Prostate Cancer and How You Can Defeat It

Biopsy-Free Diagnosis Established (Biopsy Risks Spreading Cancer)

noreply@blogger.com (Brian & Brian) — Mon, 17 Jan 2011 14:57:00 +0000

Heidelberg Working Group for biopsy-free diagnosis established:

Decreasing the risks of prostate diagnosis

Punch biopsies associated with a high risk / New task force established as an interdisciplinary podium / Network of German specialists in Heidelberg

HEIDELBERG ( 6 MAY 2009) - Last week saw the foundation of a working group in Heidelberg by renowned experts from the field of urology and diagnostics, whose aim is to network various medical specialties in promoting the development of new methods and the exchange of experiences in the biopsy-free diagnosis of prostate disorders. Prostate carcinoma (PCa) is a malignant form of cancer occurring in the glandular tissue of the prostate. In Germany, nearly three of every one hundred men die of prostate cancer. The early diagnosis of the disease reduces the risk of dying of such a tumor. As a measure to gain conclusive proof as to whether the prostate has been afflicted by a carcinoma, as a rule blood investigations are performed and the area is screened ultrasonically, after which a biopsy specimen is taken. This involves the invasive removal of tissue; while it is a standard procedure, it is nevertheless subject to controversial medical debate. In many cases three or even more punch biopsy specimens, selected from as many as 30 specimens punched from the prostate, are necessary to securely diagnose prostate carcinoma. "This may lead to the influx of bacteria into the bloodstream, which in worst-case circumstances can result in life-endangering septicaemia", Dr. Joachim-Ernst Deuster, the Heidelberg-based urologist, warns. "And if the biopsy needle hits a prostate carcinoma, this bears the risk of spreading tumor cells in the body. What's more, so-called cytokines may be released that are capable of enhancing the growth and metastasis of the prostate carcinoma." The urologist is director of the private Clinic for Prostate Therapy and has specialized in the gentle treatment of prostate disorders.

"Gentle treatment of the prostate should also be accompanied by just-as-gentle diagnostic procedures", says Deuster. He sees an enormous deficit of information in the branch. For this reason, in Heidelberg last week he established the "Arbeitskreis biopsiefreie Diagnostik" (Biopsy-free Diagnosis Working Group), that was attended by renowned experts from the areas of cytodiagnosis, molecular pathology, and magnetic resonance spectroscopy from throughout Germany. Together with experts from the area of laboratory medicine, they discussed the options available to reduce the risks associated with biopsy-taking procedures - for example by using entirely new and promising methods. These include so-called real-time choline PET/CT (choline positron-emission tomography / computer tomography) of the prostate - a novel, combined imaging method made possible by nuclear medicine - and MR spectroscopy.

"Our wish is to offer experienced practicing specialists an informational podium", is how Dr. Joachim-Ernst Deuster explains one of his major aims. "By creating a closely meshed network, urologists and specialists from the cytoanalysis field and in the proven imaging techniques, such as computer tomography, want to join forces to identify ways to improve the accuracy in diagnosing prostate carcinomas or, as the case may be, of being able to exclude a carcinoma with a high degree of probability", adds Dr. Thomas Dill, a urologist from Heidelberg. The principal aim is centered on the ability to avoid having to take biopsy specimens wherever possible as a measure to minimize the risk for the patient.

The Working Group will be meeting regularly in the future, and warmly invites specialists from other areas to take part.

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Click here for more biopsy alternatives.

Clinic contact data:
Klinik für Prostata-Therapie GmbH im :medZ
Bergheimer Straße 56a
D-69115 Heidelberg, Germany
Phone (+49) (0)6221 / 65085-0
Fax (+49) (0)6221 / 65085-11
E-mail: Dr.Deuster@prostata-therapie.de
Internet: www.prostata-therapie.de

Contact for media relations:
agentur pressekontakt.com
Hauptstrasse 31
D-69251 Gaiberg, Germany
Phone 06223 / 46614
info@pressekontakt.com

PSA concentration at age 60 and death or metastasis from prostate cancer: case-control study

noreply@blogger.com (Brian & Brian) — Tue, 16 Nov 2010 21:36:00 +0000

Abstract
Article Referenced to BMJ.com

Objective To determine the relation between concentrations of prostate specific antigen at age 60 and subsequent diagnosis of clinically relevant prostate cancer in an unscreened population to evaluate whether screening for prostate cancer and chemoprevention could be stratified by risk.

Design Case-control study with 1:3 matching nested within a highly representative population based cohort study.

Setting General population of Sweden taking part in the Malmo Preventive Project. Cancer registry at the National Board of Health and Welfare.

Participants 1167 men aged 60 who provided blood samples in 1981 and were followed up to age 85.

Main outcome measures Metastasis or death from prostate cancer.

Results The rate of screening during the course of the study was low. There were 43 cases of metastasis and 35 deaths from prostate cancer. Concentration of prostate specific antigen at age 60 was associated with prostate cancer metastasis (area under the curve 0.86, 95% confidence interval 0.79 to 0.92; P<0.001)>2 ng/ml) develop fatal prostate cancer, 90% (78% to 100%) of deaths from prostate cancer occurred in these men. Conversely, men aged 60 with concentrations at the median or lower (≤1 ng/ml) were unlikely to have clinically relevant prostate cancer (0.5% risk of metastasis by age 85 and 0.2% risk of death from prostate cancer).

Conclusions The concentration of prostate specific antigen at age 60 predicts lifetime risk of metastasis and death from prostate cancer. Though men aged 60 with concentrations below the median (≤1 ng/ml) might harbour prostate cancer, it is unlikely to become life threatening. Such men could be exempted from further screening, which should instead focus on men with higher concentrations.

Comparison of 12-Core Versus 8-Core Prostate Biopsy - No Evidence

noreply@blogger.com (Brian & Brian) — Thu, 21 Oct 2010 16:03:00 +0000

Urology 9/10/10 - Gold Journal Full abstract & Article Info

The study investigate the impact of additional biopsy cores on prostate cancer diagnosis among US veterans. The reported rate of positive biopsy results varies from 20% to 40%. In this large series of prostate biopsy procedures, in which the peripheral zone was well targeted, there was no evidence that 12–core biopsy improved the likelihood of prostate cancer diagnosis compared with 8–core biopsy. As such, the results of this cohort from a US veteran population suggest that targeting the peripheral zone is more important than the absolute number of biopsy cores. However, in certain subgroups of patients with specific clinical characteristics, such as those with very large prostates, more cores may be required. Further studies are needed to identify such characteristics.

Musician of Alabama Randy Owen Prostate Cancer Results PSA

noreply@blogger.com (Brian & Brian) — Wed, 13 Oct 2010 14:05:00 +0000

October 13th, Sarasota, Florida- The Diagnostic Center For Disease and Medical Director Dr. Ronald Wheeler are pleased to report that singer/songwriter/entertainer Randy Owen has received a PSA result of 0.1 on his 3-month follow-up after his HIFU treatment for prostate cancer in May. A PSA result of a 0.1 is the best case scenario for cases such as Randy’s who has maintained a lifestyle of healthy eating, exercising, and positive attitude while remaining cancer-free.

Prostate Biopsy Can Cause Urinary, Erectile Problems

noreply@blogger.com (Brian & Brian) — Wed, 29 Sep 2010 18:37:00 +0000

NEW YORK (Reuters Health) – Biopsies taken to diagnose prostate cancer commonly cause temporary erectile dysfunction and, in some cases, lingering urinary problems, according to a new study.

The findings, reported in the Journal of Urology, highlight the fact that even the tests for diagnosing prostate cancer can have side effects.

And men who are undergoing prostate biopsies -- as well as those considering prostate cancer screening -- should be aware of those risks, experts say.

This is especially important for men facing the prospect of multiple biopsies, since the risk of side effects appears to be related to the number of needle sticks used.

For the study, German researchers followed 198 men who had been randomly assigned to undergo one of three forms of biopsy to check for suspected prostate cancer: a standard biopsy, where a needle was used to take no more than 10 tissue samples; a 10-sample biopsy along with the use of a periprostatic nerve block to lessen any pain from the procedure; or a "saturation" biopsy, where 20 tissue samples were taken.

Saturation biopsies may be done in some cases where the doctor suspects a man has a particularly elevated risk of having cancer -- such as a man who has had a negative biopsy in the past yet has persistently suspicious findings on PSA screening tests. Taking more tissue samples during the biopsy should increase the chances of finding any tumor.

But all those needle sticks may come at a cost, the study found.

Men who underwent saturation biopsies had the highest risk of developing lingering problems with urination, such as straining to pass urine and frequent nighttime trips to the bathroom.

Of that group, 10 percent reported severe symptoms before the biopsy; that figure increased to 18 percent one week after the test, and to 29 percent 12 weeks afterward.

Men who'd had a standard biopsy showed an increase in urinary symptoms only in the first week. The percentage reporting moderate symptoms increased from roughly 32 percent to 39 percent, and the proportion with severe symptoms rose from 18 percent to 20.5 percent.

Among men who'd had a biopsy with nerve block, just 0.6 percent reported severe urinary symptoms before the test. That rose to 8 percent one week afterward, and to almost 17 percent by week 12 -- though that latter finding was not statistically significant, which means it could have been due to chance.

When it came to erectile function, men in all three biopsy groups had more problems one week after the test. The side effect did, however, gradually decrease over time.

Among men in both the standard biopsy and saturation-biopsy groups, just over half reported severe erectile dysfunction one week after the test -- up from around one-quarter before. In the nerve-block group, that rate rose from 11 percent to 39 percent.

By week 12, the men's rates of erectile problems had declined to close to their baseline levels.

The findings are "not unexpected," said Dr. Paul Schellhammer, a urologist at Sentara Health System/Eastern Virginia Medical School in Norfolk who was not involved in the research.

However, he noted in an interview, there has been little study into the urinary and erectile side effects of prostate biopsies.

"This study begins to define the risks," said Schellhammer, who has studied the effects of prostate cancer treatment on men's sexual and urinary function.

Men facing repeat biopsies over time -- whatever the type of biopsy -- should be particularly aware of the chances for side effects, Schellhammer told Reuters Health, since it appears that the greater the number of needle-sticks into the prostate, the greater the odds of lingering urinary problems.

It is not clear from this study exactly why men undergoing saturation biopsy had a greater risk of longer term urinary symptoms, according to lead researcher Dr. Tobias Klein of Marienhospital Herne in Germany.

But it is possible, he told Reuters Health in an email, that damage to the "neurovascular bundle" -- a complex of nerves and blood vessels close to the prostate -- plays a role.

The fact that prostate biopsies carry some risks -- which, besides the ones seen in this study, include more-immediate problems like bleeding and infection -- also has implications for men considering prostate cancer screening, according to Schellhammer.

Routine screening with PSA testing is controversial. The tests measure concentrations of prostate-specific antigen, a protein produced by the prostate gland whose blood levels generally rise when a prostate tumor is present; however, a relatively high PSA does not necessarily mean cancer, and a biopsy must be done to confirm. And those biopsies often turn out to be negative.

In the current study, 40 percent of the men were found to have cancer after their prostate biopsy.

Much of the concern about PSA testing revolves around the fact that prostate tumors are often slow-growing, and screening may result in many men being treated for cancers that would never have caused them problems. So those treatments -- with their risks of side effects like erectile dysfunction and urinary incontinence -- can do more harm than good for some men.

But men should also be aware, Schellhammer said, that prostate biopsies can have side effects as well, and that can be considered when they are making decisions on PSA screening.

He added that the findings are also relevant to men diagnosed with prostate cancer who choose "active surveillance" -- where the doctor does not immediately treat the cancer, but instead monitors its progression. That surveillance, Schellhammer noted, might include yearly biopsies.

More Details About This Study Can Be Seen Below:

Purpose
We evaluated the effect of multiple core prostate biopsy and periprostatic nerve block on voiding and erectile function.

Materials and Methods
A total of 198 patients in whom prostate cancer was suspected were randomly assigned to undergo 10-core prostate biopsy with (71) or without (74) periprostatic nerve block. The 53 men with a history of negative prostate biopsy underwent 20-core saturation prostate biopsy with periprostatic nerve block. The International Prostate Symptom Score and International Index of Erectile Function were completed before, and 1, 4 and 12 weeks after biopsy to measure changes in voiding and erectile function, and quality of life. Upon prostate cancer diagnosis patients were excluded from further analysis.

Results
The International Prostate Symptom Score was significantly increased in all patients at week 1, which persisted at weeks 4 and 12 after saturation biopsy (p = 0.007 and 0.035, respectively). After 10-core prostate biopsy with periprostatic nerve block patients had a higher International Prostate Symptom Score at weeks 4 and 12 but this was not statistically significant (p >0.05). Quality of life was significantly affected at all times after saturation prostate biopsy (p = 0.001, 0.003 and 0.010, respectively). International Index of Erectile Function scores decreased significantly in all groups at week 1 (p <0.05).

Conclusions
Prostate biopsy causes impaired voiding. Saturation prostate biopsy and periprostatic nerve block seem to have a lasting impact on voiding function. Erectile function is transiently affected by prostate biopsy regardless of periprostatic nerve block and the number of cores. Patients who undergo prostate biopsy must be informed about these side effects.

MR imaging and MR spectroscopic Imaging Evaluation of Prostate Cancer

noreply@blogger.com (Brian & Brian) — Fri, 17 Sep 2010 13:30:00 +0000

Referenced from
"MR imaging and MR spectroscopic imaging in the pre-treatment evaluation of prostate cancer"

H Hricak, MD, PhD

Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue C278, New York, NY 10021 USA

Magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (1H MRSI) are emerging as the most sensitive tools for the non-invasive, anatomic and metabolic evaluation of prostate cancer. This article reviews the current applications of MRI and 1H MRSI in clinical practice and discusses the promise of these modalities for improving prostate cancer management. MRI demonstrates zonal anatomy with excellent contrast resolution and can reveal tumours in areas not routinely sampled on biopsy and not palpable on digital rectal examination. In addition, MR images allow assessment of local extent (including extracapsular extension and seminal vesicle invasion) and thus can assist in local staging while providing surgeons and radiation therapists with a visual road-map for treatment planning. The addition of 1H MRSI to MRI can improve prostate cancer detection and assessment of tumour volume; it also contributes indirectly to improved local staging. In addition, 1H MRSI metabolic and volumetric data correlate with pathological Gleason grade and thus may offer a non-invasive means to better predict prostate cancer aggressiveness. Combined MRI/1H MRSI is currently of greatest value for high-risk patients. With greater understanding of the relationship between spectroscopic data and tumour biology, it may become possible to use MRI/1H MRSI to achieve more precise stratification of patients in clinical trials, to monitor the progress of patients who select watchful waiting or minimally aggressive cancer therapies, and to guide and assess emerging local prostate cancer therapies.

More info about the MR imaging and spectroscopic imaging (videos, testimonials, and specifics about the machine/procedure).

African Americans and Prostate Cancer

noreply@blogger.com (Brian & Brian) — Thu, 24 Jun 2010 11:00:00 +0000

In a study published by the journal of the National Cancer Institute. African American men were found to be nearly twice the risk of prostate cancer compared to white men even after an adjustment of number of known and suspected cancer risk factors. African American men have the highest rate of prostate cancer in the U.S. In addition, a Ropel Starks service showed that African American men are significantly more likely than white men to experience side effects from prostate cancer treatments including incontinence. They are also more likely than white men to be disatisfied with their doctors support. Dr. Ronald E. Wheeler will discuss diagnosis and treatments for prostate cancer in the videos below.

Introduction

Effects of Having a Prostate Biopsy

Review videos & information on prostate cancer for African Americans and the Black Almanac interview.

Famous Musician Randy Owen of Alabama Receives HIFU Treatment from Dr. Wheeler

noreply@blogger.com (Brian & Brian) — Fri, 18 Jun 2010 16:45:00 +0000

Randy Owen, famous lead singer and principal songwriter for the Country Music Hall of Fame members Alabama, told attendees at his annual fan club party in Ft. Payne, Alabama last week that earlier this year he was diagnosed with prostate cancer.

During a recent checkup, Dr. Woody Fritz in Birmingham, Alabama, noticed an elevated level of a Prostate Specific Antigen (PSA) in a routine blood test. He referred Owen to Dr. Ronald Wheeler, M.D., a world expert in High Intensity Focused Ultrasound (HIFU) and medical director of the Diagnostic Center for Disease in Sarasota, Florida. Owen chose the HIFU procedure as his form of cancer treatment which was performed by Dr. Wheeler the beginning of May and has been deemed a complete success.

“After my routine six-month physical, I was referred by Dr. Fritz to Dr. Wheeler, and I feel very good and positive about my future,” said Owen. I look forward to seeing the fans and doing what I do.”

“Randy did everything right by having his PSA checked regularly, avoiding random biopsy, and educating himself about his treatment options,” said Dr. Wheeler. ”He has set an example all men should follow to beat prostate cancer and live an excellent quality of life.”

Dr. Fritz went on to say, “we are happy with the successful outcome of the treatment. Randy is doing great and is just about fully recovered.”

As the front man for Alabama, Owen racked up sales of over 73 million albums, which includes 21 gold, platinum and multi-platinum certifications, 42 number one singles and a mantle loaded with over 150 industry awards. Owen released his debut solo album, One On One, and his memoir, Born Country, in November, 2008. He will be tending to his cattle business in Ft. Payne, Alabama through the summer and is planning on resuming touring in mid-September.

'Easy Rider' actor Dennis Hopper dies

noreply@blogger.com (Brian & Brian) — Sat, 29 May 2010 19:19:00 +0000

March 26, 2010, his star on Hollywood's Walk of Fame.

CNN States: Dennis Hopper, the one-time Hollywood enfant terrible who portrayed such indelible characters as "Easy Rider's" biker Billy and "Blue Velvet's" huffing villain Frank Booth, died of prostate cancer Saturday morning at his home in Venice, California, his wife said. He was 74.

Hopper, who was diagnosed with prostate cancer last October, was surrounded by his children when he died, his wife, Victoria Hopper, told CNN.

Funeral arrangements have not been decided, but Hopper's wish was to be buried in Taos, New Mexico, "his heart home," Victoria Hopper said.

The American film icon made his last public appearance on March 26, 2010, when his star was dedicated on Hollywood's Walk of Fame.

Over almost six decades as a performer and director, his career spanned a range of Hollywood trends: TV's live "Golden Age," films about disillusioned teenagers, a variety of Westerns, anti-establishment dramas, offbeat indie films, action blockbusters and edgy cable series. He often played villains, occasionally lost souls, almost all with a force and empathy.

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Prostate Cancer
Excerpt from Urologist Dr. Wheeler

Overview
Prostate cancer is a disease in which cancer develops in the prostate, a gland in the male reproductive system. It occurs when cells of the prostate mutate and begin to multiply out of control. These cells may spread (metastasize) from the prostate to other parts of the body, especially the bones and lymph nodes. Prostate cancer may cause pain, difficulty in urinating, erectile dysfunction and other symptoms.

About the Prostate
The prostate gland, a key part of the male reproductive system, is linked closely with the urinary system. It is a small gland that secretes much of the liquid portion of semen,the milky fluid that transports sperm through the penis during ejaculation.

The prostate is located just beneath the bladder, where urine is stored, and in front of the rectum. It encircles, like a donut, a section of the urethra. The urethra is the tube that carries urine from the bladder out through the penis. During ejaculation, semen is secreted by the prostate through small pores of the urethra's walls.

The prostate is made up of three lobes encased in an outer covering, or capsule. It is flanked on either side by the seminal vesicles, a pair of pouch-like glands that contribute secretions to the semen. Next to the seminal vesicles run the two vas deferens, tubes that carry sperm from the testicles. The testicles, in addition to manufacturing sperm, produce testosterone, a male sex hormone that controls the prostate's growth and function.

Diagnosis of Prostate Cancer
Prostate cancer is most often discovered by physical examination or by screening blood tests, such as the PSA (prostate specific antigen) test. Suspected prostate cancer is typically confirmed by removing a piece of the prostate (biopsy) and examining it under a microscope. However, blind needle biopsies spread cancer cells and only yield a 25 % success rate in finding cancer. Recent advancements in imaging technology such as prostate 3.0 Tesla MRI with Spectroscopy allow physicians to locate suspicious areas of disease and then performed targeted biopsies improving diagnostic outcomes by up to 40%. In addition to locating suspicious lesions, 3.0 Tesla with Spectroscopy can determine whether prostate cancer has spread beyond the capsule.

Treatment of Prostate Cancer
There's more than one way to treat prostate cancer. For some men a combination of treatments — such as surgery followed by radiation or radiation paired with hormone therapy — works best. The treatment that is best for each man depends on several factors. These include how fast your cancer is growing, how much it has spread, your age and life expectancy, as well as the benefits and the potential side effects of the treatment.

Click here to learn more about prostate cancer, it's treatments, and alternatives.

Results With Co-enzyme Q

noreply@blogger.com (Brian & Brian) — Thu, 20 May 2010 20:34:00 +0000

Excerpt taken from the article "Talking to Patients About Alternative Therapies for Prostate Cancer"

Mr. Moyad’s group has recently looked at a supplement called co-enzyme Q, which has been gaining popularity among patients as an anticancer therapy. They found that it did not decrease prostate cancer cell growth but, rather, increased it in a dose-dependent manner. "The more we added, the more the tumor cells grew," he said.

Such conflicting studies confirm the importance of making sure that physicians have the facts about supplements--both positive and negative evidence.

Two alternative techniques--acupuncture and meditation--may play a supplemental role in prostate cancer treatment, not in reducing tumor growth but "by possibly doing other things that can be helpful, such as lowering blood pressure and reducing stress," Mr. Moyad said.

Meditation is being used in cancer support groups across the country to help reduce the stress of living with cancer and its treatment. Although there are as yet no studies of acupuncture in prostate cancer, he noted that the NIH recently gave its seal of approval for acupuncture as an adjunctive therapy in treating chemotherapy-related nausea and cancer pain. "Prostate cancer patients often get chemotherapy and often have significant pain," Mr. Moyad said, "so it definitely looks like acupuncture is going to have a use in the future with prostate cancer as a complementary therapy."

Management of Rising Prostate-Specific Antigen Following a Negative Biopsy

noreply@blogger.com (Brian & Brian) — Thu, 20 May 2010 20:28:00 +0000

Current Opinion in Urology:
May 2010 - Volume 20 - Issue 3 - p 198–203
doi: 10.1097/MOU.0b013e3283385fbd
Prostate cancer: Edited by Andrew Stephenson

Purpose of review: Most men who undergo prostate biopsy will not be found to have cancer, but a significant number of those men may harbor cancer that was simply not identified. This is especially likely when inadequate biopsy strategies were employed, or when entities associated with a likelihood of underlying cancer such as high-grade prostatic intraepithelial neoplasia or atypia were identified, begging the question of what one means by the term ‘negative biopsy’. There is little consensus on management of this heterogeneous population.

Recent findings: Traditional sextant biopsy may miss half of cancers, and even extended or saturation biopsy protocols miss many small cancers. It is widely assumed but unproven that rising prostate-specific antigen (PSA) following negative prostate biopsy is more likely to indicate cancer than stable or decreasing PSA. Although missing small low-grade cancers might actually allow the patient to avoid overtreatment, some of these cancers are high-grade so identification may offer the ideal scenario for curative therapy.

Summary: Many men with rising PSA following negative biopsy harbor prostate cancer. Thoughtful patient selection with a low threshold for repeat biopsy offers the best opportunity to diagnose clinically significant cancers while still curable without risking over utilization of biopsy.

Prostate Cancer Diagnosis and Mistreating - How Can It Be Fixed?

noreply@blogger.com (Brian & Brian) — Mon, 30 Nov 2009 21:35:00 +0000

Did you know that 40-60% of all men who have Prostate Cancer will have recurrence within 7-10 years? This video explains why that happens, the MRI-S, Prostate Cancer overall, and how it is generally treated and diagnosed.

Dr. Wheeler is the Medical Director for the Diagnostic Center for Disease and has been treating patients for over 25 years. More information can be found at http://mrisusa.com

3D Animation of HIFU Procedure

noreply@blogger.com (Brian & Brian) — Fri, 27 Nov 2009 19:23:00 +0000

The 3D animation above shows how the HIFU procedure works with the prostate and removing the prostate cancer.

HIFU otherwise known as High Intensity Focused Ultrasound treats prostate cancer. It is a therapy that destroys tissue with rapid heat elevation, which essentially "cooks" the tissue. Ultrasound energy, or sound waves, is focused at a specific location and at that "focal point" the temperature raises to 90 degrees Celsius in a matter of seconds.

More information on this procedure can be found at http://panamhifu.com

Prostate Cancer Patient Review - From PSA to the HIFU Procedure (Video)

noreply@blogger.com (Brian & Brian) — Wed, 25 Nov 2009 14:09:00 +0000

Think you couldn't get Prostate Cancer? 30% of all Americans get Prostate Cancer after they have reached age 30.

The patient in this video goes through his initial PSA test all the way through the HIFU procedure. What is HIFU? HIFU is High Intensity Focused Ultrasound is used for prostate cancer patients. Dr. Wheeler is regarded as one of the top doctors in the HIFU procedure. More information can be found at PanAmHifu.com.

MRI-S Eliminates Needless Biopsies

noreply@blogger.com (Brian & Brian) — Mon, 23 Nov 2009 19:03:00 +0000

Why should you avoid a Prostate Biopsy? Biopsies can spread cancer cells and cause infections. This video shows a better way; non-invasive, very accurate with no side-effects. Watch this video to see the MRI-S and how it eliminates needless biopsies.

More information can be found at http://mrisusa.com.

Is it Always Necessary to Cure Prostate Cancer When it is possible? - Part 4

noreply@blogger.com (staff) — Sat, 21 Nov 2009 21:00:00 +0000

(Understanding the role of prostate inflammation resolution to prostate cancer evolution)

RONALD E. WHEELER, From the Diagnostic Center for Disease, Sarasota, Fl

CONCLUSIONS:

Prostate cancer is recognized as the number one male cancer health risk with a new case diagnosed every 3 minutes. With baby boomers aging and health care costs rising (52), an opportunity to examine novel concepts for the care of patients diagnosed with prostate cancer could not be more relevant. When a radical prostatectomy is successfully performed for a cure, consideration should be given to the potential average benefit of adding 3 years, 1.5 years, and 0.4 years to the life of a typical man in his 50s, 60s or 70s, respectively. When this benefit is weighed against the possibility of failure to cure and the associated morbidity, pain, surgical risks, complications, side effects and costs, an effective dietary and nutritional protocol may present a reasonable alternative. (53)

When all of these factors are considered in our aging population together with the risks of a significant decrease in the quality of life even in successful cases of definitive, curative therapy, a conservative approach may be welcomed as a viable first choice in Gleason 5 and 6 prostate cancer patients by Governmental agencies such as Medicare, the Health Care Insurance Industry, and patients alike. Critical to research regarding the concept of living with the disease is to locate and allocate funding to study this protocol and similar programs in greater depth with additional patients followed over a longer period of time. This study has perhaps provided the first step in our improved understanding of the concept of nutritional therapy of prostate cancer. Beyond the issue of prostate cancer treatment is the potential role of prevention. Ultimately through this research effort and that of others, the landscape of prostate cancer treatment will become better defined.

CHRONIC DISEASE MANAGEMENT PROTOCOL NOTING PSA RESPONSE TO 5–ALPHA REDUCTASE INHIBITORS (5-ARIs) VERSUS NON 5-ALPHA REDUCTASE INHIBITORS CHART (PDF)

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PROSPECTIVE STUDY PATIENT DATA (PDF)

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Nelson CP, Rubin MA, Strawerman M, et al.: Preoperative Parameters for Predicting Early Prostate Cancer Recurrence after Radical Prostatectomy. Urology, 59: 740-46, 2002.

Ornish, D, Weidner G, Fair WR, Marlin R: Intensive Lifestyle Changes May Affect the Progression of Prostate Cancer. Journal of Urology, Vol. 174, 1065-1070, 2005.

Giugliano D and Esposito K: Mediterranean Diet and Cardiovascular Health. Annals of the New York Academy of Science, Vol. 1056, 253-60, 2005

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Margolis S, Carter HB: The Johns Hopkins White Papers (Prostate Disorders). P: 28, 2002.

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Is it Always Necessary to Cure Prostate Cancer When it is possible? - Part 3

noreply@blogger.com (staff) — Thu, 19 Nov 2009 20:36:00 +0000

(Understanding the role of prostate inflammation resolution to prostate cancer evolution)

RONALD E. WHEELER, From the Diagnostic Center for Disease, Sarasota, Fl

STUDY ANALYSIS AND DISCUSSION:

The possibility of treating prostate cancer conservatively has always been intriguing to the patient and a concern for the clinician. Previous studies have commonly grouped Gleason 7 scores with Gleason 5 and 6 scores within the designation of moderately well differentiated cancers. Ostensibly, this would give patients with Gleason 7 scores improved odds for cure while decreasing the chance for success in patients with Gleason 5 and 6 scores. This assumes the higher the Gleason score, the lower the chance for cure. (5,32) Increasing evidence through analyses now suggests that Gleason 7 prostate cancer responds better than a Gleason 8-10 but not as well as a Gleason 5 or 6. (5) Additionally, it is believed that Gleason scores of 5-7 may comprise almost 90% of all cancers encountered as 35-62% of men in most study groups analyzed are identified in the Gleason 6 category (5).

Qualification for this study included men with the diagnosis of prostate cancer who had not been exposed previously to anti-androgen therapy, LHRH therapy or any other definitive process of prostate cancer manipulation. Of the twenty three patients evaluated, 11 men were diagnosed with a Gleason 6 score, 6 men had a Gleason 5 score, 3 men had a Gleason 5-6 score, 2 men were noted with a Gleason 6-7 score, while one man had a Gleason 7 pattern. The clinical stage assessment noted 15 men with a T1c, 4 men with a T2c, 2 men with a T2b and 2 men with a T2a stage classification. Pathologically, the biopsy diagnosis ranged from T1a – T2c. (Refer to Patient Performance chart) While the number of biopsy cores positive for cancer and the percentage of cancer per core varied widely, the percentage of cores positive for cancer (identified at the biopsy procedure) ranged from 12.5%-73% (mean: 33%; median 20%) associated with a range of biopsy samples from 2-18. This suggests the presence of significant disease in the study group.

In a unique study, Dean Ornish and colleagues at the University of California-San Francisco evaluated the ability of the Vegan Diet (n=44) to alter the PSA in a comparative analysis with a non-restrictive diet (n=43) in men documented with a Gleason 6 prostate cancer over a one year time period. (33) All of the men in this study, as in ours, had declined definitive curative treatment and hormonal therapy. While the merits of the Vegan Diet cannot be disputed as a benefit in heart disease prevention, it was less clear what effect this diet would have on men with known prostate cancer. An average decrease in PSA of 0.25 ng/ml (4%) identified in the Vegan group was statistically significant when evaluated in concert with a 0.38 ng/ml (6%) rise in the placebo group. While statistically significant, the difference was nonetheless modest at one year. This study result does not suggest a lack of benefit to the Vegan Diet, but rather demonstrates that the impact of diet alone on prostate cancer may be modest.

In our prospective study, we evaluated the benefit of a modified Mediterranean diet on known prostate cancer patients with Gleason scores of 5-7. The Mediterranean diet is recognized worldwide for its health benefits systemically but more specifically its promotion of cardiovascular health and cancer avoidance (colorectal, breast, pancreas, prostate and endometrial) properties. (18-19, 34-35) By design, men were asked to avoid red meat and dairy products including eggs in an effort to decrease saturated fat. It is commonly recognized that animal fat and dairy fat may play a role in prostate cancer proliferation. (6-17, 36) Unlike the Ornish cohort, men did not use soy in their diets. Fresh fruits and cruciferous vegetables belonging to the brassica classification were highlighted while the oil of choice was virgin olive oil.

Beyond the modified Mediterranean Diet, our study group used a complex nutritional supplement called Peenuts that was originally developed to treat prostatitis. This formula represents a unique, synergistic blend of vitamins, minerals, amino acids and herbs. These ingredients have been shown individually to affect cellular oxidation, inflammation and immune function, while less clearly offering additional potential benefits from beta-sitosterols. (37-38) While using this formula, previous clinical investigations have shown an improvement in the expressed prostatic secretion (EPS) and voiding symptoms. (31) The EPS is the recognized diagnostic marker for prostatitis as shown through the historic work of Stamey, Meares, and others (39-43), while voiding symptoms are common to the diagnosis of benign prostatic hyperplasia and prostatitis.

The concept of looking at prostatitis within this study group was prompted by previous research from the American Association of Cancer Research (AACR) that supports a role for prostatitis in the evolution of prostate cancer. (44-46) It is postulated that the cellular oxidative stress associated with a chronic inflammatory process leads to proliferative inflammatory atrophy with subsequent evolution of free radicals through oxidative change eventually resulting in DNA alteration (cellular mutation), prostatic intra-epithelial neoplasia (PIN) and cancer. (44, 46) While it is beyond the scope of this article to review these findings in greater depth, it is well known that the process of inflammation is commonly associated with organ specific cancers including but not limited to cancer of the esophagus, colon, stomach, liver, lung and cervix. (45,47-48)

Within our study group, the mean PSA at the time of diagnosis was 6.8 ng/ml (range: 2.1-14.4 ng/ml). A statistically significant reduction in mean PSA of 3.4 ng/ml was validated using the t-test, Wilcoxon analysis and the null hypothesis. (Refer to statistical analysis) The mean percentage reduction in PSA was 50% while the likelihood for organ confinement in this group was 66% referencing the Partin Prediction tables. (49, 50)

While the topic of prostatitis and its role in prostate cancer evolution is likely to remain controversial for the immediate future, the topic’s relevance may be best left for the health care provider and the patient to decide. Based on an average percent reduction in the white blood cells (a universal marker for inflammation) of 77.5% associated with the EPS, there appears to be sufficient clinical indication to support the addition of a scientifically validated prostatitis therapy to any long- term prostate cancer management protocol. The relative failure of the Vegan diet in the Ornish study to significantly suppress prostate cancer (based on PSA analysis) supports this hypothesis.

Additionally, it is not unreasonable to suggest the noted reduction in PSA in our study is based mainly on the improvement in prostatitis, as it is well known that prostatitis is a common cause of PSA elevations. However, the long average duration of the reduction in PSA levels at over 3 years in patients with known prostate cancer receiving no other therapy would suggest that the treatment is acting directly on the prostate cancer. Only further study will be able to determine if this conclusion is accurate. At the very least, we can say that the nutritional component complements the diet and may well enhance the durability of response seen in the study patients.

There is a clear indication that the nutritional treatment evaluated had an impact on voiding symptoms, as there was a mean percentage reduction in the International Prostate Symptom Score Index (IPSS-Index) of 61%. This is consistent with findings from a previously performed randomized, double blind, placebo controlled study (31). This response exceeds that of any prostate or prostatitis nutritional formula such as saw palmetto described in the world medical literature suggesting a synergistic effect from the particular blend of nutrients selected. (51)

One gentleman aged 54, who had initially qualified for the study decided on a radical prostatectomy despite performing quite well at 7 months. Importantly, the delay in surgery had no adverse effect on the outcome, as his PSA was 0.0 ng/ml, 1 year post-prostatectomy. While further research could evaluate the potential benefit of this protocol to any ultimate outcome, the delay in definitive treatment allowed for improved awareness and decision making on the part of the patient and his family. Alternatively, research may demonstrate the use of the Peenuts formula or similarly validated supplements to be a reasonable first step in avoiding additional biopsies in patients where prostatitis is present.

While the use of the modified Mediterranean diet and a prostate nutritional supplement has been shown to be effective, additional ingredients and/or products may be added to enhance the collective benefit in the prostate cancer disease suppression process. Beyond the modified Mediterranean diet and the Peenuts nutritional formula that were used by all patients, 17 patients used an active form of vitamin D, 13 patients used an anti-cholesterolemic agent, 14 patients used omega-3 fatty acids, 13 patients used a 5-alpha reductase inhibitor (5-ARIs), 7 patients used a COX II inhibitor and 4 men used an alpha-blocker. When the men using 5-ARIs were studied versus the men who didn’t use them, there was a 52% reduction in PSA in the 5-ARIs group (n=13) over 32 months versus a 43% reduction in the cohort not on 5-ARIs (n=10) over 48 months. This suggests a relatively insignificant benefit in PSA reduction relevant to the men on the 5-ARIs at this point in the study. Interestingly, when the nutritional supplement formula was evaluated alone (n=4), a reduction in mean PSA of 53.8% over 41.3 months of surveillance was noted. While this finding is potentially quite significant, it would be premature to draw any conclusions from such a small sampling size and a larger study with additional patients would need to be completed before the issue can be properly addressed.

Is it Always Necessary to Cure Prostate Cancer When it is possible? - Part 2

noreply@blogger.com (staff) — Sun, 15 Nov 2009 20:28:00 +0000

(Understanding the role of prostate inflammation resolution to prostate cancer evolution)

RONALD E. WHEELER, From the Diagnostic Center for Disease, Sarasota, Fl

METHODS AND MATERIALS:

Between 1998 and 2004, 23 men (mean age: 63 years) with biopsy proven prostate cancer who had declined attempts at curative cancer treatment and hormonal therapy, were given full informed consent and offered the opportunity to try a strictly dietary and nutritionally oriented conservative protocol. The diet used was a Modified Mediterranean Diet (Prostate Diet) while a patented prostatitis formula (Peenuts) was the nutritional supplement common to all patients. By study design, none of the patients had ever been exposed to anti-androgen therapy, a Luteinizing Hormone-Releasing Hormone (LHRH) analogue, LHRH antagonist or definitive therapy with surgery, radiation, or cryosurgery. All men were followed at varying time intervals with a PSA (prostate specific antigen) blood test, while many of the men were also followed with the International Prostate Symptom Score (IPSS) Index and the Expressed Prostatic Secretion (EPS) examinations. With the exception of two men with Gleason 6/7 components, three men with Gleason 5/6 components and one male with a Gleason 7 pattern, all men exhibited either a Gleason 5 (n=6) or a Gleason 6 (n=11) pathological pattern. All men were clinically diagnosed as T1c (n=15), T2a (n=2), T2b (n=2), or T2c (n=4). Interestingly, all of the men who met the entry criteria outlined above except one, enthusiastically chose to treat their disease through a dietary and nutritional supplement protocol represented by the term Chronic Disease Management (CDM) rather than undergo definitive therapy. The one male who initially qualified dropped out after 7 months, opting for a radical prostatectomy. CDM therapy is a unique cancer concept, but not dissimilar to the conservative holistic treatment of diabetes, hypertension, or arthritis whereby patients learn to live with the disease based on lifestyle changes consistent with improved diet, nutritional supplementation, stress reduction and exercise.

While the PSA level is a recognized marker of disease activity, it is noted that PSA levels may rise based on any combination of prostatitis (non-bacterial inflammation in greater than or equal to 95% of cases), BPH (benign prostatic hyperplasia), and/or prostate cancer. The IPSS- Index is a recognized marker associated primarily with BPH and prostatitis, while the EPS (expressed prostatic secretion), represents the diagnostic biological marker for prostatitis. All men were evaluated at varying intervals of surveillance ranging from 13 months to 84 months (mean: 38.5 months). Three study subjects had a slight increase in their PSA levels of 0.3, 0.7 and 0.9 ng/ml at 14 months, 42 months and 34 months, respectively. Excepting these three patients with a small rise in PSA, the remaining 20 patients (87%) decreased their PSA levels during the study period an average of 58%.

Statistical Analysis

A performance analysis of these 23 patients relevant to any change in PSA noted statistical significance using the Null Hypothesis, t-Test and Wilcoxon Analyses. There was a significant decrease in PSA levels (ng/ml) after treatment with dietary modification and the specific herbal supplement taken at 2 capsules daily. The P value (Tless than or equal to t) one-tailed T test is 0.000068.

The null hypothesis can be postulated from the population of 23 patients. The first observation, u1, is the initial PSA value taken. The second observation, u2, is the follow-up PSA taken after treatment with the herbal supplement and dietary change. H0: u1 – u2 = 0. The null hypothesis postulates that the mean value of the difference is zero. There will be no significant difference in PSA levels after herbal supplementation and dietary change.

In the alternative hypothesis, the mean is different using the observed values; therefore, a two- tailed test is utilized.

An additional non-parametric test was calculated. The results of the Wilcoxon Matched-Pairs Signed-Ranks Test are as follows:

RESULTS:

All men within an age range of 43-74 years with a diagnosis of prostate cancer (Gleason Score: 5, 5/6, 6, 6/7,7) who declined standard curative and hormonal therapy were offered an opportunity to participate in a conservative quality of life protecting study with the understanding that diet and nutrition could play a significant role in disease proliferation or control. With the exception of the Gleason Score (excluding men with a primary Gleason Score of 8, 9, or 10) as a qualifying category of prostate cancer, there was no bias inherent in the entrance process. Twenty three men qualified for study evaluation using the PSA levels from the date of diagnosis (biopsy date) or the initial clinic appointment date (whichever was higher) as the reference PSA value for the starting point for data collection. 20 of 23 men experienced a positive response (decrease in PSA levels) relevant to the conservative therapy while 3 men noted a mild increase in their PSA values. Specifically, 87% of men (n=20) noted a 58% reduction (range of improvement: 13-90%) in PSA levels over an average of 38.5 months (range: 13-84 months). Using a mean PSA starting point of 6.8 ng/ml, 87% of men in the study experienced a mean reduction in PSA of 3.93 ng/ml (range: 0.9-12.5 ng/ml) over the identified time frame, while the median reduction was 3.45 ng/ml. The three men, who experienced a mild elevation in PSA, noted an increase of 0.3 ng/ml, 0.7 ng/ml and 0.9 ng/ml over 14 months, 42 months and 34 months, respectively. Overall, the effectiveness of Chronic Disease Management therapy to suppress prostate cancer was 87% using the PSA level as the disease activity marker.

A urinary assessment with a voiding symptom score (IPSS-Index) and prostatitis evaluation utilizing the expressed prostatic secretion (EPS) examination was conducted at the time of baseline (initial visit) and follow up evaluations on the majority of the participants. 15 men completed an initial and secondary IPSS-Index while 14 men had undergone an initial and secondary EPS. All men reduced their voiding symptom score with an average 4.9 points (range: 3-11), while noting an average starting score of 9.1 points (range: 2.5-19.5 with a median of 8.5). The mean percentage reduction in IPSS-Index was 61% (range: 20-100% with a median of 55%). Relevant to the EPS, an average starting point of 283 white blood cells (WBC’s) per high-powered field (HPF) (400X) demonstrated an average decrease to 65 WBC’s/HPF. To state further, a mean reduction was noted in the prostatitis marker of 218 white blood cells (range: 70-495) with a mean percentage improvement of 77.5% (range: 33-99% with a median of 82%). The reduced number of white blood cells on the EPS examinations as well as the improvement in urinary symptoms as documented by the average reductions in IPSS-Index scores in this group of men treated with nutritional means alone was statistically significant.

Is it Always Necessary to Cure Prostate Cancer When it is possible? - Part 1

noreply@blogger.com (staff) — Fri, 13 Nov 2009 20:24:00 +0000

(Understanding the role of prostate inflammation resolution to prostate cancer evolution)

RONALD E. WHEELER, From the Diagnostic Center for Disease, Sarasota, Fl

ABSTRACT

Objective – Definitive therapy with radical prostatectomy, cryotherapy or radiation therapy generally follows the initial diagnosis of prostate cancer, particularly when men have at least 10 additional years of life expectancy. There is growing concern regarding the optimal conservative treatment for patients who decline or do not otherwise qualify for such definitive curative treatment. For those patients who choose a watchful waiting approach, it would be beneficial to know what specific dietary and nutritional methods could potentially slow the progression of their disease. In this prospective study, it was our goal to analyze the efficacy and safety of treating prostate cancer conservatively using the principles of a Mediterranean diet in association with a specific prostate nutritional supplement.

Method – 23 men aged 43-74 (median age: 64) with biopsy proven, organ-confined prostate cancer who had already declined immediate hormonal therapy and attempts at a curative cancer treatment agreed to participate in a Chronic Disease Management (CDM) protocol highlighted by diet with a specific prostate nutritional supplement. The diet recommended was a modified Mediterranean diet while a patented nutritional prostatitis formula (Peenuts) was the supplement common to all patients. PSA, a recognized marker of prostate disease and prostate cancer activity, was the primary indicator to validate exacerbation or suppression of disease. All men were followed with serial PSA testing, a digital rectal exam, an International Prostate Symptom Score index (IPSS-Index) and an expressed prostatic secretion (EPS) examination. The primary Gleason sum/score represented in this study was 6 (n=11), while Gleason sum patterns 5, 5/6, 6/7, and 7 were also evaluated. Referencing the Partin Tables, organ confinement was predicted to be 66%.

Results – 87% of men (n=20) noted a 58% reduction (range of improvement: 13-90%) in PSA over an average of 38.5 months (range: 13-84 months). The remaining 13% of men included three men who experienced a mild elevation in PSA of 0.3, 0.7, and 0.9 ng/ml over 14 months, 42 months and 34 months, respectively. 15 men had completed an initial and secondary IPSS-Index while 14 men had undergone an initial and secondary EPS. The mean percentage reduction in IPSS-Index was 61% (range: 20-100% with a median of 55%), while men evaluated with EPS examinations noted a mean percentage reduction in white blood cells of 77.5% (range: 33-99% with a median of 82%). These results were evaluated using the t-Test, Wilcoxon Analysis and the Null Hypothesis and found to be statistically significant.

Conclusion –Clearly there is a need to develop effective alternative conservative therapies for the increasing numbers of prostate cancer patients who will not tolerate definitive curative measures or simply choose a conservative approach. Although this prospective study had no control arm, was of limited duration and included only 23 participants, it did appear to show significant benefit to the majority of prostate cancer patients treated with selective nutritional and dietary therapy alone. Such treatments may provide a safe and effective long-term treatment alternative for some patients. Further study is encouraged.

Prostate cancer is the most commonly diagnosed malignant neoplasm among men in North America.(1) Notwithstanding the strides that have been made related to diagnosis and treatment, prostate cancer still poses a significant health risk. In 2005, the incidence of prostate cancer was noted to be in excess of 232,000 new cases while prostate cancer death currently ranks as the second most common male cancer death with approximately 32,000 men dying from the disease. (2) According to the SEER (Surveillance, Epidemiology & End Result) data and the age specific population projections in association with the United States Census Bureau, it is estimated that 99,000 men will die from prostate cancer in the year 2045. (3) Besides the health risk, there is also concern about the best way to pay for expensive prostate cancer treatment in the future where an aging population is expected to exhibit high rates of prostate cancer detection. (4) Despite our best efforts to cure, failure rates for prostate cancer may be as high as 40-60% in high-risk cases. (5)

Epidemiological studies suggest that diets rich in grains, specific vitamins, fruits and vegetables are associated with lower prostate cancer rates than high fat diets associated with red meat, dairy product intake and high dose calcium. (6-11) High temperature cooking and/or well-done or charred meat contains heterocyclic amines, nitrosamines and polycyclic aromatic hydrocarbons that have been shown prospectively to increase prostate cancer risk in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. (12) Dairy products and diets with high calcium content have also been found to increase the risk of prostate cancer possibly through an increase in phytanic acid levels which are also elevated in high meat (protein) diets. (13, 14) A number of studies have found an association between saturated fat and prostate cancer although the precise mechanisms are not clear. (15-17) We, therefore, selected a modified Mediterranean diet which includes a high intake of cereals, grains, vegetables, fruits, virgin olive oil, beans, garlic, fresh herbs and seafood or poultry (white meat) with an avoidance of red meat and dairy products. (18, 19)

We know that many prostate cancer patients; up to 73% in one study, will take nutritional supplements on their own and the typical patient averages about three separate supplements daily. (20-23) Animal studies, epidemiological data and other evidence suggests that plant-based dietary supplements providing indoles, isothiocyanates, phenolics, monoterpenes, flavonoids, phytosterols, lignan precursors, lycopenes, and soy proteins as well as zinc, selenium, Vitamin E and various other anti-oxidants may serve as natural inhibitors of prostate carcinogenesis and growth. (24-29) The “Peenuts” product is a standardized, certified and patented nutritional supplement that contains appropriate levels of these ingredients from plant-based sources. (30) The formula has been shown to suppress and help resolve non-bacterial prostatitis in randomized, placebo-controlled double blinded studies and is readily available commercially. (30, 31) Reductions in white blood cell count in the expressed prostatic secretions of prostatitis patients were reported at 66-77% using only this nutritional supplement. (31)

A number of recent studies have suggested that nutritional therapies alone could possibly lower the aggressiveness of prostate cancer and prevent its progression but randomized clinical trial data so far is very limited and no prospective studies have yet identified an optimal combination of dietary measures and nutritional supplementation that can effectively control prostate cancer growth.

There are many experts who question whether we are over treating prostate cancer. The poignant words of the late Willet Whitmore, M.D. may prove most prophetic. To paraphrase, his oft-quoted rhetorical question asks, “Is it possible to cure prostate cancer when it is necessary” and “Is it necessary to cure prostate cancer when it is possible”? If we accept that a cure is not always possible or even desirable in some cases due to complications, surgical risks, side effects, morbidity, cost and patient choice, this leads us to the next logical question, “Is it possible to significantly suppress or slow prostate cancer growth for prolonged periods using only nutritional and dietary measures”? The goal of this study was to attempt to begin to answer this important question by prospectively treating prostate cancer patients exclusively with conservative measures including optimal dietary modification and standardized complex nutritional supplementation to determine the feasibility and effectiveness of such an approach as a possible alternative in prostate cancer treatment.

Will you be Proactive or Reactive?

noreply@blogger.com (staff) — Wed, 11 Nov 2009 19:46:00 +0000

Excerpt taken from the book Men at Risk, a Rush to Judgment

For men with PSA levels of greater than 1.0 ng/ml, it is not too premature to begin to think about the educational process as you will learn later in this book that 20-30% of all prostate cancers are present in the PSA range of 1.0-4.0 ng/ml. If you choose to wait as you believe yourself to be too healthy, you could face the same tough decisions that faced Jon Freda who never knew he had another option. On the other hand, you can think ahead and begin planning your strategy as if you had the disease while possibly avoiding the disease altogether. Will you be a willing participant when a biopsy is recommended when the PSA exceeds 4.0 ng/ml (20-30% of biopsies are positive in this range) or will you reach out first to an improved technology like that available at the Diagnostic Center for Disease in Sarasota for a conformational MRI-Spectroscopy scan, noting that more biopsy procedures are negative than positive? Random biopsies should be discouraged based on the sampling bias as well as the relatively low risk of prostate cancer on any given prostate biopsy procedure; not to mention the risk of spreading cancer cells (if present) beyond the prostate. Will what you have read thus far stimulate you to be proactive and try to avoid an inevitable disease by controlling prostatitis with a patented, scientifically proven, prostatitis formula called Peenuts® or are you content to be reactive and take your chances that the disease won’t come your way? Whatever your personality, whatever your choice, I am dedicated to making a difference with you when the time comes. If cancer is inevitable, I want your case to be predictably successful giving you the opportunity to continue to take from life all that is yours. The remaining chapters in this book are instructional and will make you think. What makes this book different from other prostate books is that I have brought together national, if not international experts who are prepared to present the facts in a fair and balanced format as well as respond to tough questions where they may not have the answer. For these and other reasons, I encourage you to use this book as a learning tool, as a reference and as a guide to keep you health conscious while protecting your prostate and your heart. It has taken me years to do my research and years to write this book, so please take your time to read it carefully and absorb it so that you are equipped to face the battle, should the disease present itself.

An Icon in Urology Speaks Out

noreply@blogger.com (staff) — Mon, 09 Nov 2009 20:44:00 +0000

Excerpt taken from the book Men at Risk, a Rush to Judgment

William Fair, M.D., former Chairman of the Departments of Urology and Surgery at the esteemed Memorial Sloan-Kettering Cancer Center was so frustrated with his inability to predict a successful outcome with radical prostatectomy or radiation for prostate cancer patients that he stated in a now famous speech from 2000; “Based on everything we know about prostate cancer, I am not sure that it should not be treated as a chronic disease”. While I am not saying that radical prostatectomy is obsolete yet, I am saying that if we continue to apply the same therapy to every patient without a realistic understanding for treatment success as well as limiting the procedure to only those who best qualify, the future of radical prostatectomy will be doomed based on the public’s perception suggesting a lack of physician understanding of the disease, greed and/or inappropriate dogma tied to a disease we know too little about. What Bill Fair may truly have been seeking was a moratorium on radical prostatectomy and radiation therapy until he and other research experts could figure out the natural history of the disease, thereby, selecting patients for a treatment based on a sound strategy as opposed to a “one size fits all” mentality. There is rarely a doctor among us who will share Dr. Fair’s commentary with his newly diagnosed prostate cancer patients, much less, investigate and embrace valid conservative options as appropriate care. These conservative, yet effective, options will be addressed later in chapters that discuss minimally invasive treatment like high intensity focused ultrasound (HIFU).

“Based on everything we know about prostate cancer, I am not sure that it should not be treated as a chronic disease” William Fair, M.D. Memorial Sloan-Kettering

What will you do when Cancer is Diagnosed?

noreply@blogger.com (staff) — Fri, 06 Nov 2009 19:42:00 +0000

Excerpt taken from the book Men at Risk, a Rush to Judgment

So when the diagnosis of prostate cancer is made in your case, what will you do? Will you try to live with the disease or do you have to remove the cancer at any cost? Is your goal a cure and if so, is this realistic? While I never want to deprive you of hope, false hope and unrealistic expectations is unfair to you, the patient, who so desperately wants to succeed. If cure is possible, what are the chances of success? Is it worth the risk when your chance of success is less than 50%? If cure is impossible, what is the best strategy to ensure the best outcome? This is not as simple as applying a radical prostatectomy or radiation to a cancer but rather lies in a multi-factorial approach that may include a radical prostatectomy or radiation but only if the odds of success are overwhelmingly in your favor and you are willing to take the risk. Based on the inability to predict success predictably versus prostate cancer suggests that we should take our time and consider all options including CDM before the commitment is made to proceed. Get a second and a third opinion! If you act on impulse and make the incorrect choice, you will have, what will appear to be, a lifetime to lament the error in judgment.

If you act on impulse and make the incorrect choice, you will have what will appear to be, a lifetime to lament the error in judgment

The Clinic Appointment – A Difference Maker

noreply@blogger.com (staff) — Wed, 04 Nov 2009 14:17:00 +0000

Excerpt taken from the book Men at Risk, a Rush to Judgment

By making the commitment to see me in the clinic, Carl and Sandy had become a member of my extended family. During the 3 plus hour clinical evaluation and interview process, I reviewed viable options including the option of allowing Carl to live with the disease through a protocol of CDM. Minimally, this option would buy us some time while not burning a bridge; allowing us to be more aggressive later if an option presented itself that made sense when the risk-reward discussion took place. My clinical experience allowed me to share other patient success stories using the CDM concept. Together we created and accepted a treatment strategy that was intended to minimally stabilize the cancer disease process. I made it very clear that we were in this together and I was as close as a telephone call. I was confident we could make a difference! Based on his heightened disease status and aggressive Gleason Score, I elected to start him on a CDM protocol that included various mechanisms of action to suppress the disease or make it less aggressive or even dormant.

First and foremost, Carl was placed on the Modified Mediterranean diet as well as the Peenuts® prostatitis formula to resolve prostate inflammation. This was an important step as prostatitis has been shown to evolve into prostate cancer by many research experts including the American Association of Cancer Research (AACR), headed up by Johns Hopkins and independently by David Bostwick, M.D., a world renowned Pathologist. Carl was also started on Avodart (a 5 alpha Reductase inhibitor) at 0.5 mg daily to decrease the conversion of Testosterone to Dihydrotestosterone (DHT) as well as promote an anti-angiogenic component (decreases new blood vessel formation) while reducing the size of the prostate. We knew full well that the PSA would be decreased by some number less than half based on the combined presence of benign prostatic hyperplasia cells and cancer cells. I was also cognizant of the Prostate Cancer Prevention Trial (PCPT) data where Finasteride (a 5 alpha Reductase inhibitor) was associated with a decreased incidence of prostate cancer by 25% when compared to placebo. While I had no data to show specific benefit versus prostate cancer with this class of drug, I did not want the cancer to be exposed to DHT, the more active form of the cancer growth promoting male hormone. Vitamin D3 (the active form of Vitamin D) was added for its benefit in decreasing prostate cancer cell proliferation, while Omega 3 fatty acids were added to enhance the heart healthy Omega 3:6 fatty acid ratio while also decreasing prostate cancer cell proliferation.

The last integral piece of the treatment strategy was the use of Casodex (Bicalutamide), a non-steroidal anti-androgen, used at 150 mg per day, similar to the dose effectively used in Europe. I have had tremendous experience using Casodex at the aforementioned dose as a monotherapy. This represents a higher dose than that typically used in the United States but is quite safe and effective when used intermittently. Specifically, the anti-androgen blocks the prostate cancer cell receptor, thereby, inhibiting the growth of cancer. To state this differently, Testosterone, which remains normal to high utilizing this treatment protocol, is preferentially blocked from its usual action of attaching to the cell receptor at the nucleus, allowing the cell to become disabled and die. The concept is analogous or similar to what you would expect to see when you put plastic child safety caps on an electrical outlet. No matter how hard you try to connect an electrical plug of a lamp (as example) to the source of electricity, you can’t do it. Thusly, Casodex blocks the interaction of DHT with the cell receptor and promotes cell death preferentially over cell growth.

While there are a few side effects from the use of Casodex, as a monotherapy, including but not limited to a transient elevation in liver enzymes, mild breast tenderness or swelling and the potential for diarrhea, the side effect profile is acceptable for the anticipated short interval of usage. The side effect profile, nonetheless, can be avoided using additional medications or supplements that would minimize and/or eliminate these concerns. Using this approach, we were able to avoid an LHRH-analog (Luteinizing Hormone Releasing Hormone), thereby, by-passing chemical castration associated with its host of undesirable side effects including but not limited to: lethargy, increased fasting blood sugars secondary to decreased insulin resistance, muscle wasting, hypercholesterolemia, anemia, bone loss, hot flashes, cognitive changes, depression, mood swings, and weight gain. When used as a monotherapy, intermittently, disease specific anti-androgen therapy has a tremendous lifestyle advantage when compared to the more traditional monotherapy of an LHRH-analog alone or in combination with an anti-androgen (combined androgen blockade), discussed elsewhere in this book.

The decision was made to use the anti-androgen intermittently between PSA action points of 10.0 ng/ml and 1.0 ng/ml. 10.0 ng/ml or higher would mark the point where Casodex would begin and 1.0 ng/ml or lower would mark the point where the Casodex is discontinued. For the short term, Carl remained on the treatment protocol for 17 months in total. During this timeframe, the Casodex was used for the first two months only, dropping the PSA (the marker of disease activity) from 13.0 ng/ml to 0.3 ng/ml. In effect, Carl had been off of Casodex for 15 months, while his PSA had remained stable at 1.7 ng/ml. This response represents a truly remarkable turn of events for a very aggressive cancer; possibly never recorded before in the annals of medicine. In his yearly follow-up appointment to the clinic, Carl’s white blood cell count associated with the expressed prostatic secretion had gone from TNTC (too numerous to count) down to 45 white blood cells when reviewed under 400X (microscopically). This represented a 91% decrease in the inflammatory response; a process that promotes prostate cancer evolution. While the reduction in white blood cells is attributed to the Peenuts® formula, Carl’s urinary symptoms had also improved from 10.5 (moderate symptoms on the International Prostate Symptom Score Index (IPSS-Index)) to 1.5 (mild symptoms) in the same time frame representing an improvement in symptoms of 86%; again attributed to the patented prostate formula. (refer to the addendum for the complete IPSS-Index).

In his follow up, rather than discussing his demise or worse yet, death, as predicted by one of his previous Urologists, the three of us celebrated a measure of victory versus an unpredictable and potentially deadly disease. We had demonstrated the success of CDM in a very difficult clinical scenario. While I believe this case represents one of the more spectacular responses of prostate cancer to CDM, highlighting Casodex as a monotherapy, this should not diminish the impact of key nutrients and medications as outlined previously. While I am sure I will hear from my colleagues that this case is “too good to be true”, I always welcome calls from any of my critics. More importantly Carl and Sandy would be happy to share their joyous experience with those who care to contact them. Maybe someday, Carl and Sandy will be able to tell their story on a bigger stage, thereby, bringing more than just hope to the hundreds of thousands of men who face the same uncertainty of prostate cancer every day. Now, with the disease suppressed, the Lackeys decided to take yet, another step; in effect, a calculated risk to get rid of the disease once and for all, by undergoing High Intensity Focused Ultrasound (HIFU) at a site outside of the USA under my supervision. HIFU is still under FDA scrutiny and therefore not offered on US soil as of June, 2006. Carl’s progress will be monitored by a spectral analysis of his prostate, using the 3.0 Tesla magnet from General Electric to validate an absence of disease without the need for additional biopsies to confirm. I refer you to the section on Magnetic Resonance Imaging Spectroscopy (MRIS) for an improved understanding of this technique, as well as rationale, for why prostate biopsies may soon be a technique of the past as the procedure of choice commonly used to confirm treatment success or failure.

Prostate Cancer Diagnosis & Treatment - Clinical Case Study # 2

noreply@blogger.com (staff) — Mon, 02 Nov 2009 22:10:00 +0000

Excerpt taken from the book Men at Risk, a Rush to Judgment

Carl Lackey’s case history and clinical experience is equally riveting for even the most learned or savvy prostate cancer patient! A 60 year old former All-American hockey defenseman at Michigan State University, who now resides in Green Bay, Wisconsin, Carl learned he had prostate cancer when his PSA reached 8.2 ng/ml in October, 2004. The year prior, his PSA was 3.9 ng/ml. It is unfortunate, but when he asked if there was anything that could be done to try to lower the PSA, he was told by his Urologist, it was still in the normal range and not to be concerned. A 12 core biopsy, performed a year later based on the 8.2 ng/ml PSA, yielded a Gleason score 4+4 cancer in 3 out of 6 biopsies on the left side and a cancer precursor cell type called High Grade PIN (prostatic intraepithelial neoplasia) on the right side (See Glossary and Pathology Chapter for an improved understanding of these terms). His biopsy stage was T2b meaning that significant disease (cancer) was located in more than one quadrant on the left side of his prostate. Following the biopsy, the PSA value reached a high of 13.0 ng/ml. Given the poorly differentiated cancer cell type, Carl went about the process of trying to determine the best way to defeat the disease. 3 Urologists representing 3 different Urology practices had recommended that a radical prostatectomy was his only chance to survive the disease. One Urologist went so far as to state; if he did not have the radical surgery, he would be “dead within 1 year”. Concerned for his well being and quite frankly scared beyond belief, Carl had decided hastily that surgery seemed like the only option. He had completed his pre-op evaluation and had received the hospital wrist band, defining him to all hospital personnel, as scheduled for surgery. At home, his wife Sandy was feverishly looking for other options as she did not feel good about the choice that the man of her life had made. Several days prior to his early morning arrival at the hospital for the expected surgical procedure, Carl’s life changed. Sandy had come across my website, mrisusa.com and placed a toll free call to the clinic. While I can’t recall if it was that day or the next day, I had a chance to talk to the man with the disease about his treatment and what, if any, was his expectation from the surgery.

After a brief factual and straightforward discussion, Carl cut the hospital wrist band from his arm and scheduled an appointment at my clinic in Sarasota, Florida. In our conversation, I had said nothing that would diminish his hope for a successful outcome, although, I had informed him that while radical prostatectomy may have provided his greatest percent chance for cure, as represented by his 3 urologic consults, no one informed him, the percent chance of cure was only 15%. In other words, 85% of all prostate cancer represented by Gleason Scores of 8, 9, or 10 would have disease recurrence within 5 years. He was incredibly disappointed that no one had discussed the literature based facts on the historical surgical futility associated with this cancer grade, but rather, opted for a leap of faith to try to save his life. No one had allowed Carl and Sandy the opportunity to understand that what they were about to do, made little sense and was obviously the wrong approach based on well documented statistics and therefore, should have been out of the question as an option.

Prostate Cancer Diagnosis & Treatment - Clinical Case Study # 1

noreply@blogger.com (staff) — Fri, 30 Oct 2009 21:07:00 +0000

Excerpt taken from the book Men at Risk, a Rush to Judgment

Let’s take a look at an actual clinical case that allows us to better understand the present state of prostate cancer treatment and the associated angst that comes with the diagnosis. Jon Freda, a 54 year old Caucasian male, was diagnosed with prostate cancer with a Gleason score of 6 (3+3) associated with a PSA of 4.2 ng/ml. A Gleason 6 prostate cancer designation comprises the most common cancer cell type identified, as well as recognized to be the cancer type that predicts the most favorable clinical outcome. This is the group of patients that Pat Walsh, M.D. and the team at Johns Hopkins and other major centers of excellence operate on to establish their respective outcome data, thereby, validating their treatment choice of radical prostatectomy for prostate cancer. This is also the group of cancers that many experts like Michael Barry from Harvard believe are over treated. In other words, many men with this classification of cancer would do equally well with a radical prostatectomy (assuming cure) or with a more conservative approach like Chronic Disease Management (CDM -reference the Prospective Diet & Nutritional Study) or active surveillance, if offered. It is for this reason that word needs to be promulgated throughout the world that CDM is a viable alternative to radical prostatectomy or radiation when this category of cancer is diagnosed.

     Based on Jon’s relative youth and fear of impending death from a presumably predictable cancer, the patient agreed to a radical prostatectomy at the urging of his family and surgeon. Now 6 years later the patient’s PSA is rising consistent with treatment failure. A progressive rise in PSA following any attempt to cure signals the failure of the operation (or any definitive therapy) to cure the disease. This is also called biochemical failure or disease relapse. A rise in PSA despite the removal of the prostate tells you that the disease had escaped the prostate while looking to find a new source of nourishment in the lymph nodes or bones (or both). It is estimated that the range of disease recurrence following radical prostatectomy or radiation is 30-40% and possibly as high as 40-60% by 7-10 years. The earlier the rise in PSA following surgery or radiation and/or the failure to nadir the PSA to less than 0.5 ng/ml suggests that the disease is more aggressive and was likely systemic at the time when the disease was thought to be localized or confined to the prostate. Unfortunately this information does not help us after the fact except to predict a troubled and probable aggressive clinical course that will likely hasten the patient’s demise. The only way to have avoided this misstep is to have avoided the surgery that you thought would get rid of the disease in the first place. Confused? Join the millions, who like you, are going to learn first-hand from this book and the experiences of others. Minimally the failure of Jon Freda to be cured calls into question the ability to cure anyone with certainty and should slow the march of the ignorant or educationally challenged to the operating room door.

     The literature suggests the failure to cure a patient when radical prostatectomy or radiation is performed, bodes poorly for the patient. Specifically, according to Anthony D’Amico and colleagues, when the PSA doubling time (the time it takes for the PSA number to double) is less than 3 months following radical prostatectomy or radiation, the patient has a 20 times increased chance of dying from prostate cancer within 6-10 years. Importantly, our clinical research concurs showing the clinical course observed for the patient who isn’t cured by radical prostatectomy or radiation will be a much more aggressive battle to fight than the individual who chose the more conservative treatment concept associated with a strategic CDM protocol, whereby, the patient learns to live with the disease. Examples will be provided throughout this book that will make this point very clear.

     Returning to the case of Jon Freda; again, a gentleman who could have lived with this disease very easily with CDM, there were issues other than a rising PSA following the failed attempt at cure with radical prostatectomy. Ever since the operation, this patient has been a sexual cripple; meaning that he cannot achieve adequate erections despite the use of erectile stimulating drugs like Viagra (the little blue pill) or Caverject (an injectable known as a 5-PDE Inhibitor). He also complains of urinary leakage which would be tolerable if only the operation was a success. What is sad is that this patient should have been cured as his disease characteristics could not have been more favorable; suggesting that anything short of cure is a significant failure. This case history establishes very clearly why a more conservative approach may have been the better first choice. Unfortunately, Jon had never been told that he could live a long and prosperous life with the prostate remaining untouched using a CDM protocol. Had this happened Jon would not have been the first patient discussed in this chapter.

     While hind site is 20/20, this is the reason, nonetheless, that patients must become increasingly aware that radical prostatectomy is not what it is made out to be. There are no guarantees even when you hear…the treatment represented ‘gives you your best chance at cure’. Improved awareness and understanding of the topic is the only defense that will allow the patient to comprehend the options discussed; but more importantly, to walk away and rethink what has been discussed absent the emotion of the moment. It is my opinion; while our patient Jon Freda made the ultimate sacrifice for an unnecessary chance at success, I believe he would have been willing to live with quality of life limiting side effects of impotency and incontinence had the cure been achieved. At this junction in Jon’s life, he is now facing off with the next set of questions that will require intelligent decisions related to how the disease will be managed moving forward. His choice at this point is to consider radiation or CDM (active surveillance). Radiation, replete with its own set of side effects, including but not limited to rectal bleeding and radiation cystitis, is also likely to worsen his already limited potency as well as worsen his ability to control his bladder. A much more reasonable approach would be the use of a CDM or active surveillance protocol.

     At this point, Jon’s cancer will respond predictably to hormone manipulation utilizing an anti-androgen (Flutamide, Casodex or Nilutamide) given intermittently. An anti-androgen prevents the remaining cancer cells from growing; by depriving them of the male hormone Testosterone; enabling residual cancer cells to die. More about this concept in clinical case study number two. While his PSA is just beginning to rise from the nadir of 0.2 ng/ml, I would defer the use of an anti-androgen until the PSA becomes substantially higher. This would allow us an opportunity to try other conservative measures to extend the doubling time as no one knows predictably that the disease cannot be stabilized when conservative measures are employed; noting no two cancers are alike. Besides, earlier treatment with an LHRH-analog or anti-androgen at a lower PSA number may hasten the onset of hormone refractivity (disease resistance), a well known consequence of hormonal manipulation. Furthermore, I would not discount the role of diet and nutrition to assist holding the cancer in check. In an effort to prevent the PSA from rising to a higher and more definable number, I would use various products or formulas associated with various mechanisms of action versus the cancer process in an effort to enhance a successful outcome, and thereby, prolong life. Remember, while there is no clear decision choice, there are also no tests that can tell us with certainty where the cancer is located or that the cancer will not respond to conservative measures; now that radical prostatectomy has failed to be the treatment to cure the disease. At this point, I will assist Jon regardless of the choice he makes and do all I can to foster his success, including the application of a CDM protocol in the event radiation is chosen and fails. It is not as important why this clinical scenario happened with Jon, but rather, how we can prevent this from happening to the next generation of men diagnosed with prostate cancer!