Yes - fear-mongering and doubt are way too common in the prostate cancer industry. For a large part, directly due to the so-called standard practice of using the embarrassingly unscientific ultrasound-guided 12-core prostate needle biopsy.
On the one hand this silly test samples blindly and randomly about 0.1 percent of the prostate when the volume of the 12 cores is measured against the volume of the prostate. The "test" also leaves you clueless about what's going on in the 99.9 percent rest of the prostate.
On the other hand, prostate cancer typically occurs in 1-5 areas of the prostate and prostate tissue is also impacted by field effects - meaning that in some men the prostate tissue has been triggered to become cancerous at some point.
How then is it possible that this risky, hit or miss 0.1 percent sampling is considered reasonable for screening or AS? Is a yearly 0.1 percent random sampling of your prostate for AS being recommended by a physician or by someone with only a passing interest in healthcare?
The only test reliable enough to review the whole prostate gland for screening or AS is the non-contrast MRI - by an expert. Then we have a 100 precent view and can catch other areas of involvement - if they occur.
The areas of concern on a biopsy that make me think this way, are those HG-PIN and Focal HG-PIN areas. They are supposed to be “pre-cancerous”, so I would still want to keep an eye on those. Not that I ever want another biopsy, but if it came to it...
A physician's duty to the patient is to keep them from harm and injustice. And, injustice here also includes telling the truth. This allegiance is to patients and not to the many groups feeding from the healthcare trough of dollars.
The only reason the grade 3 (as in the 3+3=6) was believed to be a low-risk cancer was on the basis of some very subjective low-power microscopic appearances. Years later, with more knowledge, it was determined by several investigators that the biological pathways for cancer development and spread in the grade 3 were inactive. Therefore, the grade 3 (as in the G6) is a bogus cancer. Sadly, much of the prostate cancer arena like prostate cancer awareness and early detection lacks scientific evidence for saving significant numbers of lives and is therefore, also bogus.
Tom, I have written a lot about this, including this piece with several doctors on renaming Gleason 6: https://ascopubs.org/doi/full/10.1200/JCO.22.00123?role=tab It's an idea that has been batted around for a while. But I'd be surprised change will come that quickly. From your doctor's mouth to the AUA's and NCCN's ears. Tom, if Gleason 6 were named a noncancer, would you still go for surveillance? Howard
At my last AS check up in early September my doc said within the coming year, the new guidelines will be coming out, removing the cancer label for Gleason 6
Thanks, Bert. Rattle the cages, mate. Howard
My doctor's worried 13 years ago about high grade pins but they don't seem concerned now writing from my urologist's waiting room.
Yes - fear-mongering and doubt are way too common in the prostate cancer industry. For a large part, directly due to the so-called standard practice of using the embarrassingly unscientific ultrasound-guided 12-core prostate needle biopsy.
On the one hand this silly test samples blindly and randomly about 0.1 percent of the prostate when the volume of the 12 cores is measured against the volume of the prostate. The "test" also leaves you clueless about what's going on in the 99.9 percent rest of the prostate.
On the other hand, prostate cancer typically occurs in 1-5 areas of the prostate and prostate tissue is also impacted by field effects - meaning that in some men the prostate tissue has been triggered to become cancerous at some point.
How then is it possible that this risky, hit or miss 0.1 percent sampling is considered reasonable for screening or AS? Is a yearly 0.1 percent random sampling of your prostate for AS being recommended by a physician or by someone with only a passing interest in healthcare?
The only test reliable enough to review the whole prostate gland for screening or AS is the non-contrast MRI - by an expert. Then we have a 100 precent view and can catch other areas of involvement - if they occur.
Good point, Tom. I am struggling with some of this now myself. More later. Howard
The areas of concern on a biopsy that make me think this way, are those HG-PIN and Focal HG-PIN areas. They are supposed to be “pre-cancerous”, so I would still want to keep an eye on those. Not that I ever want another biopsy, but if it came to it...
A physician's duty to the patient is to keep them from harm and injustice. And, injustice here also includes telling the truth. This allegiance is to patients and not to the many groups feeding from the healthcare trough of dollars.
The only reason the grade 3 (as in the 3+3=6) was believed to be a low-risk cancer was on the basis of some very subjective low-power microscopic appearances. Years later, with more knowledge, it was determined by several investigators that the biological pathways for cancer development and spread in the grade 3 were inactive. Therefore, the grade 3 (as in the G6) is a bogus cancer. Sadly, much of the prostate cancer arena like prostate cancer awareness and early detection lacks scientific evidence for saving significant numbers of lives and is therefore, also bogus.
Tom, I have written a lot about this, including this piece with several doctors on renaming Gleason 6: https://ascopubs.org/doi/full/10.1200/JCO.22.00123?role=tab It's an idea that has been batted around for a while. But I'd be surprised change will come that quickly. From your doctor's mouth to the AUA's and NCCN's ears. Tom, if Gleason 6 were named a noncancer, would you still go for surveillance? Howard
I would because you never know when a higher grade may present itself
At my last AS check up in early September my doc said within the coming year, the new guidelines will be coming out, removing the cancer label for Gleason 6