In my case, my initial diagnosis occurred in 1995 when I was 54 years of age. At that time, the only option for me was surgery by the best urologist-surgeon I could find. Since that time, over fifteen years have passed which have yielded volumes of clinical data concerning treatment successes and failures, tumor grades, Gleason scores, survival rates, side effects etc. For many men, “watchful waiting” is now an option to be seriously considered along with surgery. If you have been given a recent diagnosis of prostate cancer, two articles have recently been published in the National Cancer Institute (NCI) Cancer Bulletin which you should share with your physician. The first article entitled “Prostate Cancer Study Provides More Data on Surgery versus Watchful Waiting” was published in the May 17th, 2011 issue (Volume 8, Number 10). The most recent entitled “Study Questions Benefit of Surgery versus Watchful Waiting in Some with Prostate Cancer” appeared as a feature article in the May 31st, 2011 issue (Volume 8, Number 11). While one cannot formulate a general rule for every man regarding the question of surgery versus “watchful waiting”, it may be useful to share this information with your physician / health provider before devising the best strategy for your individual prognosis and treatment plan, if any. As Dr. Julio Pow-Sang of the Moffitt Cancer Center at the University of South Florida stated, “the bottom line is that treatment of early-stage prostate cancer must be individualized.”
Benefits and risks accompany virtually every method of treatment. Hormonal therapy for prostate cancer is no exception. Potential risks include osteoporosis and bone fractures, cardiac effects, diabetes, depression, hot flashes and metabolic changes resulting in weight gain. (These issues are discussed on this website under “My Story”, 2009 entries of July 5th-27th, September 29th, October 20th, November 25th, and December 6th, as well as March 12th, 2010.) I have been on continuous or intermittent hormonal therapy since August, 2006. Fortunately, my side effects have been minimal although I had gained approximately fifteen pounds. I was told by a urologist that it was difficult to lose weight while on hormonal therapy. Eventually however, I was determined to lose these unwanted pounds. It has not been easy but I have lost most of the weight while continuing my therapy. I found that once I made up my mind to lose the weight, it was indeed possible with diet and exercise. Here are some practical tips I learned along the way.
Personally, it helped to make an initial investment and enroll in one of the popular advertised weight loss programs. It did not take long to begin to understand their general principles and one could discontinue enrolling after a month or so thus saving money. The diets in general consisted of very low-fat, low-carbohydrate meals with moderate protein content. I found the following strategies to be helpful.
1) Eat a fairly substantial breakfast of whole-grain cereals, fruits and light soy or low-fat milk; eggs (omelets) can be substituted.
2) Eat about 5 small meals a day and eat less as the day progresses. Mid-morning and mid-afternoon 100-calorie snacks (cheese, yogurt, fruit) were useful in curbing hunger.
3) If possible, eat dinner at mid-day and your usual lunch as the evening meal. Low fat meats such as chicken, turkey, lean beef (ground sirloin, lean roast beef) as well as fish become staples. Bread was limited to 1-2 slices of 40-calorie whole grain bread daily. Fresh vegetables and salads with low-fat dressing are of course encouraged. Low-fat mayonnaise is recommended but I personally found that one could never fully replace the flavor of real mayonnaise, so I used it in moderation.
4) Sip on water during the day; drinking an 8 oz. glass before meals helped me eat less while feeling satisfied. Diet drinks can be used but I found that water alone was best in satisfying my hunger.
5) Exercise is a must. Aerobic and weight-bearing exercises are also good for healthy bones. My wife and I exercise for 60 minutes in a gym three-times a week.
6) Minimize the use of alcohol, although a small glass of wine on occasions can be incorporated.
7) To satisfy my salt craving, pretzels seemed to be lowest in calorie content.
8) Don’t eat within three hours of bedtime except for a small piece of fruit or similar low calorie snacks. Midnight snacks are forbidden.
9) The eventual goal is portion control. I found that after a few weeks, my hunger was fully satisfied with 33% less food than I had previously consumed. Maintaining this level remains my goal.
(An initial blog was published on this website on Jan. 8th, 2011, describing results from late stage clinical trials of abiraterone acetate in hormone-refractory prostate cancer patients.)
On April 28th, the Food and Drug Administration (FDA) approved abiraterone (Zytiga) for the treatment of men with metastatic castration (hormone)-resistant prostate cancer (meaning the disease progresses despite low levels of tumor growth-promoting hormones) that are no longer responding to the chemotherapy drug docetaxel (taxotere). It should also be noted that in spring, 2010, the FDA approved cabazitaxel (Jevtana) for the same indication. (Cabazitaxel is a member of a class of drugs based on natural products called taxanes. These were originally isolated and identified from yew plants.) In both cases, the FDA approvals were based on findings from large phase III trials in which both drugs improved patient survival as reported in the National Cancer Institute’s Cancer Bulletin, May 3rd, 2011.
The survival improvements produced by abiraterone and cabazitaxel are meaningful but the benefits are still modest: both drugs improve patients’ median overall survival by approximately 2 to 4 months. One advantage is that abiraterone seemingly has fewer side effects and can be taken orally according to Dr. William Dahut of the National Cancer Institute’s Center for Cancer Research.
In the phase III trial, 1,200 patients were randomly assigned to abiraterone administered in combination with the steroid prednisone or to prednisone plus placebo. The median survival time was 14.8 months in patients who received abiraterone and prednisone compared to 10.9 months in those receiving prednisone alone. In addition to testosterone, abiraterone affects production of other hormones that can lead to side effects such as hypertension. Therefore steroids like prednisone are used to protect against or minimize such side effects. Steroids can have their own long-term side effects, though, so the need to combine abiraterone with steroids could limit use of abiraterone in men with earlier-stage disease and longer life expectancies.
Abiraterone’s target is the production of testosterone. It works by inhibiting an enzyme, CYP17, that plays a central role in allowing the body to produce testosterone from cholesterol. However, studies have shown that tumor cells adapt to a low-androgen (such as testosterone) environment, in part by increasing the expression of the androgen receptors on their cell surfaces. So, while the overall amount of testosterone in the body may be very low, it is still being produced, and tumor cells develop the ability to take in as much as they can get. For more information, see the following link to WebMD.
With these newly-approved drugs and several others in clinical trials, more research is needed to determine the best sequence of therapies, or which combination of multiple therapeutic agents might be more effective to benefit the individual patient. In addition to abiraterone, two other drugs, TAK-700 and MDV-3100, are in phase III clinical trials in men with castration (hormone)-resistant prostate cancer that is no longer responding to docetaxel. TAK-700 also targets the production of testosterone but it could potentially be used at doses that would not require concomitant steroid supplementation and the resulting side effects of steroids such as prednisone. MDV3100 works differently, disrupting tumor cells’ ability to use testosterone. It does this in part by clogging up androgen receptors on cells which bind testosterone. Because of its mechanism of action, MDV3100 does not have to be used in combination with steroids.
The overall good news is that newer therapies which perform their functions differently are progressing through the pipeline for use in combating prostate cancer.
Cancer researchers led by Dr. Michael Carducci at the Johns Hopkins Hospital in Baltimore, MD recently reported the results from studies funded by POM Wonderful to investigate the potential benefits of their POM-X pomegranate extract. The results were reported at the February 2011 American Society of Clinical Oncology (ASCO) Genitourinary Symposium. PSA doubling time in 104 men taking 1,000 mg or 3,000 mg (milligrams) of the extract increased from a median of 11.9 months before taking POM-X to 18.5 months after taking the extract. “There was no significant treatment difference between the different dosages on PSA doubling.” According to a recent article in the March 2011 issue of the Prostate Cancer Research Institute (PCRI) Insights (Vol. 14, No.1, http://www.prostate-cancer.org/pcricms/node/59), “This implies that cancer growth is slowed. It is hoped (but not yet proven) that doubling times induced by POM-X will result in longer time to progression and improved lives for men with prostate cancer.”
This study reinforces a smaller 2005-6 study at UCLA wherein men drinking 8 oz. daily of POM Wonderful pomegranate juice experienced longer PSA doubling times. A research group led by Dr. Manuela Martins-Green had determined that pomegranate juice concentrate increased cell death in prostate tumor cell lines that were resistant to testosterone (which are associated with metastasis), increased cell adhesion and decreased migration in prostate cancer cells that survived. More recently, it was reported at the American Society for Cell Biology’s December 12th, 2010 meeting that specific families of chemical compounds isolated and identified from the pomegranate extract inhibited the migration of cancer cells and their attraction to a signal that promotes metastasis to the bone.
Neither of these above studies had a placebo arm so it is not unequivocally proven that the pomegranate actually caused the improvement. One can read about this study and others in the PCRI Insights Newsletter (see below). One such example is “Pomegranates and Prostate Health: A Research Report” available at http://www.prostate-cancer.org/pcricms/node/112. The useful PCRI Insights are also available by mail. Their contact information is 5777 West Century Blvd. Suite 800, Los Angeles, CA 90045; phone: (310) 743-2116; helpline: (310) 743-2110; e mail: email@example.com; web address: www.prostate-cancer.org and www.pcri.org.
As always, material on this website is presented for information purposes only. Significant interactions between natural food products and various medications are possible. The reader is urged to consult their health professional before using any new substances or products.
One of the major issues for men who are being screened for prostate cancer is whether or not to undergo a prostate needle biopsy. Factors considered in the standard risk model include prostate-specific antigen (PSA) level, digital rectal examination result, age, family history of prostate cancer and history of any prior prostate biopsies. The rate of change in PSA levels with time, referred to as PSA velocity, has also been used as one criterion for determining the need for a prostate biopsy. Clinical recommendations from two organizations, the National Comprehensive Cancer Network (NCCN) and the American Urology Association (AUA), suggest that men with a PSA velocity that exceeds a certain threshold value (0.35 ng/ml per year) should consider having a needle biopsy, even if their overall PSA levels are below the standard cutoff for the procedure and they have a normal result on a digital rectal examination. However, a recent study published online February 24 in the Journal of the National Cancer Institute concluded that a rapid increase in prostate-specific antigen (PSA) levels is not grounds for automatically recommending a prostate biopsy. This study was also summarized in the March 8th, 2011 issue of the National Cancer Institute (NCI) Cancer Bulletin. Researchers looked at whether a PSA velocity above the 0.35 ng/ml per year threshold—when added to a standard risk model that includes age, PSA level, DRE result, family history of prostate cancer, and history of a prior prostate biopsy—improved the model’s predictive accuracy. The authors concluded that “in all cases, the addition of PSA velocity yielded only a slight difference in the risk model’s predictive accuracy. In fact, the analysis indicated that lowering the PSA threshold for a biopsy from 4.0 ng/ml to 2.5 ng/ml would be a more effective means of directing prostate biopsies.”
As always, the content of this website is intended for information use only. All personal medical decisions and actions should be made only after consultation with established medical professionals.
Monday, March 7th, 2011 was my day for my 4-month PSA test in preparation for my urologist appointment next week. In the past, the week leading up to the PSA test had been characterized by periods of mild depression and apprehension. But the intensity and frequency of these episodes had been on the decrease. In fact, as time goes on, I find myself getting more and more trusting and confident in God’s power to maintain my disease. It is a general rule that our trust levels increase in times of stress as opposed to times of tranquility. At the end of our March 6th Sunday church service, my pastor again anointed me with oil and prayed over me in accordance with James 5:14-15. My consistent prayer is that my prostate cancer either be healed completely or that I be kept in natural or medication-induced remission. But I am always being challenged that in addition to my prayer for healing, it should instead be like that of Christ’s prayer before His crucifixion, namely that “not my will but God’s be done.” In any event, as I entered the hospital parking lot on a beautiful sunny Florida Monday afternoon, I paused for a few minutes and meditated upon, prayed and claimed (where appropriate) God’s wonderful promises and wisdom listed in my website section entitled “Spiritual Medicines.” With a resulting sense of peace, tranquility and humble confidence, I entered the hospital and my blood was drawn. The result would be known in 24 hours.
Tuesday morning I awoke with a great deal of apprehension. Would I continue to be in “remission” or would the PSA result show that I had become resistant (refractory) to the hormone treatments? This would be disastrous as it would accelerate my downward disease progression. I could not shake the negative feelings. I have got to learn to counter these worst-case scenario “what if…” feelings. By noon, I could wait no longer and called my urologist who informed me that my PSA again was <0.02 ng/mL or basically undetectable. Halleluia!!! On the phone I exclaimed “praise the name of Jesus” in response to the congratulatory voices from my urologist’s office. God is so good!!!! I now await my next Lupron treatment or perhaps a “holiday”???? I will have been on hormonal therapy for five (5) years this coming July, 2011. My most troubling side effect has been a fifteen pound weight gain which I am attempting to lose by a strict diet and weight-bearing and aerobic exercise several times per week. My goal is to lose twelve (12) pounds. I’ll let you know if I succeed.
Avodart (dutasteride) used to treat benign prostatic hyperplasia (BPH) may slow the growth of early-stage prostate cancerbjgabrielsen : February 25, 2011 2:31 am : 2011, General Patient Information
A recent study presented on Feb. 17-19th at the 2011 Genitourinary Cancers Symposium in Orlando, FL by researchers from the University Health Network in Toronto, Canada concluded that for men who are undergoing “watchful-waiting” for prostate cancer, Avodart could help control the disease and prevent the need for more aggressive treatments. “Watchful waiting,” or active-surveillance refers to the practice of foregoing immediate treatment after a prostate cancer diagnosis in favor of regularly-scheduled testing and clinical exams to closely monitor the disease.
Avodart (dutasteride) is already approved by the Food and Drug Administration (FDA) for the treatment of an enlarged prostate gland, or benign prostatic hyperplasia (BPH). The drug inhibits an enzyme called 5-alpha reductase, which converts testosterone into its more potent form, dihydrotestosterone. In addition to BPH, 5-alpha reductase drugs are also used to treat prostate cancer and baldness. Further details from the study can be found in the Feb. 22, 2011 issue of the National Cancer Institute (NCI) Cancer Bulletin. ”In the dutasteride group, 38 percent of the 302 men enrolled in the study experienced some progression of their cancer, compared with 49 percent of the men in the placebo (control) group. This difference translated into a reduction of relative risk for cancer progression of 38.9 percent in the dutasteride group. In addition, taking dutasteride increased the chances that no cancer would be found during a participant’s final biopsy. Thirty-six percent of the men in the dutasteride group and 23 percent of the men in the placebo group had no cancer detected in their final biopsy specimens.” The researchers suggested that it could be “very reasonable” to give a 5-alpha reductase inhibitor such as dutasteride to patients with “ultra low-risk” prostate cancer who elect for “watchful waiting”. It was also noted that the FDA’s Oncologic Drugs Advisory Committee had previously rejected GlaxoSmithKline’s application for dutasteride for use in preventing prostate cancer.
A word of caution regarding the Avodart study described above was recently published on March 9th in the Johns Hopkins Health Alerts: Prostate Disorders. The Hopkins physicians stated that it was unclear whether Avodart actually prevents prostate tumors or simply reduces the chance of a diagnosis. They noted that in the above study, “more people in the placebo group than in the Avodart group received a diagnosis of prostate cancer during the four-year study: 25% versus 20%. While these findings may sound like good news, it’s possible that Avodart simply suppressed PSA levels, rather than preventing the development of new cancers. Another concern: More men in the Avodart group than in the placebo group were diagnosed with a tumor with a high Gleason score — the tumors most likely to be lethal. ” The Johns Hopkins physicians advised that “if you take Avodart for any reason, be sure that the doctor who performs your PSA screening test is aware of this information. Because Avodart may simply be suppressing your PSA level, he or she will need to perform a mathematical calculation to determine your “true” level. “
MDV 3100 is a promising new treatment under clinical development by Medivation, Inc. and Astellas Pharma Inc. for advanced prostate cancer patients who have already received chemotherapy with taxotere (docetaxel) as well as those who have not been treated with taxotere. MDV3100 slows growth and induces cell death in bicalutamide (casodex)-resistant cancers via three complementary actions. MDV3100 blocks testosterone binding to the androgen receptor, impedes movement of the androgen receptor to the nucleus of prostate cancer cells (nuclear translocation) and inhibits binding to DNA. In preclinical experiments published in Science in April 2009(3), the novel, triple-acting, oral androgen receptor antagonist MDV3100 provided more complete suppression of the androgen receptor pathway than bicalutamide (casodex), the most commonly used anti-androgen drug. For further information, see the February 15th, 2011 issue of ZERO HOUR – an action advisory from ZERO – the project to end prostate cancer.
Positive Phase III clinical trial results for MDV 3100 have been recently disclosed. See the November 18th, 2011 blog from this website.
The Johns Hopkins Hospital in Baltimore, Maryland is recognized as possessing the foremost urology department in America according to the annual hospital survey in U.S. News and World Reports. A recent article by Dr. Alan Partin from Johns Hopkins and published on January 26th, 2011 in the Johns Hopkins Health Alerts described the various surgical options for prostate cancer surgery. These include open, laparoscopic and robotic surgery. If you are considering surgery as an option for treating prostate cancer, this article might be useful in your deliberations.
David Powlison was on the eve of prostate cancer surgery when he and John Piper, a noted Christian author, penned the following ten (10) very relevant points. The following is an excerpt. I suggest you read the relatively short essay in its entirety. See “Don’t Waste Your Cancer”.
- You will waste your cancer if you do not believe it is designed for you by God. God has allowed your cancer and has a specific reason for it.
- You will waste your cancer if you believe it is a curse and not a gift. In His beloved children, our Father works a most kind good through our most grievous losses: sometimes healing and restoring the body (temporarily, until the resurrection of the dead to eternal life), always sustaining and teaching us that we might know and love Him more simply.
- You will waste your cancer if you seek comfort from your odds rather than from God. With God, you aren’t playing percentages, but living within certainties.
- You will waste your cancer if you refuse to think about death. Cancer is merely one of the enemy’s scouting parties, out on patrol. It has no final power if you are a child of the resurrection, so you can look it in the eye.
- You will waste your cancer if you think that “beating” cancer means staying alive rather than cherishing Christ. To ‘beat’ cancer is to live knowing how your Father has compassion on his beloved child, because He knows your frame, that you are but dust. Jesus Christ is the way, the truth, and the life. To live is to know Him, whom to know is to love.
- You will waste your cancer if you spend too much time reading about cancer and not enough time reading about God. It is not wrong to know about cancer. Ignorance is not a virtue. But the lure to know more and more and the lack of zeal to know God more and more is symptomatic of unbelief. Cancer is meant to waken us to the reality of God. For every one sentence you say to others about your cancer, say ten sentences about your God, and your hope, and what he is teaching you, and the small blessings of each day. For every hour you spend researching or discussing your cancer, spend 10 hours researching and discussing and serving your Lord.
- You will waste your cancer if you let it drive you into solitude instead of deepen your relationships with manifest affection. The kind of heart God is aiming to create with cancer is a deeply affectionate, caring heart for people. Don’t waste your cancer by retreating into yourself. Our culture is terrified of facing death. It is obsessed with medicine. It idolizes youth, health and energy. It tries to hide any signs of weakness or imperfection. You will bring huge blessing to others by living openly, believingly and lovingly within your weaknesses.
- You will waste your cancer if you grieve as those who have no hope. Jesus’ final promises overflow with the gladness of solid hope amid sorrows: “My joy will be in you, and your joy will be made full. Your grief will be turned to joy. No one will take your joy away from you. Ask, and you will receive, so that your joy will be made full. These things I speak in the world, so that they may have my joy made full in themselves” (selection from John 15-17).
- You will waste your cancer if you treat sin as casually as before. Cancer is designed to destroy the appetite for sins such as pride, greed, lust, hatred, unforgiveness, impatience, laziness, procrastination—all these are the adversaries that cancer is meant to attack. If you are God’s, then suffering in Christ’s hands will change you, always slowly, sometimes quickly. You come to terms with life and death on His terms. He will gentle you, purify you, cleanse you of vanities. He will make you need Him and love Him. He rearranges your priorities, so first things come first more often. He will walk with you.
- You will waste your cancer if you fail to use it as a means of witness to the truth and glory of Christ. Jesus is your life. He is the person before whom every knee will bow. He has defeated death once for all. He will finish what He has begun. Let your light so shine as you live in Him, by Him, through Him, for Him. In your cancer, you will need your brothers and sisters to witness to the truth and glory of Christ, to walk with you, to live out their faith beside you, to love you. And you can do same with them and with all others, becoming the heart that loves with the love of Christ, the mouth filled with hope to both friends and strangers.