Richard J. Ablin, research professor of immunobiology at the University of Arizona College of Medicine, has been studying prostate cancer for over 40 years. After discovering the Prostate-Specific Antigen (PSA), an enzyme made by the prostate, and subsequent approval by the Food and Drug Administration in 1994, the PSA test is the most commonly used tool for detecting prostate cancer in men. Approximately 30 million American men undergo testing for PSA each year, which Dr. Ablin refers to in a recent New York Times editorial as a “public health disaster1.” He states that, although prostate cancer receives a lot of attention, “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.” As a result, he believes that “the medical community must confront reality and stop the inappropriate use of PSA screening” because it could save our ailing health care system billions of dollars from “unnecessary, debilitating treatments.”
Several letters were published in response to Dr. Ablin on March 122.
The president of the American Urological Association (AUA), Anton J. Bueschen, responds with AUA’s recommendation “that men ages 40 and older talk to their doctors about prostate health and the pros and cons of having a PSA test.”
Stephen Teitelbaum, Chief of Urology at the Kings Highway Division of Beth Israel Medical Center, argues that the studies Dr. Albin cites in his article are “too short to draw any conclusions regarding the utility of PSA screening.” He suggests conclusions be made after a 20-year follow-up period to determine the test’s effectiveness. In addition, he believes that “prostate-specific antigen testing is our best chance of finding prostate cancer while it’s still curable.” Furthermore, he places great emphasis on the potential number of lives spared as a result of PSA screening, early detection and treatment, referencing that 3 percent of men “sounds like a lot of men to me.”
Prostate cancer survivor, Lewis H. Miller, Jr., describes his experience and states that “over the last 12 years, I have never regretted my decision, and I have become a proselytizer for yearly PSA testing so long as the primary focus is on acceleration and not merely on a single numerical reading.” The acceleration Mr. Miller refers to is the change in PSA readings over a short period of time, which can signal abnormal prostate health.
Prostate cancer survivor, Scott Winokur, also describes his experience, “I had no family history of the disease and was utterly asymptomatic nearly 14 years ago when, at age 50, a routine PSA test turned up an aggressive cancer (the disease is often aggressive and therefore especially dangerous in younger men).” He ends his letter, “But the answer is not to climb aboard the bandwagon and issue a blanket condemnation of the PSA test. In doing so, authorities like Dr. Ablin condemn tens of thousands of men to early, painful deaths each year.”
Men’s Health Network (MHN), alongside 10 other independent, not-for-profit organizations, collectively known as America’s Prostate Cancer Organizations, issued a joint statement to the House Committee on Oversight and Government Reform on March 4, 20103. Relevant excerpts to the debate for screening, early detection and treatment are listed below.
Our shared goal is that all such men should receive the most appropriate advice and care, and that we continue to limit the devastating impact of prostate cancer on men and their families.
The early detection and appropriate treatment of clinically significant and potentially lethal prostate cancer remains a critical priority, especially among men at high risk because of family history, ethnicity, or other factors that define such risk.
Every man has the right to know whether he is at risk for potentially lethal prostate cancer.
Until more accurate tests are available, all health care insurance plans should include coverage of regular testing for prostate cancer (including the prostate-specific antigen or PSA test and the digital rectal exam or DRE) – and its subsequent diagnosis.
Have you or a loved one been affected by prostate cancer? What are your views about prostate cancer screenings? Please contact me at ramonl@menshealthnetwork.net and I would love to hear your story.
We also encourage any women who have been affected by prostate cancer to share their stories with Women Against Prostate Cancer, a grassroots organization founded to provide support for women and their families affected by prostate cancer by providing access to resources and supportive programming. They can be reached at info@womenagainstprostatecancer.org.
References
1https://www.nytimes.com/2010/03/10/opinion/10Ablin.html?scp=1&sq=the%20great%20prostate%20mistake&st=cse
2https://www.nytimes.com/2010/03/12/opinion/l12prostate.html?scp=4&sq=psa&st=cse
3https://www.menshealthnetwork.org/library/PCagroupshearingstatement030410.pdf
If one were to put into practice everything that comes from so-called experts, then someone had better do something to help doctors who daily face real and perceived threats from patients, lawyers, insurance companies, and government agencies such as CMS and state boards of medical examiners. Chiefs of Urology and medical associations have absolutely no idea what it is like for a doctor who treats patients daily and must conform to a system out of control in order to make even a meager living to have time to deal with patients who are told to “talk to their doctors about prostate health.” American medicine is collapsing. Do you wonder why?