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Medical Forum / Diseases and Disorders / Prostate Cancer / November 2005Active Surveillance Plus Supplements -- Encouraging
I'd be interested to hear the experiences of others who have combined "active surveillance" (my doc's term for "watchful waiting") with lots of supplements, changes in diet, etc. My history: PSA in range of 1 to 1.1 1999-2001, then three years of no tests. (I know, I know...) PSA 4.8 in Feb. 05, followed by a 12-needle biopsy that found no evidence of PCa. PSA 6.2 in July 05 (14% free), followed by a 12-needle biopsy that did find PCa. Johns Hopkins checked 14 slides and reported two small foci, Gleason 3+3, on two of three cores from one lobe. In August saw a PCa specialist, who did ultra-accurate test at a different lab, showing PSA of 5.81 In late August a color Doppler ultrasound confirmed two small foci, 10 by 5 mm and 8 by 7 mm, in an 88 cc gland. The enlarged gland, due in part to BPH, also showed an enlarged median lobe and "subclilnicial chronic prostatitis." Age 61, good health, nonsmoker, 190 lbs, 6 ft. Because a family member has had horrendous long-term side effects from a radical prostatectomy eight years ago, I decided to carefully evaluate all treatment options. My PCa specialist encouraged this, saying there was no need for immediate action. Meantime I radically changed my diet, cutting back sharply on animal proteins (per "The China Study") and gulping down supplements: green tea, pomegranate juice, curcumin, lycopene, vitamins C, D and E, selenium, omega 3, calcium and saw palmetto. (This from a guy whose idea of a quick snack was a half-pound burger with cheesecake for dessert.) Yesterday I got the results of my latest labs: PSA according to my "old" lab (for purposes of comparison with 6.2 reading): 4.9, 20% free. PSA according to 3G Immulite (to compare with 5.81): 5.25. Not a dramatic drop, but an encouraging move in the right direction. Any thoughts? Alex This brings up some interesting questions. Does a drop in PSA indicate a drop in tumor size and less of a risk of PC cancer spread/reoccurance? > This brings up some interesting questions. > Does a drop in PSA indicate a drop in tumor size and less of a risk of > PC cancer spread/reoccurance? The problem is that prostatitis can also increase PSA as can BPH. These can coexist with prostate cancer, so it seems unlikely that one can draw firm conclusions from relatively small changes. In Alex's case, the hopeful sign is that the PSA didn't increase dramatically. I don't know his age, but if he is in his late 60s or older, with his diagnosis, he seems an ideal candidate for active surveillance. Alex...Sounds like you are pretty well informed and making information-based decisions that are right for you. Clearly, many US men are being diagnosed with indolent disease. Some estimates say that 20-50% of those detected may not need invasive treatment. With AS, staying on top of it is the key and it sounds like you are doing this. Measuring your PAP might be one more simple thing to do. BTW, using the us test provides no benefit if your PSA is up in the range where yours is. Also, am I correct that the uro didn't feel anything during the DRE and the color doppler (did Fred lee or Duke Bahn perform this?) showed the foci to be away from the edge of the capsule? Where are you located, some places like Hopkins, actually have AS programs where they work closely with you...Best wishes and good health, Ron > I'd be interested to hear the experiences of others who have combined > "active surveillance" (my doc's term for "watchful waiting") with lots of [quoted text clipped - 37 lines] > > Alex "Alex" wrote... > I'd be interested to hear the experiences of others who have combined > "active surveillance" (my doc's term for "watchful waiting") with lots of [quoted text clipped - 4 lines] > > Any thoughts? Yeah. Short answer: Get treated. Longer answer: WW, with or without rabbit food, is for old men with other major health problems, not young athletes like you and me with a dozen good years left in us. RIGHT answer: spend the next 40 days and evenings researching the issue, as many of us have done. That led me to a) the short answer, b) a treatment, and c) peace of mind, but you must do the research to gain (c), IMO. And, oh yeah: dump the burgers and cheesecake or your PC may not have the OPPORTUNITY to kill you. I.P. > I'd be interested to hear the experiences of others who have combined > "active surveillance" (my doc's term for "watchful waiting") with lots of > supplements, changes in diet, etc. Alex, If your goal is to avoid surgery and radiation, then you should check out the paper at: http://www.prostateweb.com/pdfs/ASCO_PCF_02_2005.pdf They list one prostate cancer related death in their study, but that patient actually had ductile adenocarcinoma. Their procedure is so far 100% successful for patients with early stage (T1-T3) primary adenocarcinoma of the prostate. Ed Friedman Thanks to all who left feedback. As I.P. recommends, I have done a lot of self-education and research during the last three months (Strum, Ornish, Hennenfant and Campbell books done, four more on my to-read list, and file folders of articles and web page printouts. I've also learned a lot from this NG and from the PCa e-newsletters I get daily. I.P. believes watchful waiting is for the elderly and frail, and seems to believe that medically mild options such as dietary changes don't really constitute "getting treated." I'm not ready to agree. I think it is reasonable for patients in my situation -- early stage disease, no indication of spread or aggressiveness -- to explore options that are minimally invasive both of our body and our quality of life. As the Orlando study cited below by Ed points out, "evidence that any form of radical local therapy prolongs life is absent," yet all major treatment options are virtually certain to impose serious side effects. One incremental change I've discussed with my doc is the use of Avodart, a relatively benign (small risk of breast enlargement) drug that blocks DHT (which "feeds" PCa) without halting the production of testosterone. If modest steps don't appear to be working, I'm prepared to have my prostate snipped out, nuked or frozen. But I'd prefer to postpone that as long as possible, if there is a realistic hope that (1) the PCa will remain indolent, or (2) researchers will find even better treatments than the ones they can offer us today. Alex >> I'd be interested to hear the experiences of others who have combined >> "active surveillance" (my doc's term for "watchful waiting") with lots of [quoted text clipped - 13 lines] > > Ed Friedman > As the Orlando study cited below by Ed points out, "evidence that any form > of radical local therapy prolongs life is absent," I thought that changed recently, that RP had been determined to prolong life. Did I imagine or misinterpret something? > yet all major treatment options are virtually certain to impose serious > side effects. I've never read anything even close to that. I.P. >> As the Orlando study cited below by Ed points out, "evidence that any >> form of radical local therapy prolongs life is absent," [quoted text clipped - 8 lines] > > I.P. I was quoting from the study Ron had cited. It stated, "Evidence that any form of radical local therapy prolongs life is absent from prospective randomized trials. That such therapy has a serious and often permanent impact on potency, continence, or fecal function has been clearly proven." (The study, by Drs. Tucker, Roundy and Leibowitz, was of the use of triple androgen blockade followed by finasteride maintenance as a way to suppress PCa, treating it as a chronic disease.) Take a look at http://www.hrpca.org/myers425.htm. Speaking to a PCa support group in 2002, Dr. Charles "Snuffy" Myers said, "There seems to be a broad recognition among those doing research in this disease that there are a group of men with Gleason score of 6 or below who have very slowly growing cancers, and if you put them on a low fat diet you slow it down even further, and doubling times of their cancers can go out to 10 or 15 years, and nothing more needs to be done. "Right up front, if you’re newly diagnosed, one of the questions you need to ask yourself, “is that [diet] going to be enough?” I would say to you, no matter what your cancer is, and even if you’re heading for surgery or radiation, any approach that slows the prostate cancer growth down by two thirds isn’t a bad adjunct to the other things you’re doing. Especially since it’s going to improve your general health anyway. "So I would think that this diet and lifestyle choice is something that everyone should adopt if they have prostate cancer, but there’s a subset of people that’s all they’ll need to do." Let me be clear. I am NOT advocating that men turn away from surgery, radiation or other forms of treatment in favor of nuts, grass and chanting. I'm simply saying that for some men, whose PSA and Gleason numbers strongly suggest their cancer is slow-growing, it might make sense to try diet and lifestyle changes as a way to "manage" the disease, at least while they continue to explore their options for more aggressive treatment. Alex > Thanks to all who left feedback. > > One incremental change I've discussed with my doc is the use of Avodart, a > relatively benign (small risk of breast enlargement) drug that blocks DHT > (which "feeds" PCa) without halting the production of testosterone. Alex, If you use Avodart, you should be aware that you should also be avoiding the ingestion of phytoestrogens, e.g. soy and flaxseed. The explanation for this is fairly complex - basically, when you knock out DHT you become dependent on your estrogen receptor-beta to keep your bcl-2 (the protein that protects prostate cancer) levels low. Phytoestrogens, whether they are antagonistic or even partially agonistic to estrogen receptor-beta, will increase your production of bcl-2, which may cause your prostate cancer to grow more rapidly. The biology of this is covered in my paper at: http://www.tbiomed.com/content/2/1/10 Also, you should be aware that Dr. Leibowitz and Dr. Tucker give this advice to all of their patients on Avodart or Proscar (although it is not mentioned in their paper) because they observed rapidly rising PSA in some patients who did ingest these substances, which usually went back down when those substances were eliminated. In my opinion, not controlling their patients' diet is the reason that other researchers can't reproduce the results of Dr. Leibowitz and Dr. Tucker. Ed Friedman >> Thanks to all who left feedback. >> [quoted text clipped - 26 lines] > > Ed Friedman Thanks for the information! Alex Sal Palmetto is the fly in the ointment. As I recall, it can cause an artificial reduction in PSA without reducing PCa.  SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05 PSA .07 .05 .06 .05 .08 non Illegitimi carborundum > I'd be interested to hear the experiences of others who have combined > "active surveillance" (my doc's term for "watchful waiting") with lots of [quoted text clipped - 37 lines] > > Alex > Sal Palmetto is the fly in the ointment. As I recall, it can cause an > artificial reduction in PSA without reducing PCa. I have read this too. There are conflicting opinions about it. In Europe they believe that it reduces prostatitis, and if your prostatitis drops, then the prostatitis contribution to PSA may have dropped, making it appear that the cancer is receding. I suggest the following: 1. Research treatment options so you know which treatment you want and are prepared to move quickly if and when you decide to seek treatment. I have reluctantly concluded that there is no one right answer to what is the best treatment. Surgery and radiation both work most of the time, and both fail some of the time. People argue about which is better and about which options within each treatment is best (retropubic or laparoscopic surgery, external beam or seeds in radiation, permanent low dose or temporary high dose in seeds, or various combinations.) One fellow on this newsgroup argues for hormone therapy as a primary treatment - though that is a minority view. 2. Find a specialist your comfortable with. It's important to find a doctor, maybe a Urologist, maybe a Radiation Oncologist, whom you think is highly qualified and whom you think has your interests at heart. I decided on radiation in part because I liked the rad oncs I met but didn't like the surgeon I was referred to. I'm still glad I didn't let that guy operate on me. 3. If you decide to do WW or AS, emphasize the "Watchful" and "Active". Don't let a year go by between PSA tests. Even 6 months may be more than you want. Talk to your doctor about a good schedule that will catch the cancer while it's treatable even if it starts to grow quickly. As for supplements, I go back and forth between thinking they are life savers and thinking they really don't do anything. My doctor thinks the data is just too skimpy to know, and I think he's right. But certainly a lot of the supplements are clearly harmless and you might as well take them. Tomato juice, for example, is very high in lycopene and I've never heard that anyone died from drinking it. Alan > Tomato juice, for example, is > very high in lycopene and I've never heard that anyone died from > drinking it. And watermelon has 40% more than tomato products. I.P. A legitimate concern. See http://www.priory.com/med/saw.htm . Alex > Sal Palmetto is the fly in the ointment. As I recall, it can cause an > artificial reduction in PSA without reducing PCa. [quoted text clipped - 52 lines] >> >> Alex > Sal Palmetto is the fly in the ointment. As I recall, it can cause an > artificial reduction in PSA without reducing PCa. Finasteride (Proscar), dutasteride (Avodart) and SP block the conversion of T to DHT by interfering with the 5-alpha reductatse pathway. There are two 5AR isoenzymes, finasteride blocks the dominant pathway while dutasteride and SP block both pathways (that's why Avodart is usually somewhat more effective than Proscar in HT). There is still discussion about whether or not SP suppresses PSA secretion (as finasteride does) and leads to artificially low PSA serum readings, but I think many / most now believe that unlike finasteride, SP does not interfere with PSA expression (Int J Cancer. 2005 Mar 20;114(2):190-4; Serenoa repens (Permixon) inhibits the 5alpha-reductase activity of human prostate cancer cell lines without interfering with PSA expression; Habib FK, Ross M, Ho CK, Lyons V, Chapman K.)...Best wishes and good health, Ron >I'd be interested to hear the experiences of others who have combined >"active surveillance" (my doc's term for "watchful waiting") with lots of [quoted text clipped - 15 lines] >also showed an enlarged median lobe and "subclilnicial chronic prostatitis." >Age 61, good health, nonsmoker, 190 lbs, 6 ft. ........... >Any thoughts? > >Alex I would still seek treatment because you can't be sure there isn't something bad growing at or near the margin of the gland, in which case the chance for spread beyond the prostate is greater. I had stats similar to yours: PSA 7, (biopsy: 1 of 12 sticks positive, Gleason 6 (3 + 3). RRP in 8/2003; pathology report was worse, with Gleason 7 (4+ 3), and one positive margin (ironically on the side where all biopsy samples were negative), but with no evidence of spread beyond the capsule. Since the surgery, my PSA has fluctuated between 0.1 and 0.2. I'm all for supplements, healthy diet and lifestyle, however. I do these, myself, in an effort to prevent or forstall recurrence. Dennis >>I'd be interested to hear the experiences of others who have combined >>"active surveillance" (my doc's term for "watchful waiting") with lots of [quoted text clipped - 43 lines] > > Dennis Good advice, Dennis. I am of course regularly seeing my PCa doc, and will be doing a color doppler ultrasound every six month to (literally) keep an eye on things. I don't see supplements and diet as a "cure," but simply as a supportive strategy while I explore the treatment options available to me. Glad to hear your PSA is staying low! Alex |
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