Prostate Cancer Treatment -Deception and Lies
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 and, many don’t need detection or treatment. 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 encouraged a few 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 patients will hear is the terrorizing cancer word.
Which prostate cancers fail to act 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 and, inserting the bogus G6 under the all-inclusive “prostate cancer” tag or, labeling it as a low-risk cancer is very, very deceptive.
Unfortunately, ill-informed patients and amoral doctors hiding behind pseudonyms continue to poison the prostate cancer “information” well on forums and “support” groups with their spin on prostate cancer screening, detection and treatment. Shamefully, this trade in junk science only serves to mislead the vulnerable and rob them of their health. In fact, other physicians have long suggested that, because the G6 fails to behave as a cancer clinically, it should NOT be labelled as a cancer. In addition, the bogus G6 should NOT be included in prostate cancer statistics; not be screened for; not detected and, not treated.
Which prostate cancers are potentially deadly?
Only the 15% or so of high-grade/high-risk 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.
Aside from these important high-risk prostate cancers there are some that have a mix of grade 3s and 4s and are grouped into the so-called intermediate-risk category — as opposed to low-risk and, high-risk. This intermediate-risk Gleason 7 category actually includes two very differently behaving prostate cancers; the 3+4=7 and, the 4+3=7. First, the 3+4 tends to behave like the bogus G6 especially when it has 10% or less of pattern 4 disease and usually only requires monitoring with surveillance MRIs (the exact amount of pattern 4 to be significant is yet to be determined). Second, the 4+3 behaves more like the high-risk Gleason 4+4 and, should be considered for treatment.
The hoax of PSA-based screening
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 (like many biomarkers such as the PCa3; anything based upon the unreliable PSA, 4k tests and others including genome testing). 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 — this book describes in great detail the medical misconduct and dirty deeds undertaken to get the PSA FDA “approved”). However, although a much better biomarker is needed badly, there may be some usefulness in monitoring PSA densities and following serial PSAs. 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. Lastly, screening and detection guidelines for prostate cancer must always be constrained by a full consideration of the patient’s co-morbidities and life-expectancy because many of these cancers grow slowly. Furthermore, not only are the treatments commonly worse than the disease but, they are are often unneeded.
The highly unreliable prostate 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 feeble test every few months during so-called surveillance makes no scientific sense; can be very uncomfortable; 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 “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 and surveillance” 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 blind and unable to identify high-grade prostate cancer (nor is the 3D color doppler able to detect only high-grade cancer) but, despite the knowledge that prostate cancer often develops in more than one area of the prostate and or, at different times (not unlike a bladder cancer), this blind needle biopsy “test” samples randomly only some 0.1% — 0.3% of the prostate to leave one absolutely uninformed about the 99% rest of the prostate — especially for the anterior portion of the prostate. Even 120 needle biopsies would sample only about 1% of the prostate. Worse still, not only do many men find this “study” embarrassing and painful but, 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; rectal bleeding requiring cauterization; erection issues and or, depression. Shamefully, how a blind needle biopsy of the prostate sampling RANDOMLY only about 0.1% of the prostate was ever determined to be scientific, “standard” or, following medical guidelines for detecting high-risk prostate cancer is beyond bizarre and indefensible. Not surprisingly, current European guidelines demand an MRI study before any TARGETED prostate needle biopsy is undertaken.
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 (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 or, 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 cancers can benefit from treatment. However, 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 MRI is a sham
The “reasoning” behind “active surveillance” are the facts that most low-risk prostate cancers don’t need treatment as you are most likely to outlive them; most “treatments” are worse than the disease itself and, you are much more likely to be hurt during this screening, detection and treatment process than having your life “saved”. So, if instead of rushing someone with a low-risk cancer (the G6 should never be classed as low-risk since 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, 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 — field change effects. 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 unscientific information is simply ludicrous since something else could be going on in the over 99% of the prostate that was unevaluated. Therefore, it is completely understandable why there is so much confusion about whether a previously detected G6 or low-risk cancer has suddenly 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 was impacted by gross sampling errors (ie failing to detect a small area of high-risk cancer since 99% of the prostate was unevaluated by the blind and random 12-core needle biopsy); new areas of cancer have developed because of field change effects 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 MRI is not available for you, stable PSA densities and PSAs would suggest that your disease is not changing while abnormal PSA densities and or, persistently rising PSAs may indicate a change that demands an MRI evaluation.
Regretfully, the current “standard” surveillance process using unreliable PSAs, DREs and blind and random 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 compassionately, 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 MRI
To date, the newer versions (versions 3–5) 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. This is important since granulomatous prostatitis, can mimmic a cancer on an MRI study.
On the other hand, random/template biopsies are NOT part of an MRI study and, those urologists advocating a 0.1% RANDOM sampling of the prostate in addition to the 3T MRI study and any possible MRI-guided TARGETED biopsy in case “something should be missed” are simply using pseudo-science to create confusion and doubt in order to preserve their income stream. Should there be concern for any “missed” disease, a follow up 3T MRI at a later date would be the most useful and scientific surveillance approach.
Furthermore, although other MRI “detection” options such as those using an older 1.5T MRI; an endorectal coil MRI or, that incorporating technology (“fusion technology”) to fuse a previous MRI study to a real-time trans-rectal ultrasound procedure for possible 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 such as the bone scan and CAT scan lack sensitivity and, commonly fail to detect microscopic amounts of high-grade spread leading to the false impression that the cancer is still contained 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 treatment is a hoax
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 horribly skewed. Worse yet, the men pushed into getting robotic surgery for their bogus G6 cancers are not survivors of a “cancer” but, survivors of their brutal “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 Johns Hopkins 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; only became “standard practice” because urologists parroted the myth about surgery being safe and effective so often that they eventually convinced themselves that it was true; 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 also as a “standard” medical treatment. A terrible lie since urologists know full well that it is impossible to function normally after the prostate has been “cut out”. As well, its a shocker for patients and their wives/partners only after the fact, irreversible and, will be remembered by them as the worst healthcare decision they ever made — see book by A. Horan M.D., The Big Scare — this book describes the history of the brutal radical prostatectomy and, the many barefaced lies told by surgeons about its safety and effectiveness.
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, commonly more surgery to fix failed implants and pumps. Even more revealing, urologists were clearly concerned about the many dangers associated with their radical prostate surgery since they developed a number of techniques to improve survival and 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 surgical complications. Issues and troubles that the robotic device manufacturer were also very well aware of since the list of disclaimers and warnings on the manufacturers’ website is extensive and, gets longer with each site revision. 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 high-grade cancer has returned. Shamefully, 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 dangers and warnings concerning robotic prostatectomy
Aside from these many 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 postoperative course of radiation to try and treat this residual cancer.
Not only are these many 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. Furthermore, 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.
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 concerning imaging discussed previously), one can return to the recent 3T MRI (or, if you have not had an MRI wait a number of 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 high-grade cancer(s) and see if the area(s) can be treated with focal therapy (a male “lumpectomy”). If so, MRI-guided focal laser ablation (FLA); MRI-guided trans-urethral high intensity focused ultrasound (HIFU) — see the TULSA-PRO https://profoundmedical.com/new-tulsa 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 (not seeds) with or without testosterone suppression injections such as lupron/eligard (every few months for about 12 months — this androgen deprivation therapy or ADT) is usually recommended. However, these testosterone suppression medications should only be considered when facing significant amounts of high-grade/high-risk prostate cancer and, with caution as some men can develop severe mood swings, depression along with several other significant side effects. Finally, although high-risk/high-grade prostate cancers are the only prostate cancers worthy of treatment, choosing a focal or whole gland treatment can be confusing because scientific evidence-based data scoring risks and rewards and proof of health benefit from patient studies stratified according to validated identical pathology and tumor amount is deficient.
Unproven prostate cancer care, money and medicine
Current prostate cancer screening, detection 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”, in total disregard of accepted physician codes-of-conduct, continue to prescribe and deliver outdated and unproven medical “care”. In fact, the stupefying dogged determination of urologists to rely on junk science as a justification for using highly unreliable PSA-based screening, cancer detection methods using blind, 0.1% random biopsy sampling of the prostate and robotic treatments that are unproven and toxic, is not only mind-numbing and embarrassing but, broadcasts their ignorance.
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 they could own the physicians, then maybe they could “encourage” these doctors to “work harder” and, tap into even more profits. Not surprisingly, greedy companies soon snapped up as many physicians and practices as they could and then quickly 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 and unaccountable 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 and 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, unproven and dangerous “treatments” of mainly the 85% of bogus and non life-threatening prostate cancers. Propaganda turbocharged by a powerful industrial-medical complex and, whose self-serving prostate cancer information simply drowned out the important public health warnings from Government oversight agencies such as the USPSTF. Sadly, these events underscore the fact that modern healthcare has become much less about health and much more about profit-driven, orchestrated deception for services.
Must Reads
Barrett, S. and Jarvis, W., The Health Robbers
https://www.nejm.org/doi/full/10.1056/NEJMoa0810696
https://www.nejm.org/doi/full/10.1056/NEJMoa1113162
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4708232/
Horan, A., How to Avoid the Over-diagnosis and Over-treatment of Prostate Cancer
Horan, A., The Big Scare. The Business of Prostate Cancer
Ablin, R. and Piana R., The Great Prostate Hoax
Bert Vorstman BSc, MD, MS, FAAP, FRACS, FACS