Ben Stiller on wrong side of Psa debate? Mr. Psa says,”Why is everybody always picking on me?”


Ben Stiller’s misguided prostate cancer recommendations aren’t based on

No it is based on examining the risks of the disease and the risks of the treatment and making a decision he felt was best for him. Regardless of your position on Mr. Psa 30,000 men a year die of prostate cancer. How is that?

Kevin Lomangino is the managing editor of He tweets as @Klomangino.

Comedic actor Ben Stiller clearly had the best of intentions when he decided to write about his experience with prostate cancer and urge men to get a prostate specific antigen (PSA) test starting at the age of 40 – advice which contradicts the guidelines of all major professional organizations.

I admire Stiller’s intention to help out help out his fellow man, and I am glad to hear that he’s apparently doing well and satisfied with his treatment choices. I also applaud Stiller for acknowledging the controversy surrounding PSA testing with the following:

The criticism of the test is that depending on how they interpret the data, doctors can send patients for further tests like the MRI and the more invasive biopsy, when not needed. Physicians can find low-risk cancers that are not life threatening, especially to older patients. In some cases, men with this type of cancer get “over-treatment” like radiation or surgery, resulting in side effects such as impotence or incontinence.

That’s important context that’s often missing from similar celebrity health stories — and he also tells men to have a discussion with their doctors about the test. That’s certainly the best way for men to sort through their options and make an informed choice.

My problem with Stiller’s piece is that it makes a number of false or misleading assertions and fails to accurately reflect the evidence on prostate cancer screening. And because Stiller is smart, persuasive, and famous, his skewed piece may do a great deal of harm to men who may be led astray by his faulty reasoning.

NO PROOF that a PSA test saved Ben Stiller’s life

The most glaring problem with Stiller’s argument is that it’s built on a false assumption. He says, “Taking the PSA test saved my life. Literally. That’s why I am writing this now.”

He can’t say that with any certainty.

The facts are these: Prostate cancers vary in their aggressiveness, and some very aggressive cancers will prove fatal despite early detection and treatment like Stiller received, whereas the majority grow slowly and might never pose a problem to the patient. Stiller says his cancer had a Gleason Score of 7, but doesn’t offer full details about his case that would allow experts to assess the likelihood that he’d benefit from prostate removal. Even with those details, it would be impossible to know for certain whether his cancer would have spread or not.

For that reason, no one-including a celebrity with greater-than-normal access to top-notch healthcare–can say whether the test saved his life, or merely detected a cancer that could have been monitored and might never have bothered him.

Here’s how oncologist Vinay Prasad, MD, MPH, explained the flaws in Stiller’s logic to me:

Before embarking on any screening test, a physician MUST council a patient about harms of screening, including false positives and overdiagnosis–where a real cancer is found and treated, but it would not have caused the person problems. Ben Stiller’s strong faith that the test “saved his life” is incompatible with a true understanding of overdiagnosis. If he really understood overdiagnosis, he would understand that he could not say this definitively. Gil Welch has shown that often most people with breast cancer diagnosed by screening cannot claim to have their life saved. The same principles that apply in this study also apply to prostate cancer, and no person whose cancer was found by PSA screening can say definitively, “The test saved my life.” contributor Douglas Campos-Outcalt, MD, agreed that the evidence cuts against Stiller.

When someone says “Taking the PSA test saved my life,” they have over a 95% chance of being wrong. There is a spectrum of aggressiveness in prostate cancers. The vast majority detected by screening are not aggressive and screening does more harm than good in these men. The most aggressive forms are not helped (usually) by screening because they are too aggressive and are not asymptomatic long enough to be detected by screening. The moderately aggressive tumors are the only ones that can benefit from screening and the unusual man who has one of these detected by screening may have their life “saved,” but this is offset by the number killed by the treatments and the large number who are left impotent and incontinent.

Here’s an evidence-based infographic from the Harding Center for Risk Literacy that explains the numbers – note that for every thousand men screened, up to 160 false positive tests will occur and up to 20 men will be treated unnecessarily (risking harm from unneeded surgery) with no clear mortality benefit.


Although Stiller dismisses those harms – incontinence, impotence, among others — as being “in the purview of the doctor treating the patient” (whatever that means), the fact is that the treatments themselves can be deadly or cause serious disabling side effects. Even the biopsy resulting from a false-positive PSA can lead to serious infections requiring hospitalization and – rarely – death.

In fact, the treatments can be so grueling that it’s possible they may increase other causes of death – canceling out any reduction in prostate cancer deaths. That’s why Prasad and others argue that overall mortality, and not prostate cancer mortality, should be the benchmark to assess benefits from cancer screening.

Celebrities have a responsibility to use their platform wisely

Another problem with saying the PSA saved his life: He might still die from prostate cancer, in spite of being tested. Sadly – and I very much hope this is not the case – it’s possible that Stiller’s cancer is one of the aggressive ones that will recur despite early detection and treatment – meaning that Stiller’s declaration of having his life “saved” will turn out to be premature. This is a reality that needs to be acknowledged. Everyone needs to choose their words carefully when addressing a topic as deadly serious as cancer.

That’s especially true for celebrities, who in our culture have an outsized platform to express their views. Timothy Caulfield, who studies celebrity health messaging at the University of Alberta, calls Stiller’s post “exactly the kind of celebrity advice that is not needed.”

The message that is conveyed by Stiller’s post is that PSA testing is a benign procedure (“it is a simple, painless blood test”) that only has upsides – that is, if you have the right doctor (how a patient is suppose to know this, isn’t clear). But his personal story is not evidence. This is a well-told anecdote, not good data that demonstrates that PSA testing is worthwhile. It is advice that can only confuse the public discourse surrounding PSA testing. More important, it runs counters to the emerging evidence-informed consensus that, for most, PSA screening is not helpful and may be harmful. But because the advice is coming from a celebrity, it will get pop culture traction and could encourage the utilization of a test that has questionable value.  And, alas, we also know that a powerful narrative, like the one in Stiller’s blog, can overwhelm even a mountain of good clinical data.  Bottom line: not helpful.”

How much traction is this getting? The Today Show, with its audience of millions, has already had Dr. Mehmet Oz on the show discussing the piece and its implications. It was great to see the sometimes evidence-challenged Dr. Oz pouring some cold water on Stiller’s claims and citing U.S. Preventive Services Task Force data on the very modest benefits — and considerable harms — of PSA screening.

Caulfield gives Stiller points for engaging the controversy around PSA testing and referring to the relevant policy statements. However, I’d note that Stiller’s thesis appears to reflect the views of his urologist, Dr. Edward Schaeffer, who’s helped promote fear-mongering messages about “skyrocketing” rates of prostate cancer due to reduced PSA testing. Those statements aren’t based on sound science as I pointed out in a post a few months ago.

Skewed statistics can certainly stir up fear that would lead to blog posts about the need for more PSA testing. But such posts telling personal stories are no substitute for a comprehensive assessment of the evidence. The choice that was right for Stiller is not right for everyone.

“Frankly, I am sick of celebrities telling anecdotes about cancer screening,” says Prasad.  “Screening is too important to too many people, and has too broad public health repercussions.”

Prasad adds: “When celebrities choose to volunteer some, but not all, of their health information they may affect health decisions for many Americans (as was seen with Angelina Jolie). As such, celebrities have a responsibility to do so wisely. I am afraid Ben Stiller’s post does not meet this mark.”

Note: Please see the comments section for additional commentary from Dr. Prasad that was edited from the post for length.

Comments (38)

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Kevin Lomangino

October 5, 2016 at 11:36 amThe following comment is from Vinay Prasad, MD, MPH, whom I interviewed via email for the main post above. I edited these comments from the post to improve readability, but I think the point is worth sharing.

Ben Stiller says “I was lucky enough to have a doctor who gave me what they call a “baseline” PSA test when I was about 46.” He notes this runs counter to the USPSTF and even the ACS. Ben Stiller says everyone over 40 should get a PSA, but why does he discriminate against 39 year olds? If you accept Ben Stiller’s logic, that we should do anything to find cancer early (with near total disregard for net effects, harms or overdiagnosis), why is 40 Ben Stiller’s cutoff? He criticizes the American Cancer Society for 50, and yet equally arbitrarily chooses 40. If Ben Stiller thinks a 40 year old should be offered a PSA, why not a 39 year old? Why not every man? Since Ben Stiller does not employ careful scientific reasoning to reach his position, I would argue that Ben Stiller is logically inconsistent.

If he believes we should do everything possible to prevent advanced prostate cancer (and that seems his position), the test should be offered to any man of any age. Also, if Ben Stiller was to push his own thinking, he would argue that a prophylactic prostatectomy should be offered to any informed man. After all, PSA screening misses some prostate cancer– he conceeds that. Why should a healthy person not be allowed to remove their prostate beforehand? Since prostate cancer accounts for 2-3% of all deaths, the number needed to treat would be 33-50, and not that dissimilar from the most optimistic estimates of the PSA from the European randomized trial. Actually, Ben Stiller–since he thinks cutting out cancer early is the main priority and does not seriously weigh harms and overdiagnosis– should support the prophylactic removal of all un-essential organs, as any may become cancerous.

The purpose of this thought experiment is to illustrate the absurdity with Ben Stiller’s position: a slight more aggressive, slightly less evidence based recommendation the ACS. He is surely entitled to his opinion, but unfortunately his celebrity status will give that opinion disproportionate influence.

11 Replies to “Ben Stiller on wrong side of Psa debate? Mr. Psa says,”Why is everybody always picking on me?””

  1. OK, I’m 9 plus years out from surgery and post radiation. My prognosis was not real positive but things (psa), have stabilized. Did the PSA save my life.
    It was a first step.


  2. Dr. McHugh, I respectfully have to disagree with your conclusions regarding PSA testing. First, the recommendation of the U.S. Preventive Services Task Force was not based on Prostate cancer science, as there were no Urologists, Medical Oncologists, Radiation Oncologists or prostate cancer patients on the panel making the recommendation. The over treatment of prostate cancer lies in the hands of the doctors that recommend treatment for small amounts of indolent Gleason 6 disease. This is not the fault of the messenger, IE the PSA test. While not perfect, the PSA test is one of the few tools that we have to detect prostate cancer. It is what is done after the test, that makes the difference. If the conclusion was to instruct doctors to not perform treatment for low risk, indolent prostate cancer, I would agree, but that is not the case.

    In my opinion, if there is a rise in PSA, we need to start with imaging before doing a biopsy. The prostate is the only organ of the body where they do not regularly do imaging before a biopsy. A better approach is to do a multi-parametric MRI scan, if an area is found that is suspected of harboring clinically significant cancer, then do an MRI guided biopsy. With this approach, a man can make an informed decision, along with his doctors, as whether to treat or not treat and which type of treatment is most appropriate. This is a path based on science and not some bogus pseudo science put forth by the U.S. Preventive Services Task Force that is more than likely, designed to save Medicare and the Insurance companies money at the expense of men’s health.

    Henry Oat


    1. Thank you! Hence …”The Decision.” Why criticize someone who makes a decision based on thoughtful consideration? The bottom line is they are considering the cost to find cancer and they don’t like the numbers. Jm


  3. Mr. Lomangino,

    I meant to address my previous comment to you and not to Dr. McHugh. I would appreciate it if you could make the correction.




  4. I think the PSA results I got led me to decisions that will prevent me from dying of prostate cancer. Whether it “saved my life” remains to be seen. I could get hit by a bus as I cross the street while texting.
    My first PSA test at age 48 was around 4.0. By age 50 it was 6.0 and a lump was detected by the DRE and I got a biopsy that showed a Gleason 7 (3+4). I was stage T2a and I chose surgery. My PSA came back up 2 years later and I had 8 weeks of radiation this summer. It is undetectable now.
    I am not a cancer crusader but I do encourage my friends to get a first test some time in their 40’s.


  5. I’m sorry, but the PSA test saved my life. My journey started just before my 50th birthday:
    4/01/2004 First PSA Test, 4.39, with a negative DRE. I was given a round of antibiotics.
    10/18/04 PSA 3.48
    01/31/06 PSA 6.71
    02/25/06 PSA 4.46
    05/24/06 PSA 4.92, 8 sample biopsy: negative, prostate normal size
    10/07/06 PSA 5.40
    01/30/07 PSA 13.36
    02/26/07 PSA 6.01, Doctor encouraged… PSA is not erratic with cancer
    05/10/07 PSA 16.84, 14 sample biopsy: negative, prostate normal size
    05/01/08 PSA 18.11
    09/02/08 PSA 26.54, Request saturation biopsy to check anterior zones
    16 sample biopsy: positive – GS 4+3=7 – Stage T2b, Prostate normal size.
    Told cancer is a slow growing, as it took multiple biopsies over 2.5 years to detect it. Told I could take up to 6 months to decide treatment, if any.
    11/10/08 Requested another opinion from a top specialist. Appointment scheduled for next day.
    11/11/08 PSA 37.50, Scheduled for surgery in 10 days.
    11/17/08 PSA 40.98, Pre-op appointment.
    11/21/08 Non-nerve sparing Laparoscopic radical prostatectomy

    Post Op Pathology: GS 4+5=9 – Stage T3b N0 MX – bilateral lobes – perineural and seminal vesicle invasion – surgical margins: negative – largest tumor 2.1 CM
    Informed my prostate was the size of a large potato.

    01/30/09 Started 6 months of Lupron (hormone deprivation therapy)

    06/2011 PSA detected

    06/2012 40 days of prostate bed radiation (I had to fight with both my primary oncologist and radiation oncologist to get radiation, as they said it would not help.

    11/27/16 Still alive and still in remission!

    DREs and trans-rectal ultrasounds never detected anything wrong. My fourth biopsy in 2.5 years finally detected cancer, but not the true severity of it. Only the PSA Test reliably showed that something was wrong over 4.5 years, and strongly indicated severity.

    Bottom line is I am responsible for my own well being, and I want as much information as possible from my doctors to make the best decision. The PSA Test was the major driver pushing me to stay on top of my prostate health.


  6. Dr. McHugh: You asked: “Why criticize someone who makes a decision based on thoughtful consideration?” But that’s not what I criticized. In fact, the “thjoughtful consideration” part was what I praised about Ben Stiller’s message. I criticized Ben Stiller’s decision to tell millions of people that the PSA test “saved his life” when he can’t possibly know that. He also downplayed the risks associated with the test. It wasn’t a balanced message. I agree that people can and should have the option to take the test based on careful consideration and with all the facts at their disposal. Different strokes for different folks. Thanks for your interest.


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