WHICH PROSTATE CANCERS NEED TREATMENT?

The very common Gleason 3+3=6 prostate “cancer” is NOT a health-risk because on both clinical and molecular biology grounds, the Gleason 3+3=6 disease LACKS the hallmarks of a cancer. http://www.ascopost.com/issues/june-10-2016/prostate-cancer-opinions-vary-on-gleason-scores-and-surgery/ Shamefully, the Gleason 3+3=6 “cancer” label has been retained to have you believe that it has the same potentially lethal risk as high-grade prostate cancers.http://www.ascopost.com/issues/december-25-2016/a-gleason-6-tumor-is-it-cancer-and-should-it-be-treated/

Only the less-common high-grade prostate cancers demand detection and treatment as only the high-grade prostate cancers are a health-risk and potentially lethal. Only this category of prostate cancer is connected to prostate cancer death statistics. Although prostate cancer is the second most common cancer in men, most of these cancers are NOT a health-risk and only 3% of men diagnosed with cancer will die from their disease. The other 97% will die from another cause.
Read more from our Introduction to Prostate Cancer

WHY RADICAL (ROBOTIC) PROSTATECTOMY IS NOT FOR YOU

The simplistic “cutting it out” concept is deceptively attractive and intuitively reasonable but horribly false. The dastardly underhanded promises of easy surgery and easy recovery from surgeons who wish it were true will leave most men suffering from miserable complications, limp, leaking and robbed of quality-of-life.

Most prostate “cancers” are the Gleason 3+3=6 and clinical and molecular biology studies have shown that this disease LACKS the hallmarks of a cancer. Yet, most men with this Gleason 3+3=6 disease will undergo a toxic robotic prostatectomy as if they had a real cancer. To boot, the robotic prostatectomy device was fraudulently approved by the FDA for use in prostate cancer on the basis of some irrelevant gallbladder studies. Only high-grade prostate cancer is potentially lethal, demands detection and demands treatment but not with the robotic prostatectomy.

THE PSA BIOMARKER FOR PROSTATE CANCER

The prostatic specific antigen (PSA) is a blood-test biomarker originally FDA-approved for use as a measure of prostate cancer activity NOT prostate cancer detection.
PSA-based screening for prostate cancer detection is highly UNRELIABLE.

The PSA is not prostate-specific and often fluctuates. The bigger the prostate, the greater the PSA. The so-called normal levels of 0-4 ng/ml are arbitrary and many situations can raise the PSA in the absence of cancer while other situations can lower the PSA without guaranteeing protective value.

PSA-based screening may be somewhat more informative by measuring several PSA formats before considering an mp-MRI and or, a prostate biopsy. The following PSA tests when considered together may improve screening reliability; the total PSA, PSA derivatives (free and percent free), PSA kinetics (velocity and doubling time), PSA density, age specific values, PCa3 test and evaluating the PSA after a 3 month course of finasteride (proscar). Sometimes this requires monitoring over some time before an MRI/ biopsy is considered.

Made Sick from Prostate Cancer Awareness and Screening
Prostate Blog

MRI PROSTATE CANCER DETECTION AND TARGETED BIOPSY

MRI is magnetic resonance imaging using a magnetic field and radio waves. Currently, the latest 3T MRI studies include diffusion-weighted imaging and dynamic contrast enhancement ie multi-parametric MRI (mp-MRI), to produce detailed images. These studies are undertaken in the supine position without and with intravenous gadolinium contrast. mp-MRI studied regions of the prostate not detecting disease have about a 95% probability of being free of clinically significant prostate cancer. Since the very common Gleason 3+3=6 disease LACKS the hallmarks of a cancer, it does NOT need detection or treatment. Only clinically significant high-grade prostate cancer requires detection and treatment. The mp-MRI imaging is superior to standard trans-rectal ultrasound (TRUS) imaging. Compared to mp-MRI, some high-grade cancers can be missed with the random biopsies taken using TRUS imaging. Before undertaking an mp-MRI study following a biopsy, a waiting period of 6-8 weeks is required to allow healing. mp-MRI suspicions and PSA-density are significant predictors of prostate cancer.

Tumor Focality
Prostate cancer is for the most part, a multifocal disease meaning it can exist in several areas of the prostate. The PSA is not significantly different between men who have multifocal disease compared to unifocal. About 20% of men have a unifocal cancer. The largest cancer lesion in the prostate is the index lesion and usually it is the dominant area of cancer determining outcome.
The index lesion predicts the clinical outcome in some 90% of men.

The secondary foci of cancer within the prostate usually do not meet criteria for clinical significance (greater than 0.5cc). Multifocal cancers whether bilateral or not, are not more significant than unifocal. The presence of secondary foci of cancer appears not to impact recurrence rates. At present, there is no long-term data to confirm that treating only the index lesion is adequate although there is some information to suggest that this could be so.

NEGATIVE prostate mp-MRI
monitor PSAs
SUSPICIOUS mp-MRI for prostate cancer and targeted biopsy
Can be returned to MRI suite at same visit if mp-MRI shows a suspicious area.
* risks of prostate needle biopsy discussed, hematospermia, hematuria, urine infection, urinary obstruction, rectal bleeding, fever & chills 1
* no symptoms of acute illnesses
* no anticoagulants
* enema prior to procedure
* IV antibiotics
* oral sedation
* TRUS-guided periprostatic nerve block
* placed in MRI in prone position
* a needle sleeve biopsy guide is placed in the rectum and secured with the localization device to the MRI table
* T2 MRI axial and sagittal images are acquired
* coordinates for biopsying suspicious areas are generated by the software and localizer adjusted
* the 14g hollow needle/trochar is inserted into target lesion and biopsy gun used to take a needle biopsy
* additionally, a random sextant 12-core biopsy is taken till MRI imaging for detecting only the high-grade prostate cancers is full-proof
* post-evaluation patient is sent home if in satisfactory condition and voiding, on antibiotics
* all biopsy slides are sent to a recognized prostate cancer reference laboratory for validation of diagnosis

FOCAL PROSTATE CANCER THERAPY

Focal therapy of prostate cancer is possible using LASER, CRYOABLATION or HIFU. Currently, only focal cryoablation is reimbursed by insurance companies. Focal laser and HIFU may be reimbursable in some cases. In contrast to the debilitating complications associated with radical whole gland treatment by either radical surgery/robotic prostatectomy or radiation, focal therapy enabled through MRI imaging, has the ability to identify potentially lethal localized high-grade prostate cancers for eradication and potential for cure while maintaining quality of life.

Prostate Cancer