Prostate Hoax?

The Economist review of The Great Prostate Hoax by Richard Ablin observes that opposition to prostate testing has moved in from the margins.

Ablin, who claims to have identified the protein widely associated with prostate cancer, questions whether it gives any useful information. As the review explains, “In some men with cancer, PSA levels may be elevated. But a high PSA does not necessarily mean that a man has cancer, nor does a low PSA mean he should be carefree.”

Ambiguous though it was, “the PSA test became common practice in the 1990s, particularly in America. In 1986 the Food and Drug Administration approved the test to monitor those already diagnosed with cancer. In 1994 it went further, authorising the test to help detect cancer in men aged 50 and older.”

Ablin shows that the dangerous levels rested on an arbitrary decision: “A level of four nanogrammes per millilitre (ng/ml) became the standard threshold for a high PSA. William Catalona of Northwestern University, who argued for the test’s approval, admits that the cut-off of 4ng/ml was ‘completely arbitrary.’ He created a scatter plot from data of men’s PSA levels and rates of cancer. ‘Just sort of eyeballing it, it looked like four would be a good number.’”

The testing seems to have been successful, but that’s a debatable point: “Deaths from prostate cancer dropped by 45% between 1993 and 2010, suggesting that the test may have helped. But the number of deaths began declining before PSA screening would have had much effect; screenings may also have identified cancers that were never going to become lethal, artificially raising survival figures.”

The book makes a wider point about the distortions embedded in the American medical establishment: “Mr Ablin, and his co-author, Ronald Piana, are good at describing how the many ills of American health care—from doctors’ fears of malpractice suits to their fascination with new gizmos—conspired to encourage treatment.”