In the article titled ‘The Greatest Prostate Mistake’ published in the NYTimes, Dr. Ablin explains how his discovery of the PSA test for detection of prostate cancer in the 1970 has become a ‘hugely expensive public health disaster’.
As Popularity Rose…
Every year on an average 30 million American men, take the prostate specific antigen test. The test has become immensely popular for detecting prostate cancer since its FDA approval in 1994.
Some salient features as to why the test is so popular and why the PSA test is still conducted as a screening method for prostate cancer detection:
- Drug companies push the test as a means of spreading prostate awareness and encourage men to screen for PSA test.
- American Urological Association continues to recommend PSA test.
- National Cancer Institute has not yet stated anything against PSA screening.
- Even though the Preventive Services Task Force has, recommended men aged 75 years and above to refrain from PSA testing, they have not yet given any advice for younger men.
Dr Ablin feels that the entire PSA screening test episode has been profit driven. Annual expenditure for PSA screening in America is a whopping $3 billion and the Veterans Administration and Medicare pays most of this amount. In times when Congress is searching for effective cost cutting in the health care system, controlled PSA screening can contribute substantially.
Are the numbers significant enough?
- Only 16% of American men are diagnosed with prostate cancer.
- Of this, only 3% of men would actually succumb to the disease since prostate tumor grows very slowly.
The best part of the argument given by Dr Ablin is that, PSA cannot detect prostate cancer; neither can it distinguish the malignant ones from the benign. All that a PSA test can do is detect levels of prostate serum antigen levels that can fluctuate due to quite a few reasons like,
- Over the counter drugs (ibuprofen)
- Benign swelling of prostate
Evidence Against Routine Screening of PSA
- American study results published in The New England Journal of Medicine show that in a period of about 7 to 10 years, there was no reduction in death rate due to PSA screening in men 55 years and over.
- European study results shows a small decrease in death rates but also they also found that only one in 48 men is treated and saved, leaving the remaining 47 with sexual dysfunction and other complications.
So how should PSA be used?
According to Dr.Ablin, PSA can be use efficiently to indicate,
- Return of prostate cancer after treatment (high scores).
- Prostate cancer in men with a family history of the same.
Dr.Ablin says that screening entire population of men over age 50 is a strict NO NO.
- Prostate Specific Antigen (PSA) Test And Its Results
- Dr. Otis Webb Brawley, CMO American Cancer Society, Condemns Overuse Of PSA Screening Test
- PLCO And ERSPC Clinical Trials, Two Landmark Studies Of Prostate PSA Screening
- Prostate Cancer PSA Screening – Giving Patients The Right Not To Know
- FAQs About The Latest PSA Screening Test Recommendations