Every year, more than a million men in the USA undergo, with associated risks, painful needle biopsies for prostate cancer, and upward of 100,000 have radical prostatectomies, often resulting in crippling side effects, such as incontinence, impotence and psychological trauma. But the shocking fact is most of these men would never have died of this common form of cancer, which frequently grows so slow that it never even leaves the prostate. How did we get to a point where so many unnecessary tests and surgeries are being done resulting in a multibillion-dollar industry?
The unsavory extrapolation of the "science" of the PSA test beyond its capabilities to serve as a harbinger for the recurrence of prostate cancer for: i) the purpose of screening asymptomatic men for prostate cancer and ii) a medical community too quick to biopsy and treat, were the initiating events. These events followed by clever marketing of PSA test manufacturers; the media, through high-profile political, entertainment and professional sports figures "get tested, get diagnosed, get treated" and well-intended but ill-informed urologists, screening proliferated to a "fevor which would not disgrace a medieval inquisition". The consequence systematically devastated the quality of life of millions of American men and their families, and depleted our healthcare system of precious resources at an annual cost of $3 billion for a test that cannot do what it is purporsed to do. Most assuredly the widely known principle in medicine: Primum non nocere (First do no harm) was lost in the tsunami of manipulating science for personal and financial gain. The answer of how we got to the present "the almighty bloody dollar" becomes clear. Nonetheless, it is instructive, lest history repeats itself, we look at the facts – pro and con of PSA screening as they developed the past almost 50 years.
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Welcome
Annette Grüters-Kieslich
Vice-President Berlin-Brandenburg Academy of Sciences and Humanities
PSA: People Seeking Answers
Richard J. Ablin
University of Arizona, College of Medicine / Arizona Cancer Center and BIO5 Institute, Tucson