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Most Prostate “Cancers” are Forgettable

Bert Vorstman MD, MS, FAAP, FRACS, FACS
www.urologyweb.com/

Most prostate cancers such as the common Gleason 6 prostate “cancer”, even though labelled as a cancer, behave as non-cancerous.
The Gleason 6 “cancer”
> does not cause death
> is labelled a “cancer” based purely on low-power microscopic appearances
> unlike a typical cancer cell, lacks a number of cancer molecular biology mechanisms > unlike a typical cancer cell, has a long cell doubling-time at 475+/- 56 days so that from mutation to growth of about 1cm (smaller than 1⁄2 an inch) in diameter, takes some 40 years
> is considered a process of aging since 50% of 50 year olds, 60% of 60 year olds, etc, etc, will have areas of disease
> the Gleason 6 disease is actually a pseudo-cancer (NOT all “cancers” are equal)

The Gleason 6 prostate “cancer” is not a health-risk and does not require detection or treatment. Especially not, the ill-founded and debilitating radical (robotic) prostatectomy.

Only the 15% or so of high-grade prostate cancers are potentially lethal and require detection and treatment but, many of these make little or no PSA.

A Gleason 6 Tumor: Is It Cancer, and Should It Be Treated?
http://www.urologyweb.com/bogus-gleason-6-prostate-cancer/
http://www.ascopost.com/issues/june-10-2016/prostate-cancer-opinions-vary-on-gleaso n-scores-and-surgery/

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BLADDER REINNERVATION, EPONYMS and FAKE NEWS

Bert Vorstman MD, MS, FAAP, FRACS, FACS
www.urologyweb.com

Eponyms commonly represent a twisting of the truth. On this point, the recent editorial regarding sacral nerve rerouting for the purpose of establishing a bladder reflex arc (The Xiao Procedure–What have we learned? J Urol 2016; 196: 1608-1609) is to be commended only, because of a call to action for seeking truth in science. The cautioning against reliance on hypotheses, unchecked confirmations and biases is also laudable and timely. Disappointingly however, the reviewer fell for the unscientific practice of using an eponym and, especially for this report, perpetuating the error of false credit.

An eponym attempts to honor a procedure or thing with a name and often, a person’s name. In that regard, an eponym implies not only that a completely spontaneous and novel idea or development was founded solely on the basis of an individual’s creative mind but, that the bestowed honor was worthy. Since most, if not all, “new” concepts are the result of an evolution and confluence of necessary conclusions, eponyms, especially when ascribed to a person, commonly represent an arbitrary weighting and approximation of originality so that misattribution of credit is frequent. Therefore, the assumptions and inaccuracy associated with eponyms have no legitimate place in a fact-based scientific world.

In 1983 I initiated a bladder reinnervation study at the Eastern Virginia Medical School (supported by NIH sponsorship) after believing that I had stumbled upon the seemingly novel concept of nerve crossover surgery (to re-establish the bladder reflex arc). However, before I was awarded a Master of Surgery diploma from the University of Otago in New Zealand in 1988 on the basis of my thesis “Urinary Bladder Reinnervation”, I discovered that Kilvington had already published his findings on the surgical treatment of certain paralyses years before in 1907.

Unfortunately, much of the urological literature is still burdened by appeals to emotion, beliefs and treatment philosophies while short on accuracy and objective factual science. Not only is there a great need to dispense with the use of trivial and pseudo-scientific eponyms in urology but, there is an even greater need for the pursuit of truth in urology. This need is especially great for the prostate cancer arena where the Gleason 6 prostate cancer is still labelled as a “cancer” although it clearly behaves as noncancerous and, its ill-founded and debilitating radical (robotic) prostatectomy “treatment” is marketed as FDA “approved” but never scientifically validated with evidence-based studies on even a single case of prostate cancer for safety or, effectiveness. Finally, without facts and truth there is only fake news and, its only purpose is to sway an opinion about something towards a certain ideological mindset with misleading or, false narratives. Such reporting is not only underhanded but, indefensible.

1. Kilvington, B.: An investigation on the regeneration of nerves with regard to surgical treatment of certain paralyses. Brit. Med. J., 1: 988-990, 1907
2. Vorstman, B., Schlossberg, S., Kass, L., Devine, C. J., Jr. Urinary bladder reinnervation. J. Urol., 136: 964-969, 1986
3. Vorstman, B., Schlossberg, S., Kass, L.: Investigations on urinary bladder reinnervation. Historical perspective and review. Urology, 30: 80-96, 1987
4. http://www.urologyweb.com/bogus-gleason-6-prostate-cancer/
5. http://www.urologyweb.com/stop-treating-the-fake-gleason-6-prostate-cancer/

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5 Great Prostate Cancer Lies

Bert Vorstman MD, MS. FAAP, FRACS, FACS www.urologyweb.com

1. the PSA will save your life
The USPSTF (US Preventive Services Task Force) has already given the PSA-based screening of healthy males a “D” or, fail grade because it is non-cancer specific and highly unreliable. It has a very high false-positive rate that leads to the detection of mostly benign and non-lethal prostate cancer and, at best, MAY save 1:1000 men (according to the USPSTF). Because it is so unreliable, the PSA test simply leads to a gross amount of over-evaluation and injury from the unnecessary treatments of non-lethal prostate diseases. Unfortunately, the potentially lethal high-grade cancers which need detection, often escape detection as they make little or no PSA.

2. a biopsy will rule out a cancer
It has been established for many years now that the standard 12-core needle biopsy of the prostate is not only very risky but, also grossly unreliable as it samples randomly only a tiny volume of the prostate (less than 1%) and, often misses important regions of the prostate where cancer may reside.

3. you have prostate “cancer”
It has also been established for many years that not all cancers are equal and, in fact, many prostate cancers don’t even act as cancerous. Such is the case for the very common Gleason 3+3=6 prostate “cancer” which incredibly:
– lacks several molecular biological mechanisms found commonly in real cancer cells
– unlike a typical cancer cell, the Gleason 6 has a cell division time of about 475 days so that it takes some 40 years to grow to half an inch
– is part of the aging process as the Gleason 6 disease is commonly detected in 50% of 50 year olds; 60% of 60s etc, etc and, is without impact
– not potentially lethal
– not a health-risk
– is a pseudo-cancer

4. the radical (robotic) prostatectomy will get it all
The FDA “approved” label given to the the radical (robotic) prostatectomy deceives the public by implying that it went through rigorous scientific evaluation for safety and benefits when the procedure was simply rubber-stamped by the FDA using their 510(k) process and, not surprisingly therefore, is not only associated with a raft of complications but, fails to extend life. The surgery is highly debilitating as all the legal actions on Google and the FDA MAUDE site attest to. Even worse, it is commonly used to “treat” the Gleason 6, a prostate disease which is part of the aging process and does not require any type of radical or focal treatment as it is a bogus cancer.

5. it was your decision
Both the processes of “shared decision making” and, the so-called “informed consent” are commonly highly suspect as they are based upon an alchemy of physicians biases, medically illiterate patients and a prostate cancer label. A label with incredible shock value and, which simply allows unscrupulous physicians to ply salesmanship and, the engendering of doubt and fear to railroad patients towards unnecessary treatments. Regrettably, the deceptions surrounding the highly unreliable PSA-based screening, the risky and unreliable prostate needle biopsy, the bogus Gleason 6 cancer, the scientifically unproven robotic prostatectomy treatment philosophy and, the spurious process of “shared decision making” have resulted in many, many men worldwide being injured for zero benefit. If only we could get rid of all of this background noise about the Gleason 6 and turn our direction towards finding a simple reliable screening test that could detect reliably, early high-grade disease for early, reliable, effective outpatient treatment, we might arrest this worldwide public health disaster. Then, instead of another bogus claim about making a “survivor” (although limp and leaking) after his unnecessary Gleason 6 treatment just maybe, we could help those with real, potentially lethal high-grade prostate cancers.

Read More
http://www.urologyweb.com/bogus-gleason-6-prostate-cancer/

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The BOGUS Gleason 6 prostate cancer (and most everything else about prostate cancer)

Press Release:

DSC00588CORAL SPRINGS, Fla., Sept. 22, 2016 /PRNewswire/ — Noted urologic surgeon, Bert  Vorstman MD, MS, FAAP, FRACS, FACS today, has issued a stinging report regarding the unreliable PSA test, the mislabelling of the common Gleason 6 prostate disease as a cancer and, the misrepresentation that the radical (robotic) prostatectomy treatment is scientifically proven to be safe and effective. A charade which represents an outrageous and shameful trifecta of abominations.

Said Dr. Bert Vorstman, “It has been established irrefutably that the very common Gleason 6 prostate “cancer” is a pseudo-­cancer because no man has died from this disease and as well, it lacks several of the molecular biology mechanisms typically found in cancerous behaving cells. Additionally, unlike a usual 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 6 disease lacks the hallmarks of a cancer, it is not a health-­risk, does not progress to become a health-­risk, does not require detection and, does not require treatment. The Gleason 6 is a bogus cancer.”

Dr. Vorstman continued, “Not only is the Gleason 6 “cancer” bogus but, it has also been established irrefutably, that the robotic radical prostatectomy lacks supporting scientific evidence-­based medicine studies proving safety or effectiveness for treating any prostate cancer. This operation was based simply upon an ancient treatment philosophy which, through unbridled trial and error human medical experimentation, dogma, propaganda, medical bullying and, fear­-mongering went from a conviction based upon tradition and consensus medicine to becoming fully transformed as an ideology into “standard practice”. Even the recent FDA approval of the robotic device for use in the radical prostatectomy was achieved simply by being rubber­-stamped through its corrupt 510(k) process and bypassing any requirements for scientific validation. Shamefully, this ill­-founded radical cancer surgery is undertaken commonly for the noncancerous behaving Gleason 6 disease.”

Said Dr. Vorstman, “That the Gleason 6 has been misrepresented by urologists as a cancer and, the robotic prostatectomy misrepresented as scientifically vetted for being safe and beneficial constitutes an outrageous deception. A deception justified by corrupt urologists and their colluding prostate cancer industry partners who have committed an evil health crime by generating a false prostate cancer crisis involving contrived dangers simply to exploit vulnerable men for endless financial gain. Only the 15% or so of high­-grade prostate cancers are potentially lethal and, only these types of prostate cancer demand detection and treatment but, are often missed in screening as they make little or no PSA.”

To review Dr. Bert Vorstman’s full report, please go to:
http://www.urologyweb.com/bogus-gleason-6-prostate-cancer/

About Bert Vorstman MD, MS, FAAP, FRACS, FACS

Dr. Bert Vorstman is a Board Certified urologic surgeon. Born to Dutch parents in Indonesia, he grew up in New Zealand. After training at the Otago Medical School in Dunedin, New Zealand he completed a urology residency at Auckland Hospital, Auckland, New Zealand. He fellowship trained in adult and pediatric reconstructive Urology at the Eastern Virginia Medical School in Norfolk, Virginia and, after NIH sponsored pioneering research on “Urinary Bladder Reinnervation” he earned the honor of a Masters of Surgery Diploma from the University of Otago in 1988. Dr. Vorstman was a faculty member at the University of Miami, Jackson Memorial Hospital, Miami, Florida and then went on to found Florida Urological Associates, a busy urology practice in Coral Springs, Florida, USA.

Dr. Vorstman’s passion and dedication is to help men and their spouses/partners understand fully the implications of their particular prostate cancer as well as the minimally invasive treatment options available to certain men with localized, high-­grade prostate cancer.

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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:
Is it time to abandon the DRE?

https://www.ncbi.nlm.nih.gov/pubmed/27264113

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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