The prostate-specific antigen (PSA) test has screened 30 million American men annually for over three decades. The man who discovered PSA in 1970, Richard Ablin, now calls mass screening “a public health disaster.” Two landmark 2012 studies found no survival benefit from radical surgery compared to watchful waiting. The U.S. Preventive Services Task Force concluded PSA screening does more harm than good. Yet the $3 billion annual industry continues largely unabated.
These revelations emerge from three insider accounts: Ablin’s The Great Prostate Hoax, urologist Anthony Horan’s The Rise and Fall of the Prostate Cancer Scam, and oncologist Mark Scholz’s Invasion of the Prostate Snatchers. Together they document how a test meant to monitor existing cancer patients became a screening juggernaut that has left millions of men incontinent, impotent, or dead from unnecessary treatment.
The numbers are staggering. Since 1987, when PSA screening exploded nationwide, over one million American men have undergone radical prostatectomies. Studies show 40 to 50 men must be diagnosed and treated to prevent one death from prostate cancer. The other 39 to 49 men receive no benefit but face permanent side effects. Medicare and the Veterans Administration fund most of this treatment, pouring billions into a system that prominent urologists privately acknowledge has failed.
What follows are the most damaging truths about how PSA screening became entrenched despite overwhelming evidence of harm, why it persists against scientific consensus, and what this reveals about American medicine’s inability to abandon lucrative practices even when they damage patients.
Hellbound and Down 