Tomn, Your call. The doc in Washington state has been dealing with some issues with being displaced by a flood. You might check in with him. He will get to it. Howard
Folks - that prostate cancer testing and treatment don't work maybe controversial for some but this conclusion was established already some time ago.
Anthony Horan MD a urologist, published his book in 2009 "The Big Scare" (now retitled "The Rise and Fall of the Prostate Cancer Scam") - supported by 100s of references as to why prostate cancer surgery and radiation don't work.
Ablin and Piana published their book in 2014, "The Great Prostate Hoax" - supported by 100s of references as to why PSA testing doesn't work.
Anyone stepping into the prostate cancer arena should read and digest these books. There are a lot of financial conflicts-of-interest, opinions and scare-tactics in healthcare. These are great for continuing to foster doubt and continuing the same old. Einstein said the definition of insanity is doing the same thing over and over and expecting a different result. Welcome to the world of prostate cancer testing and treatment. We need new tests, new treatments and irrefutable and reproducible data. We need to stop the false hope and false promises. The wives know this - but only after the fact - cheers
Not sure who AEC is but anyway - yes that statement about the second leading cause....... is commonly used to imply that all prostate cancers are equally deadly and require immediate attention. Clearly, that implication is a crock when it's mostly the high-grade prostate cancers that are responsible for the 30 thousand or so U.S. deaths annually - recall that some high-grade cancers fail to produce much PSA so go undetected. As for the death rate dropping - likely due to 2 reasons - Anthony Horan MD in his book detailed how death certificates were quite unreliable. Another reason for a drop in the death rate has been ascribed to better cardiovascular and other medications being available to treat co-morbidities and help us live longer (with and without cancer). Also, could the 10-15 percent potentially deadly high-grade cancers be less deadly than before? cheers
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?
Hey tom - the PI-RADS classification system is like the Gleason grading and scoring system - complex and subject to errors of interpretation - worse with inexperienced physicians. 29 biopsies is only sampling about 0.2 percent of the prostate. Hopefully, you just had the non-contrast MRI. The best and only screening and AS tool is the non-contrast MRI - by an expert. I would recommend you reach out to Joe Busch in Atlanta - a highly experienced prostate MRI specialist and ask him for a second opinion re. the MRI - I can contact him if you like - cheers
I have sent my MRI discs to a doc in Washington state that Howard once mentioned for second opinions. Sent both the original and latest (1.5 weeks ago). Unfortunately they both were without and with constrast. Gadolinium. Prohance I believe. Waiting to hear back on MRI second opinion. I see my uro Monday for their results of MRI and PSA
Got MRI results back. Lesion 1 is unchanged in 2.6 years. Lesion 2 actually shrunk down to .6 cm. No need for another biopsy and no treatments to start. Keeping on AS
Howard, I could kiss you!! "No, please don't!" Two points: First, because of your history with the American Medical profession and intent extracting accountability within its membership, each of us ride your coattails and become armed to do battle with "Father Knows Best"-or, was it Kildare? For the silent majority, eternal thanks. Now, more importantly, to the second point. One of us recently lambasted your inclusion of Bert Vorstman, M.D. comments on Active Surveillance in The Active Surveillor. This forum is designed for free and open expression, clearly not present in the history of AMA. It is what we want, it is what we demand, self-aggrandizement having no place even when coming from one at the tip of the spear of this movement. Who is this individual and newsletter in which he made his comments?
It's not about not liking AS - its a very laudable concept as in the past men were simply pushed towards surgery with scare-tactics and the cancer word. The sad part about AS is that the program uses the same unreliable and risky recommendations as for prostate cancer screening. ie the prostate exam, the PSA, the ultrasound-guided prostate needle biopsy. And, to cap it off, the possibility of a "treatment" for which there is no long-term scientific evidence for benefits.
In the article you mentioned that the prostate can hold different Gleason grades. In my case, my MRI showed a PIRADS4 (4.1cm) and a PIRADS5 (~2cm) and according to my docs info, I should have a high grade, serious cancer. But out of 29 cores in the biopsy, only 5 came back with Gleason 6. Had a fusion biopsy. And every single one of those 5 positives, only 5% of the core was "cancer". Don't understand that but they put me on AS, and every 6 months it is high anxiety time waiting for test results. But anyway, if the prostate can hold different Gleason levels, how is one to know if there is a lurking Gleason 8 or 9?
Bert is controversial. But he isn't alone. Some docs feel that AS is overused. They feel some of us with very-low Gleason should never have been diagnosed to begin with and likewise too many are on AS. I can send more on that. I feel that if I was starting from scratch today there's a good chance I would not be diagnosed and would have been saved from all the surveillance, biopsies, MRIs and PSAs. On the other hand, surveillance beats aggressive treatment, no? Howard
Sounds good, Tom. Relieved? Results from. Westphalen?
Tomn, Your call. The doc in Washington state has been dealing with some issues with being displaced by a flood. You might check in with him. He will get to it. Howard
Folks - that prostate cancer testing and treatment don't work maybe controversial for some but this conclusion was established already some time ago.
Anthony Horan MD a urologist, published his book in 2009 "The Big Scare" (now retitled "The Rise and Fall of the Prostate Cancer Scam") - supported by 100s of references as to why prostate cancer surgery and radiation don't work.
Ablin and Piana published their book in 2014, "The Great Prostate Hoax" - supported by 100s of references as to why PSA testing doesn't work.
Anyone stepping into the prostate cancer arena should read and digest these books. There are a lot of financial conflicts-of-interest, opinions and scare-tactics in healthcare. These are great for continuing to foster doubt and continuing the same old. Einstein said the definition of insanity is doing the same thing over and over and expecting a different result. Welcome to the world of prostate cancer testing and treatment. We need new tests, new treatments and irrefutable and reproducible data. We need to stop the false hope and false promises. The wives know this - but only after the fact - cheers
Tom, You might write to the doctor. He is havibg some personal issues--his house was flooded out. But maybe he can help you by Monday. Howard
Not sure who AEC is but anyway - yes that statement about the second leading cause....... is commonly used to imply that all prostate cancers are equally deadly and require immediate attention. Clearly, that implication is a crock when it's mostly the high-grade prostate cancers that are responsible for the 30 thousand or so U.S. deaths annually - recall that some high-grade cancers fail to produce much PSA so go undetected. As for the death rate dropping - likely due to 2 reasons - Anthony Horan MD in his book detailed how death certificates were quite unreliable. Another reason for a drop in the death rate has been ascribed to better cardiovascular and other medications being available to treat co-morbidities and help us live longer (with and without cancer). Also, could the 10-15 percent potentially deadly high-grade cancers be less deadly than before? cheers
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?
Hey tom - the PI-RADS classification system is like the Gleason grading and scoring system - complex and subject to errors of interpretation - worse with inexperienced physicians. 29 biopsies is only sampling about 0.2 percent of the prostate. Hopefully, you just had the non-contrast MRI. The best and only screening and AS tool is the non-contrast MRI - by an expert. I would recommend you reach out to Joe Busch in Atlanta - a highly experienced prostate MRI specialist and ask him for a second opinion re. the MRI - I can contact him if you like - cheers
I would be interested in Joe Busch’s second opinion if you could put me in contact with him. TY
Actually would be a third opinion. I sent MRI to doc in Washington state as well
I have sent my MRI discs to a doc in Washington state that Howard once mentioned for second opinions. Sent both the original and latest (1.5 weeks ago). Unfortunately they both were without and with constrast. Gadolinium. Prohance I believe. Waiting to hear back on MRI second opinion. I see my uro Monday for their results of MRI and PSA
Got MRI results back. Lesion 1 is unchanged in 2.6 years. Lesion 2 actually shrunk down to .6 cm. No need for another biopsy and no treatments to start. Keeping on AS
you are welcome.
Howard, I could kiss you!! "No, please don't!" Two points: First, because of your history with the American Medical profession and intent extracting accountability within its membership, each of us ride your coattails and become armed to do battle with "Father Knows Best"-or, was it Kildare? For the silent majority, eternal thanks. Now, more importantly, to the second point. One of us recently lambasted your inclusion of Bert Vorstman, M.D. comments on Active Surveillance in The Active Surveillor. This forum is designed for free and open expression, clearly not present in the history of AMA. It is what we want, it is what we demand, self-aggrandizement having no place even when coming from one at the tip of the spear of this movement. Who is this individual and newsletter in which he made his comments?
It's not about not liking AS - its a very laudable concept as in the past men were simply pushed towards surgery with scare-tactics and the cancer word. The sad part about AS is that the program uses the same unreliable and risky recommendations as for prostate cancer screening. ie the prostate exam, the PSA, the ultrasound-guided prostate needle biopsy. And, to cap it off, the possibility of a "treatment" for which there is no long-term scientific evidence for benefits.
In the article you mentioned that the prostate can hold different Gleason grades. In my case, my MRI showed a PIRADS4 (4.1cm) and a PIRADS5 (~2cm) and according to my docs info, I should have a high grade, serious cancer. But out of 29 cores in the biopsy, only 5 came back with Gleason 6. Had a fusion biopsy. And every single one of those 5 positives, only 5% of the core was "cancer". Don't understand that but they put me on AS, and every 6 months it is high anxiety time waiting for test results. But anyway, if the prostate can hold different Gleason levels, how is one to know if there is a lurking Gleason 8 or 9?
yeah tom - this doctor can give you that
https://howardwolinsky.substack.com/p/whats-wrong-with-active-surveillance
cheers
bert
A chilling essay and warning. Thanks for sharing, Howard.
Do you have a link to the article about this doctor not liking Active Surveillance? I would be interested in reading thayt
Tom: https://howardwolinsky.substack.com/p/whats-wrong-with-active-surveillance
Bert is controversial. But he isn't alone. Some docs feel that AS is overused. They feel some of us with very-low Gleason should never have been diagnosed to begin with and likewise too many are on AS. I can send more on that. I feel that if I was starting from scratch today there's a good chance I would not be diagnosed and would have been saved from all the surveillance, biopsies, MRIs and PSAs. On the other hand, surveillance beats aggressive treatment, no? Howard
TY!