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The Great Prostate Hoax: How Big Medicine Hijacked the PSA Test and Caused a Public Health Disaster
Every year, more than a million men undergo painful needle biopsies for prostate cancer, and upward of 100,000 have radical prostatectomies, resulting in incontinence and impotence. But the shocking fact is that most of these men would never have died from this common form of cancer, which frequently grows so slowly that it never even leaves the prostate. How did we get to a point where so many unnecessary tests and surgeries are being done? In The Great Prostate Hoax , Richard J. Ablin exposes how a discovery he made in 1970, the prostate-specific antigen (PSA), was co-opted by the pharmaceutical industry into a multibillion-dollar business. He shows how his discovery of PSA was never meant to be used for screening prostate cancer, and yet nonetheless the test was patented and eventurally approved by the FDA in 1994. Now, doctors and victims are beginning to speak out about the harm of the test, and beginning to search for a true prostate cancer-specific marker.
272 pages, Hardcover
First published March 4, 2014
85 people are currently reading
238 people want to read
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Displaying 1 - 27 of 27 reviews
August 27, 2022
My doctors are all trying to get me on the "Prostate Cancer Train" but I am resisting in part because of this book. Professor Ablin is the researcher who discovered the PSA molecule in 1970. And since them he has been trying to temper the enthusiasm for using his discovery as a marker for Prostate Cancer....it's not, he says. He is in a good position to know.
More to the point, he is claiming that:
-the PSA test cut off point of 4 is arbitrary; 78% of those tested will have a false positive
-Most men over 60 years old, WILL test over 4 and have a neoplasm; men over 70 - almost all will have a neoplasm.
-biopsies (the next step after 4+ PSA) are completely overused
-Biopsies and the Gleason score that results are undependable...you can't tell slow from fast growing tumors.
-Removal of Prostate vs active surveillance produces the same mortality rate.
-There is a 97% chance that a detected tumor NOT being a threat to your life
-The side effects of treatment, incontinence and impotence, are devastating to male self image, as well as messy
-There is a strong economic incentive for urologists to biopsy and remove prostates.
I would have liked if Dr Ablin had address the issues of what men SHOULD do in various scenarios, given all these claims, since we don't seem to have anyone to turn to that doesn't have a vested interest; but I understand he is not a physician.
For instance, if you have the biopsy and get a Gleason score of 6, and you have another biopsy in a year and the score is up to 7 or 8, should treatment be considered then? (if you are 68?) Or should you not be getting a biopsy in the first place, since it will not matter to your mortality?
Required ready for anyone on the fast moving "train".
More to the point, he is claiming that:
-the PSA test cut off point of 4 is arbitrary; 78% of those tested will have a false positive
-Most men over 60 years old, WILL test over 4 and have a neoplasm; men over 70 - almost all will have a neoplasm.
-biopsies (the next step after 4+ PSA) are completely overused
-Biopsies and the Gleason score that results are undependable...you can't tell slow from fast growing tumors.
-Removal of Prostate vs active surveillance produces the same mortality rate.
-There is a 97% chance that a detected tumor NOT being a threat to your life
-The side effects of treatment, incontinence and impotence, are devastating to male self image, as well as messy
-There is a strong economic incentive for urologists to biopsy and remove prostates.
I would have liked if Dr Ablin had address the issues of what men SHOULD do in various scenarios, given all these claims, since we don't seem to have anyone to turn to that doesn't have a vested interest; but I understand he is not a physician.
For instance, if you have the biopsy and get a Gleason score of 6, and you have another biopsy in a year and the score is up to 7 or 8, should treatment be considered then? (if you are 68?) Or should you not be getting a biopsy in the first place, since it will not matter to your mortality?
Required ready for anyone on the fast moving "train".
August 23, 2014
Every man who has a prostate should read this book. Certainly has changed how I view the PSA tests. I am one of those "millions" who has suffered from the painful need biopsy procedure. This was recommended as my PSA increased from 2.5 to 5.2 - I believe the change has more to do with a new lab being used for the higher reading. Not only was it painful but effects lingered for 2-3 months until my functions returned to normal. I intend to continue PSA tests but will not take actions despite what the doctors tell me - I will be armed with a hard copy of this book to argue my case.
May 10, 2016
A man, or a woman with a man she loves, should read this book!
For me this was an eye opening book. I think I might have lucked out finding this book by accident (or was it ?) just after being scheduled for a biopsy. After reading it I cancelled the procedure. So now quay sarah sarah. The things that can go wrong and the possible repercussions are something that I think I'll have to pass on.
For me this was an eye opening book. I think I might have lucked out finding this book by accident (or was it ?) just after being scheduled for a biopsy. After reading it I cancelled the procedure. So now quay sarah sarah. The things that can go wrong and the possible repercussions are something that I think I'll have to pass on.
April 7, 2015
Dr Ablin is a pathologist, professor and scientist who initially discovered PSA which was later marketed into a testing mechanism for the detection of cancer. Dr Ablin contends that the PSA Test is not a specific test for prostate cancer in that it could be and indication of an enlarged prostate, prostatitis, infection and other factors. Moreover, the cancer that is found is only fatal in only three percent of the cases leading to the conclusion that a man would have an equal chance of survival opting for no treatment than a treatment potentially leading to incontinence and or impotence. It is interesting to note that men between the ages of 60-69 are likely to be diagnosed with prostate cancer 60 percent of the time soley as an age related disease increasing as one enters his 70 and 80's. Although this is a very interesting and informative book which casts a pall on the multi billion dollar prostate industry in which many people are pushed into unnecessary and expensive treatment, the author makes no suggestions of what approach or approaches could by most viable options in treating prostate cancer. This is not an uplifting book.
February 16, 2018
Vital read for all men
The book is a bit repetitive, but credible and convincing. Written by the PSA discoverer, and one alarmed at the gross misuse of said discovery, men in the screening crosshairs would do well to read his arguments slowly and carefully. There is no difference in mortality between men who get screened, whether they have subsequent prostatectomy or not, and those who do not. That should be the end of the matter, but in the "doing something is better than doing nothing" paradigm of panic, many simply cannot accept that.
The book is a bit repetitive, but credible and convincing. Written by the PSA discoverer, and one alarmed at the gross misuse of said discovery, men in the screening crosshairs would do well to read his arguments slowly and carefully. There is no difference in mortality between men who get screened, whether they have subsequent prostatectomy or not, and those who do not. That should be the end of the matter, but in the "doing something is better than doing nothing" paradigm of panic, many simply cannot accept that.
October 23, 2021
Not so scientific as I expected, and a bit too repeatative book, but still very important. Main takeaway - PSA testing will not tell exactly if you have a cancer, and even if you have one, it's not obvious and clear thay you should cut it off from your body for good. This is also a good story about the medical system in the US with its worst.
April 4, 2016
The premise is on page 127: “The prostate cancer industry is herding countless numbers of men via PSA screening into a system that renders them incontinent and impotent.” The book alleges that there is much evidence of harm caused by mass PSA screening and little or no evidence of benefit to men. The benefits accrue as profits to the prostate cancer industry and its offshoots. Much of this book is concerned with the money links of the prostate cancer industry, its “profits-over-patients ethos.” The PSA test is not specific for prostate cancer. It provides many false positives. It is as accurate as a “coin toss,” says the author, but its consequences can be life changing.
In fact, the PSA is typically only one of a series of diagnostic tests. It can suggest that there is a problem, but the life-changing consequences follow from other tests and procedures. It is “the system” that renders men incontinent and impotent, not the PSA test, which is not dangerous if used ethically, within its limitations. This book alerts readers to those limitations. The PSA leads to more tests, not to the life-changing maiming of men. Granted that those additional tests are profitable for doctors and may not be necessary. Granted that biopsies are painful and may not be necessary.
The two authors are a professor of pathology and a science writer specializing in oncology. The former was allegedly the discoverer of the PSA antigen in 1970.
A point of view with implications! This book is worthy of consideration, but the PSA test is not harmful in itself. The harm is in the overestimation of its importance.
In fact, the PSA is typically only one of a series of diagnostic tests. It can suggest that there is a problem, but the life-changing consequences follow from other tests and procedures. It is “the system” that renders men incontinent and impotent, not the PSA test, which is not dangerous if used ethically, within its limitations. This book alerts readers to those limitations. The PSA leads to more tests, not to the life-changing maiming of men. Granted that those additional tests are profitable for doctors and may not be necessary. Granted that biopsies are painful and may not be necessary.
The two authors are a professor of pathology and a science writer specializing in oncology. The former was allegedly the discoverer of the PSA antigen in 1970.
A point of view with implications! This book is worthy of consideration, but the PSA test is not harmful in itself. The harm is in the overestimation of its importance.
January 2, 2015
The Great Prostate Hoax, by Richard J. Ablin, is my sixty-eighth book that I have received and read from Goodreads. I think every man who has prostate problems or not, shoud have this book to read. I am a male Sixty years . old, and have had PSA tests done. I am lucky so far that I am not one of those who have suffered from the painful needle biopsy procedures. It is great to see that the researcher Professor Ablin, who discovered the PSA molecule in 1970, has been trying to temper the use them. PSA does not detect prostate cancer, just abnormalities that could also be caused by a number of factors, sex for instance. This might lead to a needle biopsy, which is generally safe. This biopsy is not 100% accurate. A positive biopsy might lead to a radical prostatectomy, which will leave you incontinent and impotetent for an undetermined period. There is also no evidence that having a prostatectomy will extend your life. It is important to understand that PSA, no matter who discovered it, is not cancer specific. Therefore it cannot detect prostate cancer.
There are over a million needle biopsy per year, leading to more than 100,000 radical prostatectomies, most of which are unnecessary.
This is a great book, fantastic information for all males. I volunteer work at the library, and will ask them to purchase a book to have to take out.
There are over a million needle biopsy per year, leading to more than 100,000 radical prostatectomies, most of which are unnecessary.
This is a great book, fantastic information for all males. I volunteer work at the library, and will ask them to purchase a book to have to take out.
April 3, 2018
27,000 guys die every year from prostate cancer.
Sadly, many of them will be guys who have read this book and decided not to have yearly PSA screenings, which is a simple blood test.
While the PSA test is not perfect, and sometimes gives false positives, it is the only test we currently have for prostate cancer.
I discovered I had prostate cancer by a fluke. My family doc had quit giving PSA tests 8 years ago, I just happened to ask for one at my last physical, found out I did have aggressive fast growing prostate cancer, and had my prostate removed by robotic assisted surgery. Post-op pathology showed the cancer was within 4 thousandths of an inch of breaking out of my prostate and spreading throughout my body.
Had I read this book first and followed it's foolish advice I would have never asked for a PSA test, and by now I would be dead.
Sadly, many of them will be guys who have read this book and decided not to have yearly PSA screenings, which is a simple blood test.
While the PSA test is not perfect, and sometimes gives false positives, it is the only test we currently have for prostate cancer.
I discovered I had prostate cancer by a fluke. My family doc had quit giving PSA tests 8 years ago, I just happened to ask for one at my last physical, found out I did have aggressive fast growing prostate cancer, and had my prostate removed by robotic assisted surgery. Post-op pathology showed the cancer was within 4 thousandths of an inch of breaking out of my prostate and spreading throughout my body.
Had I read this book first and followed it's foolish advice I would have never asked for a PSA test, and by now I would be dead.
February 25, 2018
Don't be a sheep. Educate yourself. And be prepared to be shocked at what no one in the medical field is telling you and why.
June 10, 2018
It didn't answer my question, How do my meds affect my PSA score.
March 18, 2024
It's curious that the book only went through just one printing run given its wide appeal. (Ablin's 2012 New York Times column was among their most read online articles to date.) He also had trouble televising and finding distributors for his powerful documentary "Second Opinion." Although, if you read it, you may get a better idea why. It's difficult to get a copy of this, but thankfully it still seems to be available as an ebook.
The heart of the book is his economic analysis in the chapter "The Color of Money," which he executes masterfully. I didn't personally like or agree with the way Ablin characterized men who had undergone radical prostatectomies and subsequent surgeries, constantly focusing on "the loss of their manhood"; however, he was in personal contact with many such men in preparation for this book. For all practical purposes, perhaps with the exception of bad urinary incontinence, life goes on after a radical prostatectomy. Lots of men have had them. Ablin would say too many, but this point runs both ways. In addition to dissatisfied patients, he also focuses a lot on worst-case complications of prostate surgeries, making the book seem a little sensational at times. I know that he claims that these prostate cancer decisions are too emotionally driven, but he isn't exactly totally innocent of hitting below the belt himself. However, he brings it up to support his political economic analysis of the prostate cancer industry, so it's still germane.
This really speaks truth to power. The late Professor Ablin is almost singlehandedly and heroically taking on a juggernaut here in this sardonic jeremiad, which he said was twenty years in the works. He's the one to tell it. It's an incredible and improbable story, almost the archetypal and gruesome Frankenstein-type story of runaway technology and bad science. I simply couldn't put it down. The opening chapters are especially strong, and the book culminates in his conclusions about poor government administration and too much bureaucratic cross pollination between government and pharmaceutical industries.
The heart of the book is his economic analysis in the chapter "The Color of Money," which he executes masterfully. I didn't personally like or agree with the way Ablin characterized men who had undergone radical prostatectomies and subsequent surgeries, constantly focusing on "the loss of their manhood"; however, he was in personal contact with many such men in preparation for this book. For all practical purposes, perhaps with the exception of bad urinary incontinence, life goes on after a radical prostatectomy. Lots of men have had them. Ablin would say too many, but this point runs both ways. In addition to dissatisfied patients, he also focuses a lot on worst-case complications of prostate surgeries, making the book seem a little sensational at times. I know that he claims that these prostate cancer decisions are too emotionally driven, but he isn't exactly totally innocent of hitting below the belt himself. However, he brings it up to support his political economic analysis of the prostate cancer industry, so it's still germane.
This really speaks truth to power. The late Professor Ablin is almost singlehandedly and heroically taking on a juggernaut here in this sardonic jeremiad, which he said was twenty years in the works. He's the one to tell it. It's an incredible and improbable story, almost the archetypal and gruesome Frankenstein-type story of runaway technology and bad science. I simply couldn't put it down. The opening chapters are especially strong, and the book culminates in his conclusions about poor government administration and too much bureaucratic cross pollination between government and pharmaceutical industries.
June 14, 2024
Must read for any one who loves a man over the age of 40.
Heavily documented book from the man who discovered PSA and how the FDA and Big Pharma co-opted his find and twisted it into yet another money mill for the industry.
Quote from Dr Ben Goldacre paints the big picture “if I toss a coin, but hide the result. Every time it comes up tails, it looks as if I always throw heads. You wouldn’t tolerate that if we were choosing who should go first in a game of pocket billiards, but in medicine, it is accepted as the norm. In the worst case, we can be misled into believing ineffective treatments are worth using; more commonly, we are misled about the relative merits of competing treatments, exposing patients to inferior ones.”
Just like cholesterol, statins, mammograms and yearly flu shots, the PSA test is wielded like a threatening weapon to guilt asymptomatic men into a cascade of probably harmful tests and treatments.
Heavily documented book from the man who discovered PSA and how the FDA and Big Pharma co-opted his find and twisted it into yet another money mill for the industry.
Quote from Dr Ben Goldacre paints the big picture “if I toss a coin, but hide the result. Every time it comes up tails, it looks as if I always throw heads. You wouldn’t tolerate that if we were choosing who should go first in a game of pocket billiards, but in medicine, it is accepted as the norm. In the worst case, we can be misled into believing ineffective treatments are worth using; more commonly, we are misled about the relative merits of competing treatments, exposing patients to inferior ones.”
Just like cholesterol, statins, mammograms and yearly flu shots, the PSA test is wielded like a threatening weapon to guilt asymptomatic men into a cascade of probably harmful tests and treatments.
July 8, 2021
Enlightening
Required reading for anyone considering a biopsy as a result of a high PSA reading, the first step on the conveyor belt to being maimed by surgery or radiation. Wish author would have addressed two points in more detail a) how many years of high quality life does one have after cancer is detected in a biopsy or MRI scan, and b) explanation of why Gleason score is used to determine whether treatment (surgery or radiation) is justified, if (as the author states) there is no way to distinguish cancers which are “rabbits” as opposed to “turtles”. Is the Gleason score also a “hoax”, or at a minimum a poor indicator. Do extremely high Gleason scores or PSA values have some value in indicating presence of “rabbit” type cancers?
Required reading for anyone considering a biopsy as a result of a high PSA reading, the first step on the conveyor belt to being maimed by surgery or radiation. Wish author would have addressed two points in more detail a) how many years of high quality life does one have after cancer is detected in a biopsy or MRI scan, and b) explanation of why Gleason score is used to determine whether treatment (surgery or radiation) is justified, if (as the author states) there is no way to distinguish cancers which are “rabbits” as opposed to “turtles”. Is the Gleason score also a “hoax”, or at a minimum a poor indicator. Do extremely high Gleason scores or PSA values have some value in indicating presence of “rabbit” type cancers?
November 8, 2024
Remarkable Book
I truly hope this book makes a difference in the lives of men dealing with prostate and PSA issues. I hope men have the courage to believe this book and act accordingly.
I lost my dad due to complications resulting from his choice of prostate cancer treatment. If I wound have known this information before he made his choice, I would have advised him differently.
I truly hope this book makes a difference in the lives of men dealing with prostate and PSA issues. I hope men have the courage to believe this book and act accordingly.
I lost my dad due to complications resulting from his choice of prostate cancer treatment. If I wound have known this information before he made his choice, I would have advised him differently.
February 26, 2025
Highly recommended reading for men 45 and older. Although published in 2014, so much of the story of the PSA test parallels that of the COVID-19 narrative, in the fact that both are designed around promoting a falsehood in order to generate public fear and make money for Big Pharma. Never mind the aftereffects and lives ruined.
February 5, 2023
Would have given 3.5. Somewhat dated but interesting about the prostrate health treadmill so many men are on. Recommend anyone read if they are on this treadmill or love someone who is. Being informed is never bad.
July 18, 2023
I found this book to be very informative and enlightening and a very good read. It also helps equip you with the right language when conferring with your Urologist. I strongly recommend this as one of the sources of information in your research on PSA tests and of the prostate.
September 25, 2024
Fantastic research and overall book on prostate issues and the PSA test.
February 21, 2017
I received an ARC from Goodreads in exchange for an honest review.
This was actually a surprisingly interesting read. I have been putting off reading this book for a while now, because while I had a vague interest in the subject, I never thought it would be nearly as intriguing a read as it turned out to be.
The text was very informative, yet still captivating in the narrative as Ablin summarized the politics, greed, and misleading statistics that have become such large factors in the history of prostate cancer.
While the text was repetitive at times, I think Ablin actually needed to keep repeating himself because, as he points out many times in the book, many people still ignore the evidence he presents against using PSA to diagnosis prostate cancer. The repetition helped to drive the point home as he added more and more evidence and commentary against off label use of PSA.
I also feel that as the first to discover PSA, Ablin had an important authority on the subject, which added a level of confidence, force, and power to the book.
This was actually a surprisingly interesting read. I have been putting off reading this book for a while now, because while I had a vague interest in the subject, I never thought it would be nearly as intriguing a read as it turned out to be.
The text was very informative, yet still captivating in the narrative as Ablin summarized the politics, greed, and misleading statistics that have become such large factors in the history of prostate cancer.
While the text was repetitive at times, I think Ablin actually needed to keep repeating himself because, as he points out many times in the book, many people still ignore the evidence he presents against using PSA to diagnosis prostate cancer. The repetition helped to drive the point home as he added more and more evidence and commentary against off label use of PSA.
I also feel that as the first to discover PSA, Ablin had an important authority on the subject, which added a level of confidence, force, and power to the book.
March 22, 2015
I give this book 4 to 5 stars for the attempt and for it's investigative journalism. And I'll say he makes a few decent points. But I give him 2 to maybe 3 stars for the logic involved. He thinks most of the issue revolves around money, which I disagree with. And there are other holes in his analysis. It's a very one sided argument and he brings in experts that support his viewpoint. He makes it well known that he discovered PSA. It's a long persuasive essay, and the science and standards have changed some since he started writing this book. But I admire his gumption and again, he certainly makes some good points. I'm a physician who deals with this issue quite often, so I have a different viewpoint. If you read it, read it with a grain of salt, and discuss the issue with your 'provider' if applicable.
May 30, 2014
Wow, did this book take me by surprise!
Written the the doctor who developed the PSA test, I was expecting
medicalese jargon and technical claptrap, but found it was well written, easy to understand (for a layman) and explains everything
a man would want to know about his prostate.
As a 74 yr old prostate cancer survivor, the PSA test didnt save my life, but Im sure it extended it.
Thank you Dr Ablin, for the PSA test and a very well\-written book!
Written the the doctor who developed the PSA test, I was expecting
medicalese jargon and technical claptrap, but found it was well written, easy to understand (for a layman) and explains everything
a man would want to know about his prostate.
As a 74 yr old prostate cancer survivor, the PSA test didnt save my life, but Im sure it extended it.
Thank you Dr Ablin, for the PSA test and a very well\-written book!
April 5, 2014
Thank you, sir, for such an informative book!! Seems like every time one watches a daytime television show nowadays, there is a lawyer warning of the dangers of some drug or procedure. You have performed a great service to all men by informing us of another possible danger. In compliance with FTC guidelines, I am disclosing that I received this book free through Goodreads First Reads.
May 1, 2015
An outstanding amount of information and documentation.
Would recommend this book to any male over 50 years old. Dr should recommend the book to any male that has a PSA value reading over 3. This will shed additional light on the subject. I have a PSA reading of 8! I have began a program of activity surveillance
Ron Panico
Would recommend this book to any male over 50 years old. Dr should recommend the book to any male that has a PSA value reading over 3. This will shed additional light on the subject. I have a PSA reading of 8! I have began a program of activity surveillance
Ron Panico
July 24, 2014
Lots of important and timely information but the repetitious hammering on points was annoying.
December 6, 2014
More men need to read this. The PSA test is not a reliable predictor of prostate cancer.
June 28, 2023
This book alerted me to a lot of the corruption in the medical community.
Displaying 1 - 27 of 27 reviews