A book review
In my zeal to get to the bottom of everything I often uncover stuff that blows my mind. This is what happened this morning when I read this book review. This info doesn't apply to my female readers because it's about prostate cancer, but you may find it interesting and informative, particularly if you have an older male partner.
I have heard my friends Mark and Victor and Craig talking about their PSA levels (prostate-specific antigen) and thought nothing of it. My doctor doesn’t test for this so I thought it was unimportant. However, last spring my friend Mark actually got invasive surgery to remove his prostate, and I now wonder whether it was even necessary.
The PSA test has remarkable similarities to the PCR test, which was used to diagnose COVID even though Dr. Kerry Mullins, its inventor, said specifically that his test could not be used to diagnose anything. (The PCR test cannot distinguish between live virus and dead fragments, so the PCR test for COVID is useless. The CDC stopped recommending its use at the end of 2021.) Anyway, here it is, a book review about prostate cancer.
This book review excerpt is from the excellent Unbekoming substack, in an article titled “The Great Prostate Hoax.”
You can subscribe to Unbekoming at https://unbekoming.substack.com/
Analogy
Imagine you're the owner of a large orchard filled with thousands of apple trees. You know that some of these trees might have a disease that could potentially kill them, but it's rare - only about 3% of your trees will actually die from this disease. The rest will live out their natural lives, disease or not.
Now, a salesman comes to you with a new "revolutionary" test that he claims can detect this disease early. He suggests testing all your trees regularly. It sounds great at first, but there's a catch:
The test often can't tell the difference between healthy trees, trees with harmless spots, and trees with the actual deadly disease. In fact, it's wrong about 80% of the time. When the test says there's a problem, you're forced to cut off large branches from the tree to check if the disease is really there.
For every 1,000 trees you test, you might save one tree from dying of the disease. But in the process, you'll unnecessarily damage hundreds of healthy trees. Many of these trees will never produce apples again, some will be permanently stunted, and a few might even die from the damage caused by your well-intentioned but overzealous pruning.
What's worse, the salesman and the pruning company are making a fortune from all this testing and pruning, which costs you millions every year. They're so invested in this process that they resist any suggestion to change it, even when other orchard experts start to question its value.
This is essentially what's happened with PSA screening for prostate cancer. The test, like our hypothetical orchard test, is often inaccurate. It has led to millions of men undergoing unnecessary biopsies and treatments, which frequently result in life-altering side effects. All of this for a disease that, in most cases, would never have caused them harm. Meanwhile, the medical industry has profited enormously from this process, creating a powerful incentive to maintain the status quo despite mounting evidence of its flaws.
The book's main message is a call to recognize this situation for what it is – a public health disaster driven more by profit than by sound medical science – and to advocate for a more measured, evidence-based approach to prostate cancer detection and treatment.
“The Great Prostate Hoax”
Unbekoming’s 12-point book summary
Here's a 12-point summary of the book, including key data and statistics
PSA (Prostate-Specific Antigen) is not cancer-specific. It's present in normal, benign, and cancerous prostate tissue. There is no specific PSA level that definitively indicates cancer.
Routine PSA screening leads to significant overdiagnosis and overtreatment. For every 1,000 men screened, only 1 man may avoid death from prostate cancer, while many others suffer unnecessary biopsies and treatments.
Prostate cancer is age-related. About 40% of men aged 40-49, 70% of men 60-69, and 80% of men over 70 have prostate cancer. Most of these cancers are slow-growing and unlikely to cause death.
The lifetime risk of dying from prostate cancer is only 3%, meaning 97% of men will die from other causes, even if they have prostate cancer.
Radical prostatectomy, a common treatment resulting from PSA screening, often leads to significant side effects. Up to 60-80% of men experience erectile dysfunction and 10-20% have long-term urinary incontinence.
PSA screening has not significantly reduced prostate cancer mortality. Studies show similar death rates between screened and unscreened populations.
The PSA test has a high false-positive rate of up to 80%, leading to many unnecessary biopsies and treatments.
Active surveillance is increasingly recognized as an appropriate option for many men with low-risk prostate cancer, potentially avoiding unnecessary treatments and their side effects.
The U.S. healthcare system spends an estimated $3 billion annually on PSA tests alone, with billions more on subsequent procedures and treatments.
New technologies like robotic surgery and proton beam therapy, while heavily marketed, have not shown superior outcomes to traditional treatments but are significantly more expensive.
Conflicts of interest are prevalent in prostate cancer care. Many researchers and physicians promoting PSA screening have financial ties to companies that profit from increased screening and treatment.
The FDA approved the PSA test for screening in 1994 despite significant reservations from its own advisory panel. This decision, along with aggressive marketing by medical companies, led to widespread adoption of PSA screening before its benefits and harms were fully understood.
“The Great Prostate Hoax”
I hope you found this informative, I sure did. I’m sure that 99% of doctors who prescribe prostate surgery using the PSA test are sincere folks.
There’s an old saying: “Never assign to malice that which can adequately be explained by stupidity.” Nevertheless, I’m beginning to wonder if some of this stupidity is deliberate. It’s not coming from the grassroots, it’s coming from the top of the pyramid.