{"id":4259,"date":"2022-05-25T10:00:09","date_gmt":"2022-05-25T10:00:09","guid":{"rendered":"https:\/\/healthdrum.com\/blog\/?p=4259"},"modified":"2022-06-15T18:16:31","modified_gmt":"2022-06-15T18:16:31","slug":"psa-testing-active-surveillance-and-more-damned-lies","status":"publish","type":"post","link":"https:\/\/healthdrum.com\/blog\/psa-testing-active-surveillance-and-more-damned-lies\/","title":{"rendered":"PSA TESTING, ACTIVE SURVEILLANCE AND MORE DAMNED LIES"},"content":{"rendered":"

PSA testing and prostate cancer management remain controversial. In recognition of the fact that many prostate cancer treatments are harmful and that many low-risk prostate cancers can be outlived without intervention, a less hurried active surveillance program was developed. Although heavily promoted, is this monitoring program (6 monthly doctor visits for a PSA, prostate exam, and other possible practices – including MRIs and possible biopsies) safe and beneficial or, is it merely a cutdown version of unsafe and scientifically unproven prostate cancer management drills? <\/span><\/p>\n

<\/b>1. The prostate exam<\/b><\/span><\/p>\n

The prostate exam or digital rectal exam (DRE) is dependent on the interpretive skills of the doctor and is no more reliable than a coin-toss. Additionally, the sensitivity for detecting prostate cancer is low<\/span><\/a>, and even for those where a \u201cnodule\u201d was felt there\u2019s no scientific evidence that the finding led to life extension. Little wonder, a strong argument exists for eliminating the DRE <\/span><\/a> from physical examinations.<\/span><\/p>\n

<\/b>2. The PSA<\/b><\/span><\/p>\n

The PSA (prostate-specific antigen) test is highly unreliable with a false-positive rate of 78 percent<\/span><\/a>. It is neither specific to the prostate nor specific to prostate cancer. Along with fake levels of normal, a raised PSA does not mean prostate cancer, and lowering the PSA does not confer less risk. The PSA can\u2019t distinguish between aggressive and non-aggressive cancers and it can be artificially raised or lowered in numerous situations without cancer being present or advancing. As well, since some aggressive cancers produce little or no PSA <\/span><\/a>they may be missed. Not surprisingly, <\/span>a 2009 study by urologists showed that PSA testing<\/span> failed to save significant numbers of lives. <\/span><\/a><\/span><\/p>\n

<\/b>3. The 12-core prostate needle biopsy<\/b><\/span><\/p>\n

The 12-core ultrasound-guided prostate needle biopsy is a grossly unscientific test that potentially exposes patients to serious complications of sepsis and bleeding while sampling blindly and randomly about 0.1 percent of the prostate<\/span><\/a>. With such a large sampling error, missing a cancer is embarrassingly common. And, although one study showed a false negative rate of 30 percent<\/span><\/a> the actual error rate is much greater as over half the \u201ccancers\u201d included were Gleason 5 and 6 pseudo-cancers.<\/span><\/p>\n

<\/b>4. Imaging for prostate cancer<\/b><\/span><\/p>\n

Imaging for the detection and staging of prostate cancer using ultrasounds, CT, and bone scans is recognized as being relatively insensitive<\/span><\/a>. For staging, they lack accuracy at detecting small volume spread. Underlining this concern is the fact that prostate cancer cells have been found in the bone marrow <\/span><\/a>of patients with so-called localized disease. The best screening tool for prostate cancer detection appears to be the non-contrast MRI <\/span><\/a>(by an expert) and then a real-time MRI-guided targeted biopsy of areas judged as Pirads 4 or 5 for diagnosis. Staging using the whole-body MRI <\/span><\/a>to detect boney spread and the PMSA PET-CT scan<\/span><\/a> to detect lymph node spread are now considered standard practice. <\/span><\/p>\n

<\/b>5. The Gleason 3+3=6 \u201ccancer\u201d<\/b><\/span><\/p>\n

The grade 3 in the Gleason 3+3=6 \u201ccancer\u201d is a classification of cellular growth judged to be consistent with a low-grade prostate cancer under low power microscopy. However, <\/span>the Gleason grade 3 lacks the hallmarks of a cancer<\/span><\/a><\/span> on both clinical and molecular biology grounds. Especially, since the genetic pathways enabling invasion and cancer spread are inactive. And, because biological mechanisms eclipse microscopic appearances, both the Gleason and cancer labels need to be dropped <\/span><\/a>and the grade 3 retagged as a benign disease. <\/span><\/p>\n

<\/b>6. The unreliable Gleason grading system<\/b><\/span><\/p>\n

Because of the complexity of the Gleason grading classification system, errors of interpretation and disagreements amongst pathologists are common. Underscoring a profound<\/span> lack of reproducibility<\/span><\/a> <\/span>with this very subjective prostate cancer diagnostic system<\/span> Swedish pathologists disagreed about Gleason grades a staggering 50 percent of the time<\/span><\/a>. <\/span>Since grade misclassifications are common, second opinions are strongly recommended.<\/span><\/p>\n

<\/b>7. The unproven radical prostatectomy \u201ctreatment\u201d<\/b><\/span><\/p>\n

Radical prostatectomy has been a fraudulent cornerstone of prostate cancer management since Johns Hopkins surgeon<\/span> H.H. Young\u2019s claim of early diagnosis, cure, <\/span><\/a><\/span>and that \u201cThe four cases in which the radical operation was done demonstrated its simplicity, effectiveness and the remarkably satisfactory functional results furnished.<\/i>\u201d Unbelievably, there was no evidence for early diagnosis or cure, two patients died and the other two were left with lifelong urinary incontinence. Yet, this risky treatment philosophy became standard practice and continues so despite a study concluding that<\/span> surgery failed to save significant numbers of lives<\/span><\/a>. <\/span>More disturbingly, when robotics arrived the device received an<\/span> FDA approval<\/span><\/a> <\/span>although it delivered no clear surgical benefits. Worse still, the FDA\u2019s fallacious 510(K) process<\/span><\/a><\/span> was manipulated<\/span> to obtain approval for use of the tool in robotic prostatectomy without any evidence for safety or benefits.<\/span><\/p>\n

8. The false urgency for prostate cancer treatment<\/b><\/span><\/p>\n