Men: Avoid Prostate-Cancer PSA Screening

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Friday, August
21, 2009, the CNN television show, Larry
King Live
, turned thousands of otherwise healthy men into
patients and caused them irreparable harm when in-studio guests
John McEnroe, Michael Milken, and Dr. Christopher Rose recommended
that all men over the age of 40 years undergo PSA examinations in
order to find prostate cancer. (This show can also be found free
on iTunes as a podcast
and as a transcript.)
I know Larry King personally. I was a guest on his national radio
show 3 times in the distant past. He is an honest man, but I believe
he was duped into selling for the prostate cancer businesses at
the expense of men’s health on this particular evening.

The show touched
the viewers’ emotional cords with live and recorded testimonies
from high profile men with a history of prostate cancer detected
by the PSA testing. Former Secretary of State General Colin Powell,
Los Angeles Dodger manager Joe Torre, radio talk show host Don Imus,
actor Charlton Heston, actor Jerry Lewis, golfer Arnold Palmer,
New York City Mayor Rudy Giuliani, Senator John Kerry, Senator Bob
Dole, and General Norman Schwarzkoff all told of their bouts with
prostate cancer and the apparent benefits they received from early
detection and the treatments that followed. TV personality Merv
Griffin also appeared in a video clip, but as an example of “the
foolish patient” who ignored his doctors’ recommendations
and paid with his life. (From this long list you might think all
older men have prostate cancer.) Viewers were told that with modern
techniques the dreaded complications of incontinence and impotence
are now rare. The guests were unopposed in their unified message
for all men over 40 to get tested – there were no phone calls
taken during the hour.

To his credit,
host Larry King attempted to bring up the controversies surrounding
prostate cancer screening using prostate specific antigens (PSA)
and digital rectal exams (DRE), and the treatments that follow –
but his challenging comments were always dismissed by his guests.
Possibly Mr. King was aware that many of the opinions expressed
during this hour-long show were wrong and opposite to the recommendations
for PSA testing held by the American College of Preventive Medicine,
British Columbia Office of Technology Assessment, the Canadian Cancer
Society, the U.S. Preventive Services Task Force, and other industry-independent
organizations.

Follow the
Money

By no coincidence
the primary support for early detection of prostate cancer through
PSA testing comes from medical trade organizations. The best example
is the American
Urological Association
, representing the special interests of
over 16,500 members (mostly people from areas of urology and oncology)
and funded by industries such as GlaxoSmithKline, Lilly, Novartis,
Pfizer, and many other companies that derive their income from men
with prostate cancer.

All three in-studio
guests on this Larry King Live show have financial ties to
prostate cancer industries. John McEnroe is an official spokesperson
for a drug company, Michael Milken works with pharmaceutical industries
through his Prostate Cancer Foundation, and Dr. Christopher Rose
is a radiation oncologist and serves as medical director of The
Center for Radiation Therapy of Beverly Hills. Undeniably, widespread
PSA testing means more profits for doctors, hospitals, laboratories,
and device and pharmaceutical companies.

A time line
suggests this particular Larry King Live show on August 21,
2009 may have been a promotional piece designed to sell the drug
Avodart for the pharmaceutical giant GlaxoSmithKline (GSK). On March
16, 2009 it was announced
that McEnroe had teamed up with GSK to ask men to see a doctor in
order to learn their PSA levels. On April 27, 2009, the results
of the REduction by DUtasteride of prostate Cancer Events (REDUCE)
trial were announced at the American Urological Association meeting
in Chicago, Illinois.

In this study,
dutasteride, an inhibitor of the prostate-stimulating androgen 5-alpha-dihydrotestosterone,
was shown to reduce the number of men with prostate cancer found
on biopsy by about 5%. GSK sells dutasteride as Avodart. With these
results from the REDUCE trail, the marketing challenge now becomes
finding the customers; in this case, men with marginally elevated
PSA levels. In order to do this men must be encouraged or frightened
into going to their doctors to request an order for the test. That
is exactly what the Larry King Live show accomplished. John
McEnroe did his job well. With approximately 1,300,000 viewers daily,
this show definitely added to the 218,900 men who are diagnosed
annually with prostate cancer in the United States. This discovery
of an elevated PSA might benefit men except for the fact that present
day treatments of surgery, radiation, and chemotherapy (androgen
deprivation) have not been shown to save lives (approximately 27,050
men died in 2007 of this disease).

Why PSA
Testing and the Treatments that Follow Fail

On the surface
it would appear that the early detection of cancer in the prostate
by any means would result in a longer life for men with less risk
of dying from prostate cancer. However, research finds otherwise.
The first report from the Prostate, Lung, Colorectal, and Ovarian
(PLCO) Cancer Screening Trial on the effect of screening with prostate
specific antigen (PSA) testing and digital rectal examination (DRE)
on the rate of death from prostate cancer was published in the New
England Journal of Medicine, March 26, 2009 – PSA and DRE
saved no lives. The second landmark report, published in the same
issue, was from Europe and it showed an absolute reduction of less
than 1 death in every 1000 men getting PSA tests. There are two
reasons why PSA testing fails to save lives: first, extremely few
biopsy-proven cancers are life threatening, and second, early detection
is a myth.

Worldwide
the incidence of prostate cancer, found by microscopic examination
of the prostate at autopsy, occurs in about 30% of men over the
age of 50 years. In the USA the rate of microscopic prostate cancer
is even higher at all ages: 8% of men in their 20s, 30% of men in
their 30s, 50% of men in their 50s, and 80% of men in their 70s.
However, for most men these cells that look like cancer will never
noticeably spread, and therefore, never threaten a man's life. Larry
King apparently knew this; he twice asked his three guests, u201CIs
it a myth you die with it, not of it?u201D (The quote is: u201Cmany more
men die with prostate cancer than from it.u201D)

Even though
prostate cancer eventually occurs in most men, it has an extraordinarily
small risk of killing the patient: the death rate is 226 per 100,000
men older than 65 years. The very common innocuous cancers are referred
to as latent cancers. The cancers that kill are referred
to as advanced cancers. Unfortunately, doctors cannot tell
by looking at the prostate tissues under the microscope whether
or not the cancer will ever become life threatening. As a result,
almost all men found with either type of cancer will be treated
aggressively: surgery, radiation, castration, and/or chemotherapy.

Read
the rest of the article

September
1, 2009

John McDougall,
MD [send him mail],
a board-certified Internist, is the founder and medical director
of the nationally renowned McDougall
Program
, a ten-day, residential program located at a luxury
resort in Santa Rosa, CA – a place where medical miracles occur
through proper diet and lifestyle changes. He has been studying,
writing and “speaking out” about the effects of nutrition on disease
for over 30 years. Dr. McDougall is the author of 11 national bestselling
books, writes a monthly newsletter, and is co-founded Dr. McDougall’s
Right Food’s Inc., a producer of high quality vegetarian cuisine.
You may subscribe to the free
McDougall Newsletter
. This
article is the first chapter to Dr. John McDougall’s upcoming book.

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