The PSA Test: Prevention or Business?
For years, millions of men were offered the PSA (Prostate-Specific Antigen) test as a “preventive method” for prostate cancer. But according to the very discoverer of this marker, Dr. Richard Ablin, the massive use of the test has been one of the greatest medical frauds driven by economic interests.
Who Discovered PSA and What He Said Later
Richard Ablin identified PSA in the 1970s. From the beginning, he made it clear that it was not useful as an early detection test, but only for monitoring patients already diagnosed or treated.
Decades later, he publicly denounced that the test had become a tool for profit for the pharmaceutical industry and part of the medical community, with serious consequences for men’s health.
How It Was Approved and Why It Was Controversial
In 1994, the FDA (U.S. Food and Drug Administration) authorized its use for screening in healthy men, despite warnings from internal experts who described it as a “potential public health disaster.”
The approval was driven more by lobbying pressure and the expectation of multi-billion-dollar profits than by solid scientific evidence.
The Problems with the PSA Test
- Not specific for cancer: It can rise due to prostatitis, infections, or benign prostatic hyperplasia.
- Arbitrary cutoff point: The classic threshold of 4 ng/mL lacks solid scientific basis.
- High false-positive rate: Up to 80% of men with elevated PSA do not have cancer.
- No distinction in aggressiveness: It cannot differentiate between indolent tumors and aggressive ones that truly threaten life.
The Consequences of Over-Diagnosis
PSA has led to unnecessary biopsies, over-diagnosis, and over-treatment.
Many men have suffered:
- Impotence
- Urinary incontinence
- Anxiety and severe psychological effects
All of this in cases where intervention might never have been necessary.
What the Major Studies Say
- ERSPC (European Randomized Study of Screening for Prostate Cancer): Showed a modest reduction (21%) in mortality, but with 40% over-diagnosis.
- USPSTF (U.S. Preventive Services Task Force): Eventually recommended against routine PSA screening in healthy men due to the unfavorable balance between benefits and harms.
What to Do Then?
PSA can be useful in certain contexts but should not be used indiscriminately.
Today, an individualized approach is recommended, taking into account age, family history, race, and symptoms.
Alternatives exist, such as active surveillance for low-risk tumors and ongoing research into new, more specific biomarkers.
Conclusion
PSA is not the enemy, but its massive use as a preventive test was a mistake fueled by economic interests rather than science. What matters for each man is to stay informed, ask questions, and not be guided by fear.
Dr. Ablin himself summed it up this way:
“PSA is a terrible public health disaster. It has done more harm than good. It doesn’t save lives—it ruins them.”
📚 Supporting Articles and Sources
- New Scientist – Prostate cancer test has been misused for money (2014)
newscientist.com - The Washington Post – A case against prostate screening, from a scientist who made it possible (2014)
washingtonpost.com - Reuters – Prostate test a ‘public health disaster’: discoverer (2010)
reuters.com - The Pathologist – The Great Prostate Debate (2015)
thepathologist.com - Arizona Sonoran News – Prostate cancer screening a hoax, says expert (2012)
arizonasonorannews.com - Nature – Prostate cancer screening: The great debate (2011)
nature.com - ERSPC (European Randomized Study of Screening for Prostate Cancer): Publications on results and risks of over-diagnosis.
- U.S. Preventive Services Task Force (USPSTF): Updated recommendations on PSA screening.
uspreventiveservicestaskforce.org
Responses