Health
Prostate Cancer: Over-Testing and Over-Treatment
From the Brownstone Institute
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.
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.
From the Fraser Institute
Canadians continue to endure long wait times for health care. And while waiting for care can obviously be detrimental to your health and wellbeing, it can also hurt your pocketbook.
In 2024, the latest year of available data, the median wait—from referral by a family doctor to treatment by a specialist—was 30 weeks (including 15 weeks waiting for treatment after seeing a specialist). And last year, an estimated 1.5 million Canadians were waiting for care.
It’s no wonder Canadians are frustrated with the current state of health care.
Again, long waits for care adversely impact patients in many different ways including physical pain, psychological distress and worsened treatment outcomes as lengthy waits can make the treatment of some problems more difficult. There’s also a less-talked about consequence—the impact of health-care waits on the ability of patients to participate in day-to-day life, work and earn a living.
According to a recent study published by the Fraser Institute, wait times for non-emergency surgery cost Canadian patients $5.2 billion in lost wages in 2024. That’s about $3,300 for each of the 1.5 million patients waiting for care. Crucially, this estimate only considers time at work. After also accounting for free time outside of work, the cost increases to $15.9 billion or more than $10,200 per person.
Of course, some advocates of the health-care status quo argue that long waits for care remain a necessary trade-off to ensure all Canadians receive universal health-care coverage. But the experience of many high-income countries with universal health care shows the opposite.
Despite Canada ranking among the highest spenders (4th of 31 countries) on health care (as a percentage of its economy) among other developed countries with universal health care, we consistently rank among the bottom for the number of doctors, hospital beds, MRIs and CT scanners. Canada also has one of the worst records on access to timely health care.
So what do these other countries do differently than Canada? In short, they embrace the private sector as a partner in providing universal care.
Australia, for instance, spends less on health care (again, as a percentage of its economy) than Canada, yet the percentage of patients in Australia (33.1 per cent) who report waiting more than two months for non-emergency surgery was much higher in Canada (58.3 per cent). Unlike in Canada, Australian patients can choose to receive non-emergency surgery in either a private or public hospital. In 2021/22, 58.6 per cent of non-emergency surgeries in Australia were performed in private hospitals.
But we don’t need to look abroad for evidence that the private sector can help reduce wait times by delivering publicly-funded care. From 2010 to 2014, the Saskatchewan government, among other policies, contracted out publicly-funded surgeries to private clinics and lowered the province’s median wait time from one of the longest in the country (26.5 weeks in 2010) to one of the shortest (14.2 weeks in 2014). The initiative also reduced the average cost of procedures by 26 per cent.
Canadians are waiting longer than ever for health care, and the economic costs of these waits have never been higher. Until policymakers have the courage to enact genuine reform, based in part on more successful universal health-care systems, this status quo will continue to cost Canadian patients.
Mackenzie Moir
Senior Policy Analyst, Fraser Institute
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