A story about prostate cancer (PC) screening titled “The Great Prostate Mistake” which appeared in the New York Times last week, “went viral”. Everybody’s talking about it. (See http://www.nytimes.com/2010/03/10/opinion/10Ablin.html?scp=1&sq=ablin&st=cse) I refer to an opinion piece written by Dr. Richard Ablin, a researcher in immunobiology and pathology who invented the prostate-specific antigen (PSA) test in 1970, the most commonly used tool for detecting prostate cancer (PC) today . The test measures the levels of PSA, a protein secreted by cells in the prostate which leaks into the blood, excessively if there is prostate cancer.
Dr. Ablin is clearly unhappy that he released this particular genie from the bottle. He decries the widespread, indiscriminate use of the PSA test, by which he means the practice of testing all men over a certain age regardless of risk. (The recommended age used to be 50, but it was recently lowered to 40 by the American Urological Association). Dr. Ablin believes mass PSA testing has become a “costly, profit-driven public health disaster”, spurred by greedy drug companies who “peddle” the test and overzealous patient-advocates who sponsor screening events as part of “prostate cancer awareness”.
Dr. Ablin claims the PSA test is hardly better at detecting PC than a coin toss. The test generates a lot of false positives because many common factors other than cancer can cause PSA levels to be elevated. And the PSA test misses 30% of cancers. But by far the biggest problem with the PSA test is that it can’t distinguish between the majority of PCs which are slow-growing and harmless and may not need treatment, and the fast-growing PCs, which require aggressive treatment.
In spite of these lim