Prostate cancer: Overtesting and overreatment--a review of two classic books by an American living in Japan
Guess correctly who the mystery speaker will be at Active Surveillance '25 and win valuable prizes
(Editor’s note: I ran across Prof. Bruce Davidson’s review of two of my favorite books, “The Invasion of the Prostate Snatchers” and “The Great Prostate Hoax.” These books changed my life, turning ,e a fierce activist for patients with low-risk prostate cancer from being a mild-mannered medical editor on a major metropolitan newspaper. Davidson gave me permission to reprint his review from the original Brownstone Institute article. His conclusions are his own.
(I asked hom a few questions and found he was a retired humanities professor. He is an American citizen who has spent most of his professional life in Japan. As I guessed, he is a prostate cancer patient. He has a Gleason 7 but isn’t sure what kind and whether he would have qualified for AS.
(In fact, he said: “I don't know anything about Active Surveillance being done here (in Japan), and I've never heard of it (being) recommended. I think overdiagnosis and overtreatment are probably pretty bad. Japanese doctors tend to be technicians who slavishly follow any test results and do what the government health bureaucrats recommend as standard treatment.”)
By Prof. Bruce Davidson
The excessive medical response to the Covid pandemic made one thing abundantly clear: Medical consumers really ought to do their own research into the health issues that impact them. Furthermore, it is no longer enough simply to seek out a “second opinion” or even a “third opinion” from doctors. They may well all be misinformed or biased. Furthermore, this problem appears to predate the Covid phenomenon.
(Prof. Bruce Davidson)
A striking example of that can be found in the recent history of prostate cancer testing and treatment, which, for personal reasons, has become a subject of interest to me. In many ways, it strongly resembles the Covid calamity, where misuse of the PCR test resulted in harming the supposedly Covid-infected with destructive treatments.
Two excellent books on the subject illuminate the issues involved in prostate cancer. One is Invasion of the Prostate Snatchers by Dr. Mark Scholz and Ralph Blum. Dr. Scholtz is executive director of the Prostate Cancer Research Institute in California. The other is The Great Prostate Hoax by Richard Ablin and Ronald Piana. Richard Ablin is a pathologist who invented the PSA test but has become a vociferous critic of its widespread use as a diagnostic tool for prostate cancer.
Mandatory yearly PSA testing at many institutions opened up a gold mine for urologists, who were able to perform lucrative biopsies and prostatectomies on patients who had PSA test numbers above a certain level. However, Ablin has insisted that “routine PSA screening does far more harm to men than good.” Moreover, he maintains that the medical people involved in prostate screening and treatment represent “a self-perpetuating industry that has maimed millions of American men.”
Even during approval hearings for the PSA test, the FDA was well aware of the problems and dangers. For one thing, the test has a 78% false positive rate. An elevated PSA level can be caused by various factors besides cancer, so it is not really a test for prostate cancer. Moreover, a PSA test score can spur frightened men into getting unnecessary biopsies and harmful surgical procedures.
One person who understood the potential dangers of the test well was the chairman of the FDA’s committee, Dr. Harold Markovitz, who decided whether to approve it. He declared, “I’m afraid of this test. If it is approved, it comes out with the imprimatur of the committee…as pointed out, you can’t wash your hands of guilt. . .all this does is threaten a whole lot of men with prostate biopsy…it’s dangerous.”
In the end, the committee did not give unqualified approval to the PSA test but only approved it “with conditions.” However, subsequently, the conditions were ignored.
Nevertheless, the PSA test became celebrated as the route to salvation from prostate cancer. The Postal Service even circulated a stamp promoting yearly PSA tests in 1999. Quite a few people became wealthy and well-known at the Hybritech company, thanks to the Tandem-R PSA test, their most lucrative product.
In those days, the corrupting influence of the pharmaceutical companies on the medical device and drug approval process was already apparent. In an editorial for the Journal of the American Medical Association (quoted in Albin and Piana’s book), Dr. Marcia Angell wrote, “The pharmaceutical industry has gained unprecedented control over the evaluation of its products…there’s mounting evidence that they skew the research they sponsor to make their drugs look better and safer.” She also authored the book The Truth About the Drug Companies: How They Deceive Us and What to Do About It.
A cancer diagnosis often causes great anxiety, but in actuality, prostate cancer develops very slowly compared to other cancers and does not often pose an imminent threat to life. A chart featured in Scholz and Blum’s book compares the average length of life of people whose cancer returns after surgery. In the case of colon cancer, they live on average two more years, but prostate cancer patients live another 18.5 years.
In the overwhelming majority of cases, prostate cancer patients do not die from it but rather from something else, whether they are treated for it or not. In a 2023 article about this issue titled “To Treat or Not to Treat,” the author reports the results of a 15-year study of prostate cancer patients in the New England Journal of Medicine. Only 3% of the men in the study died of prostate cancer, and getting radiation or surgery for it did not seem to offer much statistical benefit over “active surveillance.”
Dr. Scholz confirms this, writing that “studies indicate that these treatments [radiation and surgery] reduce mortality in men with Low and Intermediate-Risk disease by only 1% to 2% and by less than 10% in men with High-Risk disease.”
Nowadays prostate surgery is a dangerous treatment choice, but it is still widely recommended by doctors, especially in Japan. Sadly, it also seems to be unnecessary. One study cited in Ablin and Piana’s book concluded that “PSA mass screening resulted in a huge increase in the number of radical prostatectomies. There is little evidence for improved survival outcomes in the recent years…”
However, a number of urologists urge their patients not to wait to get prostate surgery, threatening them with imminent death if they do not. Ralph Blum, a prostate cancer patient, was told by one urologist, “Without surgery you’ll be dead in two years.” Many will recall that similar death threats were also a common feature of Covid mRNA-injection promotion.
Weighing against prostate surgery are various risks, including death and long-term impairment, since it is a very difficult procedure, even with newer robotic technology. According to Dr. Scholz, about 1 in 600 prostate surgeries result in the death of the patient. Much higher percentages suffer from incontinence (15% to 20%) and impotence after surgery. The psychological impact of these side effects is not a minor problem for many men.
In light of the significant risks and little proven benefit of treatment, Dr. Scholz censures “the urology world’s persistent overtreatment mindset.” Clearly, excessive PSA screening led to inflicting unnecessary suffering on many men. More recently, the Covid phenomenon has been an even more dramatic case of medical overkill.
Ablin and Piana’s book makes an observation that also sheds a harsh light on the Covid medical response: “Isn’t cutting edge innovation that brings new medical technology to the market a good thing for health-care consumers? The answer is yes, but only if new technologies entering the market have proven benefit over the ones they replace.”
That last point especially applies to Japan right now, where people are being urged to receive the next-generation mRNA innovation–the self-amplifying mRNA Covid vaccine. Thankfully, a number seem to be resisting this time.
Prof. Bruce Davidson, an American citizen and a permanent resident of Japan, is a retired college professor. His original discipline was English as a Foreign Language, but he wound up teaching critical thinking and English literature. He said his involvement in critical thinking led him “to question a lot of medical conventional wisdom, I consider critical thinking to be my main field these days.”
My review of “Invasion of Prostate Snatchers.”
Who’s the mystery speaker in the January 4 review of AS in 2024 and the year ahead?
By Howard Wolinsky
TheActiveSurveillor.com newsletter is holding its first event at noon Eastern, Saturday, January 24. “Active Surveillance ‘25” will be a year in review of low-risk prostate cancer and AS and what’s in the cards in ‘25.
Founding members and paid subscribers get a free pass.
Other subscribers can get a free pass by purchasing a subscription.
For information on subscribing, click here:
I am waiting for photos and a biosketch from the fourth speaker. I haven’t announced who it will be yet.
But why not take a guess? The first three patients who guess correctly will get free entry into the program.
Paid subscribers and founding members who guess correctly will win “valuable prizes” to be announced.
Here’s the line-up:”
(Speakers at The January 4, 2025 TheActiveSurveillor.com program “AS ‘25”: Clockwise: Dr. Who?; Brian Helfand, MD, PhD; Tim Showalter, MD, MPH, and Christian Pavlovich, MD)
Confirmed speakers include Johns Hopkins urologist Christian Pavlovich, MD, who just published a major study showing the benefit of a USDA diet in preventing the progression of prostate cancer; Tim Showalter, MD, MPH, medical director of Artera AI, which has been making headlines with its Prostate Test in guiding patients to AS, and Brian Helfand, MD, PhD, chief of urology at NorthShore University Health System, who researches DNA and prostate cancer.
Founding members and free subscribers, you’ve been receiving reminders to sign up for the Jan. 4 program. Please sign up. It will let me know whether I need to sign up with Zoom for a full-fledged webinar for over 100 attendees. (I’m getting close already.)
If the $50 annual subscription is too steep, let me know privately via email and I’ll give you free entry.