What a young primary care opinion leader thinks about screening for prostate cancer


In a guest blog post, published yesterday on the MedPage Today web site, Dr. Andrew Buelt, a co-producer of the “Questioning Medicine” podcast for physicians, takes on the issue of screening for prostate cancer.

Dr. Buelt carefully notes that research has most certainly cast doubt on the importance of regular screenings, but that (as clearly indicated in a recent  research letter in JAMA Internal Medicine) the actual practice of screening is still widespread.

He also praises the American Urological Association’s recommendation that patients and physicians consider the need for testing rather than advocating for universal prostate screening, commenting that

 … they deserve a standing ovation for speaking to the evidence and not to the money.

Now Dr. Buelt is not a urologist. He is a young primary care physician working in Florida. And he is considered to be an opinion-leader among the new generation of primary care physicians. From that perspective, what he thinks about screening for prostate cancer may be more important than the views of some of the entrenched “senior” physicians among the urology community.

Most of our readers are not going to like what Dr. Buelt has to say. However, bluntly, unless the research community can come up with a far better way to determine exactly who is going to benefit from any form of testing for prostate cancer in the near future, The “New” Prostate Cancer InfoLink thinks that the views of physicians like Dr. Buelt are going to become strongly held by the next generation of primary care physicians … and we are not unsympathetic to his perspective, even if we do not wholly agree with him.

9 Responses

  1. About universal screening and treatment for prostate cancer. Researchers say the findings suggest formation of the hybrid genes (fusion transcripts that are formed from previously separate genes) may underlie the aggressive behavior of prostate cancer. Each man has more than 30,000 individual genes; only genes involved in iron metabolism disorders contribute to prostate cancer. Genes that maintain iron homeostasis may facilitate iron uptake, storage or egress, or the regulation of any of these processes. Around 5-9% of prostate cancers are linked to genes and family history. DNA is a complex molecule, and errors creep in all the time. Regulation of iron levels is a task of the whole body, as well as for individual cells. In most cases, the cell can correct its own defects, but when cellular iron overload attacks DNA and chromosomes, molecular biologists observe poly-gene fusion transcripts and chromothripsis in the prostate cancer cell lines. All metastatic and advanced prostate cancers are characterized by extensive genomic instability, which can be detected among all histological subtypes and among different foci within prostate tumor. The genomic changes occur at different levels, from mutations in single or few nucleotides to gains or losses of entire chromosomes or large chromosome regions. Prostate cancer cells are riddled with genetic errors, and each prostate tumor has its own chaotic set of genetic mistakes. Based on autopsy material, in both men and women, primary tumors always develop at body sites of excessive iron deposits. Mechanisms of carcinogenesis are simple. On the one hand, genes involved in iron metabolism disorders create inherited prostate cancers and other cancers. On the other hand, any health problems (old age, obesity, prostatitis), lifestyle factors (sexually transmitted infections, lack of exercise) and environmental causes (ionizing radiation, chemical carcinogens) distort iron metabolism (the set of chemical reactions maintaining homeostasis of iron) and create spontaneous prostate cancers and other cancers. Cancer that spreads outside the prostate gland to the lymph nodes, bones, or other areas is called metastatic prostate cancer. Currently, no treatments can cure advanced prostate cancer. Surgery (ceramic blades), direct intratumoral injections of iron-deficiency agents (modern medical plastic syringes and ceramic needles) and clinical iron-deficiency methods (special diets; accurate blood donations) can successfully beat inherited and spontaneous; localized, inoperable and metastatic prostate cancers.

    Vadim Shapoval

  2. Dear Vadim:

    I have no idea why you would think that “only genes involved in iron metabolism disorders contribute to prostate cancer.” We know of dozens of SNPs that may be linked to the development and proliferation of prostate cancer, and they are most certainly not all involved in disorders of the iron metabolism pathways.

  3. My GP thinks PSA is a poor indicator for prostate cancer. He says he sees guys with high PSA cured with antibiotics. He does believe that PSA velocity is the all-important indicator and reason to refer to a urologist. That happened to me. I had Gleason 9 and stage pT3b after PSA went from 2.9 to 5.4, which precipitated a TRUS biopsy and subsequently RP, ADT, and SRT.

  4. It is very important to understand that there is a huge distinction between the need to identify men with potentially clinically significant prostate cancer as early as possible so that they can receive appropriate and necessary treatment (or active surveillance) and the need to avoid diagnosing forms of prostate cancer that are (almost always) going to be clinically irrelevant because they are indolent. At present we can’t do either of these particular tricks well at all.

    As I have said a thousand times before … we need better tests, and while tests that are derivative of the PSA test (such as the phi test and the 4KScore test) may be helpful in deciding who needs a biopsy, they still aren’t good enough to be able to tell us with accuracy who is really at significant risk for clinically significant prostate cancer.

  5. Dear Sitemaster,

    You have no idea why Vadim would think that only genes involved in iron metabolism disorders contribute to prostate cancer? Cancer conspiracy theory states that there is a cure for cancer but people are keeping it a secret because of monetary gains. Why are so many people saying there is a cancer conspiracy? Who are the conspirators? Cancer research organizations full of people just pretending to be doing research. Numerous cancer research organizations say that we don’t know exactly what causes prostate cancer, but research shows that some factors may affect your risk. Vadim says that on the one hand … and on the other hand ….

    It’s very strange, but Vadim knows exactly what causes prostate cancer. Besides, Vadim knows exactly that in both animals and humans, primary neoplasms develop at body sites of excessive iron deposits. By 2030, 27 million new cancer cases and 17 million cancer deaths will occur each year world wide? Cancer represents “big money.” Cancer is “big business” and those who are profiting have great financial interest. Prostate cancer is the second leading cause of cancer death in men because scientific researchers ignore anticancer iron-deficiency methods.

    Only about 25 percent of men who have a prostate biopsy due to an elevated PSA level actually have prostate cancer. PSA benefits are small and the harms can be substantial. Cancer is “big business” now (2014) and will be in the future (2014-2050). Richard Nixon’s “War on Cancer” has been a tragedy, with (1) billions upon billions of dollars spent to develop and apply treatments that are inadequate; (2) billionaire’s lives potentially being shortened by cancer. Cancers kill charismatic presidents, football stars, medical doctors and, even, scientific researchers (Nobel Laureates).

  6. Dear Shapoval (and Vadim):

    I still don’t see what any of this has to with the hypothesis that “only genes involved in iron metabolism disorders contribute to prostate cancer”.

    It’s not just cancer that is “big business”. Medicine is “big business” — to a large extent because we are all so self-absorbed that we think we should live forever (which is a really dumb belief if ever I heard one).

  7. Dear Sitemaster, we are all so self-absorbed that we think we should live forever. Genes involved in iron metabolism disorders? What is cancer? Cancer is a class of diseases characterized by out-of-control cell growth. Cancer is a disease of the cells in the body. The genes control the functions of the cell. Organelles are little organs of the cell. The Father of Oncology says that a cell needs to have iron overload (when excessive iron accumulates within cellular organelles) before it becomes cancerous. Primary tumors always develop at body sites of excessive iron deposits, and genes involved in iron metabolism disorders can gradually insensibly create excessive iron deposit(s) in the prostate. Prostate cancer cells are iron-overloaded (iron-rich, iron-saturated) cells. Of course, old age, chemical carcinogens or prostatitis can non-genetically create excessive iron deposit(s) in the prostate.

  8. Dear Vadim:

    I have no idea which “Father of Oncology” you think is correct in the statement that “a cell needs to have iron overload (when excessive iron accumulates within cellular organelles) before it becomes cancerous.” I have never ever heard such a statement before and I don’t for one moment believe it to be correct. Sorry. There have been some suggestions that iron overload may be important in some cancers (e.g., liver cancer) but there is absolutely no evidence that iron overload is essential to the development of all cancers and I have never seen or heard of any data to suggest that iron overload has any relevance to the development of prostate cancer.

  9. Hi Vadim,

    I will join with Sitemaster in questioning your position. I am also highly suspicious of conspiracy theory advocates in many fields; usually they are trying to draw attention to themselves and lack a sound basis for their claims.

    I am especially suspicious of claims of efforts to suppress a universal cure for cancer. As a layman (no enrolled medical education) with a once life-threatening case of prostate cancer coupled with a background in science and math, I have served as a survivor representative in the Scientist Survivor Program sponsored by the American Association for Cancer Research, a highly international organization despite its name. I have attended the annual meeting of the AACR three times, interacting with many researchers. It is incredible to me that there should be such a conspiracy. If you are interested, thousands of research abstracts and other materials presented at various AACR meetings throughout the years are available to you at no cost on the AACR web site. I have also served on proposal evaluation panels for the US Department of Defense-managed Prostate Cancer Research Program, which involves a lot of interaction with researchers. Again, I have seen no evidence at all of any conspiracy to hide a cure. On the contrary, I have seen abundant evidence and an awesome amount of activity to combat cancer, with rather awesome evidence of progress, especially in recent years. You can view some of that progress by reviewing booklets available free online, sponsored each year for the past 4 years by the AACR. (Year 2011 is in the archive section.)

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