Absolutely - this misguided labeling of the grade 3 (G6) as a "cancer" on the basis of some minor low-power microscopic appearances - when we've known for years now that the grade 3 lacks the hallmarks of a cancer on both clinical and molecular biology grounds - is shameful and embarrassing. FIRST DO NO HARM.
Bert, I admire the fire in your belly. But I have ru into lots of docs who want to leave things as they are--with anxiety for patients with a harmless cancer and financial toxicity. Let me ask you this.If you were to relabel gleason 6. What would you call it? My urologist says my so-called cancer is "lame." I want to name it Laurie after Klotz and reclassify it as a "lameoidenoma." What would you call this faux cancer. Howard TheActiveSUrveillor.com
Since the Gleason label is connected to the cancer word and, that tag simply strikes unwarranted fear in nearly everyone that hears it - many of us (Horan, Ablin, Piana, Brawley) would like to delete both the Gleason and cancer words - especially since Klotz and others have shown that the grade 3 lacked the hallmarks of a cancer and was more of an aging phenomenon. Maybe something like age related prostatic neoplasia or arpn could work as it gets rid of both the Gleason and cancer labels.
Too many patients have been hurt by assumptions and misrepresentations in the prostate cancer combat zone - way too much "friendly" fire.
The prostate cancer arena is embarrassingly unscientific and for most men, like entering a combat zone and being hit and debilitated by friendly fire.
let's review some of our "standard" practices:
- the DRE is no more reliable than a coin-toss.
- the PSA is neither prostate nor prostate cancer specific and has a false positive rate of 78%.
- the 12-core prostate biopsy samples blindly and randomly only about 0.1% of the prostate.
- prostate cancer management is undertaken without knowledge of about 99.9% of the gland.
- pathology is subject to errors of interpretation due to complexity of Gleason grading system.
- the grade 3 (and therefore G6) lacks the hallmarks of a cancer and the label needs dropping.
- "staging" using CT and bone scans is highly unreliable due to insensitivity of these studies.
- radiology is subject to errors of interpretation.
- all treatments lack evidence-based support with scientific studies for safety and benefits.
- the robotic device for prostatectomy bypassed review by using the FDAs underhanded 510(K).
- most men live with their prostate cancer rather than die from it.
- the prostate cancer arena smacks a lot like the old misguided radical mastectomy arena.
- we would do well to review John Ioannidis's MD work
https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020124
Thanks Dr. Bert. BTW, what would you name this non-cancer? HW TheActiveSurveillor.com
Absolutely - this misguided labeling of the grade 3 (G6) as a "cancer" on the basis of some minor low-power microscopic appearances - when we've known for years now that the grade 3 lacks the hallmarks of a cancer on both clinical and molecular biology grounds - is shameful and embarrassing. FIRST DO NO HARM.
Bert, I admire the fire in your belly. But I have ru into lots of docs who want to leave things as they are--with anxiety for patients with a harmless cancer and financial toxicity. Let me ask you this.If you were to relabel gleason 6. What would you call it? My urologist says my so-called cancer is "lame." I want to name it Laurie after Klotz and reclassify it as a "lameoidenoma." What would you call this faux cancer. Howard TheActiveSUrveillor.com
Since the Gleason label is connected to the cancer word and, that tag simply strikes unwarranted fear in nearly everyone that hears it - many of us (Horan, Ablin, Piana, Brawley) would like to delete both the Gleason and cancer words - especially since Klotz and others have shown that the grade 3 lacked the hallmarks of a cancer and was more of an aging phenomenon. Maybe something like age related prostatic neoplasia or arpn could work as it gets rid of both the Gleason and cancer labels.
Too many patients have been hurt by assumptions and misrepresentations in the prostate cancer combat zone - way too much "friendly" fire.
Thanks, Dr. Bert.