While I respect Dr. Vorstman's work and perspective, I'd like to play a bit of devil's advocate and hear his rationale regarding the following from Cancer.net :
"Prostate cancer is the second leading cause of cancer death in men in the United States. It is estimated that 34,700 deaths from this disease will occur in the United States in 2023. In 2020, an estimated 375,304 people worldwide died from prostate cancer.
🤷♂️However, the death rate dropped by half from 1993 to 2013 as a result of advances in screening and treatment🤷♂️. .................................. If treatments are generally not effective, as he implies, what drove the death rate down by 50% from 1993 to 2013?
Thank you for pointing out the profoundly unsettling numbers of false positives caused by PSA tests. The way that prostate cancer is current treated is often quite aggressive and the side effects of these treatments can be profound.
As an example, one of the medicines that's often used to treat prostate cancer can increase the risk of a man getting dementia by 26%, but this is almost never talked about. To me, this is really crazy and men should be treated better.
First to you, Martin (Gewirtz), and of course you, Howard, thank you, profoundly! My reason for signing up immediately for the newsletter aside from insight and what I considered equal if not MORE important, was, the platform newsletter provides to challenge status quo. Yes, Martin, erring on side of caution 'til science in is rational no matter how good the argument found in present research but to deny soothsayer is to obfuscate understanding choices which are ours despite the immense influence of the machine-AMA. We need more not less argument how effectual on ineffectual present research when we present before our provider. Vitriol here which I too may one day come to accept, summons remarks of Oncologist this week as part of National Survivors Cancer Week: PTSD found in those with cancer. Not hard to understand.
Dr. Bert Vorstman hits the nail on the head at the very end of his commentary, paraphrasing with my words: there needs to be developed and FDA approved a liquid biopsy test, blood and/or urine, that detects with a high degree of accuracy the aggressive prostate cancer. There are companies like miR Scientific / Sentinel backed by Wall Street money that have been on this Pca holy grail quest for a few years now., and it is getting closer to reality. When this happens, it will be a total game changer for the entire Pca patient and medical community.
Great job Howard - "Still running against the wind." - Bob Seger
> the history of medicine has recorded numerous examples of tests and treatments now abandoned - the prostate cancer arena is facing many serious concerns for veracity.
> tests and treatments can only be deemed safe and effective if they are supported by irrefutable and reproducible scientific data.
> John Ioannidis MD determined some time ago that most published research is false. Why? Because most published material is not founded on sound scientific principles and loaded with healthy doses of assumptions, opinions, judgements, approximations and beliefs. And, at times, blatant fabrications and conflicts-of-interest.
> arguments based on opinions, assumptions and beliefs only broadcast ignorance. Naysayers would do well to read the books "The Great Prostate Hoax" and "The Rise and Fall of the Prostate Cancer Scam."
> several of us - Horan, Ablin, Piana, Prasad and others have been examining the so-called data on which prostate cancer testing and treatment is founded. Where is the irrefutable and reproducible scientific evidence supporting that particular recommendation? read more https://lundberginstitute.org
> let's review just the PSA - even the word specific in prostate specific antigen is a fraud - The PSA has a false-positive rate of 78 percent because it is neither specific to the prostate or specific to prostate cancer; its so-called cut-off value of 0-4 n g/ml is an arbitrary and misleading metric; a PSA above 4 does not mean a diagnosis of prostate cancer; large prostates commonly generate high PSAs; the PSA value can be artificially raised or lowered without a cancer being present or progressing; the PSA cannot distinguish between aggressive and non-aggressive cancers; lowering the PSA does not lower a risk of cancer and, the subset of high-grade, aggressive and potentially deadly prostate cancers may produce little to no PSA and can go undetected.
> someone emailed me this morning concerned about their prostate MRI - he got 3 opinions - one from the local university, one from the Mayo and one from MD Anderson - all different and not reassuring in the least.
> sadly, the prostate cancer testing and treatment industry is a 32.7 billion dollar market for which there is no hard evidence that significant numbers of lives are being saved.
> the most redeeming feature of AS is that it slammed the brakes on the risky and non life-saving radical "treatments". However, we have no hard longterm data that AS saves significant numbers of lives. We need to discover a marker that detects only the 10-15% potentially lethal prostate cancers and then find a treatment that's SAFE and saves significant numbers of lives.
For me, it was the PSMA PET scan and not an MRI or biopsy that provided what I wanted to know about my cancers status. Perhaps that imaging test will be used more soon.
Dr. Bert Vorstman goes back many years as an AS advocate and contributor to the UsToo International blog site. His current, more radical view is not entirely off the deep end, but I look at it as just another side of the coin I like to hear and think about.
Personally, diagnosed Gleason 6 in 2013, I will be changing from semi annual to yearly PSA test (consistently in the 8-10 range) and will only consider a bi-metric MRI without gadolineum if it is offered in the future. My last of three 3TmpMRI's was October 2018, PI-RADS 4 (this after two PI-RADS 2's with one lesion less than 1 centimeter in the same spot as the Gleason 6, one core 5% diagnosis. I should note I had a metal hip when the 2018 MRI PI-RADS 4 reading was done. I posed 10 questions to the radiologist after reading the PI-RADS 2.0 manual and chose to discount the 4 reading based on his answers.
Thank you Howard for sharing Dr. Vorstman's opinions.
I'm wondering what Vorstmsan would do if he was diagnosed with prostate cancer. Then aging it appears he doesn't believe in testing for prostate cancer.
It would be great if the "Music program" would expand to more states.
I am a patient on AS for five years, a Board certified patient advocate, a Board member of Active Surveillance Patients International, a presenter at the AUA 2023 conference on behalf of patients voices vis a vis shared informed decision-making, and a writer on AS myself with a blog at
https://www.welcometoactivesurveillance. I think it’s highly unfortunate for The Active Surveillor to give Vorstman a platform for him to manipulate and falsely depict proven scientific data around screening and detection of PCa. I find no credibility whatsoever in his writing and I would caution all readers to do their own research and consult with their medical teams, including oncologists, while on Active Surveillance.
His rejection of Active Surveillance as a management protocol for men who choose it with low and favorable intermediate PCa (in his final paragraph) is flawed and should disqualify him as a reputable medical source for information and guidance.
The opinion expressed above is my own, and not representative of any entity or organization.
Uro-critic Vorstman: What's wrong with active surveillance for prostate cancer? What’s wrong with prostate cancer testing and treatment?
While I respect Dr. Vorstman's work and perspective, I'd like to play a bit of devil's advocate and hear his rationale regarding the following from Cancer.net :
"Prostate cancer is the second leading cause of cancer death in men in the United States. It is estimated that 34,700 deaths from this disease will occur in the United States in 2023. In 2020, an estimated 375,304 people worldwide died from prostate cancer.
🤷♂️However, the death rate dropped by half from 1993 to 2013 as a result of advances in screening and treatment🤷♂️. .................................. If treatments are generally not effective, as he implies, what drove the death rate down by 50% from 1993 to 2013?
Thank you for pointing out the profoundly unsettling numbers of false positives caused by PSA tests. The way that prostate cancer is current treated is often quite aggressive and the side effects of these treatments can be profound.
As an example, one of the medicines that's often used to treat prostate cancer can increase the risk of a man getting dementia by 26%, but this is almost never talked about. To me, this is really crazy and men should be treated better.
https://mattcook.substack.com/p/beware-this-treatment-for-prostate
First to you, Martin (Gewirtz), and of course you, Howard, thank you, profoundly! My reason for signing up immediately for the newsletter aside from insight and what I considered equal if not MORE important, was, the platform newsletter provides to challenge status quo. Yes, Martin, erring on side of caution 'til science in is rational no matter how good the argument found in present research but to deny soothsayer is to obfuscate understanding choices which are ours despite the immense influence of the machine-AMA. We need more not less argument how effectual on ineffectual present research when we present before our provider. Vitriol here which I too may one day come to accept, summons remarks of Oncologist this week as part of National Survivors Cancer Week: PTSD found in those with cancer. Not hard to understand.
Dr. Bert Vorstman hits the nail on the head at the very end of his commentary, paraphrasing with my words: there needs to be developed and FDA approved a liquid biopsy test, blood and/or urine, that detects with a high degree of accuracy the aggressive prostate cancer. There are companies like miR Scientific / Sentinel backed by Wall Street money that have been on this Pca holy grail quest for a few years now., and it is getting closer to reality. When this happens, it will be a total game changer for the entire Pca patient and medical community.
Cheers and MAY THE FORCE BE WITH YOU,
Rob Wood
Great job Howard - "Still running against the wind." - Bob Seger
> the history of medicine has recorded numerous examples of tests and treatments now abandoned - the prostate cancer arena is facing many serious concerns for veracity.
> tests and treatments can only be deemed safe and effective if they are supported by irrefutable and reproducible scientific data.
> John Ioannidis MD determined some time ago that most published research is false. Why? Because most published material is not founded on sound scientific principles and loaded with healthy doses of assumptions, opinions, judgements, approximations and beliefs. And, at times, blatant fabrications and conflicts-of-interest.
> arguments based on opinions, assumptions and beliefs only broadcast ignorance. Naysayers would do well to read the books "The Great Prostate Hoax" and "The Rise and Fall of the Prostate Cancer Scam."
> several of us - Horan, Ablin, Piana, Prasad and others have been examining the so-called data on which prostate cancer testing and treatment is founded. Where is the irrefutable and reproducible scientific evidence supporting that particular recommendation? read more https://lundberginstitute.org
> let's review just the PSA - even the word specific in prostate specific antigen is a fraud - The PSA has a false-positive rate of 78 percent because it is neither specific to the prostate or specific to prostate cancer; its so-called cut-off value of 0-4 n g/ml is an arbitrary and misleading metric; a PSA above 4 does not mean a diagnosis of prostate cancer; large prostates commonly generate high PSAs; the PSA value can be artificially raised or lowered without a cancer being present or progressing; the PSA cannot distinguish between aggressive and non-aggressive cancers; lowering the PSA does not lower a risk of cancer and, the subset of high-grade, aggressive and potentially deadly prostate cancers may produce little to no PSA and can go undetected.
> someone emailed me this morning concerned about their prostate MRI - he got 3 opinions - one from the local university, one from the Mayo and one from MD Anderson - all different and not reassuring in the least.
> sadly, the prostate cancer testing and treatment industry is a 32.7 billion dollar market for which there is no hard evidence that significant numbers of lives are being saved.
> the most redeeming feature of AS is that it slammed the brakes on the risky and non life-saving radical "treatments". However, we have no hard longterm data that AS saves significant numbers of lives. We need to discover a marker that detects only the 10-15% potentially lethal prostate cancers and then find a treatment that's SAFE and saves significant numbers of lives.
> challenge me with hard data.
cheers
bert
For me, it was the PSMA PET scan and not an MRI or biopsy that provided what I wanted to know about my cancers status. Perhaps that imaging test will be used more soon.
Dr. Bert Vorstman goes back many years as an AS advocate and contributor to the UsToo International blog site. His current, more radical view is not entirely off the deep end, but I look at it as just another side of the coin I like to hear and think about.
Personally, diagnosed Gleason 6 in 2013, I will be changing from semi annual to yearly PSA test (consistently in the 8-10 range) and will only consider a bi-metric MRI without gadolineum if it is offered in the future. My last of three 3TmpMRI's was October 2018, PI-RADS 4 (this after two PI-RADS 2's with one lesion less than 1 centimeter in the same spot as the Gleason 6, one core 5% diagnosis. I should note I had a metal hip when the 2018 MRI PI-RADS 4 reading was done. I posed 10 questions to the radiologist after reading the PI-RADS 2.0 manual and chose to discount the 4 reading based on his answers.
Cheers and MAY THE FORCE BE WITH US
Rob Wood
Martin,
Active Surveillance, like other areas in medicine, has many debates.
Should Gleason 6 be redefined as a noncancer?
Should there be a very low-risk diagnosis?
Should the transperineal approach be preferred over transrectal?
AS has evolved in the past decade and more. It will change again as AI and polygenic risk scoring is more widely adopted.
So I am glad to host Dr. Vorstman's commentary.
Also as a career journalist, I support free speech and the First Amendment. Personally, I like to hear contrary points of view.
Howard
Thanks, Steve. MUSIC is expanding. I see that it is moving into Florida and Virginia and maybe a few more spots.
Great question. Maybe the doctor can answer?
Thank you Howard for sharing Dr. Vorstman's opinions.
I'm wondering what Vorstmsan would do if he was diagnosed with prostate cancer. Then aging it appears he doesn't believe in testing for prostate cancer.
It would be great if the "Music program" would expand to more states.
I am a patient on AS for five years, a Board certified patient advocate, a Board member of Active Surveillance Patients International, a presenter at the AUA 2023 conference on behalf of patients voices vis a vis shared informed decision-making, and a writer on AS myself with a blog at
https://www.welcometoactivesurveillance. I think it’s highly unfortunate for The Active Surveillor to give Vorstman a platform for him to manipulate and falsely depict proven scientific data around screening and detection of PCa. I find no credibility whatsoever in his writing and I would caution all readers to do their own research and consult with their medical teams, including oncologists, while on Active Surveillance.
His rejection of Active Surveillance as a management protocol for men who choose it with low and favorable intermediate PCa (in his final paragraph) is flawed and should disqualify him as a reputable medical source for information and guidance.
The opinion expressed above is my own, and not representative of any entity or organization.