Radical Prostatectomy Releases Showers of Cancer Cells
During the robotic radical prostatectomy treatment, showers of cancer cells are released from the affected prostate gland into the bloodstream. Studies using PSA reverse transcriptase-polymerase chain reaction assays and other staining techniques have documented clearly the increased dispersal of cancer cells throughout the body from surgical manipulation. In fact, other studies have shown that tumor handling during a radical prostatectomy has resulted in a 3080% rise in the numbers of circulating prostate cancer cells.
Morcellator Disperses Even More Cells
A surgical device that may boost the spread of undetected cancer cells even more than those released by robotic or conventional surgical manipulation however, is the morcellator. This device is used to mince up a diseased organ so that the finely divided remains can be extracted through a keyhole opening rather than through a standard surgical incision. Similarly, a large prostate can be extracted through the urethra after holmium laser enucleation and morcellation. Unfortunately, although morcellation affords organ extraction through a tiny surgical opening or the urethra, this organ mincing appears to promote the dispersal of cancer cells into the blood and lymph streams and compromise patient welfare potentially.
Local Spillage of Prostate Cancer Cells
In contrast to the systemic spread of cancer cells via surgical manipulation or morcellation, the spillage of cancer cells locally through conventional surgery, needle biopsies or laparoscopic manipulation has also been recorded. These procedures can result in cell spillage and the development of cancerous deposits within a surgical wound, along needle biopsy tracks or, peritoneally and at port sites after laparoscopy. Although recorded, these localised tumor recurrences because of local cancer cell spillage are unusual and probably more likely to be associated with evaluations or treatments involving individuals with highgrade or aggressive cancers because their cells spread more readily.
Prostate Cancer Cell Spread can be Delayed
Surprisingly, the spread of cancer cells from a cancerous organ because of surgical manipulation may not be immediate but take several days to occur. Such an event may occur even if the cancer was removed completely or not, whether a conventional surgical approach was used, whether a no-touch surgical technique was adopted or, whether robotics were employed. Furthermore, these released malignant cells can be in circulation for several years undetectable by conventional imaging means such as bone scans, MRIs and PET scans.
Dispersed Prostate Cancer Cells May Exist in Dormant State
Despite the finding of malignant cells in the bloodstream and bone marrow from a cancerous organ before any surgical manipulation and, the increased number of these cancer cells in the circulation after surgical manipulation, the natural history of these dispersed cancer cells is uncertain, but worrisome. Also, the mere demonstration of these cancer cells in the circulation does not necessarily mean that the development of a clinically metastatic deposit is inevitable or, if a relapse occurs, whether it originated from a preexisting circulating cancer cell or, from one released by surgical manipulation . However, the dispersed malignant cells can survive and exist dormant in various areas of the body for at least several years. And, in one study, the detection of prostate cancer cells in the blood of some men after their radical prostatectomy correlated with a rising PSA during followup and therefore, failure to cure. Furthermore, this study has mirrored my experience in managing many men who had suffered the misfortune of being subjected to the toxic radical prostatectomy for seemingly localized disease only to see a rising PSA some 5-15 or more, years later. Again, these clinical events underscore the concern that prostate cancer cells spread inadvertently by surgical “treatment”, may exist dormant before reactivation and recurrence of disease years later.
Robotic Prostatectomy, Dangerous and Scientifically Unproven
The fact that tumor handling during robotic prostatectomy may actually promote cancer spread has been quietly ignored by urological surgeons just like the many other complications associated with their “standard” radical prostatectomy. A procedure based upon a misguided treatment philosophy and steeped in tradition but scientifically unproven and loaded with problems. These problems and concerns include: its lack of evidence-based medical support; questionable curative and lifesaving value; immense quality of life concerns and being associated with more significant complications than probably any other cancer operation (along with a virtual guarantee of being left with a shorter penis, limp and leaking); the many warnings about the dangers of the radical prostatectomy from various physicians and organizations; the endless lawsuits filed against robotic surgeons and the device manufacturer; the scores of self-reported harms listed on the FDA’s own product safety system, MAUDE (Manufacturer and User Facility Device Experience), representing only about 8% of actual adverse events as the site has become increasingly difficult to post and retrieve adverse events data and seemingly, is open to manipulation by both manufacturer and FDA; the warnings issued by the USPSTF (US Preventive Services Task Force), a Government oversight agency not as easily influenced as the FDA and, the acknowledgements by the robotic device makers themselves who clearly recognize the many dangers of this gadget since their disclaimers have been getting longer with each revision. However, as if this list of terrible consequences associated with the radical prostatectomy could not be even more horrific, outrageously the robotic device was able to garner an FDA “approval” through an underhanded 510(k) maneuver without this device ever having been scientifically evidence-based tested for safety and effectiveness on a single patient with prostate cancer.
- http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal /prostatecancerscreening
Most Prostate Cancers are Not a Health-Risk
Not only have men and their partners been totally deceived by medical babble and the smoke screens about the safety and effectiveness of the robotic prostatectomy but this debilitating surgery is often recommended for the common Gleason 6 prostate “cancer”. This is a disease which should not even be labeled a cancer because, on both clinical and molecular biology grounds, the Gleason 6 lacks the hallmarks of a cancer, is not a health-risk and has a 10-year survival of 100% regardless of treatment. Yet, despite knowing that men do not die from this Gleason 6 “cancer”, urologists remain intent on promoting the deception that all prostate cancers are more or less equal and or, have the potential to become lethal at some stage. In fact, deluded urologists promote actively their sham patient advocacy by using scare-tactics, falsehoods and misrepresentations about the Gleason 6 “cancer” through “Know Your Stats” and “Prostate Cancer Awareness” propaganda; endorsing and encouraging harmful PSA-based prostate cancer screening programs which detect mostly the Gleason 6 pseudo-cancer; discounting pathology subjective interpretation errors; inflating the significance of family history; overstating the importance of precancerous findings; exaggerating claims for possible prostate cancer upgrading and progression and, exploiting those made vulnerable by a flawed prostate cancer label. Unbelievably however, despite this litany of embarrassing concerns surrounding the cancer label and its fraudulent robotic radical prostatectomy treatment, urologists now have the gall to challenge the dire warnings issued by the USPSTF and their conclusion that PSA screen-based prostate cancer treatment benefits are outweighed by treatment harms. Shamefully, urologists have targeted the medical illiteracy and gullibility of Senate Staff for an outrageous political pushback on the USPSTF for its “D” grade of PSA-based screening. This reprehensible self-serving lobbying effort to corral the USPSTF is designed simply, to allow the ongoing lucrative, unbridled exploitation and over-treatment of men frightened by the non health-risk Gleason 6 prostate “cancer”. Not only should the “cancer” label for the Gleason 6 be considered a diagnostic error but its treatment should be considered malpractice. Only the 15% or so of high-grade prostate cancers have lethal potential and only these kind of prostate cancers demand detection and treatment. However, even for high-grade prostate cancer, the appalling complications and quality of life issues stemming from robotic prostatectomy surgery, along with the likelihood now that this surgery may actually be promoting prostate cancer spread, makes this invasive procedure an indefensible treatment option.
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About Bert Vorstman MD, MS, FAAP, FRACS, FACS
Dr. Bert Vorstman is a Board Certified urological surgeon. Born to Dutch parents in Indonesia, he grew up in New Zealand. After training at the Otago Medical School in Dunedin, New Zealand he completed a urology residency at Auckland Hospital, Auckland, New Zealand. He Fellowship trained in Pediatric and Adult Reconstructive Urology at the Eastern Virginia Medical School in Norfolk, Virginia and, after NIH sponsored pioneering research on “Urinary Bladder Reinnervation”, he earned the honor of a Masters of Surgery Diploma from the University of Otago in 1988. Dr. Vorstman was a faculty member at the University of Miami, Jackson Memorial Hospital, Miami, Florida and then went on to found Florida Urological Associates, a busy urology practice in Coral Springs, Florida, USA.
Dr Vorstman’s passion and dedication is to help men and their spouses/partners understand fully the implications of their particular prostate cancer as well as the minimally invasive treatment options available in selected men with localized significant prostate cancer.
Dr Vorstman owns healthcare stock. He is the grandson of acclaimed Dutch author,
Amy Vorstman/Amy Groskampten Have.