by Chi-Kwok Chan
To the young urologists, a combination of PSA, PHI, PCa-3, transrectal prostate biopsy, MRI-US fusion biopsy and recently the transperineal prostate biopsy are probably the armamentarium
that should be available before the diagnosis of early prostate cancer can be made. However, it was no easy task 70 years ago when none of the above was at hand. Dr. Perry Hudson, after
completion of training under Dr William Scott ( successor of Dr Hugh Young of John Hopkins Hospital ), took up the job of being the youngest urology department head of Francis Delafield
Hospital at age of at 33 y.o. He conducted the very first screening trial on diagnosing prostate cancer in 1951 (Prof. Patrick Walsh was just a 13-year-old boy at that time!), i.e. Bowery Series (or
called Skid Row Cancer Study). The whole series spanned from 1951 – 1966, involving over 1200 subjects. Three hundred men were recruited in just 3 years from 1951 to 1954 and 6 articles were
published in 1954. The point prevalence of prostate cancer was around 13%. Only two men were diagnosed to have metastatic cancer. He concluded that digital rectal examination was not sensitive enough to diagnose early prostate cancer as only 23% prostate cancer patients were found to have indurated prostate. Early prostate cancer could be treated by open radical perineal prostatectomy, which was the norm at that time. The message sounded ground breaking 65 years ago.
However, the whole study was totally unethical and a malpractice by today standard. The subjects, basically homeless, alcoholics, moneyless, and often mentally-ill, were living in the flophouses of lower Manhattan of New York. They were lured to participate in the study in return for clean beds, food and shelter. Apart from the first 144 subjects, the other 1000+ subjects did not have any lower urinary tract symptoms. They had not been informed of the purpose of the study, the need of having their prostate tissue removed ( 2.5 x 1 x 1 cm by open perineal prostate biopsy ), complications of the procedure like rectal perforation / erectile dysfunction / bleeding, possibility of undergoing open perineal prostatectomy and its morbidity / mortality. In addition, the men who received the operation would also be castrated and given diethylstilbestrol as “adjuvant therapy”. NO written consent was attained from the subjects till the end of the study. Some might think a lot of the men were black. The answer was “NO” – Francis Delafield Hospital did not accept ‘coloured’ persons in 50’s and 60’s !!!!