When treatments are worse than the disease –
Treatment deception, prostate cancer hoax. You will recall from the articles “Unreliable PSA-based Screening Prostate Cancer Hoax Part 1”, “Unreliable Biopsy & Imaging Reports Prostate Cancer Hoax P.2” and the “Prostate MRI study, Prostate Cancer Hoax P.3” that there are very significant concerns about PSA-based screening, ultrasound-guided prostate biopsies and so-called fusion MRIs for being able to detect only the 15 percent or so of potentially deadly prostate cancers.
How doctors injure patients chasing prostate cancer.
The history of medicine has recorded numerous examples where doctors failed to challenge conventional wisdom and demand objective evidence to guide patient management. The dangerous prostate cancer screening program is a prime example where patients have been severely misled by physicians.
- The prostate exam (digital rectal exam or DRE) is as reliable as a coin-toss.
- The PSA (prostate specific antigen) has a 78 percent false-positive rate.
- The ultrasound-guided prostate needle biopsy samples randomly only 0.1 percent of the prostate leaving doctors clueless about the remaining 99.9 percent.
- The shock value of a cancer label can be overwhelming and although some predatory doctors use fear-mongering to push patients into unneeded treatments, patients need to relax as for most men the label is NOT a death sentence.
- The common Gleason 3+3=6 “cancer” although called a cancer fails to behave as a cancer and doesn’t need detection or treatment. Men treated for this cancer are survivors of the “treatment” and not the bogus cancer.
- Only the 15 percent or so of prostate cancers are potentially deadly high-grade cancers and only they are responsible for some 30,000 deaths in the U.S. each year.
- Many high-grade cancers fail to produce much, if any, PSA so escape detection.
- The PSA screening protocol for prostate cancer is ineffective, fails to save significant numbers of lives and only injures millions of men.
- The robotic prostatectomy is one of several treatment options that lacks objective evidence for safety and benefits.
- FDA “approvals” for the PSA and robotic device facilitated a global public health disaster.
How to detect the few potentially deadly high-grade prostate cancers.
Although unreliable, upward trending PSAs and a PSA density (PSA divided by prostate size) of 0.16 or more may suggest the need for an MRI of the prostate by an expert.
- Get a real-time MRI study of the prostate by an expert – NOT the “fusion” study.
- Get an MRI-guided biopsy of any PI-RADS 4 and or, 5 areas seen.
- The Gleason scoring system for cancer aggressiveness is complex and because of observer error and inadequate knowledge amongst some pathologists all biopsies should be validated by a second opinion from an expert.
- The PI-RADS or PIRADS is a COMPLEX MRI scoring system where T2, diffusion weighted and dynamic contrast changes in the transition and peripheral zone of the prostate are judged for potential aggressiveness. Here too patients may be misinformed and harmed because of observer error and inadequate knowledge amongst some radiologists.
How do you know if your high-grade prostate cancer is contained?
- Get a metastatic workup with a PMSA PET/CT scan to see if there has been any spread to pelvic lymph nodes and a whole body diffusion MRI study to see if there has been any spread to the bones.
- The “standard” CAT scan and bone scan are too insensitive, unreliable and unhelpful when used to determine if a cancer is localized.
Is the treatment of prostate cancer an emergency?
Treatment doesn’t appear to be an emergency. However, most if not all studies included various grades of prostate cancer and not just high-grade.
- The 10-year survival of prostate cancer generally is estimated at about 98 percent while the 15-year survival is estimated to be about 96 percent REGARDLESS of the type of treatment.
- Even more stunning is the revelation that NO treatment has a similar 10-year survival to someone who did have treatment.
Why are treatments for localized high-grade prostate cancer listed as “options”?
- When there are treatment “options,” the so-called shared decision-making process between patient and doctor is clearly a sham.
- When there are treatment “options,” you will realize immediately that no one has objective evidence for safety or effectiveness.
Why are all prostate cancer treatment options scientifically unproven?
Despite the charade of FDA approved, standard-of-care and insurance authorized, there is NO objective data for proving the effectiveness and life-saving ability of any prostate cancer treatment option for high-grade disease BECAUSE:
- Most, if not all, prostate cancer diagnoses have been based upon the blind ultrasound-guided prostate needle biopsy sampling randomly only 0.1 percent of the prostate. And, because a different grade of cancer may have been going on in the 99.9 percent rest of the prostate that was not biopsied, doctors were clueless as to what they were really treating.
- Most, if not all, “treatment” studies included a mix of Gleason grades, scores and tumor volumes. No studies have been done with validated Gleason scores and tumor volumes with identical tumor score and volume equally distributed between various treatments to get objective data for safety and benefits. (Underscoring the unreliability of biopsy reports is the fact that if the same pathologist was asked to interpret the same slides at a later date, a diagnosis different from the first one is likely. Furthermore, if the same slides are given to a different pathologist, it is not uncommon to receive a diagnosis different from that given by the first pathologist).
- Most, if not all, statistics and treatment studies included the Gleason 6 pseudo-cancer and or men treated arbitrarily with testosterone suppression. Not only can testosterone suppression produce life extension, but the treatment of Gleason 6 “cancer” will skew treatment results towards a semblance of cure.
- Most, if not all, studies have been taken out only 10 years or so and this time frame is woefully short because some prostate cancers can recur 20-30 years after a treatment.
- “Staging” or determining whether the cancer has spread or not and to what degree has invariably employed the highly unreliable CAT scans and bone scans. Because these studies are grossly insensitive they commonly fail to pick up metastatic disease and staging this way is unreliable.
- Physician bias, misrepresentations, financial conflicts-of-interest, false hope and false promises, orchestrated deception and a lack of oversight from medical boards and government oversight agencies are responsible for the public health disaster that is prostate cancer management. Think lobotomy and radical breast surgery.
- Ioannidis has established clearly that, “most published research findings are false” – because physicians assume their testing and treatment philosophy to be valid and then design their studies around this extraordinary but unfounded bias. Most, if not all, prostate cancer studies underscore poor design and false conclusions.
Personalized precision treatment of high-grade prostate cancer?
- Since we have NO objective evidence to tell us which treatment (focal or radical) is the most effective I would recommend options that are the least invasive, have a minimum of complications and are considered generally to be effective.
- The principle of “first do no harm” was never important to the prostate cancer industry and highlights why the treatment options come with endless complications.
- After your high-grade prostate cancer diagnosis is validated by an expert pathologist and the PMSA/whole body MRI scans indicate that the high-grade cancer has not left the prostate you can return to your prostate MRI (not the fusion study) to determine the number(s), size(s) and location(s) of the high-grade cancer within the prostate.
- Review of the MRI will help determine if your cancer can be treated with focal therapy or whether a whole-gland approach is preferable.
- If the MRI determines that your cancer is amenable to focal treatment, MRI-guided transurethral HIFU (high intensity focused ultrasound) or laser by an expert may be suitable. Currently, MRI-guided treatments are the most accurate, the least invasive, come with the least “limp and leaking” complications and have encouraging results. They do however require significant expertise and are not covered by insurance plans. Focal treatment using ultrasound-guided HIFU and cryoablation (freezing) are old school, less reliable, come with more complications and treatment is often incomplete. Especially, when relying on inaccurate “fusion” studies.
- If review of the MRI indicates that the high-grade prostate cancer is not amenable to MRI-guided focal therapy because of its size and or position in the prostate, proton beam or one of the external beam radiation options may be more suitable. Radioactive seeds is old school, more invasive and associated with more complications.
- Post-op management after focal therapy may be a little more burdensome with PSA monitoring and repeat MRIs to be sure that there are no recurrences. Random biopsies are not part of this follow-up.
- Robotic surgery can NOT ever be recommended as its complications and lack of life-saving ability outweigh any perceived benefits.
Why you need to stay away from robotic prostate cancer surgery.
Coming soon Robotic Deception, Prostate Cancer Hoax P5
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”
Eban, K., “Bottle Of Lies”
Your body, your rules
Bert Vorstman BSc, MD, MS, FAAP, FRACS, FACS