Fear and Money Keep PSA in Use
Dr. Topol: It seems outlandish, and you cover this in the book. We then go from 1994, when the FDA approves the PSA for mass screening, to today. I was presenting at the American Urological Association (AUA) in May 2013, the day after the professional society said that we should no longer use the PSA routinely. Why did it go on for almost 20 years?
Dr. Ablin: Fear and money, because other than melanoma, prostate cancer is the most prominent cancer in men. It went on because of the continual proselytizing of fear and the money that was being generated by the screenings.
For example, in 1989, which was 5 years before the test was approved by the FDA for detection, Schering-Plough paid $1.2 million to a marketing firm during September, which is Prostate Cancer Awareness Month, to promote PSA screening. Primary care physicians were brainwashed that they needed to do a PSA test. If you don't do a PSA test and a man is subsequently diagnosed with prostate cancer, you could be sued.
Dr. Topol: Urologists who have incorporated the PSA test into their practice are still very tied to it , even after the May 2013 backing off from the AUA initial recommendations. This happens because patients and doctors believe that lives have been saved by the PSA test. This is offset by all of the men who have developed urinary incontinence or who have lost sexual function -- all of the travesties that have occurred.
We know from the analyses that net benefit isn't there -- but there is striking net harm. In 2010, you wrote a New York Times op-ed calling this is a public health disaster, and stating that several billion dollars a year could be saved by eliminating the PSA test as a screening test. That was back in 2010, and then you published this book. You said that you were working on it for several years. What were you trying to accomplish in the book?
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Cite this: PSA Test Is Misused, Unreliable, Says the Antigen's Discoverer - Medscape - Aug 08, 2014.