Although the idea of “cutting out” a prostate cancer is seemingly reasonable, it is based upon junk science and will likely rob you of your health. Besides, what is the evidence that the robotic-assisted prostatectomy has any life-saving potential?
Does Prostate Cancer Surgery Save Lives?
There are two widely referenced studies that have been undertaken by urologists, but largely ignored by them. The PIVOT study (Prostate Intervention Versus Observation Trial) published in the New England Journal of Medicine concluded that; “Among men with localized prostate cancer detected during the early era of PSA testing, radical prostatectomy did not substantially reduce all-cancer or prostate cancer mortality, as compared with observation (active surveillance), through at least 12 years of follow up. Absolute differences were less than 3 percentage points (statistically insignificant)”. In other words, despite undergoing this risky invasive surgery, it offered zero protection against dying from prostate cancer and, according to Horan, “without proof of life extension in man or animal that would satisfy the committee on medical experimentation at Nuremberg”.
The other radical prostatectomy study commonly referenced had a 29 year follow-up and claimed a mean of 2.9 years of “life” gained. However this study also, was hopelessly flawed and skewed towards a semblance of life extension because men with Gleason 6 pseudo-cancer were included while others received arbitrary additional interventions such as testosterone suppression (androgen deprivation therapy or ADT) which by itself can extend life.
What about the fact that robotic prostate cancer surgery is FDA (Food and Drug Administration) approved? Regretfully, the FDA “approved” label for the radical (robotic) prostatectomy is a distortion of fact. Because urologists have always assumed that their radical prostate surgery procedure was safe and effective they assumed by extension that the robotic-assisted prostatectomy would also be safe and effective. However, the robotic device for robotic-assisted prostatectomy was never proven to be safe or effective through objective studies. It was only because urologists used the FDA’s misguided 510(K) process to rubber-stamp an approval for the robotic device that automatically enabled its use in robotic-assisted prostate cancer surgery. An exercise that simply allowed the assumption that surgery was safe and effective to continue.
What are the Complications Associated with Radical Robotic Prostatectomy?
Not only does prostate cancer surgery fail to save significant numbers of lives but, it is associated with many complications. From general surgical problems including deaths within 30 days of surgery, suicidal depression, deep vein thrombosis and many other issues, there are complications specific to robotic surgery such as insufflation embolism, trocar and positioning injuries. As well, there are injuries that are particular to prostate removal. From every possible sexual problem imaginable including lack of libido and loss of manhood, damaged or loss of erection (despite the use of a so-called nerve-sparing technique), lack of emission, lack of ejaculate, ejaculating urine, pain on orgasm and, infertility. Additionally, there are potential penile issues such as a shortened penis, penile pain, numbness, curvature and, wasting. Also, there is the likelihood for testicular pain and bladder problems such as urinary leakage, bladder neck scarring, bladder stones and infections. Even worse, in some 11–48 percent of cases patients have wasted their time because the cancer was removed incompletely and they were left with a positive margin. An even greater list of complications can be expected in those with locally advanced disease and “advised” (without objective evidence for life extension) to undergo surgery to remove as much of the prostate as possible (“debulking”) and then, to “mop up” residual cancer with radiation and testosterone suppression. A similar list of troubles and also without evidence for life extension can be expected in those advised to have a “salvage” prostatectomy because residual or recurrent cancer was detected after another form of treatment. Tragically, the many complications associated with robotic-assisted prostate cancer surgery impact not only the patient but also the wife, partner or girlfriend to a degree that can strain and even break up the relationship.
Are There Many Warnings About Prostate Cancer Surgery?
In step with the findings that prostate cancer surgery fails to save significant numbers of lives and is associated with many complications, Robert Aronowitz, an internist and medical historian published, “Screening for Prostate Cancer in New York’s Skid Row: History and Implications”. Here, troubled about prostate cancer screening and treatment effectiveness he made the observation that, “our screen-and-treat paradigm in prostate cancer is evidence-challenged”.
Additionally, the many dangers associated with robotic prostatectomy have been clearly recognized by the legal fraternity as well Government oversight agencies. Not only are there many lawsuits linked to surgeons and hospitals regarding robotic prostatectomy and its complications but, the FDA’s MAUDE (Manufacturer and User Facility Device Experience) site has recorded numerous issues regarding robotic prostatectomy despite only about eight percent of actual adverse events being listed there because of the website’s complexity. Also, the USPSTF (United States Preventive Services Task Force) has expressed deep reservations about the PSA-based prostate cancer screening program and the treatment of screen-detected cancers because “the benefits do not outweigh the harms”. Furthermore, Dr. Otis Brawley from the American Cancer Society, Dr. A. Horan, “The Big Scare” and, R. Ablin and, R. Piana “The Great Prostate Hoax” have all recorded in glaring detail not only the many dangers associated with prostate cancer screening and the surgical treatment of prostate cancer but, questioned its effectiveness as well as the impact of financial conflicts-of-interest surrounding the prostate cancer industry. Even the robotic device-maker is fully aware of the dangers of the robotic tool for prostate cancer surgery as its list of disclaimers grows with every website revision.
https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/prostate-cancer-screening https://www.fda.gov/downloads/training/cdrhlearn/ucm234355.pdf http://annals.org/article.aspx?articleid=1166177 https://www.nytimes.com/2013/10/18/health/medical-experiments-conducted-on-bowery-alcoholics-in-1950s.html
Scare-Tactics and Rot in the Prostate Cancer Narrative
Scare-tactics are the fuel for the business of prostate cancer. The rot in the prostate cancer narrative began with the report, “The Early Diagnosis and Radical Cure of Carcinoma of the Prostate” by H. H. Young at Johns Hopkins Baltimore where, despite providing zero evidence for early diagnosis and cure, Young concluded that the radical prostatectomy resulted in “remarkably satisfactory functional results furnished”. Even worse than these bare-faced lies, his first two patients died (one postoperative and the other after being treated for a complication common to this procedure) while the remaining two men were left with debilitating urinary issues. Shockingly, these complications and others are still all too common today and leave most men with severe regret for having been railroaded into surgery.
More rot concerning prostate cancer came about with the use of the all-inclusive prostate cancer label. While a few high-grade prostate cancers are potentially deadly, most prostate cancers are not and some actually fail to behave as cancerous. In fact, although appearing mildly cancerous under the microscope the Gleason 6 “cancer” fails to act like a cancer because on both clinical and molecular biology grounds the Gleason grade 3 in the Gleason 3+3=6 “cancer” (Gleason 6 or, G6) LACKS the hallmarks of cancer. Furthermore, there is no objective evidence that the Gleason 6 can change into one of the few aggressive high-grade types of prostate cancer.
What About Screening for Prostate Cancer? Can Early Detection Possibly Bring About a Cure?
More rot. The illogical DRE (digital rectal exam) finger examination of the prostate has the same accuracy as a coin-toss while the PSA (prostatic specific antigen) is a highly UNRELIABLE prostate cancer screening test with a 78 percent false positive rate. Not only is the PSA NOT cancer-specific and lead to the detection of mainly benign and non-lethal diseases but, the few important high-grade prostate cancers are often missed as they commonly make little or no PSA. Furthermore, the unscientific ultrasound-guided 12-core prostate needle biopsy samples randomly and blindly only some 0.1 percent— 0.3 percent of the total prostate to leave one absolutely ignorant about the 99 percent rest of the prostate.
In fact, urologists themselves have already concluded from the study, “Mortality Results from a Randomized Prostate-Cancer Screening Trial” that “PSA-based screening results in a small or no reduction in prostate cancer specific mortality”. In other words, PSA screening fails to save significant numbers of lives. A situation that has not been bettered by the many other and often costly prostate cancer biomarkers and genome tests available.
MRI Screening for Prostate Cancer
The prostate non-contrast MRI (but only in the right hands) is the most dependable (almost foolproof) device for screening and detecting the 15 percent 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 — a feature which makes the MRI an ideal surveillance tool to monitor existing low-risk 3+4 cancers or, for detection of possible “field-change” effects and the uncommon development of a higher grade cancer at some future time. Any high-grade areas identified can then be targeted for needle biopsy under real-time 3T MRI for pathological confirmation as only these particular prostate cancers demand detection and treatment – commonly now, with MRI-guided focal therapy.
Prostate Cancer – The Dark Art of Medical Deception
The marketing of the all-inclusive prostate cancer label with sensationalizing statistics such as 2nd leading cause of death after lung cancer, 2nd most common cancer in men after skin cancer results in about 30 million PSA tests per year and over one million prostate biopsies – with costly complications. At anyone time in the U.S. it is estimated that some three million men live with prostate cancer because the five year survival is estimated at near 100 percent while the 10 year survival is estimated at 98 percent regardless of the type of so-called treatment. The source of all the confusion here is the continued use of the all-inclusive prostate cancer label when the fact is that only high-grade prostate cancers should be detected and treated as only they are potentially lethal – causing some 30,000 prostate cancer deaths in the U.S. annually. Regretfully, the prostate cancer dogma that labels as standard-of-care a PSA-based prostate cancer screening program that is associated with a 78 percent false positive rate and a highly unscientific and risky prostate needle biopsy test that samples blindly and randomly only about 0.1 percent of the prostate simply broadcasts the embarrassing stupidity of physicians.
Trying to detect prostate cancer early to save a life potentially is a very worthy goal. However, the evidence shows clearly that men have been severely mislead about several prostate cancer issues. Not only does PSA screening lead mostly to the detection of everything but the few important potentially deadly high-grade cancers except the common Gleason 6 “cancer” fails to act like a cancer while the robotic-assisted prostatectomy “treatment” is neither safe nor saves significant numbers of lives. Sadly, while it took some seventy years or so for surgeons to quit doing radical surgery for breast cancer because the harms outweighed the benefits urologists still railroad men towards radical robotic surgery for treating prostate cancer despite its harms outweighing benefits
Horan, A., The Big Scare. The Business of Prostate Cancer
Ablin, R. and Piana, R., The Great Prostate Hoax
Barrett, S. and Jarvis, W., The Health Robbers
Bert Vorstman BSc, MD, MS, FAAP, FRACS, FACS