Undependable Prostate Cancer Detection and Diagnostic Methods
Unreliable biopsy and imaging reports are additional major concerns in the prostate cancer arena. You will recall from the article “Unreliable PSA-based Screening Prostate Cancer Hoax Part 1” that PSA-based screening and the prostate biopsy although labelled as “standard practice” are both highly unreliable. https://urologyweb.com/unreliable-psa-based-screening-prostate-cancer-hoax-part-1/
Let’s move on and look at the next steps taken after the biopsy and so-called diagnosis of prostate cancer.
Are prostate biopsy and x-ray/imaging reports reliable? NO, they are not.
- Your biopsy specimens are read by a pathologist who has to make a judgment call. However, he or she can make incorrect diagnoses because of inadequate knowledge and/or 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 appearances of the two most common patterns of growth seen (each arbitrarily graded 1–5, with 5 being the most aggressive) on the slide under the microscope. These two grades are then combined to give a Gleason score (for example, for the two patterns seen, there may be a Gleason grade 3 and the next most common pattern may also be a grade 3. These grades are then combined for a Gleason score of 6 or, 3 + 3 = 6).
- Since the biopsy reading is very dependent upon the individual ability of the doctor, incorrect judgements of cancer grade, Gleason score, cancer amount (volume), core length and/or, whether a cancer is even present are possible. Furthermore, although other background findings such as atypical small cell acinar proliferation (ASAP), high-grade prostatic intraepithelial neoplasia (HGPIN) and perineural invasion 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 grades of cancers can benefit from treatment.
- Because of possible errors-of-interpretation and because treatment is predicated upon knowing what type of prostate cancer you have, getting prostate biopsy findings confirmed and validated by a recognized leader in prostate cancer pathology is highly recommended.
- Radiologists studying and interpreting your imaging studies like CAT scans and bone scans also have to make judgement calls and can make incorrect diagnoses because of inadequate knowledge and or because of errors-of-interpretation.
- Staging of prostate cancer on the basis of CAT scans and bone scans is undependable, unhelpful and too insensitive for detecting small-volume cancer spread. The fact that this is so has been underscored by bone marrow aspiration studies and the use of sophisticated staining techniques. These tests have demonstrated that some men who were believed to have high-grade cancer localized to the prostate on the basis of CAT scans and bone scans did in fact have cells in their bone marrow already. These metastatic cells can lie dormant in the bone marrow for years before some of them activate and spread.
- The PMSA PET/CT scan and the Whole Body Diffusion MRI studies are next generation techniques for detecting small-volume spread to lymph nodes and bones. Only these two imaging studies are sensitive and reliable enough to be used in staging and the detection of metastatic prostate cancer. https://www.ncbi.nlm.nih.gov/pubmed/16372494
You will now appreciate that there are significant concerns about the accuracy of your pathology and imaging reports. Let’s move on.
Are all prostate cancers deadly? No, they are not.
First and foremost, the term prostate cancer is highly misleading as it gives the impression that all prostate cancers are a danger to your health when some actually fail to behave as cancerous. Therefore, many so-called cancers do NOT need detection or treatment.
The common Gleason 3+3=6 is NOT a real cancer – it’s a bogus cancer.
Despite low-power microscopic appearances suggesting a mild cancer, the Gleason grade 3 as in the Gleason 3+3=6 “cancer” (Gleason 6 or, G6) LACKS the hallmarks of cancer on both clinical and molecular biology grounds (L. Klotz MD).
- The G6 cell has a very long doubling-time of 475 +/- 56 days so that from mutation to a growth of about one cm (smaller than half an inch) in diameter takes some 40 years.
- About 50 percent of 50 year-old-men have unrecognized and asymptomatic areas of G6 disease in their prostate.
- The prevalence of G6 increases with age.
- That the G6 fails to evolve and harm men suggests it’s part of the aging process.
- Because of these findings, there is NO justification for continuing to call the Gleason 6 either a cancer or a low-risk cancer.
- Because of this knowledge the G6 doesn’t need treatment. In fact, those unfortunate men who were treated for their Gleason 6 disease are survivors of their treatment and not survivors of the bogus cancer.
- All prostate cancer statistics are false as they include the bogus G6 cancer.
The real prostate cancers are the 15 percent or so of potentially lethal high-grade cancers. These are maybe some 4+3s but more so 4+4s, 5+4s and 5+5s. These high-grade cancers can have the genes to metastasize early since prostate tumors as small as two millimeters have been shown to have cells in the bone marrow already.
In between the high-grade cancers and the G6 pseudo-cancer is a group of so-called intermediate-risk prostate cancers. Be aware that there are two very different Gleason 7 cancers here and especially, remember to always get a second opinion from a recognized pathologist and expert in prostate cancer.
- The 3+4=7 behaves very much like the bogus G6, particularly in those with low volume pattern 4 disease. These can be monitored with periodic MRI surveillance as most if not all men will outlive this low-risk prostate cancer. However, we are not clear as to what percentage of pattern 4 disease is significant enough for the 3+4 to deserve treatment. Be wary of urologists using fear-mongering to profit from treatment.
- The 4+3=7 is very different from the 3+4 and appears to behave much more like the high-grade Gleason 4+4 and may need attention.
- Also, recall from the Part 1 article that the 15 year prostate cancer 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.
Is there anything that may control or prevent prostate cancer?
We’re not sure as objective studies to answer this question have not been done. However, it is believed that eliminating animal fats and adopting a vegan diet MAY help with so-called prostate health and in the prevention and control of prostate cancer progression. Many men on surveillance for low-risk cancers commonly add this lifestyle change to their management.
By now you will realize that,
- PSA testing and the ultrasound-guided prostate biopsy are hopeless for the accurate detection of high-grade prostate cancer.
- There are serious concerns about the accuracy of your pathology and imaging reports.
- Only significant amounts of grade 4 cancer and above are potentially deadly.
- Only SOME prostate cancers MAY need treatment.
What steps can I take to REALLY KNOW what is going on in my prostate?
Coming soon, Prostate MRI Imaging, Prostate Cancer Hoax Part 3
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”
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Bert Vorstman BSc, MD, MS, FAAP, FRACS, FACS