PSA Test Is Misused, Unreliable, Says the Antigen's Discoverer

; Richard J. Ablin, PhD, DSc (Hon)

Disclosures

August 08, 2014

As Costly as the Human Genome Project

Dr. Ablin: I will give you an example of why I call this a public health disaster, as you wrote in your book, The Creative Destruction of Medicine (Basic Books, 2013).[4] Our healthcare system is broken. The latest statistics show that the annual budget for the National Cancer Institute is about $5.1 billion; of that, approximately $300 million goes for urologic research. But every year, we spend $3 billion on PSA screening in asymptomatic men, using a test that can't do what it's purported to do.

Every year, we spend $3 billion on PSA screening … using a test that can't do what it's purported to do. Richard J. Ablin, PhD

Dr. Topol: Even though the recommendations have changed by the US Preventive Services Task Force[5] and AUA,[2] there doesn't seem to be any decline in the use of PSA screening. Has it changed?

Dr. Ablin: Some reports have suggested a slight decrease. The other reason for calling this a public health disaster may hit closer to you because of your interest in genomics. The Human Genome Project, which took 13 years, also cost $3 billion, but look at all the information that we got out of the Human Genome Project. Just think: We spent $3 billion through Medicare and the Veterans Administration in 1 year, not over 13 years, on PSA screening, using a test that can't do what it's purported to do.

Dr. Topol: And the cost is much larger than that, because of all the procedures that are done. You also discuss in the book that it is not just the fact that all of these biopsies, surgeries, and radiation treatments are being done, but use of the surgery has also led to such technologies as robotic surgery of the prostate, proton beams, and Dendreon immunotherapies. It developed this medicine-industrial complex. Do you want to elaborate on that?

Dr. Ablin: Robotic surgery is a train that is ready to come off the tracks. When the FDA approved robotic surgery for the prostate, the basis of that approval was cystectomy of pig bladders. There was never any study on the use of robotic prostatectomy.

Dr. Topol: There were no human data?

With the PSA test, we have tried to make a silk purse out of a sow's ear. It can't be done. Richard J. Ablin, PhD

Dr. Ablin: No. We are seeing the results now, which have been disastrous in many cases. The machine for robotic prostatectomy costs $2 million, with a $100,000 contract. Now we have proton-beam centers that cost $200 million. With the PSA test, we have tried to make a silk purse out of a sow's ear. It can't be done.

In the book, I talk about 4 cruxes that explain why the PSA test is not being used appropriately. First, the PSA test is not cancer-specific. Second, there is no cut-off, no dichotomy in the response for a certain PSA level. For many years, we used 4 ng/mL, but we now know that a man can have a PSA of 0.5 ng/mL and have cancer, or a PSA of 11 ng/mL and not have cancer.

Dr. Topol: Genomics can play into that. Some men are walking around with high PSA levels from a very young age.

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