Prostate Cancer Screening
Prostate cancer screening of otherwise healthy men fails to make a difference since PSA-based testing lacks the specificity to detect the few killer-type prostate cancers early enough. Instead, this misguided agenda and trickery of “shared decision making” has allowed physicians to exploit the shock value of the mostly non-lethal prostate cancers detected and profit from crippling and unneeded “treatments”. Regretfully, the once trustworthy and noble art of healing has become a license to traffic in deception and financial exploitation.
Which Prostate Cancers Can Kill?
Despite the prostate cancer industry’s campaign to paint all prostate cancers as equal and potentially deadly, the fact is that only the 15% or so of high-risk prostate cancers with SIGNIFICANT amounts of pattern 4 or 5 disease are killer cancers. The very common Gleason 3+3=6 prostate “cancer” lacks several molecular biological mechanisms typically found in real cancer cells (Klotz and others). Because the Gleason 6 LACKS the hallmarks of a cancer, it does not evolve to become aggressive and, doesn’t require detection or treatment. Furthermore, the true incidence of prostate cancer would be far lower if the bogus Gleason 6 was deleted from cancer statistics.
Prostate Cancer Causes and Symptoms
Prostate cancer is a process whereby prostate cells grow uncontrollably. Exactly what causes the small percentage of potentially deadly prostate cancers to develop is unknown but, certain risks such as increasing age, ethnicity, inherited and acquired gene mutations may be factors. Early prostate cancer is not associated with any symptoms.
Prostate Cancer Awareness LIES
The peddling of prostate cancer awareness is a monumental medical scam since population screening “saves” few if any lives and, leads mainly to unnecessary treatment and harm. Although physicians clearly understand the fallacy of PSA testing, most have chosen to continue to refine their early-detection-to-cure propaganda because profiteering at patient expense trumps the use of treatments for the benefit of the ill (in accordance with ability and judgement) and, keeping them from harm and injustice (Hippocrates). Not only is the prostate cancer awareness agenda phony but, the Board of Urology has been complicit in this deception. Details about the prostate cancer awareness hoax have been published previously.
The PSA (prostatic specific antigen) blood test is an inaccurate screening tool as it fails to detect reliably the 15% or so of the high-risk prostate cancers responsible for deaths as these cancers often make little or no PSA. In fact, the PSA test is highly unreliable, NOT cancer-specific and, has artificial limits of normal (0-4 ng/ml). Furthermore, most elevated PSAs are false positives and reflect simply, prostate enlargement, infections or, laboratory errors. Even the PCA3 and newer, costly biomarker and genome tests are not foolproof. Details about the highly unreliable PSA have been published previously.
In addition to rechecking so-called abnormal PSAs (but not the night after sex) and PSA derivatives such as the percent-free PSA, determining the PSA density can be useful. This value is obtained by getting a suprapubic ultrasound estimation of prostatic size and dividing that number into the PSA. A PSA density of under 0.16 is considered normal and, will indicate whether the elevated PSA is appropriate for that particular prostate (big prostates, “big” PSAs and, bigger PSA fluctuations). For those men with a normal PSA density and stable PSAs, continued PSA monitoring is fitting. If the PSA density is 0.16 or above and or, PSAs are persistently trending up (as opposed to fluctuating) every few months, the next consideration would be a 3T MRI (magnetic resonance imaging) study of the prostate by a recognized expert.
DRE (Digital Rectal Exam) LIES
The DRE (digital rectal exam) or prostate exam is highly subjective, unreliable and, there is zero scientific evidence that this test saves lives. This examination MAY be reasonable if the PSA density is abnormal and, or PSAs start trending up above a man’s baseline values. Often however, the test is abused by urologists to con men about “feeling something” and railroad them with scare-tactics into an unneeded, unsafe and very imprecise prostate needle biopsy. Details about the inexact prostate exam have been published earlier.
Prostate Biopsy LIES
The “standard” transrectal, ultrasound-guided 12-core needle biopsy of the prostate is a dangerous, highly unscientific test that uses a needle-gun to randomly sample some 0.1-0.3% of the prostate but, leaves over 99% unchecked. This foolish and unsafe test (like the template and saturation biopsies of the prostate), is commonly “recommended” for any man with a PSA above the arbitrary 4 ng/ml level but, if he doesn’t become septic, leads mainly to the detection of benign prostate conditions and the Gleason 6 pseudo-cancer.
Prostate Cancer Pathology LIES
The pathological diagnosis of prostate cancer is not fool-proof and relies on the arbitrary Gleason grading system along with subjective interpretations of cellular appearances and patterns of growth. Although five grades of aggressiveness are described (now 5 grade groups), only those with primary grade 4 or 5 (as in, high-risk 4+3) and, some with significant amounts of secondary grade 4 disease (as in, 3+4) are potentially lethal. The grade 3, as in the Gleason 3+3=6 “cancer”, is a bogus cancer. Shamefully, some unscrupulous doctors will “mistakenly” report some pattern 4 disease in a 3+3 specimen knowing that the inclusion of some 4s will generate confusion and doubt making it easier to steer the patient away from active surveillance and towards an unneeded but, money-making “treatment”. This ugly concern underscores the need for getting a second opinion on your biopsy from a recognized expert in prostate cancer pathology before embarking on a risky and likely, unneeded “treatment”. Other features that may be listed on the pathology report such as perineural invasion, PIN and atypia hold little relevance compared to whether or not you have significant amounts of pattern 4 disease. For low-volume pattern 4 in 3+4 disease, obtaining an erg/PTEN biomarker study may assist in considering whether active surveillance is appropriate.
Prostate Cancer Staging LIES
The staging of your prostate cancer with CAT scans, bone scans or PET scans attempting to determine whether high-risk cancer has spread or not, is generally highly unreliable because these tests are very insensitive. Furthermore, while unnecessary for the diagnosis of a Gleason 6 pseudo-cancer, imaging of those men with significant pattern 4 or 5 disease may be misleading as metastatic cells can often be detected in the bone marrow when using sophisticated staining techniques despite imaging studies being “clear”. This well known fact also underscores why the preoccupation with lymph node assessment is flawed.
Active Surveillance Concerns
Active surveillance is a process whereby low-risk prostate cancer is monitored. However, this exercise can be highly unreliable when based upon the “standard” 12 core ultrasound-guided needle biopsy since this irrational test randomly samples barely some 0.1-0.3% of the prostate. Because cancers often develop in 1-5 different areas but only a minute part of the prostate is checked during this test it is little wonder that high-risk area(s) can be missed (false negative) and, why some men on active surveillance for their Gleason 6 disease seem to “progress” or “upgrade”. Because the 3T MRI (magnetic resonance imaging) study evaluates the whole of the prostate, all men on active surveillance based upon only the 12-core needle biopsy should be considered for this study especially, if their PSA density is elevated and or, PSAs continue to trend up persistently.
The Prostate MRI
Evaluating an abnormal PSA density or, persistently upward trending PSAs is best done with the 3T mp-MRI and a radiologist who has particular expertise with this imaging study. In expert hands only, the MRI evaluates the whole of the prostate and adjacent structures and is highly reliable for detecting potentially lethal high-risk cancer(s) while ignoring the bogus Gleason 6 cancer. If the MRI is read as clear, continued monitoring with PSAs and or, monitoring with MRIs at a later date is appropriate. Areas classified as PIRADS 4 or 5 are considered consistent with high-risk cancer and, these can then be targeted with a needle and, specimens delivered to pathology for confirmation. Random biopsies are NOT part of an MRI study. On the other hand, the MRIs ability to detect very small lesions can lead to premature biopsy and unnecessary treatment rather than MRI monitoring. Therefore, after consideration of a patient’s age at the time of tumor discovery, tumor growth rates, a patient’s comorbidities and median life-expectancy, continued monitoring rather than biopsy and treatment is often, a better course of action. Testing with other forms of MRI technology such as the 1.5 T MRI, the endorectal coil or, MRI-ultrasound fusion for biopsy are significantly inferior compared to imaging with the latest generation 3T MRI and targeted MRI-guided needle biopsy.
Prostate Cancer Treatment LIES
Only the 15% or so of high-risk prostate cancers (those with primary grade 4 or 5) or, those with significant amounts of pattern 4 disease in a 3+4 should be weighed for definitive treatment if believed to be localized. The addition of testosterone suppression injections such as lupron are also commonly recommended but you need to be aware of their possible significant side effects. If the cancerous area(s) is of an ideal size and location within the prostate according to the MRI, focal laser ablation may be reasonable. If the lesion(s) is too large for effective focal laser therapy, zonal or lobar treatment can be undertaken with transurethral MRI-guided HIFU (Tulsa-profound). Transrectal ultrasound-guided HIFU or cryoablation may also be considered but these options are less precise than MRI-guided therapies. If the localized cancer is even more extensive or too close to the sphincter, whole gland treatment using radiation (without seeds) or proton beam may be indicated. However, whole gland treatment using robotic surgery should never be considered as it associated with significant physical and emotional complications, the spreading of cancer cells during surgical manipulation and failure to save significant numbers of lives. Shockingly, despite these clear dangers and lack of supporting scientific studies, this harmful robotic treatment was not only fraudulently labelled FDA “approved” but, falsely tagged as “standard practice” and, “standard of care”. In fact, it is only this stupid operation where you are likely to be counseled preoperatively to prepare for the worst and then counseled post-operatively about penile rehabilitation and urinary continence recovery programs to deal with the worst. Details regarding robotic prostate cancer surgery complications have been published before.
Prostate Cancer Screening and Treatment LIES
Many “standard of care” medical treatments lack evidence-based scientific support and are founded solely on physician beliefs and self-serving studies. The ripple effect from these flawed studies endorsing a misguided treatment philosophy is more pseudoscience and falsehoods. So it was for prostate cancer where urologists were so sure that their radical prostate cancer surgery had to be a valid treatment and, that all prostate cancers needed treatment, that these surgeons designed all of their studies to prove that their assumptions were correct. As a consequence of this herd mentality, dogma and concocted “investigations” much of the information available about prostate cancer and its management is highly suspect. This outcome however, is not surprising since the now discredited, mutilating radical mastectomy that was used to “treat” breast cancer for many years had the same dubious Johns Hopkins pedigree as the barbaric, radical prostatectomy. Because this toxic ideology of curative surgery also cripples and fails to save significant numbers of lives, prostate cancer screening and treatment is mostly, just another sickening journey of medical lies.
Joe Busch MD, prostate MRI specialist, Chattanooga, Tennessee (personal communication)
Bert Vorstman MD, MS, FAAP, FRACS, FACS