What do Robert Benjamin Ablin and Frank Zappa have in common?
Richard J. Ablin Ph.D. first observed the antigen PSA forty years ago. T. Ming Chu of the Roswell Park Cancer Institute developed the process to test for it. Urologists Cooner and Scardino did the clinical studies that resulted in the recommendation that screening, digital exams and the PSA would help detect prostate cancer earlier. Although I have been a practicing urologist for over twenty years, I was unaware of Richard Ablin until his Op-ed in the New York Times recently. What got my attention in his piece, in addition to all the emotional rhetoric such as “painful prostate biopsy,” “pushed to surgery,” and “damaging treatments,” is that Ablin Ph.D. mentioned that he discovered PSA on two occasions. Then all the remarks that bespeak of a man that is angry, ill-informed regarding the clinical side of prostate cancer, and one seeking attention by highlighting the very discovery he disdains. The American Urologic Association “shamefully” recommending prostate screening, the use of PSA as a “profit driven” public disaster, and drug companies “peddling the test” all are emotional remarks used by a professor who does not actually treat prostate cancer attempting to be relevant two score years after his fifteen minutes of fame. The article and the tone of Ablin’s voice prompted my curiosity. I then happened upon the Robert B. Ablin Foundation for Cancer Research.
The Foundation is dedicated to Ablin’s father Robert who died of prostate cancer. On the surface it all fits together quite nicely; the discoverer of PSA, an interest in cancer, and a family member that dies of prostate cancer. But to the discerning eye of a urologist a glaring irony jumps off the website. We learn that Robert Ablin went into urinary retention (could not urinate) and upon evaluation was found to have metastatic prostate cancer in 1978. He died one year later of his disease. In other words, his prostate cancer quietly progressed extensively until it was found very late and only because he had voiding symptoms. The irony of this is that Robert Benjamin Ablin is the very person that would have benefited from a prostate screening and PSA that his son so vehemently abhors. It is well recognized among urologic circles that if you diagnose prostate cancer when there are symptoms or as an asymptomatic palpable abnormality on rectal exam, you have diagnosed prostate cancer too late. Mr. Robert Ablin, the elder, is the very type of patient that I and other urologists are so diligently cognizant of diagnosing earlier today. Just as his touting his discovering the PSA repeatedly in the Times arouses suspicion, so too is another statement on the Ablin’s Foundation website. The website states regarding Robert Ablin’s death,” This was in 1978, in an era of limited ability to diagnose prostate cancer. He was diagnosed in a late stage of his disease; he died one year later, in August 1979.” Well, I was a Urology resident in 1978, and there is very little we were not doing then that we are doing now save the PSA. Before you protest,” But don’t you use an ultrasound to do the biopsies now?” Yes urologists use the ultrasound to facilitate the biopsy; it has not helped us to make the diagnosis any sooner. In 1978 we still recommended rectal exams in men at age 50 or older but we only did biopsies, finger guided, on palpable nodules. With the advent of PSA, biopsies are performed well before there are palpable abnormalities of the prostate and if prostate cancer is found, it is more likely to be found early and more likely to be cured. Robert Ablin presented well beyond a palpable nodule. Urinary retention suggests a prostate cancer that was locally extensive and the metastatic bone cancer that ultimately caused his death was asymptomatic. This is the rub that is prostate cancer and it is as true today as it was in Robert Ablin’s time. How do I know these things and yet I don’t know Robert Ablin? I have seen scores of Mr. Robert Ablin’s in my career. I have watched the whole agonizing process from an elevated PSA through death. I have seen and been with the families, and I have been to the funerals of their loved ones who have succumbed to prostate cancer. I have seen the face of prostate cancer in my patients and then…had to deal with it myself. My prostate cancer was found only because of an elevated PSA.
I really did not understand the dual nature of prostate cancer until I learned of Frank Zappa. He was found to have prostate cancer in his mid-fifties and died three years later. Then a friend of mine, whose father was doctor, was diagnosed in September and died in June. Mr. Ablin’s father too unfortunately fell into this category of patients, diagnosed too late to cure. Is the PSA perfect? No. Has it saved lives? Yes. In time we will find a marker that will indicate those who we should biopsy and whose cancer kills quickly, but until we do, the PSA is the best we have and remains an invaluable tool for the family physician and urologist.
I have a question for Richard Ablin Ph.D. the discoverer of the PSA. If it were 1974, about four years before your father presented with metastatic prostate cancer, would you want your father to be screened yearly with a rectal exam and PSA even if he had no symptoms or family history of prostate cancer? I think we all know the answer to that question, and that is how the issue should be viewed, in a personal sense, not in terms of public health cost estimates and emotional verbiage.
John C. McHugh M.D.
Board Certified Urologist
Author of “The Decision: Your prostate biopsy shows cancer now what?”