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.
> 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/