Dr. Bert Vorstman skeptical of any PC treatment. What do you think?

@wwsmith
Yeah, I was prepared to switch to CMRT if SBRT proved unsuitable. I was surprised to have both tests come back high risk. I definitely preferred RT over surgery. I toyed with the idea of disregarding the results and doing RT regardless. It's a new test that's not yet standard of care. But if I did have serious problems as predicted by the test, I'm sure that I would regret ignoring it.

@brianjarvis you give such amazing answers I'm wearing out the like and helpful buttons, I hope that's OK with you! I have a trendy question maybe you've run across answers for. When you talk about Gleason scores being expert opinion of images in a microscope - what might you (or others) have heard about AI system evaluations of these biopsy images?

Medical image analysis is something they've been working AI systems with since the 1980s (maybe longer), it seems to be everywhere, so I imagine there are people out there working on it? Thanks.

OK, I should also Google it myself, right? And here's the AI conclusion on this AI question:

Current Status & Future

AI algorithms are reaching pathologist-level performance and are becoming mature for clinical use.

Integration into clinical workflows is ongoing, with AI acting as a "digital colleague" to support diagnosis and prognosis.

Research continues to compare commercial vs. research-based AI and validate performance in diverse real-world settings.

@copyman
The problem is people do die of prostate cancer.

My father died of it in 2008 at 88 years old. The last few weeks were pretty terrible, He was on morphine and couldn’t communicate he was in so much pain.

I remember when he told me Lupron stopped working and there wasn’t anything else for treatment.

He started off with radiation as his initial treatment.

Some people do go into long-term remission. I don’t know about cure.

1. I am an outlier.
2. I feel bound, however, to comment.
3. I know NOTHING about medicine.
4. I am now 88.
5. In 2010 a bit of prostate cancer appeared on some test.
6. I was offered watchful waiting or radiation.
7. I chose a month's radiation.
8. I then forgot about the matter after the radiation. My PSA was ok.
9. In about 2021, my primary care doctor told me my PSA was high.
10. I took a test. No cancer.
11. They then offered a super expensive test. If I failed to show up, I would have to pay for the test.
12. They discovered some cancer in my lymph nodes.
13. I was offered watchful waiting, hormone therapy, or radiation.
14. I --in 100% ignorance -- chose hormone therapy.
15. It was Lupron.
16. Being really stupid, I had no idea that lack of testosterone would -- in my case -- take away my muscle mass.
17. I stopped Lupron in 2022 (after only 2 shots).
18. This is 2026. My previous muscle mass still has not returned (probably because I am so old).
19. For three years, I have not dared to walk even around my neighborhood.

Dr. Bert Vorstman published an article on Medium (https://bvorstman.medium.com/why-some-cures-are-worse-than-the-disease-61a99ba7152c) back in June 2025. The article includes a dedication to ANTHONY HORAN, MD, who died, of all things, prostate cancer. I wonder if Dr. ANTHONY HORAN, MD, would have agreed with his colleague on the topic of prostate cancer treatment.

@juanmoczo Or the creator of the Dilbert comicstrip who just died yesterday from PCa at a fairly young age.
Phil

@copyman Well, thousands of men die every year worldwide from PCa - and that’s even WITH treatment. So how many men in years past were dying from undiagnosed PCa? Probably many but the cause of death would be something like ‘heart failure’ or ‘pneumonia’, etc…How many men didn’t even make it into their 80’s from a variety of diseases, including PCa?
There is statistical proof that life expectancy for males in the US is markedly higher than it was 100 years ago and a lot of that is diagnostic screening, testing and treatment.
Is it perfect? NO, and I get where you are coming from on an emotional level. Sometimes this all seems like a con, a remedy in search of a problem and I agree that net, net the results are sometimes discouraging.
It does make you wonder…but please think back to 2012 when routine PSA’s were dismissed as overkill and there was the idea that more men were being harmed than saved. We now know this is NOT the case, as evidenced by the surge in more advanced PCa cases…
It turns out that screening, indeed, does save lives…
Phil

@heavyphil Once again, demonstrates the need for men to request to have their PSA tested early and annually.