Guest Column: Q&A with a Radiologist on Prostate Cancer

How does radiation kill  prostate cancer cells—and leave healthy cells to recover? What is the difference between proton therapy and high-dose radiation? What is the future of radiotherapy in treating prostate cancer?

Radiologist Lisa Livingston

Radiologist Lisa Livingston tackles these and other questions, as our first guest columnist. Lisa has created the online site, Radiation Technician Schools, a good resource for radiation technicians on schools, career options, scholarship opportunities and more. Plus, you can find interesting articles on the history of the pharmaceutical industry in America, how mobile computing is changing health care delivery, and many other health care topics that interest everyone.  Check out her website and blog — and if you have additional questions about radiation and prostate cancer, send them to The Prostate Storm blog, and we’ll get them answered. (SV)

How does radiation kill cancer cells?

Radiation stops or slows the growth of cancer cells. It kills the genes (DNA) in cancer cells so that they can no longer grow and divide. Cancer cells tend to divide quickly and grow out of control, but radiation can impede this growth. It can also shrink a tumor and keep it from spreading to other parts of the body.

Radiation therapy does not always kill cancer cells immediately. Sometimes it can take days or weeks of treatment to kill cancer cells, and they may even continue to die after treatment ends. Tissues that grow quickly such as skin and bone marrow are generally affected right away, while nerve, breast, prostate and bone tissue will take longer to show affects.

The final debunking of Vitamin E: Now it raises prostate cancer risk

Vitamin E -- No longer miracle supplement for PC.

Tough week for guys trying to deal with the threat of prostate cancer:  First the PSA screen came under attack (previous post), now vitamin E.

Once believed to be a super supplement that could reduce the risk of prostate cancer, vitamin E (and selenium) were  shown to have no benefit at all several years ago. That was about the time of my diagnosis, years after I'd begun taking vitamin E.

Natually, this came as disappointing news. Since the early 2000s, men had been popping high doses of vitamin E, thinking this was an easy over-the-counter antidote to the second most deadly cancer among American men. 

I was among the poppers. Since the late '90s, I'd been besieged by urinary tract issues and an enlarged prostate, so I tried everything — including buying bottles of vitamin E at the local GNC and trying high doses, believing vitamin E was good for prostate health and would relieve my symptoms.  It didn't seem to help much. But I took vitamin E off and on for years, adding it to a cocktail of other so-called "miracle" supplements.

Interestingly, the researchers who revealed vitamin E and selenium had no benefit in 2008, continued to study the 35,000 men in the trial.  Now, three years later, they're reporting high doses of vitamin E actually increase the risk of prostate cancer.

They found an increased risk of 17 percent in men who took 400-unit capsule of vitamin E every day for about five years.  Look, that's a lot of vitamin E — about 20 times more than the recommended amount. But that wasn't unusual for guys who believed they might be preventing prostate cancer, or at least improving prostate health — like me.

Just goes to show you, if you wait long enough, all common wisdom will eventually be upended by another study.

PSA test not recommended by Task Force — but have they gone too far (again)?

The PSA test is an unreliable test that has led to serious overtreatment of prostate cancer. Few argue it's anything but a lousy screen for the second deadliest cancer among American men.

Grading cancer from 1 to 5, the least to the most aggressive

But the U.S. Preventative Services Task Force's recommendation (released next Tuesday, Oct. 11th) that the screen should no longer be given to healthy men is going way too far. (Reuters--PSA Test for prostate cancer not recommended: panel.)  Also read Prostate cancer test under fire.)

They may've over-reached in trying to protect men from the "collateral damage" of radiation and surgical treatments — i.e., varying degrees of impotence and incontinence.

I understand giving guys a "warning" that the test is not cracked up to what everyone may think — but hey, it's still the only game in town for early detection.

September Prostate Cancer Awareness Month; Raiders-Jets Show Support

Employees are encouraged to GO BLUE on Friday, September 16, 2011 to raise awareness for prostate cancer within the workplace. This campaign encourages employees to wear casual Friday attire, paint employee faces blue and create a blue fundraising event benefiting the Prostate Cancer Foundation. Learn more about BLUE FRIDAY.

OAKLAND RAIDERS SUPPORT PC RESEARCH

The Oakland Raiders NFL team is supporting Blue September at their home game opener against the New York Jets on Sunday, September 25.  The game will support prostate cancer awareness and a portion of specially priced tickets purchased HERE will go to support prostate cancer research. 


Raiders legend Jim Otto, a Blue September supporter since 2010, was diagnosed with a severe case of prostate cancer in 2002 and underwent treatment that was hard on him and his family. Jim encourages people to support Blue September and support the Raiders by buying tickets to the game and getting the word out.

 --PROSTATE CANCER FOUNDATION

Urine test for prostate cancer

This development might save guys  a lot of pain and suffering — with unnecessary biopsies and even unnecessary surgeries and radiation.

A new urine test may be "significantly better" at identifying aggressive prostate cancer than a PSA test, which is very unreliable as most everyone knows. Here's the article from the Los Angeles Times article with all the details and the link to the journal Science Translational Medicine, where the study was published.

The urine test could be a first step toward putting the brakes on overtreatment, which takes place about half the time when prostate cancer is detected through a PSA test and then verified with a biopsy.  Biopsies can't differentiate between nonaggressive and aggressive cancers, so treatment is often recommended when cancer is found.

I suspect the way it MIGHT work is that physicians will continue to give PSA tests. But if cancer is detected, they might then take the urine test and see if the lab can find the two gene markers for aggressive prostate cancer in the urine. If the markers are not found, guys could be spared a biopsy and treatment — instead, proceed on a "watchful waiting" track.

FREE Guides from Prostate Cancer Foundation

	An Introduction to Prostate Cancer is designed to help men, their families, and friends quickly understand the risk factors for prostate cancer, find out how it is diagnosed, and review different treatment options. (8 pages) Order a free copy or download a copy in PDF format.
	Report to the Nation on Prostate Cancer: A Guide for Men and Their Families provides in-depth information about the diagnosis of prostate cancer, the available treatment options at each stage of the disease, key issues men face at every step, and more. (108 pages) Order a free copy or download a copy in PDF format.
	Nutrition, Exercise and Prostate Cancer summarizes the “best of the best” data and information available in the research arena today. Newly revised in 2009, the guide can help everyone affected by or at risk for prostate cancer understand how to incorporate key nutritional and lifestyle strategies into their everyday life. (32 pages) Order a free copy or download a copy in PDF format.
	Straight Talk for African-American Men and Their Families provides special facts and guidance regarding African-American men and prostate cancer. Research shows that African-American men are 1.6 times more likely to be diagnosed with prostate cancer and 2.4 times more likely to die from it than Caucasian men. The guide includes personal thoughts from Charlie Wilson, D.L. Hughley and Snoop Dogg. (8 pages) Order a free copy or download a copy in PDF format.

Five Powerful Foods for Prostate Cancer Prevention

I found this article about eating for a healthy prostate from The Cancer Project, a collaborative effort of physicians, researchers, and nutritionists who have joined together to educate the public about the benefits of a healthy diet for cancer prevention and survival. Based in Washington, D.C., The Cancer Project is a program of the Physicians Committee for Responsible Medicine.  The article was written in 2006, but it supports the current view that an anti-inflammatory diet, as I discuss in The Prostate Storm,  can reduce the risk of prostate disease, including prostate cancer.  ***

Vaccine cures prostate cancer in mice: Mayo Clinic

Mayo Clinic researchers have successfully cured prostate cancer in mice (80% of the time) ... using a HUMAN vaccine that triggers a response in the immune system ... a response that recognizes and attacks prostate cancer tumors ... with no side effects ... leaving the surrounding healthy tissue unharmed.

A vaccine, really?  You get a shot in your arse, instead of emasculating major surgery, radiation or chemo. Granted, this is another study with mice, but it sounds very promising and...it's the Mayo Clinic.

Human trials are still 2-5 years away (why years?????) ... According to Majo researchers, the vaccine also shows promise for treating melanoma, and lung, brain and pancreatic cancer. 

Here's an article and video about it in the Huffington Post ... another longer article in Health Day .... and here's the abstract of the study, published in the journal Nature Medicine this week.

Smoking linked to more aggressive prostate cancer

Smokers, if you're sweating lung cancer or heart disease or stroke, put prostate cancer on your list of diseases now stalking you.  The bad news...

• If smoking when diagnosed with prostate cancer, you're 61% more likely to die from it than a nonsmoker
• Smoking might directly affect the aggressiveness of cancer
• Smokers are 61% more likely to experience a recurrence of prostate cancer after treatment
• Men who smoked a pack a day for 40 years (or the equivalent of two packs over 20 years) were 82% more likely to die of prostate cancer than non-smokers
• Even former smokers who kicked the habit are more likely to succomb to PC than nonsmokers.

This from a new study, published in the Journal of American Medical Association, that

Prevention: Coffee, green tea lower risk of prostate cancer

Men who regularly drink coffee – caffeinated or decaf – are significantly less likely to develop prostate cancer.  And the more java, the better.

According to a Harvard study published online on May 17 in The Journal of the National Cancer Institute, Harvard scientists followed 47,911 men who periodically described their coffee intake. The researchers found that those who consumed six or more cups a day were almost 20 percent less likely to develop prostate cancer over two decades than those who drank none. The study was part of the Health Professionals Follow-Up Study.

Controversy? FDA warns hair loss, BPH meds increase prostate cancer risk. Or not...

The FDA now warns that Proscar, Propecia, Avodart and Jalyn increase the risk of high-grade prostate cancer. But not every expert agrees, including the chief medical officer of the American Cancer Society.

Bloomberg reports: Merck and GlaxoSmithKline Plc (GSK)’s drugs for hair loss and enlarged prostate will carry new U.S. warnings about a low risk of being diagnosed with a more serious form of prostate cancer.

Study: Little evidence radiation is superior to watchful waiting for "early prostate cancer"

If you're in the throes of making a treatment decision on prostate cancer, the choices can seem bewildering.  Radiation (and all the different flavors), surgery (robotic and open), and watchful waiting -- what to do?  You don't want to risk your life, on the other hand, if you don't need an aggressive treatment, why risk the collateral damage, i.e. incontinence and ED? I'm posting the following story by HealthDay, because it's worthwhile reading if you're weighing those risks.  The article Jury Still Out on Radiation for Early Prostate Cancer cites a new Tufts University study funded by the Agency for Healthcare Research and Quality that says there's little evidence radiation is more likely to save your life than watchful waiting, if you have early prostate cancer.  I'm assuming "early prostate cancer" means the low-grade (Gleason 6 and under), nonlethal, slow-growing variety, although it's not clear. The Tufts study is yet another reminder that treatment for low-grade prostate cancer still has the medical experts baffled.  Best advice: Do your homework, consider all your options, talk to multiple physicians, and don't rush into a decision.

In another article this week from Reuters Health, Prostate Cancer: Is it safe to skip radiation?, a review of many recent studies reveals there is no clear picture of what works best for the majority of men when comparing different radiation treatments.  Interestingly, last year a research group in the article found that among 466 patients who chose active surveillance rather than immediate treatment, those with tumors at intermediate risk for progression fared as well as men with low-risk prostate cancer over four years.  Granted, most of us are looking for no cancer beyond four years, but it's an interesting comparison and something to keep in mind ... especially if you have a Gleason of 6 or under.

Prostate Cancer Survival Rates Up Dramatically with Exercise

Run, walk, bike, sweat a little — if you’re a guy treated for prostate cancer, you can reduce your risk of the cancer reoccurring by over 60% with three hours a week of vigorous exercise compared to men who got less than one hour per week of vigorous exercise.     These findings came from the Health Professionals Follow-Up Study, of 2705 men observed every two years over 18 years. "Vigorous" simply means "a very brisk pace" — in other words, work up a sweat for 30 minutes a day, six days a week.       For anyone who has gone through surgery or radiation and all that anxiety about how things are gonna turn out, a little exercise every day is a small price to pay (and a cheap insurance policy). Why the positive outcomes from all that exercise?  The study's authors suggest physical activity might influence cancer survival by modulating insulin activity and inflammation and/or by altering the immune system's behavior. More research is required, according to an article in The Washington Post.

'Magic Mushroom' Prevents Prostate Cancer - New Study with Mice

This is no joke.  What would you think if researchers stumbled onto a compound that (a) cured existing prostate cancer 100% of the time, (b) prevented the development of prostate cancer, (c) produced no side effects, and (d) could be found in huge quantities in mushrooms that grew in forests all over the world?

Turkey Tail mushrooms grow on  bark

Wow is right. A cure.

Well, mice ain't people, and more study is warranted ... but this one is worth keeping an eye on. So here are some facts:

Incredible new research out of Australia last month has shown that a compound called polysaccharopeptide (PSP), which comes from a type of mushroom called "Turkey Tail," is 100 percent effective at targeting prostate cancer stem cells and suppressing tumor formation in mice. The research, which has been published in the online journal PLoS ONE, represents the first to show that a natural substance is totally and completely effective in every single trial, according to an article in NaturalNews.com (June 1, 2011).

Survivor Story posted on Prostate.net

Photo credit to my son Nick

Last month, Craig Cooper, the founder of Prostate.net contacted me, wondering if I'd like to contribute my story to his Survivor series.

Today, that story got posted -- and it's all great, I'm thrilled to get the message out to Craig's readers, and I thank him for helping putting it all together.

Prostate.net is fantastic site and has a huge presence on Facebook.  It's filled with great information for anyone with prostate disease, those recently diagnosed with cancer and wondering what's next, or guys looking for a smarter approach to prostate health and healthy living. 

My thanks, again, to Prostate.net and Craig for sharing the stories and information that hopefully will help others.

Second Edition Just Released!

NEW EBOOKS ... I just updated The Prostate Storm with new studies, research and post-treatment experiences — now available in multiple ebook formats:  PDF, Sony Reader, Kindle, RTF, Plain Text (viewable as web page), and Epub for Stanza Reader and iPads.  Only $5.95 ... with a portion of proceeds going to Zero—The Project to End Prostate Cancer. Once you buy an ebook on Smashwords, you are entitled to download future updated versions FOR FREE!

NEW PAPERBACK edition ... Now available on Amazon (and Kindle version).  Take a "Look Inside" now....

My goal with all proceeds is to support researchers who are looking for a better screen that will discern between lethal and nonlethal prostate cancer. The hope is that this better screen will help men with lower-grade prostate cancer (and their advising doctors) make smarter treatment decisions ... thereby, reducing the risk of collateral damage (i.e., incontinence, impotence and rectal issues) from treatment ... and also reducing unnecessary biopsies.

A better screen is desperately needed -- and an important step toward a cure!

Prostate Cancer Statistics

Boomer guys are in the crosshairs of a prostate cancer explosion.  The number of new cases and deaths of prostate cancer is expected to increase dramatically over the next decade as baby boomer men age into the target zone for prostate cancer. If there is no change in prevention or treatment strategies, by 2015, there will be approximately 3 million men battling prostate cancer. If there are no better treatments or a cure for prostate cancer, by 2015, 45,000 men will die from the disease each year.

A man is 35% more likely to develop prostate cancer than a woman is to develop breast cancer.

Rockers Who Took On Prostate Cancer

I get more hits on my blog entry, Famous Guys with Prostate Cancer, than all the other serious stuff about PC overtreatment,  unnecessary biopsies, lethal vs nonlethal PC, recurrence anxiety, exercise and prostate health, the alarming PC money tree, and so on....

Zappa

No, most people wanna know whose famous prostate went to hell just like theirs.  Why the fascination?  I suppose, we find a new and real way to relate to those icons we grew up, strange as it is.

As a runner, for instance, when I read Bill Rogers had PC and survived, no I can't relate to him breaking the tape four times in the NY marathon, or dropping the field on Heartbreak Hill to win four Bostons — but I sure can relate to "Boston Billy" running down prostate cancer, his probable peeing problems, biopsies, catheters, PSA anxiety, and all the other fun stuff. 

...Stills

I'm not a rock star but I love rock music — I'm a boomer, grown up on Zappa, CSNY, Grateful Dead, Dan Fogelberg. These guys or bands all got rocked by PC, and for some odd reason, especially for me with Stephen Stills, who laid the soundtrack on my wonderfully misguided youth ... surviving it with the guy who ripped Sweet Judy Blue Eyes makes me feel a tad better.

Me and Stephen. PC survivor sympatico. 

Then there's cranky Frank Zappa, music weirdness legend, founder of The Mothers of Invention ... some of these stony songs followed me for 40 years to my iPod. 

In looking for famous rockers with PC, I came across this interview on The Today Show with  Zappa, talking about the surprise of PC and testing back in 1992 ... and worth dropping in here:

"Well," the iconic innovator said, "I think it’s worthwhile being examined to find out whether or not you got it but on the other hand I had urinary problems over a period of years and was examined and they didn’t find it, and so that’s why it came as such a shock to me that I had it, because I had urinary problems for years…you can imagine how irate a person might be when informed, 'yeah, you got it but we can’t operate on it' ... so yeah, go have a a test but get another test, have a few tests....”

...Lesh

Zappa was quietly pissed at how things were turning out; recall that the PSA test had only been around a few years by 1990, and testing wasn't as widespread as it is today. To Zappa's anguish, PC ended up not being an old man's disease after all. He died in 1993, three years after being diagnosed. He was 52.

Grateful Dead bassist and composer Phil Lesh underwent successful prostate cancer surgery in 2006.

...Fogelberg

Singer/songwriter Dan Fogelberg, part of the “soft rock” movement of the 1970s, wasn't as lucky, and apparently had an aggressive strain of prostate cancer like Zappa.  He died from it in 2007, at 56.   

The following day, Crosby, Stills and Nash band member Graham Nash mentioned in a Larry King interview that his 62-year-old bandmate Stephen Stills had been diagnosed with PC and was planning to seek treatment. Stills underwent surgery for prostate cancer in 2008.

How 'bout Johnny Ramone—guitarist for The Ramones? He died of PC, at age 55, in 2004.  

So, what do rock stars have to do with prostate cancer?  Nothing at all, really.  Except we (the freshly diagnosed and/or curious survivors) seem to like to know about the famous who share our diseases, all the better and more relate-able if they riffed on our life's soundtrack back in the day ....

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.