Chairman's letter

Sir Peter Michael C.B.E.
Buckingham House
West Street
Newbury
Berkshire RG14 1BE

17th February 2011

Mr Nick Somers
Chairman
Old Whitgiftian Association
The Clubhouse
Croham
Manor Road
South Croydon
Surrey CR2 7BG

Dear Nick,

Thank you for advising me of the upcoming PSA Testing Evening on 3rd March 2011 that I will be unable to attend.

I do not know Mr Smith, but I do know a lot about prostate cancer, although (so far as I know), I do not have this disease. For ten years, I have been Chairman of the Pelican Cancer Foundation based in Basingstoke, that has been involved in fundamental research and studies of this disease, in conjunction with a parallel foundation I founded in California. Whilst the following is in many ways unwelcome to those who practice urology.

I do hope you will forgive the length of this letter and not take it as an offence to your initiatives, or that of any of those attending, but here are a few facts backed up by recent references:-

1. The life time chance of death caused by prostate cancer is under 3% - that is to say there are 33 other ways to die.

2. In a recent study, it has been shown that for every 50 men treated with one of the half dozen major protocols from surgery to chemical castration – 48 were unnecessary and resulted in some form of damage, usually impotence and or incontinence.

3. Of the two remaining, one could not be helped with any treatment currently known and the other needed treatment resulting in extension of life successfully treated. The figure above, i.e. 48, has been argued about in the literature and it is now acknowledged that a large amount of unnecessary treatment takes place and the number may lie as a variable between 10 and 100.

4. There are severe doubts that PSA testing fulfils a useful function, due in part, to its huge inaccuracy with false positives and false negatives. This often results in what had been called “PSA Cripples” that arises as previously healthy active strong men wilt – I know many who wish they had never met a urologist. Very often this knowledge exerts such mental pressure from the person concerned or his partner, as he feels it absolutely necessary to get treated and, from the above, usually unnecessarily so. For these reasons and as a result of much debate at Governmental levels, as well as the House of Lords, a National PSA screening programme has not been put into place.

5. You will see from the attached article by Anthony Zietman (Harvard Medical School) that appeared in the NYT, that there are great doubts about the whole treatment of prostate cancer. He touches upon some underlying pecuniary reasons that are more evident in the USA than in the UK, but nevertheless relevant for private patients in the UK.

6. Turning to the treatments themselves, whatever they may be, there is little to commend them and in a very real sense the patient is asked to decide by which method he wishes to be made impotent and/or incontinent and experience huge life changing physical and mental anguish.

7. The real difficulty is to distinguish between the more or less benign prostate cancers that the patient will die with, from the more lethal aggressive cancers that will kill the patient - the so called “pussy cat” or “tiger” differentiator. So far, the only way of achieving this is through needle biopsy, which can cause significant collateral damage and infection, as publicly described regarding Lord Andrew Lloyd-Webber and from which he has yet to totally recover. More recently, a new drug called Provenge has been introduced and supported by Pelican research that extends the life of late stage prostate cancer patients by at most a few months and has a cost of $93,000 in a series of three injections – not something I feel will spread widely, although available in the USA on Medicare.

8. So far as detection is concerned, where Pelican has been involved in funding international collaborative research, a large number of men diagnosed with suspected prostate cancer, a good quality MRI image sequence seems able to clear many of them up as unnecessary for treatment.

All in all, this whole field is a terrible muddle and many of my colleagues at the Pelican Cancer Foundation feel that it is probably inadvisable to enter the slip road that leads you on to the motorway from which escape is sometimes impossible.

Undoubtedly, too many of us end up by dying from prostate cancer and we all seek a proper diagnosis treatment and management solution. Many of us feel however, that this should not start with a PSA test unless there are any symptoms or change in habit, any family history of prostate cancer or Afro Caribbean ethnicity (the latter are three times more likely to have aggressive prostate cancer). An MRI sequence before biopsy should be recommended before a prostate biopsy.

On the other hand, I salute your initiative and hope nobody who volunteers ends up regretting it.

Finally, I enclose with this far too long diatribe, a book; “Invasion of the Prostate Snatchers” recently published and available on Amazon that provides a broad overview and detailed medical insights into the subject that any man even contemplating a PSA should first read. Once again, apologies, but anyone who starts on this path needs to know more than he will be told, for unfortunately, many practitioners fail to tell the whole truth.

Sincerely,

Peter Michael