{"id":3922,"date":"2021-10-09T09:00:26","date_gmt":"2021-10-09T09:00:26","guid":{"rendered":"https:\/\/healthdrum.com\/blog\/?p=3922"},"modified":"2021-10-12T18:55:33","modified_gmt":"2021-10-12T18:55:33","slug":"can-prostate-cancer-information-be-trusted","status":"publish","type":"post","link":"https:\/\/healthdrum.com\/blog\/can-prostate-cancer-information-be-trusted\/","title":{"rendered":"Can Prostate Cancer Information Be Trusted?"},"content":{"rendered":"

Can prostate cancer information be trusted? John Ioannidis, MD, asked a similar question some years ago: – Was healthcare information in general trustworthy? He wanted to know if the conclusions generated by healthcare studies were reliable and based on sound scientific principles or whether they were corrupted by bad science, conflicts-of-interest, biases, assumptions and opinions. After evaluating large numbers of medical-related papers he established that<\/span> \u201cmost published research findings are false.\u201d<\/span><\/a><\/p>\n

With this backdrop, let’s review the <\/span>AUA\/ASTRO\/SUO Guideline (2017) for clinically localized prostate cancer <\/span><\/a>and determine whether their PSA testing and prostatectomy directives are safe and effective or unsafe and ineffective because of intellectual dishonesty.<\/span><\/p>\n

Guideline 29
\n<\/b>Localized prostate cancer patients undergoing active surveillance should have routine surveillance PSA testing and digital rectal exams. (Strong Recommendation; Evidence Level: Grade B).<\/span><\/i><\/p>\n

Localized<\/i><\/b>
\n<\/b>Although CT scans and bone scans are widely used to stage cancers and determine whether disease is contained within the prostate, these imaging studies<\/span> are relatively too insensitive to detect small volume cancer spread. <\/span>Underlining this fact are the findings from <\/span>bone marrow aspiration studies<\/span><\/a> and the use of sophisticated staining techniques. Here, micrometastases have been demonstrated in some men with high-grade cancer after staging studies produced negative results.<\/span><\/p>\n

Prostate cancer
\n<\/i><\/b>The diagnosis of prostate cancer is not straight-forward or exact since it is dependent on the individual pathologist’s knowledge of <\/span>the complex Gleason grading and scoring system <\/span><\/a>and his or her observational and interpretive skills. The pathologist has to judge which of the five grade patterns (1-5, with 5 being the most aggressive) described by Gleason best applies to each of the two most common growth patterns seen on the slide, e.g. Gleason 3 (grade) + 3 (grade) = 6 (score). <\/span>Grade 4 disease is judged according to four additional types of arrangements <\/span>(ill-formed, fused, glomeruloid and cribriform)<\/span><\/a>. Underscoring the profound<\/span> lack of reproducibility<\/span><\/a> and dependability with this subjective diagnostic system, <\/span>Swedish pathologists disagreed about Gleason grades a staggering 50 percent of the time<\/span><\/a>.<\/span> In fact, the same biopsy can generate a different diagnosis when viewed by another pathologist or even the same pathologist when conducting a re-reading at a later date.\u00a0<\/span><\/p>\n

Shockingly, the prostate cancer label does not always mean cancer or even translate reliably to significant health risk<\/span>. First, <\/span>despite being labelled a cancer by Dr. Gleason, Laurence Klotz, MD, and others determined years ago that the Gleason grade 3 <\/span>lacks the hallmarks of cancer<\/span><\/a> on the basis of its clinical outcome and its molecular biology. <\/span>Therefore, the common Gleason 3+3=6 \u201ccancer\u201d is a pseudo-cancer, doesn’t need diagnosis or treatment and shouldn\u2019t be included in prostate cancer statistics. Yet, <\/span>despite overwhelming evidence, the urology community has resisted dropping both the Gleason and cancer labels for the G6 disease and countless men continue to be harmed. Second, the vast majority of<\/span> prostate cancers are low-risk, commonly outlived and therefore, without need for intervention.<\/span> In fact,<\/span> about 15 percent of prostate cancers are high-grade <\/span><\/a>and only they are potentially lethal, accounting for <\/span>approximately 30,000 deaths<\/span><\/a> annually<\/span> in the United States.\u00a0<\/span><\/p>\n

PSA testing
\n<\/i><\/b>The PSA (prostate specific antigen) is mislabeled as cancer-specific, has an unjustified \u201cnormal” range of 0-4 ng\/ml and <\/span>a false-positive rate of 78 percent<\/span><\/a>. The overly subjective nature of how the test is performed and its lack of specificity leads to unnecessary treatments, many of which confer life-altering side effects. Not only is the PSA test unable to distinguish between benign disease and potentially lethal prostate cancer, many of the important<\/span> high-grade prostate cancers make little or no PSA <\/span><\/a>so that they are often missed during PSA testing. Underscoring the unreliability and lack of benefits for PSA testing, urologists concluded that <\/span>\u201cPSA-based screening results in a small or no reduction in prostate cancer specific mortality.\u201d <\/span><\/a>That is, PSA testing fails to save significant numbers of lives and should never have been FDA-approved.<\/span><\/p>\n

Digital rectal exams
\n<\/i><\/b>Digital rectal exams (DREs) or prostate exams are inexact studies because they are based on a judgement and interpretation of what the physician feels. Since the DRE study is highly subjective and undependable it too <\/span>should be eliminated<\/span><\/a> from the guidelines.<\/span><\/p>\n

Guideline 28
\n<\/b>Localized prostate cancer patients who elect active surveillance should have accurate disease staging including systematic biopsy with ultrasound or MRI-guided imaging. (Clinical Principle).<\/span><\/i><\/p>\n

Systematic biopsy with ultrasound
\n<\/i><\/b>The transrectal, ultrasound-guided, 12-core prostate needle biopsy is highly inaccurate and unsafe, whether for initial diagnosis or \u201cactive surveillance\u201d. This office-based test samples randomly and blindly only about 0.1 percent of the prostate gland, – when comparing the total volume of the 12 core samples taken by an 18-gauge needle with the size of an average prostate gland. Disturbingly, this hit-or-miss test leaves urologists clueless about the remaining 99.9 percent of prostate tissue. Not only is the test painful (despite local anesthetic) <\/span>but it carries a significant risk<\/span><\/a> for sepsis, rectal bleeding, erection issues, and depression. Despite the unwarranted risk, urologists continue to promote this unsafe and brutal test with over 1 million core-needle biopsies ordered in the U.S. each year \u2014 along with costly complications.\u00a0<\/span><\/p>\n

Guideline 34
\n<\/b>Clinicians should inform localized prostate cancer patients that younger or healthier men (e.g., <65 years of age or >10 year life expectancy) are more likely to experience cancer control benefits from prostatectomy than older men. (Strong Recommendation; Evidence Level: Grade B).<\/span><\/i><\/p>\n

Prostatectomy
\n<\/i><\/b>Prostatectomy (whether by robotic or conventional means) is highly unsafe and without objective benefits for men of any age. Dr. H.H. Young at Johns Hopkins <\/span>published the results of his modified radical prostate surgical \u201ctreatment\u201d<\/span><\/a> more than 100 years ago. Not only did Young claim early diagnosis and cure of prostate cancer without any evidence for doing so but, concluded that \u201c<\/span>The four cases in which the radical operation was done demonstrated its simplicity, effectiveness and the remarkably satisfactory functional results furnished.<\/span><\/i>\u201d<\/span> Disgracefully, his conclusion was a barefaced lie because his first two patients died (one postoperatively and the other after being treated for a complication common to the procedure) while the remaining two were left with lifelong urinary complications.<\/span><\/p>\n