Although “treatments” in alternative and complementary medicine lack proof of benefit, some common healthcare practices also lack scientific evidence for benefit despite being covered by health insurance, marketed as FDA “approved” and/or as “standard of care”. In fact, there is no greater medical arena of orchestrated deception than that concerning prostate cancer diagnosis and treatment.
Are all Prostate Cancers Deadly?
No. Not all prostate cancers are deadly. Although all are labelled as “cancers”, many behave clinically as non-cancerous despite appearing as mildly cancerous under the microscope. Unfortunately, this very deceptive prostate cancer label includes both bogus and real prostate cancers, and this well-known fact has always encouraged predatory urologists from implying that the pseudo-cancers are real and using scare tactics to bully these patients into unneeded treatments for profiteering. Easily done since the only thing these men hear is the terrorizing cancer word.
Which Prostate Cancers FAIL to Behave as Cancerous?
Failing to behave as cancerous is the very common Gleason 3+3=6 prostate “cancer”. Undeniably, on both clinical and molecular biology grounds, the Gleason 3+3=6 “cancer” (Gleason 6 or, G6) LACKS the hallmarks of a cancer (L. Klotz MD). Underscoring the sluggish behavior of the G6 is the fact that the G6 cell has a very long doubling time of 475 +/- 56 days so that from mutation to a growth of about 1 cm (smaller than half an inch) in diameter takes some 40 years. Furthermore, about 50% of 50 year-old-men have unrecognized and asymptomatic areas of G6 disease in their prostate and, that this so-called cancer fails to evolve and harm men suggests strongly that the G6 is simply part of the aging process. Therefore, because the G6 fails to behave as a cancer clinically, it should NOT be labelled a cancer; not be included in prostate cancer statistics; not be screened for; not detected and, not treated. Again, the all-inclusive “prostate cancer” label is very misleading since the term includes the bogus G6 cancer.
Which Prostate Cancers are Potentially Deadly?
Only the 15% or so of high-grade prostate cancers with significant amounts of pattern (grade) 4 and or 5 disease in their Gleason score require detection and treatment as only these types of prostate cancers are potentially deadly. However, the amount of pattern 4 disease to be significant in a man with 3+4 cancer is yet to be determined scientifically since prostates with only small amounts of pattern 4 in a 3+4 are known to behave as if they had just the Gleason 6 pseudo-cancer.
The Hoax of PSA-based Screening for Prostate Cancer
Because only the 15% or so of high-grade prostate cancers are potential killers, any screening method of benefit should be able to detect and cure at least 80% of these particular prostate cancers. However, urologists are well aware that despite being marketed as “potentially life-saving”, PSA-based screening has a very high false-positive rate (also unreliable are the PSA derivatives such as the % free PSA as well as biomarkers such as the PCa3, 4k test and others). Moreover, the PSA (prostatic specific antigen) blood test; is NOT cancer-specific; its limits of “normal” are artificial; is commonly not the same result on repeat studies as it fluctuates normally; can be artificially raised or lowered by several processes without a cancer being present; often rises with age as the prostate grows; is normally high with big prostates; leads to the detection of mainly bogus prostate disease and MOST IMPORTANTLY, commonly fails to indicate possible high-grade prostate cancers as they can make little or no PSA (see Ablin and Piana’s book, The Great Prostate Hoax). However, although a much better biomarker is needed badly, there may be some usefulness in monitoring PSA densities and following serial PSA’s. Should the PSA density be greater than 0.16 and or, there is persistent upward trending of the PSA, a 3T MRI by an expert to evaluate the whole of the prostate would be the key next step.
The Highly Unreliable Digital Rectal Exam (DRE)
The DRE (digital rectal exam) is a finger examination of the prostate that has the same accuracy as a coin-toss. Performing this silly test every few months makes no scientific sense; is especially unreliable for detecting the potentially deadly 15% or so of high-grade cancers early and, the examination is often abused by dishonest urologists to push patients towards more profitable evaluations because of “feeling something”; sensing a so-called nodule or, feeling “unevenness” (asymmetry- which is normal).
The Dangerous and Unscientific Blind and Random Prostate Needle Biopsy
Even more crazy and unscientific than the unreliable PSA and DRE for prostate cancer “screening” is using the so-called standard ultrasound-guided,12-core needle biopsy of the prostate to detect cancer. Not only is the trans-rectal ultrasound part of the study unable to identify high-grade prostate cancer (nor is the 3D color Doppler) but, despite the knowledge that prostate cancer often develops in more than one area of the prostate and or, at different times (not unlike bladder cancer), this blind needle biopsy “test” samples randomly only some 0.1% – 0.3% of the prostate to leave one ignorant about the 99% rest of the prostate – even 120 needle biopsies would sample only 1% of the prostate. Worse still, the passing of the needle directly through a dirty rectum into the prostate for this sampling is extremely risky and, can lead to a life-threatening blood poisoning.
Is your Pathology Diagnosis Foolproof?
The belief that biopsy readings and pathology reports are accurate and foolproof is simply not true. Your biopsy specimens are read by a pathologist who, like his/her radiology colleagues reviewing imaging (X-ray) studies – and, any other physician having to make a judgement call – can make incorrect diagnoses because of inadequate knowledge and or, because of errors-of-interpretation. This is especially so for diagnosing prostate cancer because of the complexity of the Gleason grading and scoring system. Here, pathologists have to judge tumor aggressiveness based upon growth pattern appearances under the microscope and then combine estimates of the two most common patterns of growth seen (each arbitrarily graded 1-5 with 5 being the most aggressive) on the slide for a Gleason score. Since the biopsy reading is very dependent upon the individual ability of the doctor, incorrect judgements of cancer grade, Gleason score, cancer amount (volume) and or, whether a cancer is even present, are possible. Furthermore, although other background findings such as atypical small cell acinar proliferation (ASAP) and high-grade prostatic intraepithelial neoplasia (HGPIN) are often recorded, by far the most important feature of the biopsy report is whether or not significant amounts of high-grade (4s and 5s) prostate cancer have been identified as these cancers can benefit from treatment. But, because of possible errors-of-interpretation, getting prostate biopsy findings confirmed by a recognized leader in prostate cancer pathology is recommended highly.
Why Prostate Cancer Surveillance Without the 3T MRI is a Sham
The “reasoning” behind “active surveillance” are the facts that most low-risk prostate cancers don’t need treatment; most “treatments” are worse than the disease itself and, you are much more likely to be hurt during this screening and treatment process than having your life “saved”. So, if instead of rushing someone with low-risk cancer (the G6 should never be classed as low-risk as it LACKS the hallmarks of a cancer whereas those with small amounts of pattern 4 in a 3+4 are considered low-risk) into a dangerous and unneeded treatment, the ASSUMPTION is that maybe they could be monitored and only treated if additional needle biopsies showed “upgrading” or “progression” of cancer. However, it has been clear for many years that prostate cancer can exist in some 1-5 different parts of the prostate, have different Gleason grades and, present at different times. Clearly then, any diagnosis based upon the current blind and random 0.1% sampling of the prostate is highly suspect and undertaking a “surveillance” based upon such sketchy information is simply ludicrous since something else could be going on in the over 99% of the prostate that was not evaluated. Therefore, it is completely understandable why there is much confusion about whether a previously detected G6 or low-risk cancer has suddenly and magically “progressed”and or, “upgraded” into a high-risk cancer. A much more logical explanation is that: the very small area of prostate biopsied previously suffered from gross sampling errors (i.e. missing an area since 99% of the prostate is unevaluated by the blind and random 12-core needle biopsy); new areas of cancer have developed and or, because the pathologist made a mistake with the previous diagnosis. Fortunately, the tool which can minimize most if not all of these errors associated with the present methods for prostate cancer detection and surveillance is the 3T MRI as it evaluates 100% of the prostate. If the 3T MRI is not available for you, stable PSA’s would suggest that your disease is not changing while persistently rising PSA’s may indicate a change that needs evaluation.
Regretfully, the current “standard” surveillance process using unreliable PSA’s, DRE’s and risky inaccurate needle biopsies is so filled with errors and risks as well as causing great anxiety due to the stress of undergoing repeat painful biopsies and test-result anticipation, that it is completely understandable why men often give up on this abusive agenda. Adding fuel to this fire of surveillance anxiety are the corrupt urologists who, rather than support and counsel these men caringly, fill their heads with even more concern and doubt just to push them towards an unneeded but profitable “treatment”.
The Best Screening Tool to Detect High-grade Prostate Cancers is the 3T MRI
To date, the newer versions of the 3T MRI (but only in the right hands) are the most reliable (almost foolproof) devices for detecting the 15% or so of potentially deadly high-grade prostate cancers. Unlike the current “standard” screening and detection methods, the 3T MRI evaluates the WHOLE of the prostate, can ignore the bogus G6 cancer and, based upon imaging details in a properly conducted study, able to identify reliably with PIRADS 4 and 5 features, almost all high-grade cancer anywhere within the prostate. Any high-grade areas identified can then be targeted for needle biopsy under real-time 3T MRI for confirmation of disease (there may be a time when the 3T MRI is so reliable that a biopsy proving disease before starting treatment is unnecessary – random biopsies are not part of an MRI study and, only show a lack of knowledge). Although, other MRI “detection” options using a 1.5T MRI; endorectal coil MRI or, that incorporating technology fusing a previous MRI study to a real-time transrectal ultrasound procedure for prostate needle biopsy are heavily marketed, none are as reliable as a real-time 3T MRI study undertaken by an expert. (Joe Busch M.D. prostate MRI specialist – personal communication)
Are Non-MRI Imaging Studies for Prostate Cancer Necessary and/or Reliable?
Since the G6 behaves as a pseudo-cancer, getting imaging studies to “determine if there has been any spread of cancer” is absurd and totally unnecessary. However, many unethical urologists will use fear mongering to persuade vulnerable men towards getting worthless imaging studies such as CAT scans, PET scans and bone scans etc on the pretext of making sure that the bogus G6 cancer has not “spread”. Not only are studies here of zero benefit but men will only be spending money to get radiated.
On the other hand, despite imaging studies being useful for men with high-grade cancer, these studies lack sensitivity and, can result in a failure to detect microscopic amounts of high-grade spread to give the false impression that the cancer is still only within the prostate. Underscoring this fact is the knowledge that in some of these men where the x-rays were read as “normal”, cancer cells can already be detected in the bone marrow when using sophisticated staining techniques. Not only can these cancer cells stay resting or dormant in the bone marrow for many years but when, why and how some of these cells leave the marrow to spread at a later date is unclear.
Robotic Prostatectomy is a Fraudulent “Treatment”
Despite the robotic prostatectomy being promoted as “life-saving”, “cutting out” a prostate cancer has never been proven to be a health benefit because scientific evidence-based studies with patients stratified according to validated high-grade pathology and tumor volume have never been done. In fact, most if not all “studies” have included men diagnosed with a mix of various types of prostate cancers including the G6 so survival statistics are skewed. Furthermore and absolutely cheated, the men pushed into getting robotic surgery for their bogus G6 cancers are not survivors of a “cancer” but, survivors of their “treatment”.
The treatment philosophy behind radical surgery for prostate cancer was born from ancient and primitive bladder stone removal procedures; was designed and promoted by the same physicians who planned the crippling radical mastectomy (now abandoned); was modified through years of unbridled human experimentation; was commonly revised based solely upon individual surgeons’ whims and often, without patient informed consent; under the guise of a medical “advancement” and an underhanded 510(k) FDA process, the robotic device was able to get an automatic FDA “approved” label for use in radical prostate surgery without ever undergoing scientific studies or trials to show proof of benefit. Shamefully, this corrupt exercise has allowed the deceptive marketing of the robotic prostatectomy as a “standard” medical treatment. (see book by A. Horan M.D., The Big Scare)
Because there is no scientific data to show proof of health benefit for any radical prostate surgery, it is hardly surprising that of all the prostate cancer treatment options available, the robotic prostatectomy; fails to save significant numbers of lives; is a “treatment” associated with the greatest number of complications; often needs corrective surgery to remedy “limp and leaking” complications; not uncommonly needs more surgery to correct complications resulting from the surgical attempts at repairing complications and, even more surgery to fix failed implants and pumps. Additionally, as if the so-called standard robotic prostatectomy is not associated with enough complications, urologists have brazenly promoted “salvage” robotic prostatectomies for those who have failed other treatments and their cancer has returned. Shockingly, not only is this so-called salvage surgery associated with even more complications than a “standard” robotic prostatectomy but, it also has zero scientific proof of health benefit.
Additional Serious Issues and Warnings Associated With Robotic Prostatectomy
Aside from these significant problems associated with robotic prostatectomy, there are two other serious issues. First, research studies have shown that the handling of the prostate during surgery causes the release and spread of cancer cells into the bloodstream and second, robotic surgery often leaves cancer behind at its cut margins (positive margin) leaving surgeons now to recommend a course of radiation to treat this residual cancer.
Not only are these dangers associated with robotic prostatectomy underlined by being linked to numerous malpractice suits but, the FDA’s MAUDE (Manufacturer and User Facility Device Experience) site has generated numerous warnings regarding robotic prostatectomy despite only about 8% of actual adverse events being recorded on the site because of its complexity. Additionally, the USPSTF (United States Preventive Services Task Force) has expressed deep reservations about the PSA-based screening program and the treatment of screen-detected cancers because the process fails to save a significant number of lives and, is associated with numerous complications. Even more revealing, urologists were clearly concerned about the many dangers associated with their radical prostate surgery since they developed several techniques to lessen the severity of these complications. As well, they developed preoperative and postoperative patient counseling programs so that patients were better mentally prepared to deal with the many downsides. Issues and troubles that the robotic device manufacturer was also well aware of since the list of disclaimers and warnings on the manufacturers’ website is extensive and, gets longer with each site revision.
How to Treat High-Grade Prostate Cancer
Once there is reliable confirmation of the existence of a high-grade cancer from an expert in prostate cancer pathology and, imaging studies suggest disease localized to the prostate (recognizing the reservations about imaging discussed previously), one can return to the recent 3T MRI (or, if you have not had an MRI wait at least 6 weeks for post needle biopsy inflammation in the prostate to settle and schedule your 3T MRI with an expert) to review the size and location of your cancer(s) and see if it can be treated with focal therapy. If so, MRI-guided focal laser ablation (FLA), MRI-guided trans-urethral high intensity focused ultrasound (HIFU) or, focal cryoablation may be used on an outpatient basis. However, if according to the MRI, the high-grade cancer is too big or too close to important areas to be treated safely focally, whole-gland proton beam or external beam radiation with or without testosterone suppression injections such as Lupron (every few months for about 12 months) is usually recommended. Although offered as definitive treatments one needs to understand that there is no hard-scientific evidence-based data from patient studies stratified according to validated identical pathology and tumor amount to indicate whether any focal or whole prostate gland treatments are of proven benefit. Furthermore, all of these “treatments” are associated with complications and, some may be severe.
Unproven Prostate Cancer Care, Money and Medicine
Current prostate cancer screening and treatment ideologies are fundamentally flawed because urologists hold a number of beliefs to be fact when those beliefs lack scientific support. Not only do urologists continue to design their clinical studies around these misguided beliefs but, despite research contradicting and documenting that these common medical practices are harmful these “physicians” continue to prescribe and deliver outdated and unproven medical “care”.
In addition to a business model that rewards doctors for delivering any kind of service to their patients, there is a fortune to be made from delivering unneeded and or, unproven care. Not only do doctors make more the more they do whether needed or not or, whether good or bad but, companies in the health technology and pharmaceutical businesses discovered they could board this money-making train by cleverly “sponsoring” physician’s clinical trials, meetings and publications so doctors could be “persuaded” to promote the clinical “messages” these companies wanted the public to hear. However, opportunistic companies and investment firms soon realized that if instead of making doctors just indebted to company propaganda and they could own the physicians, then maybe they could “encourage” these doctors to “work harder” and then share in those profits Not surprisingly, greedy companies soon snapped up as many physicians and practices as they could and then pressured their captive doctors to ramp-up production. An easy process that resulted in the ordering of many unnecessary tests and, doing many unneeded treatments – all at patient expense. Remarkably, delivering unneeded money-making medical care became even easier because technology advances shifted many treatments from an outpatient setting to office-based and, insurance companies were more than willing to pay just to keep these “treatments” out of costly hospitals.
Prostate Cancer Care by Orchestrated Deception
It has been very clear for many, many years that men diagnosed with prostate cancer die only from the 15% or so of high-grade prostate cancers. Yet inexcusably, instead of developing methods to improve the survival of these men, corrupt urologists lied to the public and promoted highly unreliable PSA-based screening techniques that lead to the detection and unneeded dangerous “treatments” of mainly the 85% or so of bogus and low-risk prostate cancers. Intentional misrepresentations and trickery that were willingly supported by the healthcare industrial-medical complex and, resulted in a tsunami of self-serving prostate cancer “information” drowning out the important public health warnings from Government oversight agencies such as the USPSTF. Sadly, modern healthcare has become a dangerous trap of profit-driven orchestrated medical deception stoked by doctors and their masters and, by health insurance companies who control and direct your care.
Miserable Patient Journeys
Horan, A., How to Avoid the Overdiagnosis and Overtreatment of Prostate Cancer
Horan, A., The Big Scare. The Business of Prostate Cancer
Ablin, R. and Piana R., The Great Prostate Hoax
Christensen,C., The Innovator’s Prescription
Goldhill, D., Catastrophic Care and How We Can Fix It
Barret, S. and Jarvis, W., The Health Robbers
Bert Vorstman BSc, MD, MS, FAAP, FRACS, FACS