B. Vorstman MD, MS, FAAP, FRACS, FACS
www.urologyweb.com
The most common cause of prostate cancer grade creep is NOT some progressive worsening of a prostate cancer grade (aggressiveness), but a tendency for some pathologists to overestimate or inflate a Gleason grade and score to have a man thinking that his disease is more significant than it really is. In other words, grade creep is commonly grade inflation.
Currently, many men diagnosed with the Gleason 3+3=6 prostate “cancer” are well aware that this socalled cancer LACKS the hallmarks of a cancer (on both clinical and molecular biology grounds) and that they do not need any treatment. However, men can be deceived into thinking they should be treated if their Gleason grades and score have been inflated.
23% of ALL men diagnosed with prostate cancer will die from their prostate cancer but, ONLY if they have highgrade prostate cancer, not the 3+3=6 disease. Furthermore, the 3+3=6 does NOT progress to become highgrade cancer.
Although, it is evident now that the mp3T MRI (in the right hands) is becoming quite reliable for detecting and diagnosing only the highgrade prostate cancer (and not the 3+3=6 which does not need treatment) to a point where a confirmatory prostate needle biopsy may not even be necessary, MRI prostate cancer screening is yet to be funded by insurance companies. Until then, there are some steps you can take to get some confidence about the real state of your pathology. Many of these steps also, may not be funded by your insurance company but they can be important for those men diagnosed with the Gleason 3+4=7 and those with high volume Gleason 3+3=6 disease. Only highgrade disease needs treatment.
> pathology validation. Any diagnosis of prostate cancer should be validated by an independent pathology reference laboratory to minimize the chance of underreading or, inflating the Gleason grades and score. Validating your pathological diagnosis is especially important as many pathologists are employed now by robotic or radiation groups and these associations can be affected by the most powerful conflict of interest which is being financially incentivised to “treat” or, not to treat
> biomarkers such as ERG and PTEN immunohistochemistry studies, ProMark (an immunofluorescent study), Oncotype DX and Prolaris (assays the cell cycle gene signature) may assist in identifying more adverse pathology
> a confirmatory 12 core prostate needle biopsy 12 months later
> 612 month PSAs, PSA derivatives and PSA density while monitoring PSA kinetics for any persistent upward trending which may suggest the need for another biopsy or mp3T MRI
Read More About the Deceptions in the Prostate Cancer Arena >
https://urologyweb.com/wpcontent/uploads/BEWAREBEWAREFDA_APPROVED_ROBOTICPROS TATECTOMYCARE1.pdf