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Posted 8/22/2011 9:14 AM (GMT -5)
FYI....

location>CORAL SPRINGS, Fla., Aug. 22, 2011 /PRNewswire/ -- In an extensive article reviewing the most popular prostate cancer treatments available to men today, location>South Florida urologist Dr. Bert Vorstman takes a critical view on manufacturers, hospital systems and some colleagues who minimize the after effects of radical surgeries while continuing to endorse the procedures as a viable option.

"I believe that the radical surgical/robotic treatment option has single-handedly increased the incidence of impotence and incontinence worldwide, and physicians would do well to consider the Hippocrates affirmation: As to diseases, make a habit of two things--to help, or at least, to do no harm," challenged Vorstman in his article. "Men who choose these treatments without reviewing alternative, less invasive options are playing Russian Roulette with the quality of life prospects following the surgery."

http://www.prnewswire.com/news-releases/prostate-cancer-treatment--the-good-the-bad-and-the-ugly-128172008.html

Good thoughts to all.

Posted 8/22/2011 10:38 AM (GMT -5)
I agree 100% and I wish it were mandatory that all men right after dx would have to read such articles before rushing off to radical surgery 6 weeks later in a panic.
Posted 8/22/2011 11:29 AM (GMT -5)
IMO, until they develop a test that can distinguish the aggressive cancers from the indolent ones, there is no way to judge if the treatment is worse than the disease.
Posted 8/22/2011 12:05 PM (GMT -5)
Doesn't the Gleason score distinguish the aggressive cancers from the indolent ones?
Posted 8/22/2011 12:11 PM (GMT -5)
Gleason is some indication, but not definitive.
Posted 8/22/2011 12:16 PM (GMT -5)

onthefence said...
Doesn't the Gleason score distinguish the aggressive cancers from the indolent ones?

I think that Dr Steven Strum provides an excellent description at the prostate-cancer.org site:

Slow-growing variants in general, have low PSA values (under 10) and long doubling times (greater than 24 months and often 48 months or longer), as well as low PSA velocities (<0.75 ng/ml/yr ± 10%).  If a biopsy is done on a patient with a PSA that is under 10, the Gleason score often turns out to be (3,3).  Depending on the calculated tumor volume, clinical stage, PSA doubling time, and other factors, these objectified biologic parameters may allow many such patients to be candidates for AS.

Aggressive variants, in general, have high PSAs (over 10) OR very low PSAs associated with very aggressive, high Gleason score [(4,3), (4,4), (4,5), (5,4), (5,5)] cancers. These variants (low PSAs) are very dangerous, often escaping investigation for long periods of time because the PSAs appear to be in the so-called normal range.  High Gleason score cancers often have reverted to an embryonic state in which PSA secretion into the blood is markedly reduced.

Checking the serum for abnormal elevations in markers such as CGA (Chromogranin A), NSE (Neuron Specific Enolase), CEA (Carcino- Embryonic Antigen) and PAP (Prostatic Acid Phosphatase) is important to discern PC activity secondary to these de-differentiated tumor cell populations. Therefore, in cases such as this, the normal guidelines for PSA velocity and doubling time may not be applicable. HOWEVER, the concept of slope or trend in a biomarker of disease activity remains valid, and any biomarker elevation should be tracked at regular intervals to determine the presence of abnormal growth of primitive (embryonic) tumor cell clones.

 

Inherent in this perpsective is that nobody should be making a determiniation based on just one test...

 

 
Posted 8/22/2011 12:17 PM (GMT -5)
And, as is often noted on several posts you will find on this forum, VERY often the Gleason Score is upgraded after surgery when full pathology can be done.

Therefore, and unfortunately, it is often only AFTER one has made a choice of treatment (surgery), that one really knows how aggressive that particular pca is, at least as measured by the Gleason scale.
Posted 8/22/2011 1:12 PM (GMT -5)
as i read it the doctor is saying that surgery is used too often when there are other options with fewer side effects, like radiation.

ed 

Posted 8/22/2011 1:34 PM (GMT -5)
Vorstman is a promoter of HIFU...
Posted 8/22/2011 1:46 PM (GMT -5)
There are no garantees in PC and no test can determine 100% the agressiveness of a given PC. That said with a multitude of tests, both scans and biological markers one can reasonably determine the agressiveness of one's individual PC. Especially is one is monitored over time then it becomes very apparent if a PC is agressive or non agressive. Post surgery pathology is a very good way to determine agressiveness, but the objective is to determine this BEFORE a radical treatment and not after.
Most doctors don't have the skilll to make this determination, but there are a few with both the experience and the knolwlege to make this call correctly and Dr Strum is one of them. This is why accurrate staging is necessary for everyone; this includes blood markers and various psa derivitives such as psa density, psa velocity, psa doubling time. a 2nd opinion on all biopsy slides and scans like color doppler or MRIS. Other indications such as PCA3 and various markers developed by Dr Bronhoff can give a reasonable indication of agresssiveness. All this information taken in TOTAL can give one a resonable expectation that the staging is correct BEFORE making a decision on treatment or non treatment.
Posted 8/22/2011 3:30 PM (GMT -5)
Irrespective of this physician's interest in HIFU, I think he makes some excellent points.  He says, "...seek several opinions on the various treatment options available".  We have seen it frequently at HW over the years where a patient gets his mind made up to have surgery w/o even bothering to educate himself or seek medical opinions about the alternatives.  We also (unfortunately) frequently see the results of such decisions.  I'm not saying there is only one treatment for everyone's PCa but, for cryin' out loud, I just don't understand men (or their wives) who don't take the time and trouble to educate themselves about the options...and the corresonding quality of life issues.

Tudpock (Jim)

Posted 8/22/2011 3:53 PM (GMT -5)
ditto...........
Posted 8/22/2011 3:58 PM (GMT -5)
I would have to say for Gleason 6 or 7, there is some truth in a very general way, at least with some surgeon/uro doctors.

As a Gleason 9, I still feel that surgery was still my best shot. Yes, there is a potential for side effects, but I will take them to have a .02 at 27 weeks.

While the reported side effects may be less in incidence for other treatments, there are none-the-less side effects, failures, and unintended consequences as well. This is a tricky disease and so far, we haven't developed the perfect treatment yet.

Goodlife
Posted 8/22/2011 3:58 PM (GMT -5)
I think, and MY experience has been, that you find a dr who is qualified, who you can trust, and when HE gives you his reasoning for the WHY he is suggesting a certain treatment, it is hard for the layman to argue against it.

"Most doctors don't have the skilll to make this determination, but there are a few with both the experience and the knolwlege to make this call correctly and Dr Strum is one of them" - Ahhhhh I just dont think so.

There are A LOT of drs with both a TON of experience, a TON of knowledge and a TON of best intentions. Yet NONE of them, including STRUM can give you a post op pathology Pre Op.

That's not to say some drs arent better than others, but most insurance policies dont allow you to get 3 different opinions to break the tie.

I
Posted 8/22/2011 4:27 PM (GMT -5)
Blue Cross Blue Shield traditional plan.....awesome....excellent. Got 8 opinions, hired and fired docs even after some testings or blood work...no questions asked. Insurance exceeded my expectations, best part of my journey and empowerment and sure happy it was there.

Fired radiation doc one day before starting, caught her in 2 mistruths ( I call them lying to the patient), so fired immediately. I noticed a year later she no longer works for Henry Ford Hospital also (-: . I did praise Dr. Menon for truthfully telling me no surgery for it wouldn't be a cure, in my case.
Posted 8/22/2011 4:37 PM (GMT -5)
Zufus, I am truly happy that was your experience, and I hope to god you live a long, healthy and happy life.

I guess I am left wondering a bit about those who were not fortunate enough to get a 1st opinion, when others are able to get 8.

I'm pretty sure that we as a society (the world society) cannot economically offer that benefit to the masses.

BTW, the one who lied to you, but got paid anyway - too bad that money wasn't spent on some uninsured sap who would be lucky to get a single opinion.

If I get pissed enough about the whole inequity/unjustice with how pca is handled in MY society (USA), then I may have to start gathering similar minds and start making it a point to make those in power listen to how badly this horrible disease is handled.

From education to investment, they treat pca like a 3rd class disease. I have family that think I have "cancer light". Just because that cant see the pain that goes on behind the curtains. Emotionally and otherwise.

Best to all of you!
Posted 8/23/2011 3:56 PM (GMT -5)
I am always looking at procedures that have better quality of life outcomes.  Of course, my time has passed and I am what I am.  I try to find things I can pass on to my family and friends.  Right now I am suggesting a look at brachy and hifu rather than surgery for low gleason diagnosis.

 The conclusions by Doctor Vorstman who wrote this article  should be viewed with some suspicion, as he makes his money doing HIFU procedures. 

http://www.hifurx.com/

That is not to say that hifu is not a good option and could become even better in the future.  One study I read said that hifu patients had a short term 80% true erectile recovery rate, but a 40% cancer return rate. It also said that 52% of the patients required a second hifu treatment to repair urinary problems or treat returning cancer.  The 40% cancer return and 52% need for further treatment are much higher than surgery.  Talk about 'russian roulette'.   If further studies endorse this quality of life statistic, then hifu has a place. 

 Incidentially, just last week I talked to a friend who had just completed a second HIFU treatment to get the cancer the first one left behind.  He hopes for a better outcome this time.

Posted 8/23/2011 5:07 PM (GMT -5)
lifeguyd, I largely agree with your comments on HIFU...the results just aren't very good right now, but I hold hopes that focal treatments will continue to improve over time and be more widely accepted (as will a greater number of active surveillance participants for those who are well-qualified).   Low Gleason scores, however, are not the only dimension for consideration...there is not a one-size fits all even for low risk guys.   I have coached low-risk men to consider the four individual dimensions spelled-out in the AUA Foundation's document " The Management of Localized Prostate Cancer Patient Guide ."   [attention moderators:   this link is a great sticky opportunity for newcomers]   The dimensions to consider (at a minimum, and will be different person-to-person) are: ·          my cancer's characteristics ·          my overall health ·          my life expectancy/age ·          my personal values   In my own individual case, if I had been two decades older (and less concerned with late-term effects) and everything else was the same, I would have gone with radiation (brachytherapy).   If I had been one decade older, it would have been a much tougher decision between surgery and brachytherapy.  
Posted 8/23/2011 6:11 PM (GMT -5)
The tumor cells can also mutate and become more aggressive with time.
Posted 8/23/2011 6:14 PM (GMT -5)
zufus,
Funny you mention that about mistruths. I will ask my doctors a specific question which I generally know the answer just to see what kind of answer I get from them.
Posted 8/23/2011 7:12 PM (GMT -5)
Some of what Dr.Vorstman says makes good sense, but it seems to me he is trying to freak people out about surgey so they will be more likely to purchase what he is trying to sell. I find more balanced presentations to be more credible.
Posted 8/23/2011 7:21 PM (GMT -5)
Hi ALL, - This is not an independently produced article but, rather, a self-serving Public Relations release from the Doctor, who is commercially promoting his own use of HIFU and doing so by attacking the other treatment modalities and those who practice them, particularly surgery. If you look at the initial citing at the beginning, you will see it came from the PRNewswire (this is the easy source for the newspaper's finding the Press Release). PRNewswire is a commercial operation that for "money" will distribute a Press Release from ANYONE (well maybe not Zufus) (;-)}, and Dr Vorstman, as he is free to do, took that opportunity to promote his own practice, under the guise of "professional" observation.

A lazy newspaper editor picked it off that wire to fill a blank space on the newspaper page (not unusual in todays journalism) and published it exactly as biasly written and without investigation as to its factual veracity.. You will see at the bottom of the page, that the "source" is listed as Dr. Vorsman and that is the origination source for the commercial press release, that was then published verbatim, evidently as a news article, rather than what it really is, which is an "opinion" piece that, according to traditional journalism etiquette should have carried the authors name following the title. But then Journalism, like Medicine and everything else. has changed substantially over the years and not necessarily for the better. You can agree or disagree with the articles content but you shouldn't be fooled into thinking of it, as a "news" article, which it is NOT. - John@newPCa.org (aka) az4peaks

O
Posted 8/23/2011 8:12 PM (GMT -5)
I read his whole original article (phew).

He had me until he constantly bashed robotic surgery.

It may be true that its yet to be proven as best,

but also not disproven.  I suspect he is mad on loosing

business.  Once again, John Hopkins, Sloan kettering, etc.

not a soloist.  Article is subjective, not objective.

Posted 8/24/2011 2:35 AM (GMT -5)
When I was diagnosed with PCa about a year ago I went through the usual late night web surfing sessions that I guess most of us have experienced. One thing I quickly learned, however, is how unreliable some US medical sites are, and how there's a number (small I hope) of US surgeons who seem to have forgotten about their Hippocratic oath, and prefer earning great wads of cash by frightening men into having their recommended form or treatment, at their hospital, and having it NOW.

I guess a scum bag with a medical degree is still a scum bag - but the great pity is that the majority of doctors who aren't scum bags have to fight against this misinformation, and many patients get frightened unnecessarily.
Posted 8/25/2011 9:29 AM (GMT -5)
I just got around to reading the entire article.  And, while it is easy to bash the author since his business is HIFU, I actually found the article itself to be thoughtful and potentially very useful to the newly diagnosed patient.  Like "Invasion of the Prostate Snatchers", this article provides a helpful counter-point for the patient who may feel pressured into surgical treatment by doctors who may be equally or more self-serving and biased as some of you feel that this author may be.

BobCape, thanks very much for sharing this.

Tudpock (Jim)

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