However, prostate cancer is in the science arena and not in the philosophy arena.
Therefore, patient advice needs to come from studies founded on sound scientific principles to garner only irrefutable and reproducible results - as per John Ioannidis.
Relying on opinions, assumptions and rhetoric like faster recovery, shorter hospital stay and better optics missies the fundamentals. The question should always be - are our treatments saving significant numbers of lives and safe according to data from studies based on sound scientific principles or, are these studies supporting only preconceived notions?
Sadly, we are still promoting:
> a highly unreliable PSA test that has a 78% false positive rate.
> promoting risky blind biopsies sampling randomly 0.1% of the prostate.
> calling the G6 a cancer when the grade 3 genetic pathways for invasion and spread are switched off.
> recommending the robotic device for prostatectomy when has never been scientifically studied for safety or benefits.
Even more worrisome, urologists have already determined that:
> PSA testing fails to save significant numbers of lives.
Let's help our patients and drill down for irrefutable and reproducible data and prove once and for all what is really safe and what really saves lives.
Yes - an interesting perspective from a former mentor who I I had fond memories of and respect as a fellow physician.
So concerning the world of prostate cancer and reality - the only scientific way we can get to the truth is to have evidence sourced from studies generating irrefutable and reproducible material. The author's case study supported only by an opinion fails this test. In fact, much if not all of the information in the prostate cancer arena is drowning in opinions and assumptions - the reason we still have so much controversy surrounding prostate cancer.
John Ioannidis's conclusion after his review of a large number of healthcare studies was that, "Most published research findings are false". This charge is especially relevant to the prostate cancer arena. Every opinion and assumption concerning our so-called standard of care dogma needs to be challenged - Where is the irrefutable and reproducible scientific evidence for that statement? For radical prostatectomy, even the PIVOT study concluded that it failed to save significant numbers of lives.
This just in--from of the world's great urologists and also a reader of TheActiveSurveillor.com: Paul Schellhammer, MD, a prostate cancer survivor himself and past president of the American Urological Association. He gave me permission to reprint his note to me re Dr. Bert Vortsman, his former fellow:
Good morning Howard,
Interesting perspective from Bert Vorstman. I had numerous interactions with him as he was a fellow in our program when I was residency Director. He was always outspoken and I enjoyed discussing issues with him. However, as always, categorical and emphatic conclusive statements in the world of prostate cancer fall short of reality.
Regarding robotic prostatectomy/if I were to have the procedure today rather than in 2000 when it was performed open, I would opt for robotics-Vision, precision, control of venous bleeding all make for a better procedure-The learning curve is shorter snd the ability to practice maneuvers in a simulator a great advance
As far as RP itself and where it stands as unnecessary for many cancers and ineffective for others, Is certainly a conundrum. As Willet Whitmore would ask “ is cure possible when necessary and unnecessary when possible”
Hopefully there are groups for whom cure is both necessary and possible— we’re still trying to ID that group more accurately
And what is cure? I had an RP in 2000. 22 years later I have MCRPC. While I can’t stay with certainty, I do have a belief that the absence of the offending organ has played some role in my indolent and slow progression.
Always good reading your perspectives And educational delivery
Thank you Rick. Sadly, Rick Davis from AnCan seems to have missed the articles' many links/references - most would gain knowledge if they read them.
Reactions without supporting data has been a huge problem in the prostate cancer arena for over 100 years. Treatment philosophies are still based on far too many opinions and assumptions.
Anyone stepping into the prostate cancer arena would do well to read:
> The Rise and Fall of the Prostate Cancer Scam by Anthony Horan MD - a urologist
> The Great Prostate Hoax by Richard Ablin PhD (discoverer of the PSA) and Ron Piana PhD
- and the many 100s of supporting references in these books.
> John Ioannidis's work referenced in my article (again) who concluded that "most published research findings are false". Because, most "studies" are not supported by irrefutable and reproducible facts.
Lastly, the biggest cancers by far in the prostate cancer arena are the endless financial conflicts-of-interest enabled through various so-called partnerships - a toxic well that clouds veracity and harms patients.
TheActiveSurveillor.encourages discussion, Rick Davis, founder of AnCan, gave me his reaction to Dr, V's commentary. I asked his permission to share this with the TAS audience. Rick did this as a favor and said he didn't wish to debate the doctor:
1) .Dr. V says .. the USPSTF (U.S. Preventive Services Task Force) had previously given prostate cancer screening a D grade in 2012 since “the harms outweigh the benefits.” Regrettably, this important warning was challenged by the AUA
Are we to understand from the word 'regrettably' that Dr. V supported the USPSTF D recommendation? Hopefully I am mistaken. You and I have discussed this enough to know it was a major and murderous mistake.
2) The following two concerns underscore why cure by robotic prostatectomy is highly unlikely for these cancers:
Cure is not an option for any cancer with a Gleason 4 - with any type of treatment .... only durable, continuing remission, to use Snuffy's vernacular. Dr. V should know that - open prostatectomy does not guarantee 'cure' either. That's why we have 30% recurrence.
3) Sadly, the scientifically unproven robotic prostatectomy (like PSA testing) is just another gigantic billboard for bad medicine.
'Like PSA testing'?!? Right - let's stop PSA testing and see how many more men die. Like the ridiculous USPSTF advisories weren't enough. Have Dr. V join our meetings and hear how many men are now being Dx with denovo Mx disease. I can guaranty it's a lot more than in his day.
Overall it sounds like Vorstman is opposed to prostate surgery of any sort. Why not say that! RPP produces no worse results than RP - and, if you are going to select surgery, it is a faster recovery with less time in the hospital. I don't see that mentioned.
Note I am not a proponent of willy nilly surgery, but it has a valid and deserved place in treating PCa under the correct circumstances.
Dr. V. OK, you have a hard knock on the robot. But a practical issue. What if you have advanced prostate cancer, what should you do? Or don't do anything? What are the alternatives?
This just in from a NZ doctor:
Fuck
I love it
It’s what I have always known
Mark Fraundorfer
High level discussions are always good.
However, prostate cancer is in the science arena and not in the philosophy arena.
Therefore, patient advice needs to come from studies founded on sound scientific principles to garner only irrefutable and reproducible results - as per John Ioannidis.
Relying on opinions, assumptions and rhetoric like faster recovery, shorter hospital stay and better optics missies the fundamentals. The question should always be - are our treatments saving significant numbers of lives and safe according to data from studies based on sound scientific principles or, are these studies supporting only preconceived notions?
Sadly, we are still promoting:
> a highly unreliable PSA test that has a 78% false positive rate.
> promoting risky blind biopsies sampling randomly 0.1% of the prostate.
> calling the G6 a cancer when the grade 3 genetic pathways for invasion and spread are switched off.
> recommending the robotic device for prostatectomy when has never been scientifically studied for safety or benefits.
Even more worrisome, urologists have already determined that:
> PSA testing fails to save significant numbers of lives.
https://www.nejm.org/doi/full/10.1056/nejmoa0810696
> the radical prostatectomy fails to save significant numbers of lives.
https://www.nejm.org/doi/full/10.1056/nejmoa1113162
Let's help our patients and drill down for irrefutable and reproducible data and prove once and for all what is really safe and what really saves lives.
Glad to see some high-level discussion here. Thanks to all. Howard
Yes - an interesting perspective from a former mentor who I I had fond memories of and respect as a fellow physician.
So concerning the world of prostate cancer and reality - the only scientific way we can get to the truth is to have evidence sourced from studies generating irrefutable and reproducible material. The author's case study supported only by an opinion fails this test. In fact, much if not all of the information in the prostate cancer arena is drowning in opinions and assumptions - the reason we still have so much controversy surrounding prostate cancer.
John Ioannidis's conclusion after his review of a large number of healthcare studies was that, "Most published research findings are false". This charge is especially relevant to the prostate cancer arena. Every opinion and assumption concerning our so-called standard of care dogma needs to be challenged - Where is the irrefutable and reproducible scientific evidence for that statement? For radical prostatectomy, even the PIVOT study concluded that it failed to save significant numbers of lives.
This just in--from of the world's great urologists and also a reader of TheActiveSurveillor.com: Paul Schellhammer, MD, a prostate cancer survivor himself and past president of the American Urological Association. He gave me permission to reprint his note to me re Dr. Bert Vortsman, his former fellow:
Good morning Howard,
Interesting perspective from Bert Vorstman. I had numerous interactions with him as he was a fellow in our program when I was residency Director. He was always outspoken and I enjoyed discussing issues with him. However, as always, categorical and emphatic conclusive statements in the world of prostate cancer fall short of reality.
Regarding robotic prostatectomy/if I were to have the procedure today rather than in 2000 when it was performed open, I would opt for robotics-Vision, precision, control of venous bleeding all make for a better procedure-The learning curve is shorter snd the ability to practice maneuvers in a simulator a great advance
As far as RP itself and where it stands as unnecessary for many cancers and ineffective for others, Is certainly a conundrum. As Willet Whitmore would ask “ is cure possible when necessary and unnecessary when possible”
Hopefully there are groups for whom cure is both necessary and possible— we’re still trying to ID that group more accurately
And what is cure? I had an RP in 2000. 22 years later I have MCRPC. While I can’t stay with certainty, I do have a belief that the absence of the offending organ has played some role in my indolent and slow progression.
Always good reading your perspectives And educational delivery
Paul
Thank you Rick. Sadly, Rick Davis from AnCan seems to have missed the articles' many links/references - most would gain knowledge if they read them.
Reactions without supporting data has been a huge problem in the prostate cancer arena for over 100 years. Treatment philosophies are still based on far too many opinions and assumptions.
Anyone stepping into the prostate cancer arena would do well to read:
> The Rise and Fall of the Prostate Cancer Scam by Anthony Horan MD - a urologist
> The Great Prostate Hoax by Richard Ablin PhD (discoverer of the PSA) and Ron Piana PhD
- and the many 100s of supporting references in these books.
> John Ioannidis's work referenced in my article (again) who concluded that "most published research findings are false". Because, most "studies" are not supported by irrefutable and reproducible facts.
Lastly, the biggest cancers by far in the prostate cancer arena are the endless financial conflicts-of-interest enabled through various so-called partnerships - a toxic well that clouds veracity and harms patients.
TheActiveSurveillor.encourages discussion, Rick Davis, founder of AnCan, gave me his reaction to Dr, V's commentary. I asked his permission to share this with the TAS audience. Rick did this as a favor and said he didn't wish to debate the doctor:
1) .Dr. V says .. the USPSTF (U.S. Preventive Services Task Force) had previously given prostate cancer screening a D grade in 2012 since “the harms outweigh the benefits.” Regrettably, this important warning was challenged by the AUA
Are we to understand from the word 'regrettably' that Dr. V supported the USPSTF D recommendation? Hopefully I am mistaken. You and I have discussed this enough to know it was a major and murderous mistake.
2) The following two concerns underscore why cure by robotic prostatectomy is highly unlikely for these cancers:
Cure is not an option for any cancer with a Gleason 4 - with any type of treatment .... only durable, continuing remission, to use Snuffy's vernacular. Dr. V should know that - open prostatectomy does not guarantee 'cure' either. That's why we have 30% recurrence.
3) Sadly, the scientifically unproven robotic prostatectomy (like PSA testing) is just another gigantic billboard for bad medicine.
'Like PSA testing'?!? Right - let's stop PSA testing and see how many more men die. Like the ridiculous USPSTF advisories weren't enough. Have Dr. V join our meetings and hear how many men are now being Dx with denovo Mx disease. I can guaranty it's a lot more than in his day.
Overall it sounds like Vorstman is opposed to prostate surgery of any sort. Why not say that! RPP produces no worse results than RP - and, if you are going to select surgery, it is a faster recovery with less time in the hospital. I don't see that mentioned.
Note I am not a proponent of willy nilly surgery, but it has a valid and deserved place in treating PCa under the correct circumstances.
TheActiveSurveillor.com itself offers no medical advice. But Dr. V. is a urologist.
Dr. V. OK, you have a hard knock on the robot. But a practical issue. What if you have advanced prostate cancer, what should you do? Or don't do anything? What are the alternatives?