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Prostate
Cancer Protocol
Introduction to dr. strum's prostate cancer update
When I was diagnosed with advanced prostate cancer in September 1991,
I thought my life, as I had envisioned it, was over. Instead, I have
found a whole new universe of living and, in doing so, have come to
terms with my own mortality.
Transformation is
what is possible when we are faced with a life-threatening illness.
When the unthinkable happens to us and we are faced with our mortality,
we have an opportunity to transform our lives.
Acceptance of our
situation is the first milestone we must pass before we can truly begin
the process of healing. For me this translates into doing everything
I can to understand the entire process of my illness and what I can
do to become well. While I do not blame myself for my diagnosis, it
has been valuable for me to take an introspective look at my life in
relation to the kinds of stressors or environmental exposures that may
have played a role. Sometimes it is not until we are on the reef that
we realize it is there.
Fortunately for
us, the cancer patient today has many more resources available than
there were just a few years ago. What follows by Dr. Stephen Strum is
an update of the treatment of prostate cancer. I have known Steve for
over 10 years. He is one of the precious few who have brought a new
and compassionate dimension to the patient/physician relationship.
Frederick Mills
Prostate Cancer Survivor
Founding Member of Educational Council
for Prostate Cancer Patients
Prostate Cancer Update 2003
Stephen B. Strum, M.D., F.A.C.P.
GENERAL
INTRODUCTION
In this, the year 2003 edition of Disease Prevention and Treatment,
I will discuss prostate cancer (PC), using the metaphor of a military
incursion--needing to have a focused, strategic approach, deployed in
a systematic, problem-solving manner. The purpose of such a metaphor
is to bring to the student of this disease a different perspective that
will hopefully provide new insights that will lead to victories in our
battles against this disease. The reason for such a departure from the
conventional formal discussion of PC is that this latter academic approach
is not being translated into winning strategies for the man with PC.
The battle is being lost because we, the generals, are not translating
what has been published in medical journals and discussed at national
meetings into real-time preventive, diagnostic, evaluatory, and treatment
tactics. Medical pragmatism--the art of being practical and using common
sense--is not being practiced.
The battle to prevent
this disease, to diagnose it earlier, and to treat it effectively is
also not occurring at the proper pace largely because men are not taking
an active role in winning this war. As we are learning in our war against
terrorism, you defeat the enemy by recognizing their presence early
(not late), preventing their buildup, learning their location, and eradicating
them with the proper weaponry. There are too many men, already diagnosed
with PC, who are not taking an active role in their own recovery. Many
believe that because they are consulting a professional with a medical
degree (who may also command a generous salary), all or part of this
equates with getting the very best advice and treatment. Wrong. In today's
world of rapid pace, where medicine is practiced with 15-minute office
visits and where physicians are too busy to read and translate much
of what is being published, the patient and his partner must not take
a passive role and assume that all that can be done is being done.
My recommendations,
therefore, either to patients with PC or to their loved ones, will be
those of a counselor or guide, offering practical advice based on 20
years of working on the front lines of PC management. I do not hesitate
in telling you that for the vast majority of men diagnosed with PC,
a successful outcome can be realized. But the principles you are about
to learn must become part and parcel of the strategic approach used
by the patient/partner/physician (PPP) team. The patient and his partner
have the most to gain as well as the most to lose when encountering
PC. They must expend serious energy to win this particular war. In doing
so, they learn the art of battle; they are brought closer together and
evolve in their lives; and other intertwined health issues are brought
to light and healed. This is the beauty of such an approach. Are you
willing to invest in the time to help yourself? Are you worth it?
THE 2003
DISEASE PREVENTION AND TREATMENT EDITION
The most important take-home lesson that I can relate to you within
the pages that follow relates to your ability to use concepts. It is
through the use of concepts--the structural framework of our thinking--that
we intelligently plan a strategy of success.
Comparison of a
Military Campaign with Prostate Cancer Strategy Table 1: Comparison
of a Military Campaign with Prostate Cancer Strategy
Winning a Military Campaign
Defeating Prostate Cancer (PC)
1
Preventing War
1
Preventing PC
2
Basic Military Training
2
Getting Help to Understand Biological Principles
3
Military Information (Intel)
3
The Importance of the Medical Record
4
Early Recognition of Enemy Activity
4
Early Diagnosis of PC
5
Assessment of the Enemy
5
Risk Assessment of the PC Patient
6
Knowing Pros and Cons of Weaponry
6
Understanding Pros and Cons of Treatment Options
7
Understanding Enemy Vulnerability
7
Learning Principles Underlying Tumor Growth
8
Stopping Supply Lines to the Enemy
8
Antiangiogenesis Treatments, Dietary Changes
9
Stabilizing Key Arenas of Conflict
9
Focus on Bone Integrity, Biomarkers, etc.
10
Supporting the Troops
10
Supportive Care of the Patient
11
Boosting Morale of Troops
11
Fostering a Will to Live, Empowering the Patient
As stated in the
introduction, defeating PC is a military campaign. Winning a military
campaign, or a war against PC, involves concepts such as prevention,
basic training, military intelligence (Intel), early recognition of
enemy activity, assessment of the strength of the enemy, an understanding
of the pros and cons of the weapons in our arsenal, stabilization of
key areas of conflict, stopping supply lines to the enemy, supporting
our troops, and other issues common to a military arena (see Table 1).
A strategy for success, be it in a military war or a war against PC,
simply involves adding factual information to a sound conceptual framework.
Please refer to
the glossary following this chapter to better understand unfamiliar
terms that are used throughout the text.
The approaches used
in a winning strategy, whether for a military campaign or a medical
battle, are superimposable. That which occurs in the life of a cell
is reflected in society as well.1 Cellular battles are but a microcosm
of what takes place on a more macromolecular level within the individual,
his community, his country, the planet, and the universe. This is reflected
repeatedly throughout the entire history of man.
1. Preventing War: Preventing PC
Hereditary PC: Risk
Factors
Genetic Transmission
Intensified Surveillance
Increased Risk with Family History of Cancer
Tests for High-Risk Persons
General Preventive Measures
Most students of either campaign will maintain that prevention is the
key to being truly victorious. There is no argument there. However,
the desire to understand the principles and importance of preventive
tactics does not appear to be a top priority for most people until the
harsh reality of war or cancer is present. For example, the appreciation
of terrorism in America was not brought home until September 11, 2001.
This appreciation of the enemy may take the form of seeing the reality
of cancer up close and personal when a father, brother, or other family
member is diagnosed with PC or another malignancy. Otherwise, the motivation
to learn and utilize prevention tactics does not seem to be part of
human reality for the vast majority of us. What can we do to foster
an appreciation of the value of preventing PC?
Hereditary PC: Risk Factors
Out of every 100 men diagnosed with PC, approximately 5 will have hereditary
PC (HPC).2 HPC is presently defined by any one of the following three
criteria:
Three successive
generations with members having PC
Three first-degree relatives, for example, a father and two brothers,
three brothers, or a father and two sons with PC
Two relatives with PC diagnosed before age 553
It is not surprising that the incidence of hereditary breast cancer
is also about 5% of the total population of breast cancer patients--the
same incidence as that of HPC.4
Genetic Transmission from Father to Son and Father to Daughter
HPC is transmitted by a gene from father to son and from father to daughter
and then to her son. When HPC is present, nearly half the male offspring
will have PC, and many of these will develop PC before age 55. In fact,
HPC accounts for approximately 43% of PC diagnosed before the age of
55 years.3,5,6
Since the transmission of the gene may also occur from father to daughter
and then to her son, a sound medical history includes information about
the health of the maternal grandfather as well as maternal uncles and
maternal cousins regarding any history of PC. Studies of PC within families
show a stronger familial inheritance pattern than colon or breast cancer.
Value of Intensified Surveillance in High-Risk Situations
Most importantly, procedures to routinely test the first-degree relatives
of those having HPC have yielded an eightfold higher detection of PC
than that found in the general population.7 Soon, genetic testing for
chromosomal abnormalities found in HPC may become commercially available.
Patients' interest in testing similar to that available for breast cancer
appears great when there exists a family history of such disease.8,9
Increased Risk of Male Breast Cancer and Colon Cancer in Male
Offspring and Breast Cancer in Female Offspring
It should also be emphasized that men with a history of breast cancer
(BC) in their family are also at greater risk for developing PC, just
as women with a family history of PC are at greater risk for developing
BC.10 Since both PC and BC share common genes, it is not surprising
that men who are carriers of the gene associated with BC (BRCA1 or BRCA2)
are at a greater risk for developing male BC in addition to PC and colon
cancer.4,11-13
Therefore, greater
vigilance is suggested when a history of PC or BC is present.
What Are the Tests for High-Risk Persons?
Currently, most physicians who focus on PC as their main specialty will
recommend routine prostate-specific antigen (PSA) testing starting at
age 40. This is important to establish objective findings that indicate
a healthy prostate. In subsequent paragraphs, this will be shown to
equate with a baseline PSA of less than 2.0 and often less than 1.0
ng/mL. In a population in which there is a family history of PC, such
as has been described, PSA testing should be commenced at age 35 with
yearly testing for a few years to establish a trend or profile. Then,
if the PSA remains below 1.0 ng/mL, consideration for testing every
2-3 years can be considered. Vigilance on the part of the empowered
patient, partner, and physician will also involve digital rectal examination
(DRE) at reasonable intervals and tracking of the PSA over time. If
any persistent PSA increase is noted, determinations of PSA velocity,
PSA doubling times, free PSA percentage, and additional testing that
will be discussed in subsequent sections must be done. Moreover, a baseline
colonoscopy and stool testing for microscopic blood (Hemoccult) would
be a reasonable consideration in such men starting at age 40 rather
than at age 50.
General Preventive Measures
Lycopenes
Dietary Fat
Total Calorie Consumption
Selenium
Vitamin E Succinate
Dairy Products and Calcium
High Fructose
Boron
Diet and Supplement Studies
Besides laboratory testing, physical examination, and investigative
procedures to rule out the presence of PC and other diseases, an action
plan to prevent their development should be considered. These types
of preventive measures are preemptive, or defensive, measures. The most
apparent of these relates to what we eat and drink.
There is no doubt
that what we put into our bodies relates to the health of our cells.
It is obvious that food intake is associated with delights to our senses
of sight, smell, and taste. However, on a survival level, food is the
necessary fuel source for all the cells of the human body. The quality
and quantity of the food, water, and air we put into our bodies clearly
have serious ramifications. There are major parallels between human
nutrition and a high-performance engine:
The kind of fuel
we add to high-performance engines
The fuel-to-air ratios that occur within the combustion chambers
The metabolic breakdown products resulting from internal combustion
The wear and tear on the engine due to driving habits
The preventive measures used to increase engine life
The human body is certainly no less of a high-performance engine than
that of an airplane or car. Yet, although we appreciate the preventive
maintenance that is part of the strategy of engine survival, we are
inconsistent when we too often ignore the needs of our own bodies--that
is, until we have signs of engine breakdown. As many of us love our
cars and care for them, we must do the same with our bodies.
Prostate
Cancer Pg (1) (2) (3)
(4) (5)
(6) (7)
(8) (9)
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(12) (13)
(14) (15)
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(18) (19)
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