The Great Prostate Hoax

The Great Prostate Hoax: How Big medicine Hijacked the PSA Test and Caused a Public Health Disaster, by Richard J Ablin, Ph.D. and Ronald Piana. Originally published in 2014, 272 pages.

This is without a doubt the most controversial modern medical book I have ever read, bar none. The backlash against it was swift and strong, as I found out once I began barely scratching the surface to gain some insight into the author’s background. Before I offer my thoughts, here is the goodreads promotional blurb:

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.

I started this book without a clear position on the subject either way. For certain, I am wary of big medicine, big pharma, and the scalpel-happy specialists who dominate western medical practice. But there have also been men in my life, whom I loved dearly, who battled prostate cancer. The rub in this book is based on a saying the author quoted at the very beginning of the book:

Some men die of prostate cancer. All men die with prostate cancer.

Of course he is referring to men who reach a certain milestone in life -approximately 70 years of age- and the rub is knowing the difference between men who can live perfectly fine and dandy never knowing if they have prostate cancer, and those for whom knowledge is a matter of life and death. The current urological standard of using PSA testing to make these determinations are what Dr. Amblin dissects in his book.

Based on the numbers of men left incontinent, impotent and otherwise impaired by what he feels are unwarranted biopsies and prostatectomies, Dr. Amblin comes down firmly on the minority side of the argument, concluding that using PSA to justify surgeries and biopsies which harm men is unacceptable. PSA is a naturally occurring antigen which can vary based on a number of factors, from horseback riding to an amorous night with one’s spouse right before the test the next morning and as such, Dr. Amblin cautions against the stock being put into it.

He also takes pains to explain the medicinal intricacies, which I found hard to follow at times. The sections where he outlines what he believes were profit driven motives to expand the use of PSA  testing into a must-have test for all men over 50 are quite interesting. All the conspiracy theory sections of my brain lit right up!

However, as the wife of a husband who is not only closing in on 50 years old in the next 5 years, and is also a member of a higher risk ethnic group where prostate cancer is concerned, I can’t say that Dr. Amblin convinced me. He did give us a lot to think about.

four out of five stars

…because I got a good education from this one.