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 Schwarzkopff 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. Saw Palmetto for Men &... Winston AHG, David Best Price: $3.00 Buy New $18.80 (as of 03:30 UTC - Details) 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. New formula- TruNature... Buy New $49.00 (as of 12:30 UTC - Details) 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. Should I Be Tested for... H. Gilbert Welch M.D. ... Best Price: $4.28 Buy New $17.99 (as of 04:55 UTC - Details) 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). The McDougall Quick an... John A. McDougall, Mar... Best Price: $5.03 Buy New $10.88 (as of 03:50 UTC - Details) 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.

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September 1, 2009

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