Are you a good candidate for active surveillance?

This first video is from September 2007, but the issues Dr. Klotz discusses are more important than ever. Half of all newly diagnosed patients, he says, are being treated with surgery or radiation yet their cancers are considered low grade (small volume cancer on biopsy, PSA in the low to intermediate range).  In Dr. Klotz's group of 500 patients monitored through active surveillance, he found that 75% never need to have a radical treatment, and 25% end up having surgery or radiation.


The second video gives new guidelines from the NCCN regarding managing early-stage PC through active surveillance (from March 2010). 

Can you detoxify for a healthy prostate?

Just prior to my cancer diagnosis, I was a reading an interesting book by Dr. Larry Clapp, 90 Days to Prostate Health Without Radiation or Surgery, in which he advocates colon cleanses as a critical component to good prostate health.

Dr. Clapp claims to have cured his own prostate cancer not once but twice (yeah, it returned) through an holistic approach that included colon cleanses, natural foods, select supplements and herbs, de-stressing his life and even dental care.

His argument for cleanses goes something like this: Over a 70-year lifetime, the average American eats nearly 70 tons of solid food that is over processed, filled with pesticides and hormones, lacking in fiber, and hard to digest. Consequently, many suffer from slow bowel transit time and/or constipation.

Study: 90% of men with low-grade prostate cancer choose risky, aggressive treatments

It's truly unbelievable: Nine out of 10 men with low grade, NON-LETHAL prostate cancer choose aggressive treatments, risking incontinence, erectile dysfunction and rectal problems — UNNECESSARILY.   The major surgeries and radiation treatments that these men are having are NOT saving their lives, according to a Johns Hopkins study of 769 men across the U.S. and published in the Journal of Clinical Oncology.  Worse still, 80% of those choosing treatments are over age 75, an age group with a shortened lifetime horizon and thought to be ideal candidates for active surveillance....

When 'Waiting' Is The Smart Treatment Option

Overtreatment of prostate cancer is a serious issue. Men with low-grade prostate cancer (Stage 1, Gleason scores 6 and under) are getting radiated or going under the knife unnecessarily. Not only are these aggressive treatments not saving lives, they're causing irreparable damage to the lifestyles of tens of thousands of men every year.

Yet because of the anxiety that "having prostate cancer" causes men, the compliance of  many urologists, and the enormous financial benefits to providers—overtreatment is now commonplace. "It's embarrassing that this is going on," one of my doctors told me.

Fact is, men with slow-growing prostate cancer are not at high risk. They can live with prostate cancer as a chronic and often asymptomatic condition. Many experts now see 'watchful waiting' as the smart treatment choice and new studies are supporting this view. 

Just this week....
Once under the radar, the epidemic of overtreatment for PC is getting more and more attention from major news outlets. Here's a couple this week ... the first from Reuters Health, citing a study published in the Journal of Clinical Oncology....More evidence for waiting to treat prostate cancer, by Leigh Krietsch Koemer, April 13, 2011.  And another from Medical News Today, April 12, 2011....Slow-Growing Prostate Cancer: "Active Surveillance" May Be Better Option Than Treatment For Older Men
  

Older men overly screened?

From the New York Times
Screening Prostates at Any Age, by Gina Kolata
April 11, 2011

When, if ever, are people just too old to benefit from cancer screening? 

The question keeps arising and has never been satisfactorily answered. Now it has come up again, in the context of a provocative new study on the popular P.S.A. test for prostate cancer. The paper, published in The Journal of Clinical Oncology, finds that men in their 70s are being screened at nearly twice the rate of men in their 50s — and men ages 80 to 85 are being screened as often as those 30 years younger.

“That is mind-boggling,” said the lead author, Dr. Scott E. Eggener, a University of Chicago urologist. “What we were hoping was that young, healthy men who were most likely to benefit would be screened at higher rates and that screening would tail off in older men.”

Myths, the male and prostate cancer video

 

From xtranormal, the education movie maker -- Debunking myths and 

misconceptions about prostate cancer, treatments and risks.

Prostate cancer doesn’t mean no sex life

Good OVERVIEW story about the risks of treatment choices on your sex life  ...

April 7 2011 at 11:15am
By Anna Hodgekiss 
Lifestyle

Composer Andrew Lloyd Webber last week revealed he’d been left impotent following prostate cancer surgery. He is one of 37,000 men who are diagnosed with the disease each year in the UK. 

There are various treatment options available, but which is best and what are the implications for your sex life? 

“There are three considerations when it comes to treatment,” says David Neal, professor of surgical oncology at Addenbrooke’s Hospital in Cambridge. “We need to remove the cancer, prevent urinary incontinence and preserve sexual function - and the majority of patients agree this is the order of importance. 

“However, the key indicator of what your sex life will be after the operation is what it was like before. Remember also that sexual function may begin to wane naturally once a man reaches his 50s and 60s.” 

Why the PSA test sucks, you still gotta get it, and a new gene screen could change everything

There are two kinds of prostate cancer —one will kill you, one won't.  Most of it won't. But doctors generally will recommend surgery and radiation for most cancer they see, even the non-lethal forms.  Why?  Because they don't know the difference.

"The biggest challenge we face in managing prostate cancer currently is determining whether someone with a newly diagnosed tumor will die or not," says Dr. Eric Klein, of The Cleveland Clinic, in an article in the Cleveland Plain Dealer, Cleveland Clinic researchers hopeful about study findings, promise of future prostate cancer test.

So what's the problem?  Why can't we separate the non-lethal from the lethal, and spare men unnecessary biopsies and life-altering treatments?

It starts with the PSA test—which sucks (non-medical term). Yes, it is the best indicator for prostate cancer that science has produced and every guy needs to get tested regularly. But it is terribly unreliable at identifying aggressive and non-aggressive forms of prostate cancer ... which, in an ideal world, should be the key to a treatment decision. Even biopsies, with their Gleason scores and in combination with PSA scores, can't predict better than 30-40% of the time which cancers are lethal.

The Lure of the Robot

Robotic surgery is the preferred choice of men today to pluck out there cancerous prostates.  But is it any better than traditional surgery?  Is the promise of fewer side effects living up to the hype?  Is there a financial incentive for physicians and providers to recommend the robot? 

From New York Times, March 11, 2011 ... "Hospitals With Robots Do More Prostate Cancer Surgery"

"Hospitals that buy surgical robots end up performing more prostate cancer operations, suggesting that technology has become a driving force behind decisions about men’s cancer care, new research shows..."

But is it better than any other treatment or doing nothing at all?  There's no evidence to say one way or the other....  

"But," the article continues, "that hasn’t stopped hospitals from conducting intense marketing campaigns that imply surgery using the high-tech robot gives prostate cancer patients a better result."

Ben Org, author of All About The Prostate, put a finer point on the issue and financial incentives in the general promotion of robotic surgery, when he wrote in the following email.... 

"Follow the money. From 2001-06, use of the da Vinci system — the only robot available for this operation — rose from one per cent to 40 per cent of all radical prostatectomies. During that time, the stock price of da Vinci’s maker, Sunnyvale, California-based Intuitive Surgical Inc., increased 11-fold.

A PROSTATE CANCER MONEY TREE

Reposted here from Wall Street Journal, December 2010.  It's worth a second look because the whole idea behind the story is so outrageous, i.e. financial gain is driving overtreatment (with new forms of radiation) of prostate cancer patients ... and it's so easy because Medicare is paying the tab.

A Device to Kill Cancer, Lift Revenue
By John Carreyrou and Maurice Tamman

"Roughly one in three Medicare beneficiaries diagnosed with prostate cancer today gets a sophisticated form of radiation therapy called IMRT. Eight years ago, virtually no patients received the treatment.

"The story behind the sharp rise in the use of IMRT—which stands for intensity-modulated radiation therapy—is about more than just the rapid adoption of a new medical technology. It's also about financial incentives...."

On Recurrence, Running & River Rocks

Anyone who has had cancer holds their breath for their regular tests, even when the pattern has been favorable. For prostate cancer survivors, when a PSA begins rising again—or even creeping up—the anxiety level creeps up with it.

That's the situation I’m facing—my PSA rising in two consecutive tests, from a .9 nadir to 1.3 to 1.5 in December (earlier post). I thought these were low and insignificant numbers until my alarmist urologist began talking “salvage therapy” and another “biopsy” and “cryotherapy” and totally freaked me out. 

His position: three rises would warrant more snipping.  He called my little creep-ups “significant.”

Really?  I didn’t want to hear it. The specter of recurrence hit me harder than the original cancer diagnosis in 2008.  Not sure why, but I got upset and depressed for about five days … until I righted that emotional ship again.

I started running more, upping my weekly mileage.  Running has always been my salvation.  I’ve been a runner since I graduated from the University of Florida, back in 1975.  I ran 13 marathons, including a Boston, two New Yorks, and three Chicagos, and covered more than 20,000 miles— a portion of which were therapeutic miles for everyday life crisis’s, large and small.

A creeping PSA qualified for self-imposed therapy. As usual, as my mileage went up, my head cleared. And when I don't feel like running, I have discovered a neat little new trick to get me out on the road.   

River rocks.

Family Guy Prostate Exam

Click here.

LOL!!!

Prostate Cancer Risk Factors You Can Control

Diet seems to be a 'smoking gun' in the development of prostate cancer, which is much more common in countries where meat and high-fat dairy are mainstays. The reason for this link is unclear.  But dietary fat, particularly animal fat from red meat, may boost male hormone levels, which may fuel the growth of prostate cells. Men who eat fewer fruits and vegetables and high-fat dairy products have higher prostate cancer risk as well.

In other words, a steady diet of greasy fat cheeseburgers -- red meat and dairy cheese -- is a terrible combo for prostate health.


While consumption of saturated fats promote the growth of prostate cancer cells, soy consumption and drinking of green tea reduce the risk, according to the Mayo Clinic.

Health News and Research reports that a U.K. Study found that eating fish, especially oily fish with Omega-3 fats helps prevent prostate cancer. Broccoli provides some protection against this type of cancer, according to a U.S. study. Beans and green peas may provide some protection too.

Study: Meat industry antibiotic prevents prostate cancer growth

When I was dazed and confused in the early days of my prostate cancer diagnosis in 2008, I kept stumbling on a theory that as men age, the presence of higher testosterone levels acts as a fuel for prostate cancer growth. It begs the question, why don't men earlier in life get prostate cancer when they are brimming with testosterone?

I'm still unclear on the answer to that question.  But a recent study shows that an antibiotic used in the meal and daily industry can turn off the testosterone receptors and simultaneously increase production of oxygen to damage the DNA in cancer cells.

This lethal combination is shown to prevent the growth of prostate cancer cells. The article is in Science Day, called Compound That Prevents the Growth of Prostate Cancer Cells Identified (Dec. 27, 2010).

Your 50/50 shot of missing prostate cancer with initial biopsy

More than one million biopsies for prostate cancer are performed annually in the U.S., with 40%-50% of initial biopsies identifying cancer.  So more than one half million new cases have negative prostate biopsies.

Yet ... in those who have repeat biopsies because of rising PSAs, cancer is identified in approximately 25% of these men.

In other words, our current biopsy procedure "misses up to half of all small tumors and up to one third of tumors eventually detected even using repeat sextant biopsy," according urologist Dr. J. Stephen Jones, in his article Managing Patients Following a Negative Prostate Biopsy, in Renal and Urology News, Feb. 8, 2011. (Graphic at right from article)

Yeah, that's scary -- there's a lot of missed cancer, but also a lot of unnecessary biopsies.

Famous guys with prostate cancer

I’ll try to keep this updated from time to time.  Many names from the “Health Diaries” and other sources.

Bill Rogers: A 4-time Boston Marathon and New York marathon winner, “Boston Billy” was diagnosed with prostate cancer in December 2007 and had surgery shortly after – and then began a running series benefitting prostate cancer research.

Dennis Hopper: ‘Easy Rider’ and ‘Apocalypse Now’ star succumbed to prostate cancer in May 2010, after being diagnosed with the disease about eight months earlier during a visit to a hospital for the flu.  At the time, his cancer had progressed beyond the prostate and into the bones. He was 74.

Robert DeNiro: The Academy Award winner was diagnosed with early-stage cancer in 2003 at the age of 60. He has kept details of his treatment private. His father died of prostate cancer at the age of 71.  To the right, early career ... as the Taxi Driver.... 

Dan Fogelberg: The American singer-songwriter battled advanced prostate cancer for three years.  He underwent therapy and the cancer went in remission for awhile before he finally died at age 56 in December 2007.

James Brown: The Godfather of Soul was diagnosed with prostate cancer in 2004 but survived. He died of heart failure in 2006.  

More help in making treatment decision

From the Wall Street Journal, Ron Winslow, February 3, 2011

Researchers said they have identified a combination of four genes that appear to play a critical role in determining whether prostate cancer in its early stages will go on to become an aggressive, lethal disease. 

The information could enable doctors and patients to make better decisions after the diagnosis of prostate cancer, a disease that is commonly overtreated today, researchers said.

Predicting Outcomes

From the Arkansas Prostate Cancer Foundation

• Almost 100% of men diagnosed with prostate cancer are still alive in 5 years*.
• Over 90% of prostate cancer cases are found while the cancer is still either local or regional, and nearly 100% of these men are still alive 5 years after being diagnosed.
• In cases where the cancer has spread to distant parts of the body, 34% survive 5 years.
• After 10 years, about 98% of men diagnosed with early-stage prostate cancer are still alive*, but only 17.6% of those diagnosed with advanced-stage prostate cancer survive 10 years*.

*not including those who died from other causes.

Cleansing for prostate health?

Harmful toxins and parasites live in the colon and digestive system, eventually making their way to the prostate, where they accumulate enmasse and set the stage for disease, infection and chronic inflammation, a potential precursor for cancer.

It's a theory, espoused by many, especially in the alternative medical fields, including Dr. Larry Clapp, who popularized the idea in his book, Prostate Health in 90 Days without drugs or surgery (first published in 1997 and updated in 2007).

Even prestigious mainstream researchers like Johns Hopkins Research now report how chronic inflammation from bacterial infection can  trigger changes in our DNA, leading to tumor development.

Because of the prostate's vulnerability to infection and inflammation—by definition prostatitis, the number one reason why men visit urologists in the U.S—JHR has called the prostate "a breeding ground for cancer."

Check out Coming Clean On My 9-Day Cleanse ... in it, I blog about my second experience with a cleanse and some thoughts on cleansing and prostate health.

I don't have any interest in the company, Isogenix, that produced the cleanse products.

New Prostate Cancer Statistics

• Prostate cancer is the most common cancer among men, excluding skin cancer.
• American Cancer Society (ACS) estimates for 2010 include 217,730 new cases of prostate cancer in the US.
• Year 2010 estimates include 32,050 deaths occurring from prostate cancer in the US alone, making it the second leading cause of cancer death in men.
• All men are at risk for prostate cancer. The risk increases with age, and family history also increases the risk.
• African American men are more likely to have prostate cancer than Caucasian men, and have nearly a two-fold higher mortality rate than Caucasian men.