How to Avoid the Over-Diagnosis and Over-Treatment of Prostate Cancer

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We have needed a book like Dr. Horan's for 30 years, ever since radical surgery at Johns Hopkins and radiation at Stanford were revived without scientific proof of life extension. Using his liberal arts education to establish a consilient science of prostate cancer, Dr. Horan takes on the entire culture of over-diagnosis and over-treatment in language the public (the taxpayer) can understand. This book is timely as we face up to the fact that we cannot pay for every legacy code under Medicaid /Medicare but must finally choose cancer treatments, or non-treatments, that prolong quality adjusted life rather than enrich the medical-industrial complex." Tony Coelho Chairperson for the Partnership to Improve Patient Care Primary author and sponsor of the Americans with Disabilities Act "As a physician and physiologist, I think Anthony Horan is on the right side of what should not even be a controversy." Roger Guillemin, M.D., Ph.D. Nobel Laureate in Physiology and Medicine 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. He left New York to become Associate Professor of Surgery at Marshall University and the Veterans Administration. Presently, he is in private practice in Delano, California.