Urology is the 5th Most Corrupt Medical Specialty? A Critical Look at Dr Robert Yoho’s Urology Exposé (2025)

We’ve reviewed the article titled "352. Urology is the Fifth Most Corrupt Medical Specialty—If You Count Dentists as Healthcare" by Robert Yoho, MD, published on his Substack on April 4, 2025. 

Below is a summary and analysis of its key points, arguments, and tone, based solely on the content provided in the linked article.

The piece asserts that urology ranks as the fifth most corrupt medical specialty, following oncology, psychiatry, dentistry, and vaccines, in the author’s view of healthcare corruption. Dr Yoho, a retired physician, frames his argument around what he perceives as systemic issues in urology, particularly focusing on the overuse of prostate-specific antigen (PSA) testing and subsequent interventions like biopsies and surgeries. He suggests these practices are driven more by profit than patient benefit, aligning with his broader narrative of healthcare being corrupted by financial incentives and institutional bias.

The article begins with his friend's father:

My friend John’s father is 80. Although he had no symptoms, he went to a urologist, who checked his “prostate-specific antigen” (PSA). It was high, so the doctor tried to enroll him in a medical treatment cascade, starting with a biopsy and probably ending with a painful, deforming radical prostatectomy surgery that would be unlikely to extend his life. The most common cause of an elevated PSA is a prostate infection, but John’s dad was never offered antibiotics.

The following excerpt from 'Butchered by Healthcare' (Free ebook download HERE) explains the sad truths:

Urology’s approach to this disease has undergone an embarrassing outing. The specialty traditionally recommends that the surgeon draw blood for prostate-specific antigen (PSA). The urologists also insert a finger into the patient's rectum to feel for prostate lumps.

If the blood test is high, or the surgeon feels nodules, they stick a large needle repeatedly through the rectum into the prostate to get tissue samples. If the biopsy shows cancer, urologists recommend perilous surgeries or other alarming therapies. This system has been discredited because it never improved survival rates for early disease.

The cancer is present but inactive in most men over 50. Only about twelve percent of men will be diagnosed with prostate cancer during their lives, and their five-year relative survival rate for this cancer after it is diagnosed (the percent with the disease who are alive compared to matched controls) is 97.8 percent. Ignoring it in the early stages produces the same results as treatment but without horrific surgical complications. The commonly performed operation, a radical prostatectomy, causes death in 1/200. Compromised or ruined sexuality and uncontrollable urination requiring diapers are common, often for the rest of a man’s life.

Some patients already have metastatic cancer before surgery. In these cases, it kills the patient even though he has suffered through the grisly procedure and recovery.

The PSA test is unreliable. It goes up with any prostate gland irritation due to factors such as infection or even bicycle riding. Antibiotics or anti-inflammatories are the treatments, not surgery. The vast majority of these tumors grow so slowly that death occurs from something else before the disease becomes an issue. PSA is little help in identifying aggressive cancers that would be fatal.

Here is a little math: The USPSTF (US Preventive Services Task Force) did a large-scale analysis of the research literature. They concluded that for every 1,000 men ages 55 to 69 who had their PSA checked every one to four years for a decade, it would save one man from prostate cancer. The number needed to test is 1000, over 10,000 patient-years, and who knows how many tests, possibly 50,000.

Even if you believe these small numbers are meaningful, the cost-benefit ratio is terrible. False-positive PSAs lead to biopsies, which have complications just like the true positives. Men with biopsies that show cancer get surgery or other treatments. The harms resulting from these interventions include erectile dysfunction, urinary incontinence, serious cardiovascular events, deep vein thrombosis, pulmonary embolism, and occasionally death. Checking PSA in asymptomatic men produces no improvement in survival.

The American Veterans Administration “PIVOT” trial compared surgery versus observation for localized prostate cancer over 13 years. There was no statistically or clinically significant difference in all-cause (absolute survival) or disease-specific mortality (relative survival). Prostate removal surgery is a net harm.

A Scandinavian study looked at 695 men with prostate cancer. They were divided into two groups. One had radical prostatectomy surgery, the other “watchful waiting.” With the surgery, the men were half as likely to die of the cancer (relative death rate). Their overall death rates from all causes (absolute deaths) at five and ten years were identical to those who did not have the surgery. Other researchers support these results.

By 2013, urologists partially responded to the heckling from the rest of the medical community. Their new guidelines recommended “individualizing” this test using “shared decision-making” between physicians and patients aged 55 to 69. This is misguided. Otis Brawley, head of the American Cancer Society until 2018, told the story of an unfortunate patient who was victimized by this system in his book How We Do Harm (2012):

Ralph entered the prostate cancer meat grinder after he had his PSA drawn in a shopping mall at a free cancer screening event. It was 4.3. He had twelve painful biopsies. Two of them showed moderate-grade cancer in about fifteen (15) percent of each specimen. Ralph read everything he could. He decided on robotic surgery because the advertising said it was “advanced.” It left him impotent and incontinent, and he required diapers for the rest of his life. His PSA several months later was .9. It would have been zero if the surgeon had entirely removed his prostate. He became obsessed with the idea that he still had cancer. So he went to a radiation oncologist who obligingly treated him with “proton beam therapy.” When he began seeing blood in his stools later, his surgeons found a fistula. This connects his urethra (urine tube) and his bowel. It was confirmed when he began passing bowel gas from his penis. The surgeons treated him by sewing his colon to the front of his abdomen with a “colostomy,” which required him to change a bag containing his stool several times a day. They also created a similar passage from his bladder to his belly, a urostomy. He still had both when he died of a severe urinary infection a few years later. He was 72.

The urologists, or at least the males, do not seem to understand the PSA math. Eighty percent of them and half the internal medicine specialists continue to test their own PSAs. Patients have little chance of understanding this if most physicians do not.

Like other diseases with expensive treatments, the prostate cancer industry has nonprofit “advocacy” associations growing in a dense thicket all around it. These universally promote PSA screening, which starts the cascade of billions of dollars in medical services. One organization, Us TOO, is 90 percent funded by the pharmaceutical and device companies that profit from this prostate circus. Zero, formerly the National Prostate Cancer Coalition, has funding from Amgen, AstraZeneca, Aventis, Cytogen, Merck, Pharmacia, and Pfizer.

Kimberly-Clark, the maker of Depends incontinence diapers, is another donor. Prostate cancer surgery sells a lot of adult diapers for them, and in 2021, they are advertising on TV using images of rough-looking senior men in diapers. Zero and the others claim to be independent, unbiased grassroots groups not beholden to any company.

Shared decision-making is an abdication of responsibility. We are losing trust in advisers who cannot advise. Fewer and fewer will shoulder responsibility in this age of lawsuits. Other People’s Money, a book about finance, explains the issue: “A good lawyer manages our problem; a bad lawyer responds to every issue by asking us what we want to do. When ill, we look for a recommended course of action, not a detailed description of our ailments and a list of references to relevant medical texts. The demand for transparency in finance is a symptom of the breakdown of trust.”

I recommend men pretend they do not have a prostate unless they get symptoms. (Disclaimer: I am not a prostate specialist. There may be advantages to these treatments that I did not find. Prostate cancer therapy has common themes with the rest of medicine, however. It is complex, and there are conflicts of interest. The treatment studies have large numbers, slight differences, and outsize claims.)

The following excerpt from the article:

Many men cannot wrap their heads around the idea that they should not allow urologists to mess with their prostate. If you still do not get it and you think that there is merit in identifying prostate cancer at an early stage, consider magnetic resonance imaging (MRI) and, if necessary, laser treatment by a radiologist. These are currently the least invasive tests and therapies. If the MRI shows a tumor is likely, an imaging specialist can put a guided sampling needle into the suspicious area(s). This results in a diagnosis rate of 90 percent after only one or two sticks.

Contrast this with the usual dozen “random” biopsies that discover only about half of the cancers. You are left sore and in limbo, anticipating a new round of biopsies a year later. Or, if you received a cancer diagnosis, you have to start considering radiation or horrifying, ineffective surgery on your most private parts.

However, with MRI guidance, a laser can accurately burn tiny cancer spots. You do not get complications from surgery or radiation. Only a few centers in the USA offer this expensive but safe and accurate method. These include Desert Medical Imaging (now Halo Diagnostics) in Palm Springs, CA, and affiliates nationwide. They also offer a noninvasive treatment for benign prostatic hypertrophy using this same technology.

Since radical prostatectomy for prostate cancer is a multi-billion-dollar surgical industry, these radiologists receive a brutal reception at urological surgery meetings and are not allowed to speak. However, the standard approaches are outdated and deforming, require years of care, and have horrible outcomes.

Note: all of these therapies are doubtful because the radiologists, like the surgeons, primarily treat low-grade prostate cancer, which rarely kills anyone. Since I can do without needles stuck in my tender places, I refuse to check my PSA ever again unless I have symptoms.

Prostate cancer that has spread or metastasized outside the gland is a different issue. For more than 50 years, synthetic estrogen has been used effectively and inexpensively to treat this, and some doctors still use it. Bio-identical estradiol is available now and should be used instead of the older horse estrogen compounds. For many patients, this suppresses the tumor, and they feel fine. The PSA should be checked at intervals to make sure.

Casodex and Lupron are the patented, expensive anti-testosterone drugs that are the current “standard of care” for metastatic prostate cancer treatment. They typically work for about five years, and then the cancer comes back. They cause heart disease, Alzheimer’s, and osteoporosis and make patients feel terrible. Otis Brawley speculates that they produce more deaths than they prevent:

Lupron is one of urology’s many embarrassments.

This is a “chemical castration” medicine, approved in 1985 to treat metastatic prostate cancer. It did not sell well until the company figured out how to pay off the surgeons. They developed a long-acting monthly shot, and urologists could buy it wholesale and retail it in their offices. This was a nasty conflict of interest that made patient care secondary.

The company increased the temptation further by giving the doctors samples. This enticed them to sell the freebies to patients and keep the money, which is illegal. Medicare paid $1200 for one of these shots. Urologists could make several hundred thousand dollars a year on this. Internally, the manufacturer called these doctors their “drug whores.” Lupron treatments accounted for 40 percent of all Medicare payments to some of these practices in the late 1990s.

After a whistleblower lawsuit and years of litigation, federal prosecutors settled this “nationwide conspiracy.” The manufacturer paid $885 million, and no corporate executives were imprisoned. The industry now skirts illegality by paying doctors an administration fee for using Lupron instead of providing free samples.

The worst part of this story is that Lupron is an atrocious drug. Men feel terrible, get hot flashes, and become impotent. Some have weight gain, fatigue, muscle loss, anemia, Alzheimer's disease, and osteoporosis. It also causes strokes, heart attacks, diabetes, and sudden death.

Otis Brawley, former head of the American Cancer Society, says men are dying earlier because of Lupron therapy. This drug and others have decreased prostate cancer deaths by 30 percent since 1990, but all-cause deaths may have increased because the drug is so toxic:

Widespread use of [anti-] hormonal agents is causing men to die of cardiovascular disease and diabetes before they would ordinarily die of prostate cancer. That’s what I suspect is taking place. If urologists stop prescribing these drugs as widely as they used to, we will see deaths from prostate cancer inch up. That could be good news. Some men who would have died earlier with strokes and heart attacks caused by hormonal treatments of their asymptomatic disease would now live long enough to die of their prostate cancer.

How We Do Harm (2012)

According to Dr Robert Yoho:

My friend Paul had his PSA checked every year. When he was 73, it jumped to 10 (normal is 4.0 ng/mL or less). Even though Paul felt fine, he went off to see the urologists, who obligingly biopsied his prostate. They found a tumor and now use a Lupron shot every few months to “block” his testosterone. Medicare pays them a nice injection fee. Paul feels terrible and will likely die sooner of heart disease because his testosterone levels are low.

Estrogen is a far better treatment. It is cheap, works for many, and has few side effects. Fifty years of experience show it controls metastatic prostate cancer, and although they are not interested in sex, it does not feminize men. Since companies cannot patent substances identical to those in the human body, they do not promote drugs like this. (Occasionally, delivery systems such as the estrogen patch or a supposedly unique drug strength are used to justify patent protection. For these medications, windfall profits can still be made.)

Analysis

​The article titled "Urology is the Fifth Most Corrupt?" by Dr Robert Yoho asserts that urology ranks as the fifth most corrupt medical specialty. However, it does not provide a clear source or methodology for this ranking, making it difficult to verify the claim's accuracy.​

Instances of unethical practices have been documented within the field of urology. For example, Advanced Urology Institute in Florida agreed to pay over $716,000 for submitting claims to Medicare and Medicaid for radiation oncology services without the required physician supervision. Similarly, Bedford Regional Urology agreed to pay $463,000 for submitting claims for services without proper supervision.

While these cases highlight specific instances of misconduct, they do not necessarily indicate a systemic issue within the entire specialty. Comparative data on corruption across different medical specialties is limited, making it challenging to substantiate claims about urology's relative standing in terms of corruption.

Yoho’s broader argument situates urology within a hierarchy of corrupt specialties. He implies that urology’s issues—over-treatment, financial incentives, and suppression of alternative approaches—mirror those in oncology (chemotherapy profits), psychiatry (psychiatric drugs), dentistry (unnecessary procedures), and vaccines (which he calls the "worst"). 

The piece concludes with a call to readers to educate themselves and resist what he sees as a predatory medical system, offering links to his other works and resources.

In summary, the article is a passionate, critical take on urology’s approach to prostate cancer. Readers interested in this topic might benefit from cross-referencing Yoho’s claims with primary studies or AUA cancer guidelines for a fuller picture.

Read More: Prostate Cancer series.