Not all prostate cancers are equal.
In fact, most prostate cancers do not behave like cancer and do not need treatment.
Non-lethal and Potentially Lethal Prostate cancers
Basically, there are two types of prostate cancer.
- non lethal
the very common Gleason 6 (3+3) prostate “cancer” is not a cancer, it does not spread, is not a health-risk, does not require treatment and should not be called a cancer.
Klotz has already underscored two important facts as to why the Gleason 6 has no hallmarks of a cancer. Clinical studies have shown that men do not die from this cancer and molecular biology studies have shown that the Gleason 6 has none of the protein alterations to make it cancerous.
Although even the low intermediate Gleason 7 (3+4) behaves like the non-cancerous behaving Gleason 6 all prostate biopsies should be validated by a recognised reference laboratory because of the subjectivity associated with interpretations.
- potentially lethal prostate cancers
potentially lethal prostate cancers are the high-grade, high-risk prostate cancers such as the
4+3 (the high intermediate Gleason 7), 4+4, 4+5, and 5+5
these prostate cancers require detection and treatment but not with surgery.
Deception and Fear-mongering
- all-inclusive prostate cancer label
The very convenient continued use of the all-inclusive ‘cancer’ word in prostate cancer has allowed unbridled and unconscionable predation of men made vulnerable by this false ‘cancer’ word and exploiting their medical illiteracy. This intentional but unconscionable fear mongering is well practiced by the prostate cancer industry for self gain and at extraordinary patient expense.
Virtually all publications generalize and sensationalize discussions on prostate cancer by treating all prostate cancers as equal when it is well known that only the high-grade, high-risk prostate cancers are potentially lethal and only these need treatment.
Unscrupulous physicians are well aware of what the “cancer” label does to a person’s psyche and are not above using fear-mongering to deceive you into thinking that your Gleason 6 is a “cancer” and that you need to undergo treatment. Not only will you be deceived into thinking you are a “survivor” after having your Gleason 6 treated unnecessarily (overtreated) but most certainly, you will be bothered and reminded of post-treatment complications for the rest of your life. Complications from a treatment you never needed.
- worthless hype
There has never been any scientific evidence that wholesale prostate cancer screening offered any benefits to man. Unfortunately, the same can be said for September prostate cancer month, prostate cancer awareness, men’s health etc. In fact, even the prostate cancer advocacy and support groups stand on shaky ground as most of their input has been for early detection and early treatment when there is zero evidence to suggest any benefit. In fact, what actually resulted was many, many men being treated unnecessarily and then left incontinent and impotent, for zero benefits and fooled into believing they were “survivors”.
They were not survivors of the “cancer” ( a Gleason 6 is not a cancer), these men treated unnecessarily are survivors of their invasive treatment.
iii. being worked over with doubt
“missed” or “upgraded”
Even more deceptive are the unconscionable attempts at creating doubt about your noncancerous behaving Gleason 6 prostate disease and suggesting that a higher grade disease may have been missed in your prostate or suggesting that your Gleason 6 may dedifferentiate and upgrade into a more significant prostate cancer at a later date and we “should treat it before it gets away”. Such despicable attempts at manipulating you towards a risky treatment with zero benefits are unfortunately common. The chance of your Gleason 6 de-differentiating to a more higher-grade cancer are believed to be less than 1% per year and the chance of missing a small but higher grade cancer at the initial biopsy is possible but unlikely to be significant as any significant changes will be picked up at a confirmatory biopsy or early enough with periodic monitoring (PSAs are accurate for monitoring cancer activity).
Furthermore, if mp-3T MRIs can reliably detect only high-grade, high-risk prostate cancer we can prevent the gross amount of prostate cancer overtreatment especially from the debilitating robotic prostatectomy.
This problem of widespread overtreatment as well as harmful treatment has been underscored by organizations such as USPSTF and many physicians.
Which Treatments are proven?
There is little or no scientific data or evidence-based-medicine support for any of the treatments for prostate cancer. They all started as philosophies of treatment.
How to Improve
Once we have biomarkers which are near foolproof for indicating only those cancers which are potentially lethal and therefore need treatment and, the mp-3T MRI can reliably detect those high-grade, high-risk prostate cancers for focal treatment we can stop the unbridled exploitation and abuse of men railroaded into thinking their Gleason 6 disease needed treatment.
This practice of medical deception is founded on a treatment philosophy spiced by egos. The treatment philosophy of removing a cancerous prostate has been in practice since the early 1900s but never validated. Despite years of grandstanding by the urology hierachey and the prostate cancer industry, prostate cancer disease management is an issue burdened by philosophy, subjectivity, unreliability, generalizations, misrepresentations and false hope.
Screening for voiding issues in association with performing the inaccurate and very subjective digital rectal exam (DRE) for detecting possible nodules on the prostate which may be cancers and which is about as accurate as tossing a coin for reliability. The PSA blood test (drawn on another day as it can be falsely elevated after the DRE or after sexual activity) is similarly highly unreliable. In fact the PSA was approved by the FDA NOT as a biomarker for early detection but as a marker for monitoring cancer activity AFTER treatment. Despite this, the renegade prostate cancer industry hijacked the PSA marker by misrepresenting its approval for prostate cancer detection.
Furthermore, the biggest charade of all and placing many men in harms way for zero benefits has been the deceptive practice of promoting robotic prostatectomy as a valid treatment. In fact, this so-called treatment has endured simply on the basis of a treatment philosophy and perceived benefits in the absence of scientific evidenced-based medicine data. Even the FDA gave the misguided radical prostatectomy approach through robotics a simple “pass” even though the place of robotics was always highly suspect. After lobbying the FDA and supplying but scant clinical information comparing laparoscopic gallbladder surgery to robotic gallbladder surgery and despite the fact that robotics was found to be no more effective than laparoscopy, the FDA approved robotics for soft tissue surgery in 2000. Not only was the manner in which this study information was obtained underscore obvious conflict of interest concerns but far worse, gallbladder surgery has absolutely nothing in common with the technical issues concerning prostate excision.
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Larson CA. Prophylactic Bilateral Oophorectomy at time of Hysterectomy: ACOG revises practice guidelines for ovarian cancer screening in low-risk women. Current Oncology 2014; 21, February: 9-12
Miles S. The Hippocratic Oath and the Ethics of Medicine
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online.WSJ.com FDA advises against morcellation use in hysterectomy
Wooten D. Bad Medicine, doctors doing harm since Hippocrates
www.iom.edu/vsrt The Healthcare Imperative, lowering costs and improving outcomes
You can learn more about the many failings in prostate cancer management by visiting:
Dr Bert Vorstman’s website, https://urologyweb.com/exclusive-medical-reports
Dr Vorstman’s blog at; https://urologyweb.com/uro-health-blog/
Contact him at email@example.com
About Bert Vorstman MD, MS, FAAP, FRACS, FACS
Dr. Bert Vorstman is a Board Certified urological surgeon. After training at the Otago Medical School in Dunedin, New Zealand he completed a urology residency at Auckland Hospital, Auckland, New Zealand. He Fellowship trained in Pediatric and Adult Reconstructive Urology at the Eastern Virginia Medical School in Norfolk, Virginia and after NIH sponsored, pioneering research on “Urinary Bladder Reinnervation” he earned the honor of a Masters of Surgery Diploma from the University of Otago, Dunedin, New Zealand. Dr. Vorstman was a faculty member at the University of Miami, Jackson Memorial Hospital, Miami, Florida and then went on to found Florida Urological Associates, a very busy private, urology practice in Coral Springs, Florida. Dr Vorstman’s passion and dedication is to help men and their spouses/partners understand fully the implications of their particular prostate cancer as well as the minimally invasive treatment options available in selected men with localized significant prostate cancer.