1- The rapid growth of prostate cancer treatment is not driving increased survival.
2- Gleason score 6 is not prostate cancer.
3- PSA-based screening does not save lives.
4- Prostate cancer surgery for localized prostate cancer does not improve survival.
5- Robotic prostatectomy has never been properly evaluated for safety and efficacy.
1) yes2)yes
3) why not?
4)maybe? If you can guarantee it won’t metastisis
5)not sure? Strange it’s outcomes hv not been compared to open Prostetechtomy ?
One post and no bio / history……..
your point?? are you looking for a reason to ignore yur high PSA? avoid treatment? avoid biopsy? or some other reason for posting? If the point is that medicine is far from solving the puzzle of prostate cancer..yes, that is true. Since PSA testing was begun, age-adjusted prostate cancer death RATES are significantly lower !! If you believe that all medical research is bogus.......well, if that is what you believe, really no way to prove that you are wrong, is there?
Your Point?...
Sweeping generalizations don't help.
I read through the article. I find the tone to be a bit defeatist and along the lines of it "appears" we have not made progress so why try. There are statements such as "probably not based", "grossly unscientific", "hit-or-miss" among other pejorative statements. The posting does not suggest any alternatives or fixes and leaves the impression that we are not making any advances so maybe we should stop.
1). There are not any details on the comparison of mortality from PCa and life expectancy. Is overall life expectancy used, that is males and females or male life expectancy? US only or worldwide? A better measure I would think would be overall mortality from prostate cancer, however it could be argued that earlier detection of PCa would skew the results.
2). Yes, this is an issue. Reading a biopsy can be as much art as it is science. This is the reason that I had my slides read by three different labs not connected with each other. All the labs agreed on the grade and number of samples involved. There was a slight disagreement about volume by about 1% (4% vs 5% in one sample). This should be improving with automated algorithms for reading slides.
I would encourage anyone with an abnormality in or a questionable result from a biopsy to have the slides read by a different lab(s).
To categorize 3+3 as not cancer seems to be an academic discussion more than a useful designation. Gleason Grade 6 is not normal, there is some issue, it could indicate there is more advanced cancer somewhere or progress to a more malignant form. Whether it is called cancer, pre-cancer, or something else doesn’t really matter.
3). PSA screening has been debated for quite a while. While on Active Surveillance (AS) I have had quite a few PSA tests. Monitoring PSA is an important part of AS. If the PSA is high (above 10 or so) then there is a good probability that there is an aggressive form of PCa. My PSA held steady at about between 3 and 4 for many years. A few years ago it began to rise and the PSA Velocity began to increase. That was the beginning of the end of AS for me. I believe PSAV and PSA doubling time are two important measurements in tracking PCa, particularly for AS.
On a government website, it is estimated that about 25% of biopsies based on PSA scores result in a positive diagnosis. Does this mean we should stop doing PSA tests or should we better manage the use of the results?
There are several causes of increased PSA value beyond PCa, riding a bike, ejaculation, BPH and obesity among others. Before proceeding to biopsy, these factors need to be accounted for.
As pointed out in the article, a biopsy samples a very, very small portion of the prostate. It is entirely possible that the PSA test was not a false positive but rather that better detection methods need to be found.
I do believe that some (many?) urologists misuse the results of PSA tests and are quick to at least order a biopsy without considering alternatives or a confirming PSA test. However, misuse of PSA results should not be an argument to stop PSA tests. More research needs to be done on PSA tests (and alternatives).
4). From the PIVOT study:
“Subgroup analyses suggested that surgery might reduce mortality among men with higher PSA values and possibly among men with higher-risk tumors, but not among men with PSA levels of 10 ng per milliliter or less or among men with low-risk tumors.”
In other words, maybe surgery is being used too quickly. Surgery is an alternative given the right situation.
My takeaway is not that surgery should not be used, but rather it has its place as a treatment (and that some urological surgeons are too quick to surgery).
5). I agree. There has been very little study of “robotic” surgery. Early on the benefits were believed to be reduced recovery time however this has not been studied. Some of the questions I would have is what would happen if the system failed? What is the back up?
I have a different view and think the emphasis should not be on the mechanism but rather the surgeon.
Surgery today can be accomplished as open, laparoscopic, and DaVinci. It seems a number of people I have talked to talk about DaVinci view it as a robot doing the surgery. That is not the case. DaVinci is only as good as the doctor(s) performing the surgery. There are two doctors involved in the surgery, one operating the “robot” the other at the operating table assisting.
In research I found one study of prostate surgery experience plotted against biochemical reoccurrence. The plot was quite definite that as number of surgeries increased, biochemical reoccurrence fell until a point at about 250 surgeries it began to level off. The study was an older study and done pre-DaVinci. It does indicate that the experience of the surgeon is important.
I believe the emphasis should be on selecting the surgeon and not requiring the surgeon to use a particular method.
In my experience, I had researched the surgeon I was planning on, read several of his articles and his philosophy on treatment. Then went to talk to him. I had several questions that we went over. None of the questions involved the how but rather outcomes, follow-up, etc. The last question I asked was how he would do the surgery. He did surgery laparoscopically. I was out of the hospital the next day and did not require any blood transfusions. Recovery went well.
The article seems to imply that since there are issues with current diagnosis and treatment we should not rely on or use what is available. I disagree. The treatment of PCa has advanced through the years. Last year new scanning methods (PCMA Pet Scan with new tracer elements for example) have been approved. The scan can spot extremely small metastases. They may be useful as diagnostic or in conjunction with other methods.
We do need to make smarter and better uses of the tools we have. More research is needed to improve the methods.
Apalutamide for Metastatic Castration-Sensitive Prostate Cancer
Abiraterone in Metastatic Hormone-Sensitive Prostate Cancer 
Interesting report on the efficacy of IMRT on prostate cancer
