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Stop treating the fake Gleason 6 prostate cancer

DSC00588The Gleason 6 prostate “cancer” is NOT a real cancer.

Larry Klotz M.D. has shown irrefutably that the very common Gleason 6 prostate “cancer” is a not a real cancer for two fundamental reasons:
1. no man has died from this disease and,
2. this so-­called cancer lacks a number of molecular biological mechanisms typically found in cancerous behaving cells.

Furthermore, unlike a typical cancer cell, this cell has a very long doubling-­time at 475 +/­ 56 days so that from mutation to a growth of about 1 cm (under half an inch) in diameter takes some 40 years.
Therefore, because the Gleason 3+3=6 LACKS the hallmarks of a cancer, it is not a health­-risk, does not require detection and, does NOT require treatment.

Not indicated for any Gleason 6 disease is whole gland treatment with the debilitating and scientifically unproven robotic radical prostatectomy, radiation or proton beam. Also, focal therapy prostate cancer treatment options using cryoablation, NanoKnife, HIFU or, laser are unwarranted because the Gleason 6 is a pseudo-­cancer.

The Gleason 6 is a disease mis­labelled as a cancer.
Only the 15% or so of high­grade prostate cancers demand detection and treatment as only these types of prostate cancers are potentially lethal.
Prostate Cancer: Opinions Vary on Gleason Scores and Surgery, ASCO, June 10, 2016
http://www.ncbi.nlm.nih.gov/pubmed/26816834
http://www.urologyweb.com/which-prostate-cancers-need-treatment/
http://www.urologyweb.com/wp-content/uploads/BEWARE-BEWARE-FDA-_APPROVED_-ROBOTIC-PROSTATECTOMY-CARE-1.pdf

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the PROSTATE EXAM or DRE

the PROSTATE EXAM or DRE

Bert Vorstman MD, MS, FAAP, FRACS, FACS

The prostate exam, also known as the DRE (digital rectal exam), is considered a normal part of a man’s physical examination. However, aside from this DRE prostate exam being considered “standard” by physicians and, expected by men as part of their testing, the DRE is highly subjective and unreliable. Furthermore, the DRE is highly over­utilized in men having their Gleason 3+3=6 “cancer” managed through active surveillance since examining a prostate every 3 to 6 months or, even yearly in the face of stable PSAs, serves no useful purpose and is unsupported by any scientific data.

DRE Indications (urological)

Urinary symptoms
Elevated PSA (prostatic specific antigen)

DRE Contraindications

Unwilling patient
Anal fissure and pain
Anal stricture
Thrombosed hemorroids
Acute inflammation or prostatitis

DRE technique

I ask my patients to assume the position by bending over the exam table, pants down, shoulders down in the customary fashion. Alternatively, the prostate can be examined with the patient lying on his side or, on his back in the lithotomy position. With a gloved hand and well lubricated index finger, jelly is applied to the anus and, with steady pressure the anal canal is then entered to feel sphincter tone before advancing the finger into the rectum and sweeping the rectal walls to check for any rectal lesions. Finally, the prostate is checked.

Prostate exam

This exam attempts to estimate very roughly:
> the size of the prostate; the prostate is basically bilobar with a slight midline furrow, about 4 cm by 4 cm, somewhat walnut shaped with the widest part attached to the bladder neck and the narrowest part to the membranous urethra and, with the urinary channel running through the middle of the gland. Generally the size is poorly estimated and, is commonly described as being small, moderate or, large. Some physicians use arbitrary classifications of 1 plus, 2 plus etc, but these are meaningless. Furthermore, findings of prostate asymmetry or, unusual shapes are also within normal limits and, not a specific reason for needle biopsy. In addition, size or weight of the prostate does not correlate with the severity of urinary symptoms. On the other hand, big prostates usually mean “big” PSAs.
> degree of tenderness; to denote existence of possible inflammation.
> texture and consistency. For urologists this is the usual reason for performing a DRE but again, the interpretation of whether or not there is any nodularity or hardness to suspect an underlying prostate cancer is quite unreliable. In fact, only about 50% of so­called hard areas will be found to be cancerous after biopsy and, many of these will be diagnosed as the non health­risk Gleason 6 “cancer”.

Prostate Massage (medical indications)
> “massage therapy” for nonbacterial chronic prostatitis has not been proven scientifically to be of benefit. In fact, most chronic prostatitis is not because of an underlying chronic bacterial infection but, because of increased pelvic floor muscle activity as a consequence of stress. This muscle overactivity gives rise to feelings of perineal pressure along with mild burning and urinary frequency and, is easily treated with an alpha blocker or, low dose valium.
> prostate massage for expressed prostatic secretions (EPS) and microscopic examination and culture may be useful rarely, prior to treatment of a chronic bacterial prostatitis. The 2 and 4 glass tests are uncommonly employed now.
> prostate massage and urine specimen collection immediately following the massage is commonly undertaken for the PCA3 biomarker prostate cancer prediction test.

DRE Complications

Aside from the embarrassment that some may feel about this exam, there may be several other issues.
>fainting or vasovagal anxiety in response to the exam.
>pain because of a rectal fissure or, because of anal stenosis from previous rectal surgery or hemorroidectomy or, because of an overly
>aggressive physician with big fingers
>some may notice seminal fluid expressed from the urethra.
>some may experience short­lived, deep­seated perineal discomfort.
>seldom, there can be some urethral bleeding.
>rarely, the examiner may cause an anal tear.
>even more rarely, dilating an anal stenosis may lead to some fecal incontinence.
> infrequently, there may be some anal bleeding.
> very rarely, the exam may cause a disseminated infection.

Accuracy of the DRE

The DRE is about as accurate as a coin toss. It is very subject to observer error (open to interpretation), meaning that if you get 10 docs examining your prostate, you are likely to get 10 different opinions. Even the same urologist examining your prostate a month later is likely to give you a different opinion.

How Often Should You Have Your prostate Examined?

The prostate exam is reasonable for the initial evaluation of urinary symptoms and, or the evaluation of an elevated PSA. Subsequent DREs are of very questionable value especially for those men whose PSAs stay within their normal fluctuating limits. A repeat DRE may be reasonable when there is persistent upward trending of a PSA during follow up. Otherwise, a study from the Netherlands suggested an interval of at least 4 years between DREs was not unreasonable. Generally however, the DRE is an ineffective screening test and, no useful information is garnered from having men return every 3-­6 months (or even yearly) and subjecting them to repeated DREs as part of an active surveillance schedule for their non health­risk Gleason 6 prostate “cancer”. Such a program could be considered abusive.

Read More:
The Invasive Robotic Prostatectomy

Robotic Prostatectomy Spreads Cancer Cells

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Testing Aggressiveness of Prostate Cancer Improves Quality of Life, Study Finds

Researchers working with the Fred Hutchinson Cancer Research Center have found that the Metamark Promark prostate cancer test increases the quality-­adjusted life­-years and decreases healthcare costs for patients who are being screened for prostate cancer. In a paper published in October 2015 in T he Oncologist, the researchers showcased their findings.

According to the study, adding Promark to the existing National Comprehensive Cancer Network (NCCN) treatment guidelines for prostate cancer increased quality-­adjusted life­-years (QALY) by .04. The study also found a $730 drop in lifetime treatment costs. Interestingly, overall life-­years, not QALY, dropped slightly by adding the test to the NCCN treatment guidelines.

Focusing on quality of life improvements is important because prostate cancer is often over-treated. Patients who have the very common Gleason 6 prostate “cancer” have a disease which lacks the hallmarks of cancer and these patients should not be treated like those who have high­-grade prostate cancer. The Promark test appears to provide doctors a way to distinguish between low­ and high­-risk patients, so those who need treatment can get it, while those who do not can continue to enjoy their quality of life.

In the United States, only about one out of every seven men diagnosed with prostate cancer will see his disease progress to the point that it is life-­threatening. This event occurs only in those who have high­-grade cancer. Yet, close to 90 percent of men with Gleason 6 prostate “cancer” will undergo unnecessary invasive treatment like the robotic prostatectomy. While more doctors are embracing an active surveillance approach for the common Gleason 6 “cancer”, over treatment (unnecessary treatment) is still common.

In the past, doctors had to rely solely on the pathologists’ determination as to whether a man had a high­-grade prostate cancer or not. Biomarker tests like the Promark may allow doctors to distinguish better, potentially lethal prostate cancers from those which are not.

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Focused Ultrasound System Receives Go Ahead for Prostate Cancer Ablation

On October 9, 2015, the Sonablate 450, a high intensity focused ultrasound (HIFU) system for treating prostate cancer, received FDA approval. The Sonablate uses high intensity therapeutic ultrasound to heat and destroy the prostate cancer without damaging surrounding tissue.

The Sonablate allows doctors to carefully target the diseased tissue within the prostate, heating and destroying it while preserving the healthy tissue around the prostate gland. While not perfect at eliminating side effects, HIFU greatly reduces the risk of incontinence and impotence which are common after robotic prostatectomy. Also, because ultrasound does not use damaging radiation, the treatment can be repeated if needed.

Because this treatment was allowed only off­shore, many men had been traveling overseas to receive it. Now that the HIFU treatment option is FDA approved, it is available domestically.

Of course, even minimally invasive treatments carry some risk of side effects. Patients who have the very common Gleason 6 prostate “cancer” may be better off with active surveillance rather treatment since the Gleason 6 lacks the hallmarks of a cancer and is not potentially lethal. Patients must weigh the possible benefits of treatment against the potential side effects before pursuing HIFU or any other treatment option.

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Bacteriophage Provides Promise in Detecting Prostate Cancer

Most prostate cancers are slow­-growing and do not behave like a cancer at all. This is particularly so for the very common Gleason 6 “cancer” which which lacks the hallmarks of a cancer. This knowledge has lead some doctors to warn against routine prostate cancer screenings and automatic treatment. However, for men with the less common aggressive high­-grade form of the disease, early detection may be the key to their survival. Researchers in the United States may have found a way to use bacterial viruses to help sort this out.

Bacteriophage, which is harmless to humans, has a natural tendency to bond with cancer cells and detect PSMA, a prostate cancer flag for aggressive prostate cancer. However, the use of bacteriophages to detect prostate cancer was not effective initially due to the non­specific adhesion between the phage and certain cell surface receptors.

Researchers in the United States then found that wrapping the bacteriophage with the polymer PEG, it created a sphere around the phage to stop non­specific cell adhesion. This made detecting cells that that the bacteriophage had bonded to much easier and more accurate.

The goal is to create a bio­marker that will allow doctors to detect the presence of aggressive prostate cancers without invasive tests. If successful, the modified bacteriophage will link to cancer bio­markers in a simple blood test and allow doctors to distinguish between aggressive, high­grade prostate cancers which need treatment and, the Gleason 6 “cancer” which does not need treatment.

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​ Gleason 6 Prostate “Cancer”

The Gleason 6
The Gleason 3+3=6 prostate “cancer”, although called a cancer, fails to behave like a cancer. The Gleason 6 is the most commonly diagnosed prostate “cancer” and, on both clinical and molecular biology levels, the Gleason 6 “cancer” LACKS the hallmarks of a cancer.
The Gleason 6 “cancer” is NOT a health­risk, lacks lethal potential, behaves as a pseudo­cancer and, is commonly treated unnecessarily creating much more harm than good. Even the concept of “active surveillance” for the Gleason 6 requires review as this term implies that the 6 may behave as cancerous when it does not. http://www.cancernetwork.com/prostate-cancer/active-surveillance-not-only-reduces-morbidity-it-saves-lives

The charade of prostate cancer awareness month
September is a very dangerous month for men as they are more likely than at any other time of the year to become ensnared by the falsehoods, misrepresentations and fear­mongering of predatory urologists embarking on widespread indiscriminate and opportunistic PSA-­based prostate cancer screening. A self­serving and misguided “awareness” program which detects mainly the Gleason 6 “cancer” form of prostate cancer. A disease where urologists have chosen to retain the misleading cancer label to imply that the 6 has, or, may develop malignant potential similar to the less common high­grade prostate cancers when that is patently untrue. Compounding this exploitation of medical illiteracy by urologists and railroading men into getting “treatments” which have no meaningful benefits for the Gleason 6 pseudo­cancer, are the considerable risks and negative quality of life issues which you will live with the rest of your life. http://www.urologyweb.com/robotic-prostate-cancer-surgery-a-public-health-nightmare/

Beware PSA-based screening and debilitating “treatments”
Various sources have warned about the dangers surrounding PSA-­based prostate cancer screening programs and its debilitating treatments time and time again. From noted physicians like A. Horan MD (How to Avoid the Overdiagnosis and Overtreatment of Prostate Cancer) and Otis Brawley MD (Chief Medical Officer of the American Red Cross); the endless lawsuits filed against surgeons and the device manufacturer because of the many complications associated with the robotic prostatectomy; the scores of self­reported harms listed on the FDA’s own product safety system, MAUDE (Manufacturer and User Facility Device Experience) ­ representing only about 8% of actual adverse events; the warnings issued by the USPSTF (U.S. Preventive Services Task Force), a Government oversight agency to, the robot device makers themselves who clearly recognize the dangers associated with the robotic prostatectomy as their device disclaimers are getting longer with each revision. In essence, the treatment harms outweigh any benefits and, are commonly worse than the disease itself.

http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/prostate-cancer-screening

Grade creep and the evolution of Gleason 6 grading and scoring
In 1978, the American Cancer Society recognized the Gleason scoring system where the primary and secondary prostate cancer grades were arbitrarily scored 1­5 under the low power microscope and then these two grades added to create a Gleason score. Most prostate cancers were diagnosed as the Gleason 3 (1 out of 5 primary pattern) + 3 (1 out of 5 secondary pattern) = 6. In 2005, Gleason scores of 5 or less were no longer considered carcinoma and, by redefining certain pathological features previously assigned to the Gleason pattern 3, were now assigned to patterns 4 or 5. This arbitrary reclassification has resulted in an upgrading and an increase in the Gleason 7s category (3+4 and 4+3). In effect, today’s Gleason 3+4=7 is similar to yesterday’s Gleason 6. In fact, despite this arbitrary redefining of certain pattern features previously assigned to the Gleason 3 pattern, it is quite evident that the Gleason 3+4=7 BEHAVES like the NON health­risk Gleason 6. This fact is especially important in light of the misleading talk of possible upgrading which can be seen at times in those unfortunate enough to have been subjected to the toxic robotic prostatectomy. Most of these so­called upgrades involving the 6 however, are to the Gleason 3+4 which behaves as the Gleason 6 pseudo­cancer and, simply reflect the randomness of prostate needle biopsies and the observer error seen with pathologists. http://www.urologyweb.com/wp-content/uploads/BEWARE-BEWARE-FDA-_APPROVED_-ROBOTIC-PROSTATECTOMY-CARE-1.pdf

Decreasing prostate cancer treatment risks and improving benefits
Soon, the mp­MRI imaging of the prostate (in experienced hands) will be refined enough to be able to detect and diagnose just the meaningful high­-grade prostate cancers, dispense with the risky, random prostate needle biopsy, the subjectivity issues and observer errors associated with pathologists and, stop all the unnecessary treatments of the Gleason 6 pseudo­cancer employing the scientifically unproven robotic prostatectomy. Only the less common but important high­grade prostate cancers will be detected and then treated as an outpatient using MRI­-guided focal HIFU or laser therapy at the same sitting.

Finally, The Gleason 6 disease has very questionable significance and the detection and treatment of the Gleason 6 should be severely curtailed in order to stop the terrible consequences of debilitating treatments such as the robotic prostatectomy. The gross generalization and marketing of the all­inclusive prostate cancer label to infer that all prostate cancers have lethal potential or, could progress to become lethal, is a flagrant lie. Only, the less common high­-grade prostate cancers are potentially lethal and, greater than 50% of men dying from high­-grade prostate cancer are diagnosed at age 75 years or older. Therefore, the best awareness you could practice in order to preserve your health and quality of life is to stay away from self-­serving PSA-­based screening programs as well as those misinformed patients fooled into believing they are survivors. They are simply survivors of a “treatment” and not their Gleason 6 which never was a real cancer.

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PROSTATE CANCER UPGRADING: more fear­mongering

Prostate cancer upgrading means that a prostate cancer grade and score (or measure of prostate cancer aggressiveness) found in a surgically removed prostate gland can, sometimes, be of a higher grade than diagnosed in the initial needle biopsy of the prostate. This so­called upgrading phenomenon is marketed by urologists to imply that prostate cancer upgrading is a likely significant event and that most prostate cancers are worse than the needle biopsy suggests. This gross misrepresentation is designed to push men into seeking treatments when any treatment is often unnecessary. Unnecessary, because even though the ubiquitous Gleason 3+3=6 is called a “cancer”, this “cancer”, fails to behave like a cancer. http://www.urologyweb.com/when-cancers-behave-noncancerous/

What are the facts about prostate cancer upgrading?
> the grade and score of the prostate cancer as estimated by pathologists in the surgically removed specimen can be the same or, even of a lower grade than estimated in the initial needle biopsy of the prostate
> the most common upgrade (if it occurs) is the Gleason 3+4=7 score which in reality, behaves similar to the non health­risk Gleason 3+3=6 prostate pseudo­cancer
> less common is an upgrading of the prostate cancer to a Gleason 4+3

Therefore, rather than sensationalizing and misrepresenting how prostate cancers may be underestimated at initial presentation, the reality is that most prostate cancer upgrades are insignificant if they occur at all. In fact, you are far more likely to be mislead by your urologist into having an unnecessary debilitating treatment than having your life “saved” from an unlikely significant upgrade. Furthermore, the USPSTF has concluded already, that the risks of PSA­based screening, evaluation and treatments for most prostate cancers far outweigh the perceived benefits. http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/prostate-cancer-screening

Prostate cancer upgrading represents mostly the problem of observer error and subjective interpretation issues amongst pathologists reviewing your pathology. To a lesser degree, the sampling error associated with the needle biopsy of your prostate may add to the issue. Therefore, before considering any treatment you should obtain several pathology opinions from pathologists well versed in prostate pathology so that you may form a consensus from these opinions. Additionally, certain biomarker studies may allow an assessment of the biological potential of your pathology and or, you may undertake an mp­MRI with a radiologist experienced in prostate cancer MRI imaging. This mp­MRI imaging is especially attractive since it appears to identify only the important high­grade prostate cancers which demand treatment and ignores the non health­risk Gleason 3+3=6 pseudo­cancer which does not require treatment. Also, should you have a small, high­grade prostate cancer which was missed on your needle biopsy, expert monitoring will detect it in a timely fashion to allow focal therapy.

The sensationalizing of prostate cancer “upgrading” comes hard on the heels of a long line of reprehensible scare tactics and half­truths marketed by the prostate cancer industry. All of these many misrepresentations are designed to give you the impression that you are dealing with a disease worse than it is or, has the potential to progress quickly.

For example:
> urologists calling the most common prostate cancer, a “cancer” when it behaves as noncancerous. In fact, the very common Gleason 3+3=6 prostate “cancer” LACKS the hallmarks of a cancer on both clinical and molecular biology grounds. It is a pseudo­cancer, is not a health­risk and does not progress. http://www.cancernetwork.com/prostate-cancer/active-surveillance-not-only-reduces-morbidity-it-saves-lives

> grade “creep”. This represents mostly grade inflation and subjective interpretation errors on the part of pathologists reviewing the initial prostate needle biopsy sample. In other words, some pathologists are assessing a higher grade to your prostate cancer in the needle biopsy than actually exists or, they are assigning higher grades to the same disease compared to what they did in the past. This issue is similar to prostate cancer “upgrading” but whereas “creep” is an inflated grade based upon your initial biopsy the so­called upgrade is inferring that the cancer grade found in your surgically removed prostate is greater than was originally believed from your initial needle biopsy sample. Both “creep” and “upgrade” are used to mislead you into getting treatment or, have you believe that you made a good choice after undergoing a debilitating treatment. http://www.urologyweb.com/prostate-cancer-grade-creep/

> inflating the incidence and significance of most prostate cancers. Men do not die from the Gleason 3+3=6 prostate pseudo­“cancers”. In fact, only 3% of all men with a prostate cancer label in the US will die from their disease but, only if they have the high­grade form of the disease. Unfortunately, the misrepresentations about prostate cancer and the toxic radical prostatectomy treatment will cause an additional 3,000 deaths within 30 days of this misguided surgery each year because of its many complications, according to A. Horan MD, “The Big Scare. The Business of Prostate Cancer”.

> implying that the FDA approval for the robotic assisted radical prostatectomy was based upon scientific studies involving prostate cancer when this FDA approval for the robotic assisted radical prostatectomy was based upon low­level gallbladder and Nissen fundoplication studies only. In fact, the fraudulent approval of radical surgery/robotic prostatectomy comes with more false hope and complications than for any other cancer operation. http://www.urologyweb.com/wp­content/uploads/BEWARE­BEWARE­FDA­_APPROVE D_­ROBOTIC­PROSTATECTOMY­CARE­1.pdf

In addition to these gross misrepresentations by urologists have been a slew of underhanded and reprehensible actions on their part attempting to influence and undermine Government oversight agencies such as the FDA and the USPSTF. As well, there was the egregious torpedoing of the minimally invasive HIFU application by FDA urology panelists attempting to protect their radical prostatectomy franchise. http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/MedicalDevic es/MedicalDevicesAdvisoryCommittee/Gastroenterology­UrologyDevicesPanel/UCM420537.pdf

Also, there was the unconscionable influencing of Senate Staff attempting to capitalize on their medical illiteracy and, through a National Prostate Cancer Council, have them initiate a pushback on the USPSTF so urologists can continue their self­serving but misguided PSA­based screening for prostate cancer. A prostate cancer screening program which has a much greater probability of causing harm than from the remote possibility of saving a life. http://urologytimes.modernmedicine.com/urology­times/news/prostate­cancer­council­bil l­earns­aua­support?page=full

Finally, more and more men are wise to the fact that the common Gleason 3+3=6 “cancer” is not a health­risk, grossly overtreated and, should NOT be called a cancer. However, to counter a potential drop off in patient traffic, urologists are engaging in all sorts of prostate cancer misrepresentations such as “upgrading”. This egregious fear­mongering ploy is designed simply to spook men into having prostate cancer treatments they never needed and, afterwards, fooling them into thinking they were survivors when they were only survivors of a debilitating treatment. http://www.urologyweb.com/robotic­prostate­cancer­surgery­a­public­health­nightmare/

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Study Finds MRI Accurate Predictor of Low­Risk Prostate Cancer

Is watchful waiting the best choice for prostate cancer patients? According to a recent study from the Memorial Sloan­Kettering Cancer Center in New York City, published in the J​ournal of Urology,​prostate MRI testing can help doctors decide whether or not this less invasive option is the right way to approach a low­risk prostate cancer patient. This was the first time the ability of an MRI to predict confirmatory biopsy results had been examined.
In the study, 388 men who were recently diagnosed with low­risk prostate cancer were given an endorectal MRI. Radiologists then reviewed the MRI and assigned it a score. Then, the patients’ biopsy results were studied. Patients who had a low imaging score from an endorectal MRI had a greater than or equal to 95 percent negative predictive value and specificity for upgrading on biopsy. For those with a higher score, 90 percent had a correlation with upgrading.

Prostate cancer, when it is not growing or aggressive, is a very low risk disease. In fact,
many forms of prostate cancer do not behave like cancers at all, and as such do not need aggressive treatments.​Watchful waiting, therefore, allows doctors to keep tabs on the tumors and determine when they need further treatment, if they ever do.

What does this data mean? This study shows that MRI can be an affective tool for the initial assessment of a patient to determine whether a watchful waiting approach is a safe course of action. Because watchful waiting requires identifying patients who have low­risk disease, this is valuable information. Tumor visualization of high­grade disease only using MRI allows for a targeted prostate biopsy. MRI may help contribute to the assessment process in determining whether a patient is a candidate for a watchful waiting approach or focal therapy.

This is important information because so many newly diagnosed prostate cancer patients are over­treated. The National Comprehensive Cancer Network also recommends watchful waiting as a treatment option for patients who have low­risk disease. When the life expectancy of the patient is at least 10 years, the risks and quality of life issues created by treating can often be worse than the tumors themselves.

While further research may be forthcoming, this shows, again, the fact that prostate cancer does not behave like a typical cancer, and as a result should be treated less aggressively until proven that it needs an aggressive treatment to prolong and save a patient’s life.

Read More >
http://www.urologyweb.com/wp-content/uploads/BEWARE-BEWARE-FDA-_APPROVED_-ROBOTIC-PROSTATECTOMY-CARE-1.pdf

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MRI May Reduce Need for Prostate Biopsy

Prostate biopsies are one of the only ways to predict an aggressive cancer, but they are painful, inconvenient and somewhat inaccurate. A report from Dr. Ahmed Haddad, fellow at the University of Texas Southwestern Medical Center in Dallas, presented at the American Urological Association annual meeting showed that multiparametric MRI scans following a suggestive PSA test or digital rectal exam could reduce the need for a biopsy while still providing an accurate prediction for prostate cancer patients.

In his report, Dr. Haddad and his colleagues found a 73 percent reduction in the need for a biopsy when using the multiparametric MRI scan, identifying fewer potential cancers and requiring fewer biopsies as a result. Interestingly, the cost for MP­MRI is slightly lower than at transrectal ultrasound­guided biopsy. However, the study also found that the MP­MRI missed a few cancers, identifying 16 cancers for every 100 men compared to 20.4 cancers out of 100 men for the biopsy.

In deciding the best way to treat prostate cancer, doctors must weigh the risks of treatment, including its affect on quality of life for patients, against the potential benefit and life­saving capabilities of treatment. Because so m​any prostate tumors do not behave like typical cancers, and do not pose a risk to the patient’s life,​urologists are constantly looking for ways to better predict the outcome of a particular cancer. This particular study showed the potential for the use of MRI technology to identify cancers even without the use of a biopsy.
According to Dr. Haddad, the study was successful in determining that MP­MRI was able to reduce the number of prostate biopsies for patients in a cost equivalent way. However, he did state that further study was needed to determine the clinical significance of the cancers missed by the MRI. As an initial study, it shows promise, and further study in the future will help determine whether this can be an effective diagnostic choice.

http://www.urologyweb.com/robotic-prostate-cancer-surgery-a-public-health-nightmare/
http://www.urologyweb.com/wp-content/uploads/BEWARE-BEWARE-FDA-_APPROVED_-ROBOTIC-PROSTATECTOMY-CARE-1.pdf

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MRI Guidance for Prostate Biopsies Increases Chances of Finding Aggressive Cancers

Traditionally, biopsies to detect prostate cancers rely on ultrasound guidance but a recent study published through the Washington University School of Medicine in St. Louis indicates that MRI may be a more accurate technology. Presented on May 19 at the American Urological Association meeting in Orlando, Florida, the research found a direct correlation between more accurate prostate biopsies and the use of MRI technology to guide the placement of needles.

Patients who are in a watchful waiting therapy for prostate cancer typically are given a biopsy when their PSA number rises above 4.0 ng/ml. This rise in PSA levels may indicate a growth in the tumors, and biopsies can help predict how aggressive the cancer is becoming. However, ultrasound technology cannot visualize tumors well, so urologists will randomly biopsy the prostate gland to gather tissue samples. This random process leads to a higher risk of a false negatives because the needle may have missed areas of cancer.
In the Washington University study, Dr. Gerald Andriole and radiologists from the Mallinckdrodt Institute of Radiology used MRI scans of the prostate to biopsy 70 men with PSA scores of just above 8.0 ng/ml, on average. Dr. Andriole took tissue samples from those areas that looked suspicious on the MRI, as well as any areas where the MRI was not able to visualize well . H​is results showed that these targeted biopsies were nearly three times as effective at finding cancer than non­targeted biopsies.​In addition, they were four times more likely to detect aggressive tumors effectively, and therefore order treatment only for patients who had this disease.

The study was not perfect, however. Dr. Andriole noted that the process predicted positive biopsies around 62 percent of the time. Researchers believe, however, that improvements in MRI technology may make it an even more viable option for prostate cancer screening, allowing doctors to rule out the need for a biopsy when the MRI result is negative.

Read More >
http://www.urologyweb.com/wp-content/uploads/BEWARE-BEWARE-FDA-_APPROVED_-ROBOTIC-PROSTATECTOMY-CARE-1.pdf

http://www.urologyweb.com/robotic­prostate­cancer­surgery­a­public­health­nightmare/

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