The Rise and Fall of the Prostate Cancer Scam

"Dr. Horan's book, written with verve and passion, presents a compelling view of the prostate cancer story over the last 30 years. The book articulates in a very clear fashion some of the missteps that took place following the embrace of PSA as a test for early detection of prostate cancer. He also points to a rational way forward, in an attempt to reduce the excessive reliance on systematic biopsies, and avoid over-diagnosis while identifying those patients with significant cancer who benefit from early detection. While experts may not agree with his views on some aspects of the data, his perspective is well informed and refreshing."

In 1973, we urologists had prostate cancer about right, no screening, no radiation, and no radical surgery. All cancers discovered were assumed to be metastatic from the get-go. If any treatment was necessary, it was systemic hormone deprivation. But, ten years later (1983 - 1987) radical surgery was revived without new evidence; ultrasound probes were miniaturized to fit in the rectum; and the PSA blood test was described as capable of finding new cancers but as lacking the specificity required for screening. The whole world screened anyway. Money poured into U.S. hospitals and faculty practice plans.

Post-radical surgery deaths (2600) peaked in 1992. By the autumn of 2011, two reports had showed that radical surgery did not lengthen cancer specific life compared to nothing. PSA screening was found by the Preventive Task Force of the U.S. Federal government to cause more harm than good. This book reinforces their statement,

Anthony H. Horan, M.D., a graduate of Dartmouth College, received his medical degree from Columbia's College of Physicians and Surgeons. He did his internship in internal medicine and one year of general surgical residency at St. Luke's Hospital in New York. After two years in the Air Force as a general surgeon, Horan returned to New York for a Urology Residency at Columbia Presbyterian Hospital. After seven years of solo private practice in New York City with an appointment as instructor at the New York Medical College, he left to be Associate Professor of Surgery (Urology) at Marshall University in West Virginia. That was a VA based medical school. This led, eventually, to his appointment as Associate Clinical Professor of Urology, UCSF, at the Fresno VA hospital. There, he gathered and published the crucial data that led to this book. After becoming fully vested, he did an additional 14 years of solo private practice in Wyoming and California. He fully retired in the spring of 2018.