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Conversations With Prostate Cancer Experts

Diagnosing Neuroendocrine Prostate Cancer

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Prostatepedia spoke with Dr. Himisha Beltran, an Assistant Professor of Medicine at Weill Cornell Medical College in New York City, about diagnosing neuroendocrine prostate cancer.

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How is small-cell or neuroendocrine prostate cancer diagnosed? Biopsy? Imaging?

Dr. Himisha Beltran: Small-cell or neuroendocrine prostate cancer is diagnosed by tumor biopsy. The pathologist typically makes the diagnosis by looking at the morphologic features of the cancer under a microscope and may perform additional testing to look at expression of neuroendocrine markers or classical prostate markers to support the diagnosis.

One of the reasons why neuroendocrine prostate cancer was thought to be so rare was that doing metastatic biopsies on patients already diagnosed with prostate cancer was just not done in the clinic. It is only recently that we are recommending biopsies to look for neuroendocrine prostate cancer in select patients with aggressive clinical features and low PSA levels. Biopsies are also being considered to look for other emerging molecular targets. There are now several prostate cancer clinical trials targeting different mutations and alterations.

An obvious next step is to try to diagnose neuroendocrine prostate cancer noninvasively. Imaging is a noninvasive way to detect different cancers, but there hasn’t been any sort of imaging tool yet that can really identify these patients. We’re starting to see clues that there may be some molecular markers that are expressed that might help future research in this area. Another noninvasive approach we have been investigating is the use of liquid biopsies that include circulating tumor cells as well as circulating tumor DNA to see if there are clues that can help us identify these patients without a biopsy. This is still in research development.

 

 

 

 

 

Read the rest of Dr. Beltran’s comments on neuroendocrine prostate cancer.

Author: Prostatepedia

Conversations about prostate cancer.

One thought on “Diagnosing Neuroendocrine Prostate Cancer

  1. A prostate cancer survival guide by a patient and victim.
    Men Beware!
    Updated March 14, 2018 with references

    The man that invented the PSA test, Dr. Richard Ablin now calls it: “The Great Prostate Mistake, Hoax and a Profit-Driven Public Health Disaster” [1].

    Read the sad truth about prostate cancer over testing and treatment dangers and exploitation for profit by predatory doctors. Prostate cancer dirty secrets, lies, exaggerations, deceptions, elder abuse, outdated testing and treatments.

    Disclaimer: I have no affiliation with any group or organizations. I am not a doctor. I do not prevent, treat, diagnose, cure or advise on medical matters. The information in this document is for educational purposes only. If you need treatment or medical advice, consult a competent and trustworthy medical doctor.

    In my opinion:
    Read the hard facts about prostate cancer testing and treatment that no one will tell you about, even after it’s too late. Any man over 50, anyone concerned about cancer in general, dangers from clinical trials, injuries and deaths from medical mistakes, quality prescriptions at a huge discount from Canada, exploitation and elder abuse, HIPAA loopholes and privacy issues should read this document. Prostate cancer patients are often elderly, over treated, misinformed and exploited for huge profits by predatory doctors [1,9,10,25,27]. At times profit vs. QOL (quality of life). Low risk Gleason 6 (3+3) is a pseudo-¬cancer mislabeled as a cancer; it does not need detection or treatment [1,2,9]. Don’t let conventional testing and treatment, predatory doctors or lack of knowledge destroy your QOL. Prostate cancer studies and statistics are often flawed because they include Gleason 6 pseudo-cancer. Recommended reading, books: The Great Prostate Hoax by Richard Ablin MD and The Big Scare, The Business of Prostate Cancer. By Anthony Horan MD. https://urologyweb.com/prostate-cancer-screening-and-treatment-a-journey-of-medical-lies/

    Facts per reliable sources:
    1. Multiple studies have verified more harm and deaths caused from prostate cancer testing and treatment then from prostate cancer itself [1,9,10,25,27].
    2. Extensively documented unnecessary testing and treatment of prostate cancer for profit or poor judgment by some doctors in the USA [1,5,9,10,25,27].
    3. Medical mistakes are the third cause of deaths in the USA (over 251,000 deaths a year, over one million deaths in 4 years) more then suicide, firearms and motor vehicle accidents combined [13].
    4. 1 man in 6 will be diagnosed with prostate cancer in his life. 233,000 new cases per year in the USA.
    5. 10% to 20% of nurses abuse drugs because of easy access [4]. Other study estimates are as high as 24%
    6. 1 million dangerous prostate blind biopsies are performed per year in the USA [5,11, 22,23].
    7. 6.9% hospitalization within 30 days from a prostate biopsy complication [11].
    8. About 1.3 to 3.5 deaths per 1,000 from prostate blind biopsies [5].
    9. 0.5% died and 20.4% had one or more complications within 30 days of a radical prostatectomy [15].
    10. A study of early-stage prostate cancer found no difference in surviving at 10 years whether men had surgery, radiation or monitoring (no treatment) [12].
    11. Low risk Gleason 3+3=6 “cancer” lacks the hallmarks of a cancer yet it is often aggressively over treated [1,2,9].
    12. Prostate cancer patients are at an increased risk for chronic fatigue, depression, suicide and heart attacks.
    13. Depression in prostate cancer patients is about 27% and 22% at 5 years, for advanced prostate cancer patient’s depression is even higher [6].
    14. 75% of physicians in the world would refuse chemotherapy if they had cancer.
    15. Breast cancer receives much more research funding, publicity than prostate cancer despite similar number of victims.
    16. The man that invented the PSA test, Dr. Richard Ablin also stated: “The medical community must confront reality and stop the inappropriate use of PSA screening. Doing so would save billions of dollars and rescue millions of men from unnecessary, debilitating treatments.” [1]
    17. When insurance payment reimbursement for ADT hormone therapy decreased so did the number of patients being prescribed ADT therapy [17,18]. ADT therapy can often have devastating side effects.
    18. By law, cancer reporting is mandatory for studies, research, etc. This can results in copying, distribution, downloading and viewing of patient files by numerous individuals without a patients knowledge or consent. HIPAA exceptions and loopholes sanction this privacy injustice.

    The generally accurate humor and sarcasm is intended to entertain and educate while reading this possibly laborious text.

    Follow the money $: If a surgeon is financially responsible for operating expenses, a large staff or an oncologist is also responsible for a lease on multimillions of dollars in radiation treatment equipment, do you think they would be more or less honest about the benefits and hazards of treatment when recommending treatment? Do you think the profit margin would compromise some doctor’s ethics? What is the purpose in over testing and treating a cancer that often will not spread (testing and treatment frequently causes lower quality of life, ED, incontinence, depression, fatigue, etc) if it was not extremely profitable? The medical field is alluding to the fact that prostate cancer testing and treatment may do more harm then good. The U.S. Advisory Panel is now recommending for prostate cancer PSA testing and screening: for men 55 to 69 “letting men decide for themselves after talking with their doctors. For men over 70, no testing at all is recommended.” Prostate cancer patients are often elderly and exploited for profit. The treatments offered have horrible side effects and newer treatment options are unavailable, not offered to patients or available outside the USA. Prostate cancer is often slow growing and of low risk and can just be monitored. Often no treatment is the best treatment. Over testing and treatment has been verified by numerous experts, studies and investigations, documentation, etc. Getting a treatment recommendation from an doctor who profits from the treatment is often a mistake. [1,9,10,17,18,25] https://urologyweb.com/why-most-prostate-cancers-and-treatments-are-fake/

    A 12 or 18 core blind biopsy, holey prostate! One million dangerous prostate blind biopsies are performed in the USA each year and they should be banned. Men with a high PSA tests result are often sent to an urologist for a blind biopsy. Men should be told about other options; Percent free PSA test, 4Kscore test, PCA3 test or a MRI, 3D color-Doppler test before receiving any biopsy. These tests can often eliminate the need for a risky and invasive blind biopsy. Insertion of 12 or 18 large hollow needles through the rectum into a gland the size of a walnut, a blind Biopsy can result in pain, infections. A high risk of temporary or permanent erectile dysfunction, 22.3% mild ED, 15.5% mild-to-moderate ED, 10% moderate ED, and 13.6% severe ED [22,23]. Biopsies can cause urinary problems, 6.9% hospitalization within 30 days from a complication[11], sometimes even death from sepsis (About 1.3 to 3.5 deaths per 1,000)[5]. There is also debate that a biopsy may spread cancer because of needle tracking. A blind biopsy can also increase PSA reading for several weeks or months, further frightening men into unnecessary treatment. Blind biopsies are almost never performed on other organs. One prestigious hospital biopsy information states “Notice that your semen has a red or rust-colored tint caused by a small amount of blood in your semen”. Another well-known hospital states “Blood, either red or reddish brown, may also be in your ejaculate.” These statements are frequently an extreme exaggeration (mostly lies). Very often after a biopsy a man’s semen will turn into jet black goo. This could be an unpleasant surprise for a man and especially for his unsuspecting partner. However if a biopsy is performed before Halloween or April Fools’ day this may be of benefit to a few men. If some prestigious hospitals are not factual about the color of semen, what other facts are being misrepresented? [5,11,22,23,28].

    Bone scan scam: Prostate cancer patients are often sent for a bone scan. A bone scan has about a 13% chance of having a false positive and only 3 men in 1,000 have bone cancer who have a bone scan. Bone scans may often be unnecessary in low risk prostate cancer patients.

    Low risk cancer patients or patients with advanced age are often sent for aggressive treatment by some doctors when monitoring is usually a better option. An extreme example of overtreatment is one SBRT radiation clinical trial. Prostate cancer patients where intentionally treated with a huge dose (50Gy total, 5 fractions) of radiation resulting in disastrous long term side effect for some of these men. The typical SBRT dose is 35 to 36.35 Gy, 5 fractions. A large percentage of prostate cancer patients in this clinical trial had low risk prostate cancer and may not have required any treatment.

    Clinical trials may (or may not) be hazardous to patients. The goal of a clinical trial is to collect information; the intent is not necessarily to help or cure patients. In a clinical trial, if someone is given a treatment that will harm them (as in the above SBRT example) or given a placebo in place of treatment or needed treatment is withheld, the patient may be deceived or harmed. Investigate before you participate in any clinical trial. Even if you do get a safe and effective treatment, it may not be available to you after the clinical trial is over. If the trial is for a drug, you will not be told if you are getting a drug or a placebo until after the trial is over.

    Your privacy and confidentiality is just an illusion: Under the HIPAA law all access to your records is allegedly by a “Need to know” basis only. This is a lie. Cancer reporting is mandated by law. All cancer patient (and possibly many other patients) will have files duplicated (downloaded) numerous times by multiple databases. HIPAA has loopholes and exceptions. Many privacy statements are convoluted and confusing. By law all cancer patients will not be able to have files sealed, deleted or have restricted access. Prostate cancer patients are asked to fill out a series of EPIC questionnaires or other forms. The EPIC questionnaire asks several intimate details about patient’s sex life, urinary and bowl function. By a prostate cancer patient completing an EPIC questionnaire may be able to assist his doctor, nurse, office workers or multiple databases track his progress or decline. By refusing to fill out these forms and supplying relevant information only one can help insure his privacy and insure he do not unknowingly become part of a study, survey or have his information forwarded to multiple databases. Most of the time a patient has no idea who has access to medical records or why the records are being looked at. Probably everyone that works in a medical office or building has access to the records, except you (often you the patient may have limited or no access without a formal request). File access may include non-medical employees, office workers, bookkeepers, janitors, insurance companies, college or high school interns, etc. This may include other facilities, programmers, researchers (clinical trial), drug companies, college students, government agencies, etc. Often records are placed on a Health Information Exchange (HIE) or servers. Dozens, sometimes even hundreds or thousands or more people may have access to medical records. Major databases like SEER (Surveillance, Epidemiology and End Results) and its contractors, partners, institutions, etc are linked to Medicare records to determine “end results” for researchers, studies, drug company clinical trial offers, etc. Almost anyone could have access to your records. SEER is just one of many databases. Servers, both government and private are sharing information. Also “health surveillance” and “data mining”. Health information may be shared by millions of entities and servers all over the USA and sometimes the world. Records may be packaged with others and offered for sale, this does often happen on “the dark web”. If a doctor, patient, insurance company or lab is involved in a criminal or civil case; medical records may become public court or law enforcement records. Financial and medical Identity theft is a growing problem, often expensive and difficult to correct. Hacking and Ransomware is also a growing problem. Your records can be accessed by any one (trainees, volunteers, college or high school interns as young as 16 years old) “for training purposes” or any other reason, all without your consent. They can also read records about your prostate problems, your wife’s hemorrhoids and your daughters yeast infections and all files for any patient, all within the HIPAA guidelines. These people do not have to be employed by the facility or have a background check. Would you like to have a high school student that possibly lives in your neighborhood or attends school with your children read over your extensive family member’s medical records and personal information? All patients should avoid supplying unnecessary information whenever possible. Supply relevant information only when filling out forms. In the USA identity theft is common, growing problem and is often financial devastating. Medical forms can be a good source of information for thieves. A pharmacy benefit manager (PBM) can track your prescriptions. Drug companies use major databases to solicit people for clinical trials and products. Numerous exceptions (loopholes) appear within the deficient HIPAA laws. Even without violations, records can be accessed by multiple people and appear in multiple databases. Sometimes medical phone calls are recorded. The medical field has little regard for our privacy, especially if it is in conflict with training, research, studies, profit or other objectives. If you are a celebrity or you are known to anyone with access to your records (neighbor, co-workers spouse, etc) they would possibly (or probably) want to have a look at your medical records. In May, 2017 Dear Abby did an article on this subject, “Snooping into medical records”. The best way to protect information is not to divulge it.

    Mandatory privacy breaches: Months after my cancer treatments ended I started receiving disturbing advertisements and clinical trial offer in the form of post cards and letters. I contacted the SEER database staff and my state cancer registry. After some investigating I learned; 1. By law cancer reporting is mandatory 2.By law your cancer records can not be deleted or sealed and are often not protected. 3. HIPAA has numerous exceptions and loopholes. 4. Anyone with a reason can apply for access to cancer records. Multiple names with unknown backgrounds can be submitted by one person. 5. Researchers and others can have immediate access to your records however if you want a copy you will be required to fill out a form and verify your identity. 6. Database WebPages will tell you how very important your privacy is to them however the convoluted disclosures will indicate otherwise. The cancer registries will state “Your information is safe”, this is an exaggeration. The only deterrent a patient can try is submitting a formal opt-out request for clinical trials to the state cancer register however this would only be partial protection. http://www.ccrcal.org/Inside_CCR/FAQ.shtml https://healthcaredelivery.cancer.gov/seermedicare/privacy/hipaa.html

    A patient’s dignity (or lack of dignity): Prostate cancer testing and treatment is stressful, degrading, demoralizing and embarrassing. According to the National Institutes of Health (NIH), per one study 80% of men with ED never talk to their doctors or seek treatment because of these reasons. After his surgery one patient stated his prostate and his dignity was both removed and discarded. EPIC questionnaires can be counterproductive impact a patient’s dignity, privacy and confidentiality. EPIC questionnaire are not a requirement to fill out and the term “strictly confidential” can be misleading. One patient posted he filled out and turned in his “strictly confidential” EPIC questioners only to have every female office staff member read it and ogle him. He stated that he became very uncomfortable and discontinued his appointments. Many women prefer or will only see female doctors. Almost all gynecologists will only employ female staff. Over half of men prefer a male doctor. Per some respected doctors: “Many men still avoid medical care because of embarrassment.” “Honest answers will often not be given if asked by a female.” Per some studies, a significant percent of men will feel uncomfortable or will completely avoid medical care if a female doctor, nurse or staff member provided it for prostate problems, incontinence, ED, etc. This can result in embarrassment, awkward conversations, unasked questions, deafening silence and canceled appointments. Some men would prefer illness, no treatment and sometimes even death over embarrassment. Some men are more likely to seek or accept medical care for personal health issues if the staff (point of contact) is male [26]. Yet modern medicine still insists on using the same old flawed traditions and strategies.

    Becoming radioactive: LDR Brachytherapy (permanent radioactive seed implant). This procedure implants about 60 to120 radioactive seeds in the prostate, sometimes resulting in urinary problems. The patient will literally become radioactive for months and up to 2 years. The patient may set off radiation alarm at airports, seaports and border checkpoints. He will also be required to use a condom initially, have no close contact with pregnant women, infants, children and young pets for months or longer. Occasionally he may even eject dangerous radioactive seeds during sexual activity or urination. The patient will become like a walking Chernobyl, having radioactive scrap metal and emitting hazardous radiation from his crotch. He will also be required to carry a card in his wallet stating he is radioactive. If he dies cremation may be a big problem. The videos of this procedure seem bizarre. Anesthesia and a catheter will also be required. Brachytherapy has a probability of ED.

    ADT Hormone therapy, big profits and devastating side effects: Lupron injections are a common and expensive treatment. Men are prescribed ADT hormone therapy, AKA chemical castration as an additional or only treatment. ADT therapy is sometimes over prescribed for profit, per some studies. Hormone therapy is often very expensive (Profitable for doctors if provided at the doctor’s office). It has horrible, strange and devastating side effects; feminization, hot flashes, fatigue, weight gain, metabolic syndrome, long term or permanent ED, depression, the penis could shrink and testicles can completely disappear, he may grow breasts. This treatment has numerous mind and body altering side effects. One man stated that ADT therapy turned him into an emotional, obese, menopausal woman. Men are sometimes actually castrated (orchiectomy) as a cancer treatment to reduce testosterone. Amnesty International calls chemical castration “inhuman”. Studies (Medicare and financial) have documented doctors do over prescribe ADT therapy for profit (depending on Insurance payout rates/profit margin). When insurance payment reimbursement for ADT decreased so did the number of patients being prescribed ADT therapy [17,18]. Per Wikipedia: “in patients with localized prostate cancer, confined to the prostate, ADT has demonstrated no survival advantage, and significant harm, such as impotence, diabetes and bone loss. Even so, 80% of American doctors provide ADT to patients with localized prostate cancer.” Overtreatment with ADT is extremely profitable, unfortunate and avoidable.

    Major surgery, major side effects: Nerve sparing Robotic prostatectomy is touted as being a better treatment and having fewer side effects, this is usually an exaggeration (lipstick on a pig). The nerves can not always be spared. Robotic surgery can result in a faster initial recovery. Long term risk of incontinence, fatigue, ED, depression, some men will ejaculate urine and have a shorter penis, etc is about the same as conventional surgery. Patients undergoing surgery are at about a 22% chance of long term or permanent fatigue. A catheter will be required. 0.5% died and 20.4% had one or more complications within 30 days of a prostatectomy [15]. Patients can have unrealistic expectations about the results and regret this option, per some studies. The ED rates and other side effects are often understated to patients. A prostatectomy may even spread cancer. Men are often left limp and leaking after this surgery. [1,2,3,14,15]. https://urologyweb.com/robotic-prostate-surgery-complications/

    Patients should not be naive: Medical mistakes are the third cause of deaths in the USA (over one million deaths in 4 years) [13]. Medical mistakes cause more deaths then suicide, firearms and motor vehicle accidents combined. Countless other patients have been harmed by medical mistakes. If you are having surgery or a procedure takes precautions if possible. Have someone qualified or knowledgeable monitor you and your medications, etc. Doctors, nurses and technicians can be profit motivated, use outdated procedures, be lazy, incompetent, make mistakes, and be apathetic or rushed. Occasionally harm can be done or not prevented with intent or for profit. 10% to 20% (or more) of nurses abuse drugs because of easy access [4]. Doctor’s offices and clinics can see many patients in a relatively short amount of time. This may be a disadvantage to patients, empathy and quality of care can sometimes be compromised. I personally know or have had contact with at least 12 doctors, nurses or other medical staff that I would consider dangerous: profit motivated, incompetent, dishonest, lazy, abusive, mentally disturbed or drug abuses. Most of these people did not have a name tag and supplied me with a first name only when asked for a name. I am now sure modern medicine protects the guilty and incompetent, also victimizes the naive patients. I now understand why medical mistakes are the third leading cause of deaths in the USA. I now believe some or most of the deaths and injuries are preventable or intentional. Medical workers can know everything about a patient, hide behind anonymity, do patients irreversible harm or death. The patient may not even know his or her first name. TV and sometimes the public idolize doctors, nurses and caregivers; however the health care profession has about the same amount of abusive or incompetent workers as other occupations. I have also had excellent doctors and nurses; however this may not protect us from the incompetent ones. What are the reasons nurses get fired: 1. Prescription drug abuse (because of easy access to drugs 10 to 20% [4], up to 24%). 2. Too many mistakes. 3. Code of conduct and privacy violations. 3. Bad attitude. 4. No proper licenses 5. Abuse of patients. If they get fired often incompetent health care workers can just find another job, without any repercussions. Patients should be aware that sometimes QOL (quality of life) may be secondary or an absent goal in treatment. Sometimes overtreatment for profit or to prevent an unlikely death or metastization from low risk cancer may be the primary or the only goals of prostate cancer treatment. Many men may not be prepared for or have unrealistic expectations about the outcome, physical and psychological impact of testing and treatment.

    Depression in prostate cancer patients is common, 27% and 22% at 5 years [6] and for advanced prostate cancer patient’s depression is even higher. Prostate cancer patients are at an increased risk of suicide. Men are seldom screened for anxiety and depression after treatment.

    The risk of chronic or permanent fatigue (that can result in depression and suicide) is almost always understated if disclosed at all to many patients. Per some studies and depending on your treatment; the risk of chronic fatigue is about 25% to 60%. Radiation with Hormone therapy has a high risk of fatigue.

    Conventional prostate cancer testing and treatment. Quackery, butchery and Frankenstein medicine? Castration, ADT hormone therapy (chemical castration), Brachytherapy, cryotherapy, radiotherapy, surgery, chemotherapy and blind biopsies are dangerous, psychically and emotionally brutal, traumatic and disturbing. These types of treatments are primitive and almost beyond belief in today’s world of advanced technology. It seems all of the best treatments for prostate cancer have not been approved and some are only available outside the USA. Newer treatments like, HIFU, hyperthermia, Conexus, Boron Neutron capture therapy, Gold Nanoparticles, PARP Inhibitors, Platinum, focal ablation (laser, IRE Therapy) and orphan drugs (dichloroacetate, etc) should be approved and used when appropriate. It often takes years or decades for new treatments to be approved. If no profit is to be made as in orphan drugs, no approval should be expected. Biopsies should be limited to selective MRI guided samples only; blind biopsies should never be performed. Per some studies vitamin D3 may help prevent prostate cancer from becoming aggressive [16]. Newer prostate cancer testing and treatment is available in the USA at some locations. I have no affiliations with any of them. Look for IRE, Laser or focal Ablation and no blind biopsies. I have listed one location as a reference: https://urologyweb.com/

    Prostate Radiotherapy (EBRT-external beam radiation therapy) for cancer treatment. New technology consists of IMRT, SBRT, IGRT, VMAT, TrueBeam, Cyberknife, etc. This newer, faster, more accurate and easer to setup radiation equipment is of much benefit for doctors, staff and a good selling point to patient’s. However as far as reducing long term side effects, only small gains have been made with the newer radiotherapy equipment. A patient should be skeptical if exaggerated claims are made about reduced long term side effects, especially fatigue and ED rates. Radiotherapy can cause hip and bone problems later in life. 44% decreased orgasm intensity and multiple forms of sexual dysfunction [8,21]. Patients should inquire as to the treatment plan: Gy dose and fractions, margins, testicular dose, constraints and age of radiotherapy equipment to insure excessive radiation exposure treatment is not given that can result in additional side effects. Patients should be aware that pelvic shaving, permanent tattoo markers, fiducial marker (small seeds) are sometimes placed in the prostate, MRI, CT scan, photographs, catheters and other procedures may or may not be required. Radiotherapy can also occasionally result in secondary cancers and damage to “organs at risk” (organs close to the prostate). Radiation has a high probability of sexual dysfunction and fatigue, just as high with the newer equipment. ED rates estimated at 35% to 75% or higher, 93% at 15 years [8,14,21]. Sometimes radiation can also cause bowel and urinary problems. A 5 day SBRT radiation treatment is now commonly available with about the same results and side effects as a 9 week radiation treatment. A doctor with a multimillion dollar lease and maintenance agreement on radiotherapy equipment and a large staff may or may not be influenced by his or her financial obligations when deciding to recommend over testing and treatment.

    Fried nuts, two: Prostate radiotherapy (EBRT) can sometimes result in a 5% to 30% or more temporary or permanent drop in testosterone levels, excluding hormone therapy. This drop is determined by the testicular radiation dose (treatment equipment and planning) [19,20]. A below normal drop in testosterone can result in fatigue, depression, sexual dysfunction and other symptoms. Always ask for a printout of testicle dose and constraints for prostate radiotherapy to insure your testicles are not over radiated, also include the CT scan exposures. With radiotherapy robotic arm equipment and the testicles included in the treatment field can result in a major drop in testosterone. Have your testosterone levels tested before and months after EBRT prostate treatment.

    Chemotherapy can be extremely toxic and sometimes deadly: Any cancer patient (man or woman) who are being offered chemotherapy should be particularly cautious. Without proof of the effectiveness of the specific chemo drug being used on the exact cancer type being treated, chemotherapy can often be more toxic to the patient then to the cancer. Chemotherapy may be extremely expensive, profitable for some doctors (if dispensed by the doctor and not by a third party) and can be misused or overused, often for profit. The “chemotherapy concession”: A doctor may purchase a quantity of chemo drugs for $10,000 and charge a patient $20,000. A doctor can also receive a percent kickback from the drug company for prescribing the drug. This is a well documented and common practice. Per some studies: 75% of physicians in the world would refuse chemotherapy if they had cancer and Chemotherapy may have a high failure rate. One Michigan oncologist who committed fraud and gave $35 million in needless chemotherapy (for profit) to patients, some who did not even have cancer is now in jail for 45 years. He was running his own in-house pharmacy. The nursing staff was indifferent and the state regulatory agency initially cleared him of any wrongdoing (a cover up). Some chemo drugs are considered a biohazard.

    Long term care for side effects is often lacking, exploitive or ineffective. Long term care consists of regular PSA testing for years. Long term side effects often consist of fatigue, bowel or urinary problems, sexual dysfunction, depression, isolation and sometimes suicide. Patients with complaints of chronic fatigue are often told to exercise, get plenty of sleep, pace your self and eat a healthy diet; this advice is of limited help for chronic fatigue. Often treatments for long term side effects are embarrassing, degrading, unavailable, nonexistent, costly, not effective, not offered or bothersome. Billions of dollars are profited from ED drug and other ED products, catheters, pads and diapers, drugs for depression, pain, insomnia or incontinence, additional treatments and surgeries for side effects. Also treatments for the side effects from hormone ADT therapy (chemical castration) are sometimes required.

    Men, ageing, exploitation and elder abuse: The elderly are the ideal victims for profiteers, scammers, sadist, etc. If any man lives long enough it is very likely he will have a prostate problem, low testosterones or some form of sexual dysfunction. In my opinion modern medicine often has been exploitive, abusive and has provided substandard care for older men in general due to all of the explanation given in this text. I believe much of the attitudes toward older Americans need improvement and they are sometimes viewed as being subhuman and exploitable by various groups and individuals. If documented cases of unnecessary surgery and radiotherapy or blind biopsies on children by doctors for profit were released, the vast majority of Americans would be outraged and this practice would quickly end. However for older men it dose not seems to be of great concern! It is well documented that all forms abuse do occur to the elderly and disabled in nursing homes and other facilities including neglect, theft, starvation, torture, harassment, sexual assault, etc. Elderly are being exploited in many ways. One patient after recovering from a brain injury testified that he was repeatedly abused, slapped and hit, forced to drink boiling hot tea by multiple caregivers and sexually assaulted by one female caregiver. I personally know of an elderly lady that is living in an expensive assisted living home that has had all of her possessions (radio, clothes, underwear, shoes, bed sheets) repeatedly stolen and replaced by her family. Scams for profit: Guardian scam, if you are declared incompetent by strangers, they can become your guardian (Guardianships and Conservatorships). You can be forced to move into a nursing home and your property can be sold and your assets can be seized by them. In other words-they can steal your assets and incarcerate you. Some predators are becoming very wealthy by using this exploitation method. Make sure you have an estate trust, executor, etc [24].

    Drug Company rip off. More exploitation! No bathtub included: Almost all conventional prostate cancer treatments usually result a high percentage of erectile dysfunction. Often claims of prompt effective treatment for ED or other side effects if they occur after treatment are often misleading. Statistics for ED percentages from treatment are usually quoted after treatment with Viagra, Muse or other ED treatments, therefore most statistics are very misleading. ED rated at 5 years may be as high as 50% to 80% or higher for most treatments. ED rated at 15 years may be as high as 90% or higher for most treatments. For cryotherapy, ED rates are extremely high. The cost for ED drugs like Levitra, Cialis, Viagra and Muse are deliberately kept very expensive by drug companies, about $11 to $60 per 1 pill or dose. At these prices Lilly could consider including a free bathtub featured in its advertisements for Cialis. The cost of 30 5MG Cialis is usually well over $330 and the cost of an inexpensive bathtub is about $200. Generic PDE5I ED drugs in Canada and other parts of the world sell for about $0.50 to $2 a pill. Some ED drugs should have already become available in a generic in the USA form for about $1 a pill. 2 ED creams have been developed however they have not been approved for use in the USA and they may never be approved. Men are also exploited by counterfeit mail order ED drug sales. ED treatments can also be embarrassing, not offered, not practical, expensive/not covered by insurance. 80% of men will not seek treatment because or these reasons. You can get safe, inexpensive quality generic and brand name drugs from Canada. Just get a prescription from your doctor and make sure the pharmacy is CIPA licensed. Generic and sometimes bran name Cialis, Viagra for about $0.50 to $3 a pill and other drugs too. Go to http://www.cipa.com/certified-safe-online-pharmacies/ for a list of trusted CIPA Canadian pharmacies. Stop getting ripped off by American drug companies.

    The numbers game, you lose: More exaggerations and lies. A doctor may state patients chances of ED is about 35% with EBRT radiotherapy (or some other treatment). A patient may think, 35% is not too bad and if I do get ED I can always take Viagra. What a doctor may not tell a patient is that the ED rate is 35% at 1 or 2 years for a patient under 65 years old and with an ED drug treatment option. For a patient over 4 years, over 65 years old and no ED drugs the ED rate may be about 75% or higher. After age 70 your chances of ED is over 85% or higher [8]. Obviously, a man is more likely to refuse treatment at a 75% ED rate verses a 35% ED rate. Some side effects may not be disclosed at all. If side effects (low libido, chronic fatigue, depression, increased suicide risk, etc) are not disclosed, no percentages will usually need to be quoted. Results are often worse for a surgery option. With both treatments together or with ADT hormones you’re in real trouble with ED percentages. Cure rates are often quoted at the 5 years mark for most treatments. 5 years is not a magic number, anyone can have a treatment failure before or after 5 years. A cure rate for a treatment at 5 years may be quoted at 85%; however the cure rate at 10 years may be only 50%. The 85% at 5 year rate was quoted to me. I was never told about my 50% at 10 year cure rate. For an estimate of your cure rate go to https://prostatecancerfree.org/ and input your treatment (remember an intermediate Gleason 7 4+3 is about the same as a high risk Gleason 8). Always ask what is the “biochemical recurrence” (AKA rising PSA or treatment failure) rate for well beyond 5 years with your computer software simulation and Partin tables. Ask your urologist or radiation oncologist for a 10-year cure Rate. If the physician is unable to provide one, consider finding another doctor. Studies, side effects percentage claims, etc can be biased. Watch out for terms like “age adjusted” or ambiguous or excluded facts as given in the above examples. I have read and have been given some extremely exaggerated claims (mostly lies) concerning cure rated, side effects, etc.

    Walking dead: After a blind biopsy and conventional treatment patients are often left impotent, incontinent, fatigued, exploited, embarrassed, isolated, devastated, demoralized, depressed, with ruined relationships, lost libido, possibly feminized-castrated or suicidal. And sometimes literally dead. Loss of libido estimated at about 45%, excluding hormone therapy. Lower libido is almost never disclosed and sometimes it is completely denied as a side effect. After testing and treatment your life may be very deferent. Prostate cancer patients are often elderly and exploited for profit [1,5,9,10,25]. Aftercare for long term side effects is frequently ineffective, expensive, not offered, degrading or nonexistent. Prostate cancer patients are seldom told about chronic fatigue, depression, loss of libido and the true risk of side effects are usually understated. Your dignity and privacy may be disregarded. Your medical records can be downloaded to multiple servers and viewed by several people. Modern medicine often fails, victimizes and exploits prostate cancer patients. The ED and incontinent rates are often underestimated because some men will simply not report them.

    Often few good choices exist for treatment: To a large extent the medical professionals want you to go get your conventional cancer testing and treatment without excessive opposition. A prostate cancer patient treatment choice often ends up being the least worst choice or the choice with the side effects a patient thinks he can tolerate. If a patient has intermediate or high risk prostate cancer and dose not have advanced age he may need treatment. He should look into other newer treatments if available. Also he should try and avoid hormone therapy if possible because of the multiple side effects especially if the cancer is organ confined. If laser or other newer treatments are not available a 5 day SBRT radiation treatment may be considered (In my opinion SBRT could be the least worst of the bad choices, still a poor option). SBRT seems to be fast, least invasive. ED and fatigue is still a high long term risk. Radiation with hormone therapy has a very higher risk of ED and long term fatigue.

    My story (my dilemma): My doctor had a 16 year old girl and a 17 year old boy high school interns that reside in the neighborhood looking over patient records (with full access to all records) working in his office for the summer, when I went to see him. I consider this to be a privacy and confidentiality issue/violation. My doctor referred me out to his urologist friend because of a high PSA test. I will refer to the urologist as Doctor “A”; he used old and dangerous testing technology (18 core blind biopsies), his nurse seemed to have a mental defect exhibiting arrogant, rude, strange, abusive behavior and was intent on inflicting psychological harm to me. Shortly after my Dr. “A” visits ended, his nurse was no longer employed at his office and no person in that office would refer to her employment or her existence. I now believe this nurse was under the influence of drugs because of drug abuse being common among nurses (easy access to drugs). I was diagnosed with prostate cancer by Dr. “A”. I refused Dr. “A” surgery and hormone therapy recommendation because of the imminent side effects and his unprofessional (sadistic) nurse behavior, so Dr. “A” referred me to Dr “T”. Dr. “T” was outside of my insurance network; however his office manager stated she was willing to work with my insurance, offered me a doctor consultation and would accept any insurance payment as a full payment. When I arrived in his office the waiting room was empty and Dr. “T” had a large staff. Dr. “T” used older conventional technology (old equipment, radiotherapy), offered me overtreatment, hormone therapy, bone scan (unnecessary procedures and testes). One week after my consultation with Dr. “T” I received an $850 bill, in conflict with what was agreed upon with his office manager. After a recommendation from an acquaintance, I called clinic “O” and met with the nurse. She offered me treatments with a verbal guarantee of “no side effects from the SBRT radiation”. However this nurse could not answer any of my basic questions lacked any credibility and sounded like an unscrupulous used car salesmen. Most of these office visits caused me multiple problems with office workers processing paperwork for tests, insurance forms and billing, etc. Two of these doctors offered me an unnecessary bone scan. Two of these doctors recommended unnecessary hormone therapy ADT (overtreatment) for my organ confined cancer. After I absolutely and utterly refused hormone therapy, both doctors admitted it probably would not help me in my final outcome because of the computer estimate run on me with my organ confined cancer. Having no newer treatments (laser, etc) available to me at that time, I decided on SBRT treatment with Dr. “K”, he could answer my questions and had new equipment. Before my treatment could start I was referred to “W” lab for an MRI. “W” lab had a trainee assisting and it took over 3 hours to complete my MRI. 2 days later after receiving my MRI report, I examined it and it had my name and some other patient history information. I wasted 2 stressful days verifying it was the correct MRI of me and not some other prostate patients MRI before my treatment could start. I did receive treatment from Dr. “K”. I did have a relatively fast and noninvasive treatment (SBRT), resulting in several months of fatigue, a large PSA bounce 18 months later. I feel this entire ordeal aged me and I’m not sure what the future will bring? I also no longer trust modern medicine, doctors, nurses, etc. Modern medicine seems to be more of a gamble then a science. I have wasted hundreds of hours and thousands of dollars. I feel modern medicine has violated my confidentiality, abused and failed me (and others) due to the lack of guidelines and regulation, still approved obsolete technology, better unapproved treatments, exploitation, greed, apathy and incompetence. Hindsight is 20/20. If I could do it over again, I would also consider no PSA testing and treatment or traveling for newer treatments from a competent provider if practical and available. I believe if I did take the two doctors recommendations and received unnecessary hormone therapy in addition to the radiotherapy my quality of life (QOL) would have been severely impacted for years or permanently and could possibly have resulting in my early death.

    “Do no harm”, unless you can make a lot of money and get away with it: I was harmed physically and verbally by Dr. “A” 18 core blind biopsy and verbally abused by his sadistic nurse. I was potentially exploited and financially harmed ($850) by Dr. “T” and offered unnecessary testing and overtreatment. Clinic “O” nurse attempted to misinform and deceive me about the treatment outcome of “SBRT treatment with no long term side effects”. I was harmed by “W” lab by mistakes and incompetence. I did also have numerous other billing and paperwork problems probably due to mistakes and apathy. I was also harmed by the release of my cancer files by my state cancer registry as explained above. A few of the office staff were incapable of completing some very simple tasks like filling out lab work request or insurance forms. At least 40% (probably substantially more, 50% to 60%) of the health care workers I came into contact with did or attempted to do some form of harm to me or provide substandard care, attempted excessive testing and treatment, mistakes, billing overcharges, blind biopsy, false statements, deception, misinformation, apathy and abusive behavior¬¬¬, as explained in this text. I have also observed several medical facilities do not require workers to wear name tags and when asked for a name most will give a first name only; this may also be a factor in health care workers not acting in an ethical manner. To me, it seems that this prostate cancer nightmare maze was intended for maximum physical, psychological, financial harm, to be of questionable benefit and maximum profit for doctors. My prostate cancer experience has been one of the worst events that have happened to me in my lifetime. Also seeking testing and treatment is one of the biggest mistakes I have ever made. I specifically hold responsible modern medicine for not protecting patients from predatory doctors, substandard technology and a lack of regulations that would protect patients. I would have probably been better off going to a Voodoo or witch doctor. I would have saved thousands of dollars, time, had no side effects, no paperwork, more confidentiality and privacy. I probably would have received better advice. I could have received a nice amulet or a good luck charm to protect against sorcery and magic (conventional testing and treatment) and evil medicine men (predatory doctors and incompetent staff).

    My (lack of a good) treatment choice: Because castration (orchiectomy), ADT therapy (chemical castration), prostatectomy, Chemotherapy, LDR Brachytherapy and blind biopsies are what I consider quackery, butchery and Frankenstein medicine (often outdated, harmful, strange, bizarre, brutal, twisted, degrading or a perverted nightmare) I would avoid all of them. Unfortunately, I was deceived into having a blind biopsy. I do not believe other conventional treatments like radiotherapy are good or great choices either, just not as horrific. The choice I made was a 5 day SBRT radiotherapy. A 5 day SBRT also has numerous drawbacks and side effects, about the same as a 9 week EBRT radiotherapy. I also had no newer treatment options available to me. As I have stated above, If I could do it over again I would also consider either no PSA testing and treatment or traveling for newer treatments from a competent provider if practical and available. I am now sure I made the wrong choice by receiving conventional testing and treatment. With prostate cancer, the testing or treatment is often worse then the disease. I was also the victim of profit motivated and substandard providers. 3 years later I now believe my prostate cancer testing and treatment greatly accelerated my ageing (through the stress, testing, treatments and physically from the radiation and was also a financial burden costing me thousands of dollars. Per a new SBRT studies my intermediate Gleason 7, 4+3 score is now considered “unfavorable” [7]. I now have about a 50% chance of a treatment failure in 8 to 10 years. My previous long term cure rate was originally quoted at 85% before my treatment started. I am also sure prostate cancer testing and treatment is mostly smoke and mirrors (lies). The man who invented the PSA test, Dr. Richard Ablin now calls it “the Great Prostate Mistake, Hoax and a Profit-Driven Public Health Disaster”[1]. When asked: “How did you live so long?” A 99 year old woman stated “stay away from doctors and don’t take anything they prescribe for you”. With some exceptions, I now believe this advice to be mostly true.

    The Book with no happy ending: After I was diagnosed with prostate cancer the doctor gave me a book written by a female. It generally contained hazardous prostate conventional testing and treatments with multiple side effects. No mention of harm from a blind biopsy, focal ablation treatments (new testing and treatment) in the book. In my opinion if you read it with attentiveness the book seemed subjective, had some demeaning and demoralizing content. I am not sure if this book was intended to cause anxiety, to devalue and frighten men into conventional testing and treatment? Legalities and copyright infringement prevents me from giving any details. They could just rename all books like this, “Conventional prostate cancer testing and treatment, A TRAGEDY”.

    Always protect yourself: With prostate cancer conventional medical care often seems to be hazardous. Do not let the sterile, friendly and professional environment of a doctor’s office detour you from protecting yourself from overtreatment or any unnecessary life changing tests and treatments. If you are concerned about misuse or privacy issues, refuse to fill out EPIC questioners and limit the information given to relevant information only. If you have a high PSA or prostate cancer, educate yourself. A patient should be extremely skeptical if exaggerated claims are made about minimal long term side effects from conventional treatments or blind biopsies, exaggerated cure rates or the need for immediate treatment. Bring someone educated or astute with you to your consultations and appointments. Inquire about newer testing if you have prostate cancer. Avoid doctors that are mostly profit motivated. Do not submit to a prostate blind biopsy. Get a second or third opinion if you are being offered treatment with low risk prostate cancer. Learn about all your treatment options, testing and side effects. Verify everything you are told. Under the HIPAA law you are entitle to a copy of all your medical records and bills. Always ask the name of the person assisting you. Get a copy and keep a file of your test results, biopsy report, Gleason score, PSA, MRI report, treatment plan, bills, insurance payouts, etc. Carefully monitor your PSA. Expect a temporary increase (for weeks or months) in PSA after some procedures. Verify the accuracy of paperwork. If treatment is necessary talk to your doctor in advance about side effect management, chronic fatigue, ED, etc. Doctors that provide treatments often have computer software to predict the outcome using test results and different treatment options. Ask to see your computer predicted cure rate outcome with your treatment options if available. This may give you some insight to your options, cure rate and also to avoid overtreatment. Always ask what is the “biochemical recurrence” (AKA rising PSA or treatment failure) rate for well beyond 5 years, 5 years is not a magic number. For help contact a good prostate cancer support group without a conflict of interest. A wise man once told me “you need to learn to think like your doctors (nurses or other providers)”. What are the motives of your providers?

    A medical holocaust: Multiple studies have verified more deaths and harm caused from prostate cancer testing and treatment then from prostate cancer itself. Medical mistakes are the third leading cause of deaths in the USA, over 251,000 deaths a year or over one million four thousand (1,004,000 deaths in 4 years). More then suicide, firearms and motor vehicle accidents combined [13]. These statistics do not include many more people that have had their lives shortened by modern medicine or a reduction in QOL (quality of life). Per the FDA, 106,000 deaths per year (Over one million people in 10 years) from prescription drugs. I personally know of 2 patients killed from medical mistakes, one got hepatitis from a colonoscopy and the other death from an upset ER nurse forcing a tube down his throat causing lethal damage.

    No national guidelines: Strict guidelines for cancer testing and treatment need to be created and enforced because of the extensive and documented abuses of prostate cancer patients: 1. Blind biopsies should be banned. 2. Strict gridlines for testing and treatment need to be created. 3. Full mandatory industry standard disclosure need to be created for tests and treatment to include realistic risk factors. 4. Newer testing and treatments need to be created and approved. 5. Dignity, privacy and confidentiality need to be standardized and enforced in addition to the deficient HIPAA laws. 6. Mandatory aftercare needs to be available, standardized and regulated. 7. The cost for drugs needs to be regulated to end financial exploitation by drug companies. 8. Medical workers should be identifiable and be required to wear name tags with first, last names and job title. 9. A new standard “Ethical Code of Conduct” needs to be created and enforced to end patient exploitation and abuse. 10. Mandatory drug testing for employees with access to control substances. 11. A truthful and accurate standardized educational book or PDF needs to be created and distributed to all high PSA and prostate cancer patients. 12. Ban for profit ADT therapy and the “chemotherapy concession”. 13. A database needs to be created to track and ban dangerous or incompetent health care workers to break the cycle of abuse. 14. All health care workers need to be screen and no adolescent under 18 years old should have contact with patients or records. It is unlikely any of the above recommendations will be implemented unless prostate cancer affected a larger percent of the population or enough prominent people are affected. Prostate cancer patients must protect themselves as the only alternative!

    Clarification: This document has angered and upset some people for various reasons. Per my experiences, some prostate cancer support group members, advocates and others are trying to spread the truth and others are attempting to suppress the truth. If you have advanced, intermediate or high risk prostate cancer you may need treatment. The intent of this document is not to imply all doctors are dishonest or to condemn all medical providers. The intent is to educate men of the consequences and dangers that may await them so they can take appropriate action and to inform patients of real world, typical or worst case scenarios. Also to obtain the best testing and treatments available. I created this document after I was extensively abused, lied to, provided substandard care and had my confidentiality breached. I have tried to include most scenarios a prostate cancer patient should be cautious of. Would some health care providers harm a patient for profit or by accident or some other reason? Yes, absolutely! Shockingly, for me it was will over 40% (probably 50% to 60%) that intended to do me some form of harm or provided substandard care as explained in my story. Are some other doctors and nurses exceptional? Yes! I have also had excellent doctors and nurses, however this may not protect you or I from the incompetent ones.

    I have been extensively criticized by some for creating this document and its blunt content. In order to insure my privacy and avoid any potential reprisals, further abuse or exploitation, I will remain Anonymous.

    Anyone may copy, email, distribute or post parts of or this entire document without changing or modifying it.

    References:
    1. Hardcover book, The Great Prostate Hoax: How Big Medicine Hijacked the PSA Test and Caused a Public Health Disaster. by Richard Ablin (Inventor of the PSA test).
    2. https://urologyweb.com/prostate-cancer-treatment-the-disturbing-facts/
    3. World J Mens Health. 2017 Apr; 35(1): 1–13. Published 2017 Apr 26. Orgasmic Dysfunction after Radical Prostatectomy. Paolo Capogrosso.
    4. Addressing Chemically Dependent Colleagues. Kathy Bettinardi-Angres, Stephanie Bologeorges. J Nurs Regulation. 2011;2(2):10-17.
    5. Medscape Urology WebMD: Mortality Risk With Prostate Biopsy Raises Concern – Medscape – Jun 17, 2013.
    6. British Journal of Cancer (2006) 94, 1093 – 1098 & 2006 Cancer Research UK. Anxiety and depression after prostate cancer diagnosis and treatment: 5-year follow-up.
    7. Alan Katz. Original research published: 08 July 2016.. Predicting Biochemical Disease-Free survival after Prostate stereotactic Body radiotherapy: risk-stratification and Patterns of Failure.
    8. C. KING. doi:10.1016/j.ijrobp.2009.07.1748. SEXUAL FUNCTION AFTER STEREOTACTIC BODY RADIOTHERAPY FOR PROSTATE CANCER: RESULTS OF A PROSPECTIVE CLINICAL TRIAL.
    9. L. Klotz. Curr Opin Endocrinol Diabetes Obes. 2013 Jun;20(3):204-9. Prostate cancer overdiagnosis and overtreatment.
    10. Loeb, S. Eur Urol. 2014 Jun; 65(6): 1046–1055. Overdiagnosis and Overtreatment of Prostate Cancer.
    11. Loeb, S. J Urol. 2013 Mar; 189(3): 867–870. Is Repeat Prostate Biopsy Associated with a Greater Risk of Hospitalization? Data from SEER-Medicare.
    12. The new England journal of medicine. October 13, 2016 vol. 375 no. 15. 10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer.
    13. BMJ 2016; 353 doi: (Published 03 May 2016) Cite this as: BMJ 2016;353:i2139. Medical error—the third leading cause of death in the US.
    14. Matthew J. Resnick. N Engl J Med 2013; 368:436-445 January 31, 2013 Long-Term Functional Outcomes after Treatment for Localized Prostate Cancer
    15. JNCI: Journal of the National Cancer Institute, Volume 97, Issue 20, 19 October 2005, Pages 1525–1532. 30-Day Mortality and Major Complications after Radical Prostatectomy: Influence of Age and Comorbidity.
    16. Rev Urol. 2004 Spring; 6(2): 95–97. Vitamin D for the Management of Prostate Cancer. Masood A Khan.
    17. Reimbursement Policy and Androgen-Deprivation Therapy for Prostate Cancer Vahakn B. Shahinian, M.D., Yong-Fang Kuo, Ph.D., and Scott M. Gilbert, M.D. N Engl J Med 2010; 363:1822-1832November 4, 2010
    18. Medicare Reimbursement and Prescribing Hormone Therapy for Prostate Cancer Nancy L. Keating. JNCI: Journal of the National Cancer Institute, Volume 102, Issue 24, 15 December 2010, Pages 1814–1815.
    19. Testicular Dose in Prostate Cancer Radiotherapy. Article in Strahlentherapie und Onkologie • April 2005.
    20. J Hematol Oncol. 2011; 4: 12. 2011 Mar 27. Low incidence of new biochemical and clinical hypogonadism following hypofractionated stereotactic body radiation therapy (SBRT) monotherapy for low- to intermediate-risk prostate cancer.
    21. International Society for Sexual Medicine. Prevalence and Predicting Factors for Commonly Neglected Sexual Side Effects to External-Beam Radiation Therapy for Prostate Cancer.. A Frey
    22. Murray KS and Thrasher JB. “Have We Underestimated Erectile Dysfunction after Prostate Biopsy?” AUANews. 2015; 20(12): 11.
    23. BJUI. A prospective study of erectile function after transrectal ultrasonography-guided prostate biopsy. Katie S. Murray, Volume 116, Issue 2 August 2015 Pages 190–195.
    24. How seniors can prevent the legal seizure of all their assets. Business Insider. Aine Cain10/9/2017
    25. Epidemic of overtreatment of prostate cancer must stop By Otis Brawley, CNN Contributor. Fri July 18, 2014
    26. Preventive Medicine Volume 84, March 2016, Pages 34-40 Masculinity in the doctor’s office: Masculinity, gendered doctor preference and doctor–patient communication. Mary S. Himmelstein.
    27. Book The Big Scare: The Business of Prostate Cancer. By Anthony Horan MD
    28. https://www.drcradiology.com/ Dr. Joseph Busch in Chattanooga

    Investigate for yourself: Internet search or Google: prostate cancer overtreatment or dangers or scam or hoax. Prostate biopsy sepsis or ED or dangers. Medical mistakes, etc, etc. The references are to massive and numerous too list them all in this document.

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