(Editor’s note: Dr. Bert Vorstman, the “uro-heretic,” is well-known to the readers of TheActiveSurveillor.com. His controversial columns have been among the most read in this newsletter—often to the dismay of his critics. He’s teaming up with Ron Piana, co-author with Richard Ablin, PhD, of “The Great Prostate Hoax,” the classic expose of the approval of the PSA blood test. Grab a cuppa of Java, buckle up, and be prepared for a wild ride. If you disagree with Vorstman and Piana, please feel free to comment or
The ProtecT study in UK showed that the mortality rate for prostate cancer was very low in men--whether they had surgery, radiation, or AS.
In 2010, when i was diagnosed, my second urologist showed me Dr. Klotz's research in Canada that had similar death rates.
Based on that, I decided to go on AS. I figured I wouldn't die from cancer but at least I could retain my prostate gland and quality of life.
My first urologist tried to rush me into surgery based on a single core of Gleason 6. If I had undergone the surgery, I would never known that in four other biopsies, no cancer was found.
Thank you for your thoughts. I would never get treatment with G6 only and never get surgery with a higher grade based on what I know today.
It’s true the PSA is a very imperfect tool. Its imperfections result in too many biopsies and the over-diagnosis of low-grade cancer or whatever you call G6. It’s hard to see any real harms from this aside from very occasional sepsis as a result of biopsy infection and the worry of being on AS after a G6 dx. But the results of not using PSA seems much worse: increased numbers of people with PC discovered at advanced stages. I just don’t understand what would you have people do instead of yearly PSA testing.
The evidence shows that men are exposed to harms that far outweigh any possible good - see Anthony Horan's book - the Rise and Fall of the Prostate Cancer Scam and the one by Ablin and Piana - The Great Prostate Hoax - supported by 100s of references - buy them on Amazon.
Just because we have no biological marker that can identify high-grade prostate cancer early and reliably to save significant numbers of lives doesn't mean we should just go on harming and deceiving patients with the lowly PSA and "treatments" that don't work. The current prostate cancer game plan is simply licensed medical malpractice.
Correct me if I’m wrong, but based on the evidence you present, wouldn’t it make sense for me to drop out of active surveillance of my one identified core of Gleason Six, stop getting not only future biopsies but also future PSA tests, and basically DO NOTHING unless and until some other symptom emerges indicating something could be wrong.
With all due respect, Dr. Vorstman, that sounds insane. I’m just fine with doing the AS protocol. And if they find a Gleason Seven or higher, I’ll do LDR Brachytherapy with an experienced Brachytherapist and whatever else is recommended.
yes Markus - of course that would seem insane - IF- there was irrefutable and reproducible evidence that:
> PSA testing saved significant numbers of lives
> AS saved significant numbers of lives
> treatments such as brachytherapy saved significant numbers of lives
Sadly, there is no evidence supporting any of these management steps. Even worse, investigations have concluded that only about 11% of all treatments - across the whole of healthcare - have been shown to be beneficial.
Unfortunately, the healthcare arena is filled with false hope, false promises and health robbery.
On numerous prostate cancer forums on the Internet I have read about men who have been on active surveillance for a few years and sometimes many years when suddenly a change is seen in their lesion indicating progression and they then opt for treatment like surgery or radiation and years later they are still alive and cancer free.
In their cases Active Surveillance saved lives, no?
Hey Markus- I suggest you read the 2 books I reference in my articles - they are absolute eye-openers. The PSA has a 78% false positive rate. Also, research has shown that the G6 lacks the biological mechanisms for it to act as a cancer. Urologists are well aware of that fact but continue to ignore the evidence. In the meantime scores of men diagnosed with the G6 are in fear of their lives. Simply appalling. By far, more men are harmed from so-called screening than garner any benefit. Just because we have no ideal marker doesn't mean we should be ok with a test that is an absolute hoax. Even urologist's own studies have shown that both PSA testing and surgical "treatment" fail to save significant numbers of lives. But, they keep recommending it. There simply is no irrefutable and reproducible data showing that NOT PSA testing leads to an increased number of advanced cases. We have no scientific proof that current screening and treatment options save significant numbers of lives. We need something that actually helps and doesn't give false hope and false promises.
So, at age 57, they found one core of Gleason Six on my second systemic biopsy. Both MRI’s which preceded the biopsies were negative. I consider myself lucky to be on AS and to know what they think I have. Am I supposed to be angry they overtreated me? This all started with a PSA that jumped to 4.6.
I would be very angry if I was in your situation. For years I drank the Kool-Aid and did what I had been told by my mentors was standard practice. However, I never believed in the radical prostatectomy as my postoperative observations were in sharp contrast to surgeons glowing reports of postoperative success. In fact, when I talked to the wives, partners and girlfriends of these men who had undergone prostatectomy it was clear that their men had only been robbed of health.
About 2010 I discovered that the so-called Gleason six - although labeled as a cancer - was in fact not a cancer at all. I then discovered that only the 10 to 15 percent of high-grade prostate cancers were potentially lethal, that the PSA test was a total fraud and that PSA testing, radical surgery and radiation failed to save significant numbers of lives. This exploitation of false hope and false promises made my blood boil. I had harmed many men by believing my mentors and their highly flawed recommendations.
I also discovered two books (referenced in my articles) that exposed the unbridled licensed malpractice that was occurring in the prostate cancer arena. There was no irrefutable and reproducible data supporting any of the recommendations for localized prostate cancer. The standard-of-care tag was hollow. Sadly, all urologists have access to the same information but still believe in a flat earth.
About 30% of men diagnosed with low-risk prostate cancer like to make up cancer names. Here's a note from one:
A good many leaps to conclusions here, and I’m still not completely comfortable with accepting Gleason classification, but I’m stymied at the idea that non-contrast MRI is the benchmark. Mine was with and without, and the conclusion that one lesion picked up the contrast was the difference between PiRADS 3 and 4. Of course, two radiologists looked at the same MRI and didn’t agree on anything. Also makes me wonder what the urologist aimed at in the biopsy. Sort of like hunting squirrels with a .22 in the dark. All negative! No squirrels here!
What’s the point of AS, if you’re gonna get your butt needled every year anyway
Gobsmacked! This hard reasoning, rattling my personal sense of trust "taught" aging with contemporaneous American medicine, is what I'd hoped I'd see in this forum. Despite some readers' negative reaction to his comments in the past, I applaud Dr. Vorstman and Mr. Piana questioning, "....Where is the undeniable and replicable ...." reminding us, sadly, we are consumers. Look forward to further development from the two and others on premise of their argument. Thank you immensely, Howard!
Thank you steve - We believe it's important for healthcare consumers to understand that in the whole of the healthcare arena that only about 11% of all medical treatments are known to be beneficial. A staggering number that implies you may well be on the receiving end of so-called care that's of no benefit, leaves you with a complication and costs you money. Demand to see undeniable proof. Don't accept nonsense like appears effective, seems promising or it's the gold-standard.
I heard that nonsense quite often during the last four years about a certain medical procedure that I totally refused to take and my health is excellent still.
It does appear that the authors take the position that there is no reasonably effective course of treatment for prostate cancer leaving unanswered if indeed that is thier position, what is one to do? Therefore, there needs to be a follow up article that addresses that question.
Hey rich - I wish we had good news. Unfortunately, we don't have scientific evidence of tests and treatments in the prostate cancer arena that actually saves significant numbers of lives. As in the greater healthcare arena there are many many opinions - from both patients and doctors. However, all healthcare recommendations should be challenged with one question. Where is the irrefutable and reproducible evidence that this recommendation is clearly beneficial? Once we have definitive evidence that something works - and is proven to work according to studies based on sound scientific principles, we will let folks know. Sadly, only some 11% of medical treatments are known to be of benefit. cheers bert
Thank you for your response. In my administrative career in Healthcare I made decisions based factual information and "science ". For us with PCa, many of us research the studies that pertain to our situation. Numerous studies appear to demonstrate the efficacy of various focal therapies, SBRT and even AS. Hence when all of these studies over more than a decade are dismissed with no recommendation as to one is to do in that case, it gives rise to serious concern. In addition, the reimbursement and physician compensation systems do not in many instances promote a focus clinical quality outcomes of care.
There is cause for a great amount of concern about truthfulness in healthcare. Several authors like John Ioannidis MD have written about this problem. The question that everyone should ask about any healthcare recommendation is this - Where is the irrefutable and reproducible data supporting this recommendation? "FACTS" can only be facts if the data from these so-called studies is based upon sound scientific principles and is reproducible. Sadly, most physicians have strayed from science and scientific fundamentals into junk science. They still label the G6 bogus cancer as a "cancer".
Your point about reimbursement (financial conflict of interest) is very pertinent as the health insurance industry controls virtually all pricing, access and delivery of healthcare. This situation has forced physicians to focus on the codes that they can apply too a consumer so as to maximize reimbursement - not what's in the very best interests of this particular patient and their situation/condition.
Unfortunately, we know what doesn't work in the prostate cancer arena. Currently, we have nothing that will identify reliably the 10-15% of potentially lethal high-grade prostate cancers early enough to get a treatment that has been shown to save significant numbers of lives.
Hey Rich - Your concerns are our concerns - both as consumers and physicians. As a urologist I drank the kool aid for many years. There is an awful lot of rot in the healthcare arena. Most studies are not founded on sound scientific principles. Most published research is false - garbage in, garbage out and only about 11% of medical treatments have been shown to be effective. This well of medical "information" is made even more toxic by social media, chat rooms and Big industry. Most physician organizations, research studies and publications are "sponsored" by Big Money. I remember Ron telling me a few years ago to "tone it down" otherwise, if Big Money didn't like it, an article we were working on it wouldn't be published. However, a source that kept me trying to get to the truth was Dr Horan's book the Big Scare (now the Rise and Fall of the Prostate Cancer Scam) - he had the business of prostate cancer figured out years ago. Also, the lack of alternatives to the current prostate cancer narrative shouldn't be an excuse to keep doing tests and treatments that don't work - we don't do lobotomies any more.
Post from Abid Hasan, a Gleason 6 patient on AS in Pakistan:
So according to the authors, everything -- PSA, MRI, BIOPSY, SURGERY, RADIATION, etc --- is either a hoax or scientifically unsubstantiated. If one were to take these writers views at face value, anyone with prostate cancer should do nothing until either they die of something else or prostate cancer metastases somewhere else and the person dies of that.
I think this article is most unhelpful and negative to the extreme . While I am sure there are unscrupulous drug companies and doctors making people do unnecessary diagnostics and treatment, advances in diagnostics and treatments in last 5 decades have helped humanity hugely across the entire spectrum of diseases.
The bottom line is that it would be far more helpful if the authors had made recommendations on what people should do to detect prostate cancer at an early stage , and how should one detect Prostate cancer if PSA, DRE, MRI and BIOPSIES are a hoax.
This work has simply taken the urologists current recommendations for testing and treatment of localized prostate cancer and searched for the irrefutable and reproducible evidence supporting that ideology. Since we have used the very conclusions published by my urology colleagues any accusations that this paper is just another opinion piece are hollow and only underscore a lack of knowledge on the subject. On the contrary, most of the healthcare arena is drowning in opinions and assumptions. And, the reason we have not offered alternatives to the current "recommended" testing and treatment of localized prostate cancer is that there are none that have been proven to be safe and effective.
Ignor,
Active surveillance at least saves prostates.
The ProtecT study in UK showed that the mortality rate for prostate cancer was very low in men--whether they had surgery, radiation, or AS.
In 2010, when i was diagnosed, my second urologist showed me Dr. Klotz's research in Canada that had similar death rates.
Based on that, I decided to go on AS. I figured I wouldn't die from cancer but at least I could retain my prostate gland and quality of life.
My first urologist tried to rush me into surgery based on a single core of Gleason 6. If I had undergone the surgery, I would never known that in four other biopsies, no cancer was found.
HW
Thank you for your thoughts. I would never get treatment with G6 only and never get surgery with a higher grade based on what I know today.
It’s true the PSA is a very imperfect tool. Its imperfections result in too many biopsies and the over-diagnosis of low-grade cancer or whatever you call G6. It’s hard to see any real harms from this aside from very occasional sepsis as a result of biopsy infection and the worry of being on AS after a G6 dx. But the results of not using PSA seems much worse: increased numbers of people with PC discovered at advanced stages. I just don’t understand what would you have people do instead of yearly PSA testing.
The evidence shows that men are exposed to harms that far outweigh any possible good - see Anthony Horan's book - the Rise and Fall of the Prostate Cancer Scam and the one by Ablin and Piana - The Great Prostate Hoax - supported by 100s of references - buy them on Amazon.
Just because we have no biological marker that can identify high-grade prostate cancer early and reliably to save significant numbers of lives doesn't mean we should just go on harming and deceiving patients with the lowly PSA and "treatments" that don't work. The current prostate cancer game plan is simply licensed medical malpractice.
Correct me if I’m wrong, but based on the evidence you present, wouldn’t it make sense for me to drop out of active surveillance of my one identified core of Gleason Six, stop getting not only future biopsies but also future PSA tests, and basically DO NOTHING unless and until some other symptom emerges indicating something could be wrong.
With all due respect, Dr. Vorstman, that sounds insane. I’m just fine with doing the AS protocol. And if they find a Gleason Seven or higher, I’ll do LDR Brachytherapy with an experienced Brachytherapist and whatever else is recommended.
yes Markus - of course that would seem insane - IF- there was irrefutable and reproducible evidence that:
> PSA testing saved significant numbers of lives
> AS saved significant numbers of lives
> treatments such as brachytherapy saved significant numbers of lives
Sadly, there is no evidence supporting any of these management steps. Even worse, investigations have concluded that only about 11% of all treatments - across the whole of healthcare - have been shown to be beneficial.
Unfortunately, the healthcare arena is filled with false hope, false promises and health robbery.
On numerous prostate cancer forums on the Internet I have read about men who have been on active surveillance for a few years and sometimes many years when suddenly a change is seen in their lesion indicating progression and they then opt for treatment like surgery or radiation and years later they are still alive and cancer free.
In their cases Active Surveillance saved lives, no?
Hey Markus- I suggest you read the 2 books I reference in my articles - they are absolute eye-openers. The PSA has a 78% false positive rate. Also, research has shown that the G6 lacks the biological mechanisms for it to act as a cancer. Urologists are well aware of that fact but continue to ignore the evidence. In the meantime scores of men diagnosed with the G6 are in fear of their lives. Simply appalling. By far, more men are harmed from so-called screening than garner any benefit. Just because we have no ideal marker doesn't mean we should be ok with a test that is an absolute hoax. Even urologist's own studies have shown that both PSA testing and surgical "treatment" fail to save significant numbers of lives. But, they keep recommending it. There simply is no irrefutable and reproducible data showing that NOT PSA testing leads to an increased number of advanced cases. We have no scientific proof that current screening and treatment options save significant numbers of lives. We need something that actually helps and doesn't give false hope and false promises.
cheers, bert
So, at age 57, they found one core of Gleason Six on my second systemic biopsy. Both MRI’s which preceded the biopsies were negative. I consider myself lucky to be on AS and to know what they think I have. Am I supposed to be angry they overtreated me? This all started with a PSA that jumped to 4.6.
Hey Marcus,
Many thanks for your question.
I would be very angry if I was in your situation. For years I drank the Kool-Aid and did what I had been told by my mentors was standard practice. However, I never believed in the radical prostatectomy as my postoperative observations were in sharp contrast to surgeons glowing reports of postoperative success. In fact, when I talked to the wives, partners and girlfriends of these men who had undergone prostatectomy it was clear that their men had only been robbed of health.
About 2010 I discovered that the so-called Gleason six - although labeled as a cancer - was in fact not a cancer at all. I then discovered that only the 10 to 15 percent of high-grade prostate cancers were potentially lethal, that the PSA test was a total fraud and that PSA testing, radical surgery and radiation failed to save significant numbers of lives. This exploitation of false hope and false promises made my blood boil. I had harmed many men by believing my mentors and their highly flawed recommendations.
I also discovered two books (referenced in my articles) that exposed the unbridled licensed malpractice that was occurring in the prostate cancer arena. There was no irrefutable and reproducible data supporting any of the recommendations for localized prostate cancer. The standard-of-care tag was hollow. Sadly, all urologists have access to the same information but still believe in a flat earth.
Cheers, Bert
About 30% of men diagnosed with low-risk prostate cancer like to make up cancer names. Here's a note from one:
A good many leaps to conclusions here, and I’m still not completely comfortable with accepting Gleason classification, but I’m stymied at the idea that non-contrast MRI is the benchmark. Mine was with and without, and the conclusion that one lesion picked up the contrast was the difference between PiRADS 3 and 4. Of course, two radiologists looked at the same MRI and didn’t agree on anything. Also makes me wonder what the urologist aimed at in the biopsy. Sort of like hunting squirrels with a .22 in the dark. All negative! No squirrels here!
What’s the point of AS, if you’re gonna get your butt needled every year anyway
If. you are having trouble getting emails to me, you can cut and paste this address: <pros8canswers@gmail.com>
Gobsmacked! This hard reasoning, rattling my personal sense of trust "taught" aging with contemporaneous American medicine, is what I'd hoped I'd see in this forum. Despite some readers' negative reaction to his comments in the past, I applaud Dr. Vorstman and Mr. Piana questioning, "....Where is the undeniable and replicable ...." reminding us, sadly, we are consumers. Look forward to further development from the two and others on premise of their argument. Thank you immensely, Howard!
Thank you steve - We believe it's important for healthcare consumers to understand that in the whole of the healthcare arena that only about 11% of all medical treatments are known to be beneficial. A staggering number that implies you may well be on the receiving end of so-called care that's of no benefit, leaves you with a complication and costs you money. Demand to see undeniable proof. Don't accept nonsense like appears effective, seems promising or it's the gold-standard.
cheers bert
Nonsense Like when they it’s “SAFE & EFFECTIVE”?
I heard that nonsense quite often during the last four years about a certain medical procedure that I totally refused to take and my health is excellent still.
Thanks, Richard.
The authors are planning a follow-up but I am not sure of the angle.
But I'll alert them to your point.
Howard
It does appear that the authors take the position that there is no reasonably effective course of treatment for prostate cancer leaving unanswered if indeed that is thier position, what is one to do? Therefore, there needs to be a follow up article that addresses that question.
Richard M.
Hey rich - I wish we had good news. Unfortunately, we don't have scientific evidence of tests and treatments in the prostate cancer arena that actually saves significant numbers of lives. As in the greater healthcare arena there are many many opinions - from both patients and doctors. However, all healthcare recommendations should be challenged with one question. Where is the irrefutable and reproducible evidence that this recommendation is clearly beneficial? Once we have definitive evidence that something works - and is proven to work according to studies based on sound scientific principles, we will let folks know. Sadly, only some 11% of medical treatments are known to be of benefit. cheers bert
Dr. Vorstman
Thank you for your response. In my administrative career in Healthcare I made decisions based factual information and "science ". For us with PCa, many of us research the studies that pertain to our situation. Numerous studies appear to demonstrate the efficacy of various focal therapies, SBRT and even AS. Hence when all of these studies over more than a decade are dismissed with no recommendation as to one is to do in that case, it gives rise to serious concern. In addition, the reimbursement and physician compensation systems do not in many instances promote a focus clinical quality outcomes of care.
Regards,
Richard M.
There is cause for a great amount of concern about truthfulness in healthcare. Several authors like John Ioannidis MD have written about this problem. The question that everyone should ask about any healthcare recommendation is this - Where is the irrefutable and reproducible data supporting this recommendation? "FACTS" can only be facts if the data from these so-called studies is based upon sound scientific principles and is reproducible. Sadly, most physicians have strayed from science and scientific fundamentals into junk science. They still label the G6 bogus cancer as a "cancer".
Your point about reimbursement (financial conflict of interest) is very pertinent as the health insurance industry controls virtually all pricing, access and delivery of healthcare. This situation has forced physicians to focus on the codes that they can apply too a consumer so as to maximize reimbursement - not what's in the very best interests of this particular patient and their situation/condition.
Unfortunately, we know what doesn't work in the prostate cancer arena. Currently, we have nothing that will identify reliably the 10-15% of potentially lethal high-grade prostate cancers early enough to get a treatment that has been shown to save significant numbers of lives.
cheers Bert
Hey Rich - Your concerns are our concerns - both as consumers and physicians. As a urologist I drank the kool aid for many years. There is an awful lot of rot in the healthcare arena. Most studies are not founded on sound scientific principles. Most published research is false - garbage in, garbage out and only about 11% of medical treatments have been shown to be effective. This well of medical "information" is made even more toxic by social media, chat rooms and Big industry. Most physician organizations, research studies and publications are "sponsored" by Big Money. I remember Ron telling me a few years ago to "tone it down" otherwise, if Big Money didn't like it, an article we were working on it wouldn't be published. However, a source that kept me trying to get to the truth was Dr Horan's book the Big Scare (now the Rise and Fall of the Prostate Cancer Scam) - he had the business of prostate cancer figured out years ago. Also, the lack of alternatives to the current prostate cancer narrative shouldn't be an excuse to keep doing tests and treatments that don't work - we don't do lobotomies any more.
This is the best article you’ve ever published. Thank you so much.
Post from Abid Hasan, a Gleason 6 patient on AS in Pakistan:
So according to the authors, everything -- PSA, MRI, BIOPSY, SURGERY, RADIATION, etc --- is either a hoax or scientifically unsubstantiated. If one were to take these writers views at face value, anyone with prostate cancer should do nothing until either they die of something else or prostate cancer metastases somewhere else and the person dies of that.
I think this article is most unhelpful and negative to the extreme . While I am sure there are unscrupulous drug companies and doctors making people do unnecessary diagnostics and treatment, advances in diagnostics and treatments in last 5 decades have helped humanity hugely across the entire spectrum of diseases.
The bottom line is that it would be far more helpful if the authors had made recommendations on what people should do to detect prostate cancer at an early stage , and how should one detect Prostate cancer if PSA, DRE, MRI and BIOPSIES are a hoax.
This work has simply taken the urologists current recommendations for testing and treatment of localized prostate cancer and searched for the irrefutable and reproducible evidence supporting that ideology. Since we have used the very conclusions published by my urology colleagues any accusations that this paper is just another opinion piece are hollow and only underscore a lack of knowledge on the subject. On the contrary, most of the healthcare arena is drowning in opinions and assumptions. And, the reason we have not offered alternatives to the current "recommended" testing and treatment of localized prostate cancer is that there are none that have been proven to be safe and effective.