequences	p. 161
6 The Hidden Truth	p. 187
7 It's 112 Degrees in Tucson	p. 205
Appendix	p. 231
Notes	p. 237
Index	p. 257

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