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Challenging views on PCa by Doctor

User
Posted 17 Feb 2019 at 11:18

I have put this under 'Diagnosis' because that's where it all starts but this also encompasses 'Treatment' and 'Living with prostate cancer', so is applicable to those sections also. Some of what Dr Bert Vorstman says has greater relevance to the experience in the USA but much is applicable to the UK.  Some of what is said can be readily accepted whilst other statements may be more open to challenge.  Some of the main contentions are that PCa is over-treated and could be better dealt with by focal treatment where necessary, also that in the USA in particular, PCa treatment is encouraged by profit.  The title of this quite long and strong submission is 'PROSTATE CANCER TREATMENTS - FACTS AND LIES' (but too long to use as title for this post).  It's worth a read and includes links to two unfortunate cases reported on YANA but we all know there is a risk of things going wrong with PCa cases. https://urologyweb.com/prostate-cancer-treatments-facts-and-lies/

 

Barry
User
Posted 17 Feb 2019 at 14:17
Very interesting article Barry. Of course, it didn’t tell us anything we didn’t know, and was a bit alarmist regarding cancer spread via and complications of biopsy.

Member ‘Madeinyorkshire’ who has popped up today might find it particularly relevant in his case.

Cheers, John.

User
Posted 17 Feb 2019 at 20:49

There was another post elsewhere where this topic came up and it was noted that the author had vested interests which could be argued to raise skepticism.

Much as I agree that particularly in the US profit can rise over care, I can’t see an entire global medical practice over fifty years backed up by empirical research being a global scam. Most medical scandals are brought to light in far less time.

Is this a case where tin foil is for cooking not hats? I wonder.....

Edit: it was Vorstman in the other posts and indeed he did tout his services as the ”better alternative”. Apart from one other medico also with vested interests he is a lone voice.

Edit 2: Also the claim about G6 is not entirely accurate. I know of a number of cases of G6 in patients on my other forum that caused BCR and relapse.

Edit 3: The one thing that may ring mathematically true is that 85% of men make ten years and 85% of men have G6 (according to Venkman) - is there a correlation?

Edited by member 17 Feb 2019 at 22:03  | Reason: Not specified

User
Posted 17 Feb 2019 at 22:16
Interestingly I notice that Urology surgeons now include the percentage of G6 in their prostatectomy cases. The guy who did mine was running at about 25%. G6 is never supposed to break out of the prostate either - mine had and final pathology confirmed it was a G6. Of course his argument for that would be that it was wrongly scored.

I also read a research piece somewhere about a patient whos tumour was genetically mapped and tracked until he died of PCA 15 years later, despite having G4 and 5 tumours too it was proven genetically that these had evolved from an original G3.

User
Posted 17 Feb 2019 at 23:44
I did look up Dr Albert Vorstman before posting and he seems to be well regarded, even though some of what he says is challenging for some. As has been picked up on, one of his contentions is about 3+3 Gleason not being regarded as cancer and many Urologists are of this opinion including the widely acknowledged top expert on Focal Therapy in the UK. It would indeed be interesting to confront these experts with cases where 3+3 has found to have spread outside the prostate but with no increase in Gleason score. (We know that PCa can mutate and result in a higher score and become more aggressive).

I feel the usefulness of the DRE test was over downplayed, Certainly it is not definitive but done by an experienced doctor can quite often be a useful procedure, to help establish enlarged, over firm or irregular Prostates.

Dr Vorstman is by no means alone in asserting that there is much over-treatment in the USA incentivized by big pharma.

Barry
User
Posted 18 Feb 2019 at 06:02
10 years ago (which is when he was most active) he was probably correct (well apart from the G3 thing!) IN THE USA. I don't think it has ever been over diagnosed in the UK - you only have to read this forum to realise that. So yes AS is the way to go for a small G6 but not one that's demonstrating invasive properties.

I also don't buy the "cancer seeding" part, the prostate gets squished and pummelled everytime a guy has an orgasm. When it's cut out the blood vessels get clamped first so how exactly will the cells escape??

User
Posted 18 Feb 2019 at 09:10

Sounds like a sad, bitter man. Much of what he says is correct - but he's twisted things in a very childish and negative way.

Much of it is 'straw man' argument. No-one ever suggested that a biopsy is perfect - it can't be: the only perfect biopsy is a prostatectomy.  No-one (in the UK at least) makes great claims for PSA, indeed, every reputably doctor goes on endlessly about how unreliable it is. I find it hard to believe that even in America, people believe a PR exam is an appropriate screening method ...

I could go on, but I get bored with hysterical idiots with a chip on their shoulder. Reading between the lines, this sounds like a guy who has been made bankrupt by the appalling US health care system and wants revenge.

.

-- Andrew --

"I intend to live forever, or die trying" - Groucho Marx

User
Posted 18 Feb 2019 at 10:20

For me, you can put this under the topic area 'Chamber of Horrors'.  Choosing a treatment is difficult enough without someone rubbishing current practises and promoting the very latest technology.

There are a lot of people who speak of overtreatment and the Consultant said to me there was always that pressure in the MDT.  My opinion is any reasonable sized tumour should be removed immediately and an op is usually the best.

I was offered laser PDT treatment for skin cancer although he said it will almost certainly come back, in my case anyway.  I have that suspicion with a lot of these non-cutting treatments as well, although radiation can reach wider areas.

User
Posted 19 Feb 2019 at 01:28

Johnathan,

It is widely accepted in medical circles that there is some overtreatment of PCa in the UK and of course some undertreatment too but the latter largely due to late diagnosis.

It is reasonable to argue that in situations where a less damaging procedure will do the job this is preferable to more drastic treatmnents that may cause more harm. Listen to what this Internationally known UK expert says on the subject after the lengthy introductions- skip the first 5 minuets.  I think Andrew would also find this of interest as neither Professor M E nor Dr Vorstman are "idiots", an opinion supported by medical contemporaries https://www.curetalks.com/event/rsvp/HIFU-Focal-Therapy-for-Prostate-Cancer/134/

 

Edited by member 19 Feb 2019 at 01:43  | Reason: Not specified

Barry
User
Posted 19 Feb 2019 at 10:37
Regardless of expertise, the one rule to follow in the US when reviewing controversial medical opinions is “cui bono”.
 
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