The PSA Scam

Older men are being urged to have their prostates checked annually, especially now that the US Centers for Disease Control claim survival rates have increased from 67 percent to 97 percent over the past 20 years. But this, like much prostate progress, is an illusion. Early detection and treatment is not making older men’s lives longer; it is making them more miserable.

Although more potential prostate cancers are detected today than ever before because of the prostate-specific antigen (PSA) test introduced in 1987, this test and the digital rectal exam can result in unnecessary biopsies. Many cancers confirmed by biopsy are “not clinically important,” according to a 2001 paper in the New England Journal of Medicine. Even men with benign cancers are subject to radiation or surgery, leaving many incontinent or impotent.

By detecting insignificant cancers, and by detecting important cancers earlier, the average time from detection to death may increase, but the average time from cancer formation to death may not. In fact, aggressive treatment could be causing people to die earlier (and certainly suffer more), yet this bias would still give the illusion of improvement.

If prostate cancer detection works, it should reduce the number of deaths. Although the rate of detection has increased dramatically since 1987, deaths continued rising from 32 per 100,000 American men in 1975, to 35 in 1987, reaching 39 in 1993, and falling back to 31 by 2000.

A 2002 study in the British Medical Journal compared a group of elderly men in Connecticut to a similar group in Seattle, where the rate of PSA testing was more than five times higher. Radiation treatment rates were more than double in Seattle and surgical removal of the prostate almost six times more frequent. Despite this, prostate cancer death rates were similar.

In 2003 the New England Journal of Medicine noted that the drug Finasteride had reduced the rate of detection of prostate cancer. However, this rate was abnormally high, meaning that the study had turned up many more insignificant cancers than normal, especially in the placebo group. Aggressive cancers, on the other hand, were significantly more prevalent in the Finasteride group.

There is no proof that an annual prostate checkup is beneficial, but doing nothing is no alternative. An active lifestyle with a healthy diet emphasizing fruits and vegetables that are known to strengthen the prostate and fight cancer will be beneficial, without risk of side-effects and the chance of making your urologist wealthier. Men should eat foods rich in antioxidants such as selenium, vitamins D and E, lycopene (found in tomatoes), and sulforaphane (found in mustard-family vegetables). Also include soy products, believed to explain the lower cancer risk of Asians, perhaps because of the isoflavones they contain.