PROSTATE CANCER
How To Make Watchful Waiting Work
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READ THIS FIRST: Recent studies have shown that after lying almost dormant for up to 15 years, an apparently non-aggressive form of Prostate Cancer can flare up and begin to grow aggressively. A sudden change in aggressiveness is revealed by the change in the speed of growth between a man's consecutive PSA readings. The only clue that your Prostate Cancer may have suddenly accelerated its speed of growth is revealed by the speed of growth between two consecutive PSA readings.
Thus it is essential to include a periodic PSA reading, under your doctor's supervision , as an essential part of your "intelligent Watchful Waiting" protocol." All this will become apparent as you read through this report.
And by the way, "intelligent Watchful Waiting" has become an increasingly popular option for treating Prostate Cancer, where it is now often called "Active Therapy," or ""Active Surveillance," or "Self Management." The important thing is not to leave your doctor out of the picture. Otherwise, a mild and medically curable case of Prostate Cancer could quickly become a high-risk case of aggressive and non-curable Prostate Cancer.
iWW -- Intelligent Watchful Waiting
by Doug Kelly M.D.
Except where noted, all the copy in this report was downloaded from the website of Cancer Treatment Centers of America. It is presented for information only in the hope that it may help men prevent Prostate Cancer and to decide on a course of treatment.
Disclaimer: Cancer may spread while on watchful waiting. This page is meant to provide my opinions about watchful waiting; it is not a recommendation. You must make your own decision about whether you feel this is a proper choice for you. - Doug Kelly, MD
Intelligent watchful waiting is an improved version of watchful waiting, which turns it from passively doing nothing to an active treatment.
Watchful Waiting is the term used to describe non-treatment of prostate cancer. The "watchful" part means keeping an eye on the cancer, "waiting" to start treatment at a later date if it is needed. The theory behind this is that prostate cancer tends to grow slowly, and often patients will die from an unrelated condition (like heart disease) before the cancer causes symptoms.
First, the problems with regular watchful waiting
Watchful waiting means different things to different physicians and patients. To many, the term has come to mean little more than avoiding conventional therapy. Some patients choose WW because they are afraid of treatment and the side effects. An encounter with a negative physician can prompt a patient to choose WW rather than seek their recommended treatment. WW also can be a form of denial that a cancer really exists or is a serious threat.
Most patients do absolutely nothing for their prostate cancer while they are on watchful waiting. They continue eating and living the same way they always have, which ultimately allows the prostate cancer to continue growing in the same environment which created it. This is why watchful waiting means doing nothing to most people. For many, it means being passive and hoping that an unrelated condition will cause their death.
The waiting part is also very subjective. Some patients panic at the slightest rise in their PSA and will start conventional therapy. However, PSA measurements can fluctuate up and down by up to 30% from day to day. A rise in PSA from 6.5 to 7.5 can be meaningless. for example. Other patients may be told by their physician that the prostate nodule seems to "feel bigger", and they start treatment. However, digital rectal exams are notoriously inaccurate and subjective. What many patients lack is an accurate sense of their goals while on watchful waiting. They are unsure when they should stop WW and start conventional therapy.
How Intelligent Watchful Waiting is Better
Intelligent watchful waiting is watchful waiting with four important differences, which turn it from passive watching to an active treatment program:
The Natural History of Untreated Prostate Cancer
Prostate cancer will typically go through the following stages, and can be diagnosed at any point in the process.
If you look at the staging systems for prostate cancer, you will see that the stages progress approximately through this list. Many prostate cancers grow slowly, so a patient will frequently die from an unrelated medical condition (like heart disease) before his cancer can pass through all these stages.
Results from Watchful Waiting Studies
First, the Problems with Published Watchful Waiting Studies
From published studies we can estimate the risk of cancer progression for the various stages, the risk of cancer spreading through the body (metastases), and the risk of dying. However, what we do not know from these studies is what these patients odds of progression would have been if they had followed conventional therapies like surgery or radiation. Perhaps there would not have been much difference in outcome. Without randomized studies, where patients are randomly chosen to undergo either watchful waiting or conventional treatment, we cannot really know if patients choosing conventional therapy will do significantly better.
In addition, there are other factors which mean that these WW study results may not be able to be applied to your situation. These factors are:
WW studies are generally from the pre-PSA era, and these patients had more advanced cancers at diagnosis than do today's patients. Today's patients are diagnosed earlier, and probably live significantly longer before their cancers progress.
There are no watchful waiting results available for cancers which cannot be felt on DRE, but rather were diagnosed on the basis of an elevated PSA alone. This represents a large number of today's prostate cancer patients.
These studies used various criteria for stopping watchful waiting and going on conventional therapy, likely different criteria than you will use. For instance, they did not use PSA measurements as a criteria for exiting watchful waiting.
The patients on these WW studies were merely passive participants, who did nothing active such as implimenting optimum diet, supplements, and lifestyle while following WW. Their cancers would be expected to continue relentlessly progressing in the same environment that created them.
In short, the WW studies can only be used as a very rough guide to what can be expected while following an intelligent watchful waiting program. These WW studies are accurate to refer to if:
However, these are not realistic assumptions for most readers of this page.
Swedish Studies
Adolfsson used watchful waiting on 61 patients with stage T1 and T2 patients with moderate or well differentiated tumors (Gleason 2 – 6), who were all diagnosed by either TURP or DRE. This was in the pre-PSA era. He found that the number of patients who had metastases or died of prostate cancer was comparable to the relative numbers reported after radical prostatectomy and radiation therapy. He also reported on a similar group of 50 stage T3 patients (with extracapsular extension) who underwent watchful waiting.
Rates of Cancer Progression of stage T1 – T2 Tumors 5 YEARS..............10 YEARS
Progression to stage T3 49% 72%
Developed Distant Metastases 8% 23%
Died from Prostate Cancer 2% 8%
Rates of Cancer Progression of Stage T3 Tumors 5 YEARS 9 YEARS
Developed Distant Metastases 24% 37%
Died from Prostate Cancer 12% 30%
These studies appear to demonstrate the slow but relentless progression of these patients from stage T1/T2 to T3, to distant metastases, and then ultimately to death.
Advantages and Disadvantages of Intelligent Watchful Waiting
There are some theoretical advantages to choosing iWW over conventional therapies. I say theoretical, because while regular WW has been researched in clinical studies, iWW has not been. As well, there are also some disadvantages of choosing iWW / WW over conventional therapy.
Some Advantages of iWW over conventional therapy
Disadvantages of iWW / WW over conventional therapy
If you are planning on eventually undergoing conventional therapy for cure, as time goes by the chance of cure will gradually decrease.
Who I think are good candidates for iWW
Patients have a right to choose whichever available treatment option is comfortable to them. This includes the right to choose no treatment, to choose an alternative treatment alone, or even to choose a treatment which is thought to be inferior, without being chastised by the medical community. This is especially true in the treatment of localized prostate cancer, where none of the available treatments has been proven better than any other, and where neither radiation nor surgery has been proven to prolong survival. For this reason, I feel that iWW can be an option for any prostate cancer patient to follow if he wishes.
As I will discuss, there are some patients for whom iWW may be a better or worse option. For example, patients with early systemic spread of their cancer to the lymph nodes or a few spots in the bones may be able to improve their length of survival if they start hormone therapy immediately. For these patients, iWW may not be the best option.
To determine if iWW is right for you, you need to analyze how aggressive your cancer is, what your lifespan is, and what your demeanor is.
How Aggressive is Your Cancer?
PSA, Gleason score, and tumor stage are commonly used risk factors to determine how aggressive your cancer is. The less aggressive it is, the less likely the cancer will cause symptoms or spread to other parts of your body during your lifetime. The simplest classification of risk is:
Briefly, stage T1 = not felt on rectal exam nor seen on ultrasound, T2a = nodule felt or seen on one side of prostate gland, T2b = cancer felt or seen on both sides of prostate gland, T3 /T4 = cancer felt or seen extending beyond the prostate into the surrounding tissues.
Patients with intermediate or high risk cancer need to be very cautious about choosing intelligent watchful waiting. Patients with cancer in the lymph nodes or bones will likely do better by starting hormonal therapy, as there are studies that show that you can live longer by starting hormonal therapy sooner rather than later if the cancer has already spread to the lymph nodes or bones.
How Much Longer are you Going to Live?
It has been suggested that the ideal candidates for watchful waiting should have less than 10 years to live. Some studies indicate that prostate cancer which has been left untreated for more than 10 years will tend to have progressed and started causing symptoms and a risk of death. The published watchful waiting studies show that prostate cancer will slowly and relentlessly progress, and if you live long enough you will develop extracapsular extension, then metastases, and possibly eventually death. Of course, by following natural therapies while on iWW, the speed of cancer progression may become much slower, or even be stopped altogether. In that case, perhaps the cancer would take 20 years to spread systemically instead of 10. A second point to consider is that with careful monitoring of the PSA and with well chosen stopping points, you can start conventional therapy at an appropriate point if progression does occur.
Determining if someone has less than 10 years to live can be difficult. Statistically, this probably applies to men older than 70 - 75 years with average health, less than this for men with other significant health problems. Of course, there is no way to accurately predict lifespan for an individual.
Is Your Demeanor Suited to Intelligent Watchful Waiting?
Anyone who wants to follow iWW can, and already has at least some part of their demeanor suited to iWW. However, there are a few beliefs and desires which make someone well suited. Don't worry if you do not have all these beliefs.
The most important factor which distinguishes iWW from WW in this list is the willingness to improve overall health -- to reverse the conditions which lead to the development of prostate cancer in the first place. A second factor is the desire to become more educated about prostate cancer, so that you can better know when to enter and exit iWW, and how to monitor the state of your cancer while you are on iWW.
Following Natural Therapies while on WW
If you do not change your health, your cancer will steadily grow and eventually spread because it is in the same environment which created it in the first place. If you optimize your diet, supplements, and lifestyle, you may be able to reduce your PSA and bring about a stabilization or slowing of your cancer. Our summary of natural therapy is found on another page. Our nutritionists and naturopathic physicians can tailor this to your needs. To summarize, this involves:
Diet
Supplements
Core supplements = vitamin E, selenium, lycopene, omega-3 oil like EPA/DHA, vitamin D or D3, multivitamin, zinc
Other optional supplements.
Lifestyle
When to Stop WW, and How to Monitor the Cancer
Setting Predefined Limits for Exiting iWW
How long should you stay on WW before stopping and going on conventional treatment?
If your PSA increases from 7.0 to 7.5 will you panic, call your physician and schedule your prostatectomy for the following week? Or will you calmly reflect that PSA values can fluctuate up and down, and that it still has a long way to go before reaching the 50% increase to 10.5 which you set as your stopping point?
This is why you need to determine your goals and your stopping points in advance, to help avoid anxiety and uncertainty if your PSA goes up slightly, and to avoid sudden emotional decisions to go with a conventional therapy. You may want to write your stopping points down somewhere, maybe on a computer file. You can always modify them later, after careful thought.
There are several types of exit points which you can use, and it is best to use a combination of them. These possible exit points include PSA changes, local cancer progression in the prostate, and systemic (metastatic) cancer progression.
These exit points are chosen depending upon what your goal is. It is very important to determine what your overall goal is for watchful waiting. Your possible goals may be:
Your goal may be different then this. Whatever it is, write it down. These goals are listed in order of seriousness. Generally, if you choose #2 as your goal, you would probably also want to exit iWW if you experienced #3, #4, #5, or #6.
PSA Changes
The first rule of PSA measurements is that they can fluctuate over a 24 hour period. This fluctuation may be as high as +/- 30%. Two common causes of PSA fluctuation are sexual activity or prostate inflammation. Medically induced causes of PSA fluctuation include digital rectal exams, and prostate ultrasounds and biopsies. Also, PSA measurements done in different labs may also be different. What all this means, is that PSA fluctuations of +/- 30% may be within normal variation.
In order to know if the PSA is truly rising, you can either look for a rise in PSA of 50% above baseline, or look for a definite rising trend, such as three successively higher PSA measurements taken at intervals of at least three months apart. These are my recommendations then, to see if PSA is progressing while on PSA:
The baseline PSA is the last PSA you took prior to starting watchful waiting. If you feel that the reading was artificially high or low (due to daily variability), you can pick one of your earlier PSA's as the baseline.
Dangerous PSA Level
Some patients want to wait until their PSA reaches a "dangerous level" before going on conventional therapy. Some people suggest that a PSA level above 10.0 is associated with a higher chance of the cancer being spreading through the body. Many published studies show that prostate cancers with a PSA above 20.0 have a low chance of cure. Unfortunately, there is no well defined value above which the cancer will metastasize. You may wish to choose a value of 10 or 15.
PSA Doubling Time
This is the number of months it takes for a rising PSA to double in value. For example if on April 1st the PSA was 3.6, and on November 1st the PSA was 7.2, the doubling time would be 7 months.
Because of the day to day variability of PSA values, the PSA doubling time calculation may be inaccurate, and this may not be a good way to monitor your watchful waiting. Generally speaking, the shorter the doubling time, the more aggressive the cancer is. A doubling time of more than 12 months is considered good, and a doubling time of less than 6 months is considered bad.
The formula for calculating DT on a calculator is: DT = (#months between date1 and date 2) * log(2) / log (PSA2 / PSA1) , where PSA1 is the PSA value done on date1, and PSA2 is the PSA value done on a future date, date2. Use an accurate value for the number of months between dates, such as 3.25. Preferably use two dates which are separated by at least 3 months.
Local Tumor progression
Local Progression can be determined by changes in digital rectal exam (DRE), increasing tumor size or stage on MRI or ultrasound, by the appearance or worsening of symptoms, or by changes on a repeat biopsy.
DRE
A digital rectal examination is very subjective. Physicians will have varied skill levels, and there can be differences in opinion about whether there is a nodule present, its size, and whether it extends beyond the prostate. Even with the same physician checking your prostate on a regular basis, he may have difficulties determining if a nodule is getting bigger or smaller unless there are significant changes. The only semi-accurate way to tell if a tumor is enlarging or shrinking is to 1) preferably have the same physician check it regularly, and 2) consider a change in stage as being a significant change. A change in size of the nodule alone should be looked at as a much softer indication. Have your physician tell you what current tumor stage your prostate tumor is at each time he examines you (i.e T1c, T2a, T2b, T3a, etc.), and how large the nodule is.
Tumor Measurements on Ultrasound or MRI
This is a more objective measure way to determine progression than a DRE. If the tumor can be seen clearly on a scan then it can be measured. Each of the three diameters, x, y, and z can be measured in centimeters, and the volume of the tumor nodule (in cubic centimeters) can be estimated by multiplying 0.52 * x * y * z. There can be some slight variations in tumor measurements, and I would consider a 50% increase or decrease in tumor volume as being a significant change. As well, scans can suggest if the tumor is directly against the prostate capsule, is extending through it , or is extending up into a seminal vesicle.
Appearance or Worsening of Prostate Symptoms
Symptoms related to the prostate gland and surrounding tissues can include problems urinating, blood in the urine or semen, pain, and potency problems. These symptoms can be caused by both benign conditions or by tumor growth. The AUA urinary symptom score gives a numeric value of 0 to 35 which indicates the amount of urine obstruction symptoms. It is possible to calculate your AUA score once every several months.
Repeat Biopsies
While I am not a big advocate of repeating biopsies, it is an option for monitoring cancer status while following watchful waiting. The first problem with biopsies is that they are painful, and may cause infections, bleeding, or even nerve damage. As well, biopsies may (rarely) cause cancer cell spread along the biopsy needle tract.
The second problem is that pathology biopsies and reports can be subjective. If a repeat biopsy comes back as "negative" while on WW, this probably does not mean that the cancer was spontaneously cured, but usually means that the biopsies missed the tumor in the prostate gland. Multiple biopsy cores are usually taken of the prostate gland and a certain percentage of the cores will contain cancer. That percentage can go up or down merely by chance, depending on where the needle biopsies cores were taken in the gland. Using this percentage may not be a reliable way to assess if the cancer is progressing.
Another feature reported is the Gleason score, which is a value that ranges from 2 to 10 and indicates how aggressive the cancer looks under the microscope, 2 being the best, 6 being the most common, and 10 being the worst. This is also known as the cancer grade. Pathologists often disagree on the Gleason score of a particular tumor, and different pathologists will frequently label the same tumor different values. To improve accuracy, you can have the same pathologist review the previous pathology slides along with the current biopsy, and have him report whether he thinks the Gleason score (and amount of cancer) has increased or decreased. As well, there can also be some random variation in the grade depending on where the biopsies were taken from in the prostate gland.
For the actual biopsy process, it is best if the urologist or radiologist doing the biopsy takes 6 to 12 cores from the prostate, and puts them in at least 6 separately labeled bottles, which indicate which part of the prostate gland the biopsies came from. The pathologist should do a detailed report. From this information you should be able to determine: 1. The maximum Gleason score obtained in the biopsy. 2. The percentage of biopsy cores which contain cancer. 3. Whether the cancer is on the right, left, or both sides. 3. Any other information you feel is pertinent for monitoring your progress.
Systemic Progression
Checking the Bones
Prostate cancer has an affinity for spreading to the bones. A bonescan is usually the best way for detecting new cancer in the bones, or a progressions of that cancer.
Checking the Lymph Nodes
A CT scan or MRI scan of the pelvis +/- abdomen can be used to see if the lymph nodes are growing in size, which would suggest that cancer is growing in those lymph nodes. These scans will miss small amounts of cancer in the lymph nodes. An MRI of the prostate + pelvis can provide useful information about the tumor size in the prostate, and the status of the pelvic lymph nodes. Alternatively, a Prostascint scan (which takes 5 days to do) can show cancerous lymph nodes throughout the body more accurately than a CT or MRI.
My Recommended Exit Points
If your goal is to remain on iWW for a short time period before seeking conventional therapy
If your goal is to remain on iWW until systemic symptoms appear
This can be risky, and may result in paralysis or death. It is safer and probably better to start hormonal therapy once cancer is found in the lymph nodes or bones.
Stop iWW if increasing pain develops in the legs, hips, back, or other bones which are in the same areas as hot spots on the bonescan.
Tumors in the spine may compress nerves or the spinal cord, resulting in pain, leg weakness, areas of numbness, loss of urinary or bowel control, or even paralysis.
If there is cancer in the spine while following watchful waiting, you should do an MRI of the spine every 3 months to reduce the chance of spinal cord compression and paralysis.
Swelling (edema) developing in the legs may indicate lymph node enlargement in the pelvis.
If your goal is to remain on iWW until health is in jeopardy
This is a risky approach which may result in paralysis or death. If there is cancer in the spine, you should do an MRI of the spine every 3 months to reduce the chance of spinal cord compression and paralysis.
Summary
When to Enter iWW
Anyone is free to choose iWW, but it is a better idea for some
Usually localized cancer
Also useful for PSA or prostate recurrences after previous therapy
Best for Gleason 2 - 6 / low risk localized prostate cancer
Best if age is 70 or more, but can be done when younger.
What to do While on iWW
Optimize diet, supplements, and lifestyle. Reverse the environment that created the cancer.
PSA every 3 months
Follow-up appointment with DRE every 6 months
Bonescan every 6 months, unless PSA has decreased.
CT scan or MRI of pelvis every 12 months to check for lymph node growth, unless PSA is decreased.
Objective prostate tumor measurement every 6 – 12 months with ultrasound or MRI
When to Exit iWW and seek conventional therapy
PSA reaches a pre-determined point, such as a 50% increase over the original baseline value, or PSA has reached a "dangerous" level of 10, 15, or 20
PSA doubling time becomes shorter than 6 months.
Bone metastases become visible (or worsen)
Lymph node metastases become visible (or worsen)
Urinary symptoms worsen significantly along with a rising PSA or worsening DRE
Prostate tumor stage worsens (subjective)
Prostate tumor measurements increase in volume by 50% over baseline.
A Summary of Dr. Doug Kelly's Recommendations
Prostate cancer is a modern disease, much more common now than it was 50 years ago, and largely caused by what we eat, and how we live. By optimizing health, and reversing the conditions which lead to the development of prostate cancer, we would expect to at least see a slowing of the cancer, and improved cancer control.
Everybody with prostate cancer can follow this plan, with individual modifications. Sometimes it can be followed on its own in a watchful waiting program, but more often it would be employed along with standard treatments to maximize the effectiveness of the conventional therapy. It can also be used if a conventional treatment did not cure or control the cancer. Patients who are malnourished, or have a reduced appetite and weight loss should not follow this exact plan. They need a diet with more emphasis on extra calories and protein.
Dietary Recommendations
Eat more natural foods, such as fruits, vegetables, whole grains, and legumes (beans). The closer a food is to its natural state, the healthier it is for you. Avoid heavily processed foods.
Every day, aim for 5 - 10 or more servings of vegetables, three servings of fruit, and two or more servings of legumes (beans) including tofu or other soy products. Fruit is great in the morning or as a snack, and vegetables should be eaten as a major component of lunch and dinner, or even as a snack.
Eat a moderately reduced fat diet. Avoid adding butter, margarine, oils, or other fats to your food, except small quantities of olive oil or cold-pressed sesame oil. Eliminate trans-fatty acids and hydrogenated oils, such as are found in margarine. Many vegetable oils like corn oil and saturated animal fats can worsen prostate cancer. Omega-3 oils found in some fish and flax seed may be beneficial.
Reduce the amount of sugar. Avoid cakes, donuts, candy bars, sodas, and other "simple carbohydrate" sweet foods. Sugar is one of the preferred fuels of cancer cells.
Reduce the amount of refined white wheat and other refined carbohydrates. These are quickly converted to sugar in the body, and wheat may also be a source of food allergies.
Avoid dairy products. Dairy fat is very bad for prostate cancer. Fat free dairy products may be fine for some, but can be harmful to those with dairy allergies, and possibly may increase IGF-1 levels, which is bad for prostate cancer.
Reduce (or even eliminate) the meat in your diet. Instead of eating meat 10 - 20 times per week, eat meat 0 - 7 times per week. Eat smaller portions. Organic free-range lean meat is the best, to avoid unhealthy fat, steroids, and pesticides, but it is also expensive and harder to find. Try soy based meat substitutes. A vegetarian diet is a healthy option.
Fish can be healthy, especially cold-water dark-fleshed fish like tuna, salmon, mackeral, and pickerel. Soy and fish are good sources of protein.
Reduce your intake of egg yolks because of the saturated fat. If you do eat eggs, free range organic eggs are best.
Eat lots of cooked tomato products. The lycopenes in tomatoes are proven prostate cancer fighters.
Beverages: avoid soda pop, diet or regular. Diluted real fruit juice is okay, but you should not exceed 2 glasses per day because of the natural sugar content. Several glasses a day of purified or filtered water is always the best option. Organic coffee in moderation appears to be okay. Green tea is a great drink for its anticancer and antioxidant effects. Reduce alcohol intake to 0 - 2 drinks per day, preferably red wine which is the healthiest form of alcohol.
Eat soy. Soy contains cancer fighting isoflavones like genistein, and is a great source of vegetarian protein. Eat soy based veggie burgers, hot dogs, and fake ground meat instead of the real thing. Blend soy protein powder with fruit, juice or fat free yogurt, and ice for breakfast or snack. You can also add soy protein powder to hot cereals such as oatmeal. Experiment with stir-frying firm tofu. Use soft silken tofu in sauces and dips.
If you are overweight, consider restricting daily your calorie intake to 1750 - 2200 calories. Moderate calorie restriction can have several health benefits.
Some will benefit from avoiding certain foods based on other individual factors such as food allergies.
Supplements
Some of these listed supplements can have side effects, and the exact list of supplements and dosages should be tailored to your individual needs and biochemistry by a skilled practitioner.
Our seven core prostate cancer supplements:
Talk to your practitioner about taking some of these optional supplements:
Modified Citrus Pectin (MCP). Helps prevent metastasis of prostate cancer cells.
Melatonin at night. Stimulates immune system, antioxidant, can reverse hormone resistance. Also helps sleep.
Soy extract or genistein if you are not getting enough soy in your diet
An immune stimulant such as MGN-3, IP-6, Arabinogalactans, Maitake mushroom, or Astralagus.
Vitamin C. Anti-oxidant
Mixed carotenoids
Saw Palmetto. A weak natural hormone therapy that was recently found worthless by Worst Pills, Best Pills, However, many men report it may help urine flow. Avoid taking if you are on Proscar.
Reduced Glutathione (Recancostat) is a powerful antioxidant
Green tea extract tablets
Do not take the following drugs or supplements which may worsen prostate cancer: DHEA, testosterone injections, androstenedione, growth hormone, and anabolic steroids. Antihistamines may worsen urination (there are natural antihistamines if needed).
Lifestyle Changes
Exercise at least 3 times a week for at least 20 - 30 minutes at a time. Briskly walking 2 miles four times per week would be an example. Exercise stimulates the immune system, strengthens the cardiovascular system and helps you maintain a good weight which is beneficial for your overall health.
If you are overweight, strive to reach your optimal weight through healthy eating and exercise.
If you smoke, you should quit because your immune system will not work optimally while you continue smoking.
Reduce your stress. Practice relaxation techniques and limit your caffeine intake. Stress will suppress your immune system.
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Comments on above program by Norman D. Ford, Health Reporter.
These comments are for information only and are not intended as medical advice. For advice about medical treatment, consult your physician.
While Dr. Doug Kelly's reports on Intelligent Watchful Waiting were probably written a few years ago, the advice is still the best we've seen. Except for a few improved tests and new drugs, it is still very relevent today.
Reading through it, one can't help but conclude that men who follow the Live To Be 90 Lifestyle Plan or the Adventist Lifestyle endorsed by this website, have a significantly lower risk of ever developing Prostate Cancer (henceforth abbreviated to PC). And for any man who suspects he may have PC or is diagnosed, a changeover to one or other of these healthful lifestyles should be a top priority (with his doctor's permission of course--this, despite that the nutritional knowledge of most doctors is pathetic).
Among our files are scores of recent reports on PC studies that support the concept of Intelligent Watchful Waiting. The concensus of most is that most men over 75 do have clinically insignificant nests of PC cells, they are either inactive or growing so slowly that most of the men will die of something else.
Most cases of PC are diagnosed at around age 72. Putting it all together, it seems clear that most PC is caused by our affluent and health-destroying western way of living and eating which leads to a deficiency of Vitamin D. And that by adopting a healthier diet and way of life, many men--70 or older with early-stage PC that appears slow-growing--have a good chance of slowing tumor growth by adopting the Intelligent Watchful Waiting program.
Regarding Dr. Kelly's Recommendations
Other researchers suspect the calcium content of dairy products. More likely, it is because the calcium sops up the body's reserves of Vitamin-D3. Vitamin D3, obtainable either from sun exposure or from D3 supplements, is actually a mild steroid hormone and is being increasingly identified as a PC fighter. (see report,"Strategy for Strong Bones" on home page menu.). Tip: be sure your Vitamin D3 does not contain Vitamin A and is not made from fish oil but is a synthetic pharmaceutical grade consisting 100% of cholecalciferol. Such D3 tablets are manufactured by Life Extension and Source Naturals, among others and are quite cheap.
Instead of dairy products, older men could take around 1,500 mgs daily of supplementary calcium carbonate, available cheaply in supermarkets and discount pharmacies, plus 4,000 I.U. of Vitamin D3 (as described above) per day. It's cheaper to buy D3 in 1,000 I.U. capsules and take one on each of 5 days per week. (Also see new info on Vitamin D3 in Reports #3 and #4 under heading "Six New Bombshell Reports" lower down on this page) However, consult your doctor first.
For best results, make as many of the recommended Nutrition and Lifestyle changes as you possibly can. A half-hearted attempt at Intelligent Watchful Waiting has less chance of success.
In conclusion: through preventing or slowing the growth of PC, Intelligent Watchful Waiting might help many older men outlive their personal life expectancy. For best results, blend Intelligent Watchful Waiting with the Number One Healthy Lifestyle Plan
A Brief Update: researchers at Texas A&M University have long recognized that humble vegetables like broccoli, cabbage, turnips and mustard greens may help prevent some common cancers. In early 2004, they reported that lab tests on animals showed that analogs of a natural compound derived from these and similar vegetables literally stopped the growth of breast, pancreatic, colon, bladder and ovarian cancer with minimal or no side effects. While no actual tests were made on Prostate Cancer, it seems likely that these same vegetable compounds might well be equally effective against PC tumors. Meanwhile, it would seem prudent to keep on eating lots of fresh vegetables--especially those with deep, rich colors--like broccoli, brussel sprouts, turnips, carrots, winter squash and onions every day.
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REPORT ONE: A study by Johns Hopkins University School of Medicine researchers recently confirmed key aspects of "How To Make Watchful Waiting Work."
The study concluded that inflammation has been clearly linked to several Cancers, including cancer of the liver and stomach, and that Prostate Cancer may also have its origin in inflammation (or a viral infection).
Abundant evidence exists to support this view. Examinations of prostate cells obtained from biopsies have shown a strong presence of inflamed cells in proximity to cancer cells. And clear signs of prostate inflammation (prostatis) is found in almost all older men in modern western, meat-eating countries, even though actual symptoms may not be evident.
Again, there is clear evidence that inflammation caused by sexually transmitted diseases is strongly associated with increased risk of Prostate Cancer. Finally, clear evidence also exists that anti-inflammatory agents like aspirin or ibuprofen may help prevent Prostate Cancer, especially in older men. (However, these medications have other drawbacks.)
In contrast, it is clearly evident that a diet containing an abundance of anti-oxidant-rich fruits and vegetables--like broccoli, cauliflower, green onions, tomatoes and garlic--are highly protective against Prostate Cancer. Other anti-oxidants like selenium and the gamma-tocopherol variety of Vitamin E also appear to contain anti-oxidants believed to help prevent Prostate Cancer.
It was also found recently that Prostate Cancer is associated with a gene that inhibits production of glutathione S-transferase, one of the body's most important cancer-fighting anti-oxidants.
To prevent or to slow the growth of Prostate Cancer, the study clearly confirms the importance of a diet rich in foods that have a powerful anti- inflammatory effect. The anti-oxidants in many of the plant foods recommended in our How to Make Watchful Waiting work--especially those with deep, richly colored pigments--are believed to inhibit tumor growth.
The John's Hopkins study was authored by Dr. W. G. Nelson and team, and entitled "The Role of Inflammation in the Pathogenesis of Prostate Cancer" Jnl of Urology, Vol 172, Nov 2004, pp S6-S12.
Ford's Comment: Click on to our report "A Primer on Fats. Good Fats! Bad Fats!" . Scroll down to "Omega-6 EFAs" which, when eaten, may become powerful prostaglandins that promote inflammation. . .and you'll find much more on how inflammation is caused by foods and by fats that promote Free Radicals.
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By Maryann Napoli © 2004 Center for Medical Consumers
A long-term Swedish study noteworthy for the fact that all the participants had early prostate cancer that remained untreated unless they experienced symptoms (watchful waiting) recently published 21-year follow-up results. Here’s what it found: 223 men with prostate cancer participated in this study; only 35 died of prostate cancer within the 21-year study period; 23 are still alive; and the rest died of other causes. Most were in their 60s and 70s when they were first diagnosed.
The study, headed by Jan-Erik Johansson, MD, of Orebro University Hospital in Sweden, is one of the longest follow-ups of untreated men. Its results have been published periodically in the Journal of the American Medical Association, most recently in the June 9, 2004 issue. 25 of the 35 men who died of prostate cancer did so within the first 15 years of the study.
The latest findings from the Swedish study make it hard to justify the immediate treatment upon diagnosis of all symptomless elderly men. In fact, the results make it hard to defend the current practice of recommending the prostate specific antigen (PSA) screening blood test to elderly men, given the overwhelming odds that they are more likely to die of something other than prostate cancer. Of the 28 Swedish men who were over the age of 80 years at diagnosis, 27 died of other causes. On the other hand, men diagnosed in their 60s or younger might opt for immediate treatment, according to the Swedish investigators.
Still No Accurate Test
Quite apart from age, the decision to treat or not to treat early-stage prostate cancer is made difficult by the fact that no test can accurately distinguish the small number of prostate cancers that will become rapidly fatal. This study, however, provides a hint in that direction. It confirmed earlier research showing that men with grade 3 tumors (poorly differentiated cells) are more likely to die of prostate cancer.
Quality-of-Life Considerations
Dr. Johansson and colleagues raised an interesting point about immediate treatment vs. treatment only if symptoms appear, stating that prolonged survival is not the only consideration. Quality of life is also an important issue. A radical prostatectomy (surgical removal of the prostate) was the usual immediate treatment in the era when the Swedish study began. And it remains the most common treatment today. But the treatments that await the men whose disease progresses are estrogen therapy or surgical removal of the testicles (orchidectomy). Both treatments can “create substantial suffering,” according to the Swedish investigators.
Of course, the radical prostatectomy can also cause substantial suffering because urinary incontinence and impotence are the known complications for a sizable minority. However, in an entirely different study co-authored by Dr. Johansson in 2002*, the men who had been treated with radical prostatectomy were surprisingly tolerant of these side effects. Their self-reported well-being was no different, after four years of follow-up, from the men in the watchful waiting group.
Significantly, the study of untreated Swedish men began before the introduction of the PSA screening blood test for early prostate cancer. The men had been diagnosed incidentally when prostatic tissue was removed during surgery for an enlarged prostate. Or, their tumors had become large enough to be found during a rectal examination. The tumors in the Swedish study were, therefore, larger than those currently detected in the U.S. where prostate cancer is usually found as a result of widespread PSA testing. Smaller cancers, detected by screening, are even more likely to remain dormant than those in the Swedish study.
What’s the bottom line for these 223 untreated men? How many would have had their lives prolonged had they been given immediate prostatectomy and how many would have—in today’s world of prostate cancer care—been treated unnecessarily? Here’s a summary:
Bottom Line: Men over the age of 70 years should consider refusing to undergo a PSA blood test when no prostate cancer symptoms are present.
Norman Ford's Comment: This is the first study ever to trace the cause of death in a group of 223 men with untreated early stage Prostate Cancer. Thus it may update the mortality rates in Dr. Kelly's IWW report and demonstrate a new, lower death rate from untreated early stage Prostate Cancer than was previously assumed.
Based on the new Swedish research, the average risk of dying during any one year of the study appears to be .7%. One can only speculate what the rate might have been had the participants practiced IWW and our Live To Be 90 Lifestyle Plan. But an educated guess might suggest that the annual mortality rate for men in the study could well have dropped to only .5%--or roughly the same as the average annual death rate for men without Prostate Cancer.
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REPORT NUMBER THREE, From Newsweek Magazine, January 17, 2005
A Neglected Nutrient: Are Americans
dying from a lack of vitamin D?
By Joan Raymond and Jerry Adler
Of all the medical orthodoxies of recent years, few were as ironclad as the prohibition against sunbathing. In a triumph of public education, the notion of a "healthy tan" was turned on its head, as conditions ranging from wrinkles to cataracts, immune-system problems and skin cancers, including deadly malignant melanoma, were linked to ultraviolet exposure. But in the last decade or so researchers have begun asking whether something was lost in the process: the often-overlooked substance that occurs naturally in some foods, especially fish, but is most efficiently produced in the body by exposure to sunlight—vitamin D.
It is best known as an essential nutrient for calcium uptake; rickets, a childhood disease that deforms bones, was largely vanquished decades ago by adding vitamin D to milk. But vitamin D may be just as important at the other end of life, where a deficiency has been associated with osteoporosis, rheumatoid arthritis and certain cancers. And studies show that even among otherwise healthy young adults, vitamin D deficiency is endemic—especially in northern latitudes at the end of the winter, when the body has used up what it made and stored during the sunny months. It's a particular problem for dark-skinned Americans, whose protective pigmentation evolved for life near the equator. "I don't like to overstate things," says Dr. Robert Heaney, a vitamin D researcher at Creighton University, "but I think we may find that vitamin D deficiency is a public-health crisis."
The most intriguing findings relate to cancer, a line of research that began 25 years ago with the discovery that colon cancer was twice as common in the Northeast as in the sun belt. There are also hints that vitamin D may help prevent breast, prostate and ovarian cancers by slowing the division of cells. The National Institutes of Health Web site warns that more research is needed to determine whether people with normal vitamin D levels can protect themselves by taking more, adding that "it is premature to advise anyone to take vitamin D supplements for cancer prevention." But the scientists who actually study the nutrient aren't waiting for more results. "I've been studying D for more than 30 years," says University of Toronto biochemist Reinhold Vieth, "and the remarkable thing is, this actually works. My jaw drops as to why isn't everybody doing this. It drives me nuts."
Vitamin D also seems to play a role in autoimmune diseases, including multiple sclerosis—which, like colon cancer, is more common at higher latitudes. A large study of women nurses found that those who took multivitamins including D lowered their risk of MS by 40 percent. And the Iowa Women's Health Study of nearly 30,000 women in their 50s and 60s found that rheumatoid arthritis, another autoimmune condition, went down as dietary vitamin D increased. Unsurprisingly, vitamin D seems to protect against osteoporosis and osteomalacia, a related condition that can cause chronic pain throughout the body. And Vieth's research even suggests that vitamin D can improve mood and may help relieve symptoms of depression.
His prescription, which is echoed by many other researchers, is for a substantial increase in the amount of Vitamin D most of us get: 1,000 international units a day, or five times the recommended dietary (or daily) allowance. (The RDA for adults older than 50 is higher.) Vitamin D at those levels is safe, readily available and relatively inexpensive. Even cheaper, of course, is sunlight, which is why Dr. Michael Holick, director of the Vitamin D, Skin and Bone Research Laboratory at Boston University, recently wrote a book promoting the health benefits of moderate sun exposure—a position that led to his resignation from the dermatology department. "Yes, a few people have called me nuts," Holick admits. "But every tissue and cell in the body requires vitamin D, and most of the population is at risk for deficiency. It has enormous consequences for overall health."
New findings are showing that almost all Americans are deficient in Vitamin D and that inadequate Vitamin D levels can increase the risk of most Cancers, including PC, by around 30%. For the latest info on Vitamin D, click on The Vitamin D Council website (www.cholecalciferol-council.com)--STRONGLY RECOMMENDED!!!
© 2005 Newsweek, Inc. Reproduced here under the Fair Use provision of the Copyright Act.. File will be removed on request.
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By MARILYNN MARCHIONE, AP Medical Writer
ORLANDO, Fla, Feb 18, 2005.. - Getting a little sunshine may be one way for men to cut their risk of prostate cancer. A large study presented at a cancer conference on February 17, 2005 found that men with higher levels of vitamin D in their blood were half as likely to develop aggressive forms of the disease than those with lower amounts.
Doctors are not ready to recommend the "sunshine vitamin" without more study, but many see little harm in getting the 15 minutes a day that the body needs to make enough of this nutrient.
"When you were little and your mother said, `Go outside and play,' it wasn't just to get you out of her hair," but may have been instinctive advice about something good for health, said Dr. Eric Klein, a prostate cancer specialist from the Cleveland Clinic.
He had no role in the research, which involved nearly 15,000 men in the Physicians' Health Study at Brigham and Women's Hospital and Harvard Medical School (news - web sites) in Boston. Five years ago, this study found that men who consumed a lot of calcium had modestly higher rates of prostate cancer.
The new findings fit with that notion, because too much calcium lowers vitamin D, and are especially believable because researchers got them by measuring blood samples rather than relying on what men said they ate — an imprecision that has hurt past studies of food and cancer risk.
Blood samples were taken in 1982, when the study began. Eighteen years later, 1,082 of the men had developed prostate cancer. Their levels of two common forms of vitamin D in the stored blood samples were compared with those of 1,701 men in the study who did not get cancer. (Our comment: we believe the Vitamin D forms are calcidiol and calcitriol.)
Levels of one or the other vitamin D derivative did not make much difference in prostate cancer risk. However, men with higher levels of both had roughly half the risk of developing aggressive tumors — the kind most likely to kill — than men with lower levels, said Dr. Haojie Li, who led the study.
That is in keeping with what previous studies have shown about prostate cancer, Klein noted.
Men in northern latitudes have higher cancer death rates, and vitamin D levels are lower in older men, who are most prone to prostate cancer.
Melanin, which gives skin its color, blocks ultraviolet light that spurs vitamin D production. Blacks, who have a lot of melanin, also have the highest rates of prostate cancer.
Experiments also suggest vitamin D inhibits cell growth. "So there is some lab evidence that vitamin D may be anti-cancer," Klein said.
It could be that the risk comes from too little vitamin D, and that consuming lots of vitamin D is not helpful, doctors say.
How much should people get? The recommended daily amount is 400 international units, but most scientists think that is probably low, Li said.
Most milk is fortified with vitamin D, but drinking a lot of it might raise the risk of prostate cancer because of its calcium content. Getting enough vitamin D from food is difficult, but doctors do not recommend supplements because they can cause unsafe levels of calcium to build up.
"If you start overloading on vitamin D you're going to cause other problems," said Dr. Durado Brooks, chief of prostate cancer research at the American Cancer Society (news - web sites).
Hence the advice to get a little sunlight — but not too much, because that can raise the risk of skin cancer.
Researchers presented two other studies from the same group of 15,000 doctors. One found that men who were overweight were 30 percent more likely to die of prostate cancer than normal-weight men. Those who were obese were nearly twice as likely to die.
The second study examined a protein in the blood, acid-labile subunit or ALS, that blocks the effects of a hormone that spurs cells to grow and has been linked to many types of cancer.
Compared with men with low levels of ALS, men with higher amounts of it were 40 percent to 60 percent more likely to develop prostate cancer, and their chances of having advanced cancer more than doubled, said Lorelei Mucci, a Harvard epidemiologist who led the study.
ALS needs more study, but may be a new marker for predicting cancer risk and may be a target for developing new treatments, Klein said.
Copyright © 2005 The Associated Press and downloaded from Yahoo News as a public service under the Fair Use provision of the U.S. Copyright Law. File will be removed on request.
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REPORT NUMBER FIVE: TWO NEW STUDIES SUPPORT WATCHFUL WAITING FOR LESS AGGRESSIVE TUMORS--According To Tufts University Health And Nutrition Letter, August 2005, Page 8.
Noting that despite the widespread incidence of Prostate Cancer, only one man in 33 actually dies from the disease, the Tufts Newsletter quoted the two following Shockwave Studies in support of Watchful Waiting as a valid choice for men over 65 with low-grade Prostate Cancer.
The first study focuses on the specific benefits of a regular and active daily exercise program, which is an integral part of the Intelligent Watchful Waiting Program described on this website.
The study, conducted on 48,000 men in the health professions over a 14-year period by lead author Edward Giovannucci, M. D., Sc D, professor of medicine and nutrition at Harvard University, found that study participants aged 65 and over who engaged in an active and vigorous aerobic exercise program for at least 3 hours weekly during the study, had a 70 percent lower risk of developing advanced or fatal Prostate Cancer.
Aerobic exercise includes walking, jogging. bicycling, swimming, rowing, playing racket sports or doing brisk calisthenics. During the study, 2,892 men developed Prostate Cancer, including 482 advanced cases. No association was found between exercise and reduced risk in men under 65.
Commented Dr. Giovannucci, " Although the mechanisms are not fully understood, the findings suggest that regular vigorous physical activity could slow the progress of Prostate Cancer and might be recommended to reduce mortality from Prostate Cancer, particularly given the documented benefits of exercise."
The study was published in a 2005 issue of "Archives of Internal Medicine."
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The second study, conducted at the University of Connecticut Health Center by Peter Albertson, M. D., M. S., Chief of Urology, spotlighted the difference in outcomes between men with localized, low-grade Prostate Cancer and those with signs of more aggressive tumors.
Results were measured retrospectively over a 24-year follow-up survey of 767 men aged 55-74 diagnosed with Prostate Cancer between 1971 and 1984. Their cancer had not spread beyond the prostate and the men were being treated either with hormone treatment or with Do-Nothing Watchful Waiting. Of the study group, 228 men died from Prostate Cancer, most within 15 years of diagnosis.
But researchers found that almost all deaths were among men with high-grade tumors. Sixty-six percent of these men died during the study period compared with just 7 percent of men with low grade tumors.
The results clearly reinforce the conventional Watchful Waiting approach of little or no treatment for men with less-aggressive Prostate Cancer. Such men may well be able to avoid radiation or surgery, either of which may cause impotence or incontinence.
The study, published in a 2005 issue of Journal of the American Medical Association, emphasizes the importance of medical treatment for men with high-grade tumors. But for the far greater proportion of men with low-grade tumors, Dr. Albertson concluded that his study validates the Swedish Study described above in REPORT NUMBER TWO.
That is, if you survive for 15 years, it's unlikely that the tumor will turn ugly and progress. For men who have chosen to "follow" the low-grade disease protocol, this study reaffirms that their Watchful Waiting choice was probably prudent. The vast majority of men with low-grade Prostate Cancer die of other causes.
While the first study focusing on exercise clearly validates Intelligent Watchful Waiting, it seems equally clear that had Intelligent Watchful Waiting been substituted for Do-Nothing Watchful Waiting in the second study, results might have been greatly improved.
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Working with human Prostate Cancer cells in tissue cultures, researchers at the San Francisco VA Medical Center , led by Millie Hughes-Fulford, Ph. D., found that the Omega-6 fatty acids contained in most cooking oils appear to spur production of a hormone-like molecule (PGE-2) that promotes Prostate Cancer cell growth as well as Colon Cancer tumors and some Breast Cancers.
Results of the study were published in the September 2005 issue of the medical journal Carcinogenesis. (For an explanation of Omega-6 and other fatty acids, go to our report "A Primer on Fats:Good Fats!, Bad Fats!".
Researchers concluded that if you are eating a diet fairly high in Omega- 6 cooking oils, you could be vulnerable not only to Prostate Cancer but also to Colo-rectal Cancer and some Breast Cancers. Surveys show that since World War II, Prostate Cancer has risen in almost direct proportion to sky-rocketting consumption of the Omega-6 oils.
Specifically, Omega-6 oils include Corn, Canola, Soybean, Sunflower and Safflower oils, all commonly used in cooking and baking. Until recently, Canola and Soybean oils were considered less harmful than other cooking oils. But no longer! Canola oil, formerly classified as a fairly harmless mono-unsaturated fatty acid, is now being grouped among the Omega-6 vegetable oils.
And while soybeans and most soy products are considered healthy foods, soybean OIL is not. It is frequently used in baking commercial bread.
The problem is that once exposed to oxygen in the air and then heated, Omega-6 oils become prolific producers of free radicals capable of damaging DNA in human cells to the point where they become cancerous. The problem worsens as these oils are heated and used in frying. Their ability to damage human cells increases exponentially as the temperature of the fat rises above 320 degrees Fahrenheit.
Most deep frying occurs at temperatures above 320 degrees, causing the frying oil to release ever greater numbers of cancer-causing free radicals. But you don't have to eat fried foods to fuel growth of Prostate, Colo-rectal and some Breast Cancers.
Widely-used Omega-6 cooking oils are present in almost all processed foods and baked goods and in many brands of supermarket breads.
The Remedy: Never, Never eat Fried Foods of any type. Try to avoid all processed foods, baked goods, and supermarket breads. And for all non-cooking purposes, try to use Extra-Virgin Olive Oil in place of corn, canola, soybean, safflower and sunflower oils.
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OTHER UPDATES AND REPORTS ON PROSTATE
CANCER RELEASED IN 2004-6
MORE QUESTIONS THAN ANSWERS was the conclusion of a detailed analysis of PC prevention published in the Aug 2004 issue of Nutrition Action (Newsletter for Center for Science in the Public Interest). And a similar in-depth article by Consumer Reports On Health in their Dec 2004 Newsletter, asked PROSTATE CANCER: DO YOU REALLY NEED TO KNOW WHETHER YOU HAVE IT?
Consumers Union found a heated controversy among researchers and a frustrating uncertainty among men about nearly every aspect of PC, which kills more men who don't smoke than any other cancer (almost 30,000 annually). The controversy surrounds the fact that most men develop a small cluster of PC cells in their prostate gland as they age but the cancer usually develops so slowly that, before PC symptoms ever appear, most men die of something else.
Many researchers are concerned that the PSA test, used to identify PC, locates too many of these harmless, slow-growing cancers , leading to numerous biopsies to confirm the existance of PC. All too often, biopsy results confirm that most elevated PSA levels are false alarms-- and biopsies can be an uncomfortable and anxiety-raising procedure typically costing $500- $800.
Moreover, the PSA test not only identifies harmless cancers but also tends to miss some larger tumors. And the older a man's age, the greater the chance that an elevated PSA reading stems from a benign prostate enlargement and not from a significant cancer.
Even the PSA test itself is considered unreliable. In Sept 2004, Thomas Stamey M. D., who pioneered development of the PSA test 20 years earlier, announced that the test should be abandoned because it detects too many small and harmless cancers. Dr. Stamey believes that it should be used only for detecting benign prostate enlargement or keeping track of the rate of growth of cancerous tumors. Today, this is precisely why most urologists continue to use the PSA test--and because the only other test available is a manual digital rectal exam by a urologist.
How Much Needless Treatment Does The PSA Test Cause?
Clearer guidelines, or a new test that indicates the difference between an aggressive, fast- growing PC or the more common, slow-growing harmless variety, is not expected to appear until 2015.
Meanwhile, due to the uncertainty of today's tests, the American Cancer Society and other organizations are advising men to learn all they can about every aspect of PC and treatment. Men with suspected PC should then discuss the pros and cons of various treatments with their doctor and SHOULD MAKE THEIR OWN DECISION AS TO WHICH TYPE OF TREATMENT TO TAKE. Or they may choose to go with Do-Nothing Watchful Waiting or with the obviously more effective Intelligent Watchful Waiting version.
One thing is certain if you go this route!
There will be no mention of IWW as a valid choice for PC treatment. Beyond what you read on this site, no worthwhile studies appear to have been made and most men who choose IWW choose to do so of their own volition.
If you depend on your doctor for advice, the choice of treatment recommended is likely to be External Beam Radiation if your physician is a radiation oncologist, or a Radical Prostatectomy if you consult a urologist-surgeon. Internal Seed Radiation might also be mentioned briefly along with Do-Nothing Watchful Waiting. Such slanted advice fails to provide the full spectrum of pros and cons on which to make an unbiased decision.
You can increase the accuracy of a PSA test by taking a "bound" or "complex" test which measures the ratio of free-to-total PSA. If the ratio is below 20-25 percent, a biopsy may be indicated. Men should also request a digital rectal exam for additional evidence.
Yet the strongest current indicator that you may have an aggressive cancer is the Rate of PSA Rise between two or three PSA tests taken at an interval of at least several months-to-two years apart (and processed at the same lab). A rise of 1.5 points or more over a two year (or perhaps shorter ) period may indicate the presence of an aggressive tumor.
BUT, by adopting the Live To Be 90 Lifestyle Plan with IWW modifications immediately after the first PSA test, a man may very possibly slow the rate of growth of even an aggressive tumor, perhaps to the point where symptoms might never occur. (This statement, however, remains unproven.)
So What Are The Pros And Cons Of Medical Treatments?
Radical Prostatectomy involves surgical removal of the entire prostate. Risk of impotence appears to be about 30% and incontinence 15%. It requires only a short stay in hospital and for younger men, may offer the best evidence for long-term survival.
External Beam Radiation requires daily visits to a radiation center for 7-8 weeks. Signs of recurrence occur in about 15% of cases after 5 years but fewer than 10% of patients die of PC. Risk of impotence seems around 30%, and incontinence 3%, with riak of frequent or painful bowel movements and urination ranging from 2-10%. Impotence may increase over time.
Internal Seed Radiation (Brachytherapy). Most data and results are similar to External Beam Radiation but treatment takes only an hour or so. Reported risk of impotence averages 35%, impotence 10%, frequent or painful urination 26%, or bowel movements 14%.
Do-Nothing Type Watchful Waiting has an average annual mortality rate of 1.25% in any one year but offers freedom from anxiety, incontinence, impotence and problems with urination or bowel movements associated with surgery or radiation. But if PC does metastasize, Hormone Suppression treatment may be necessary with its high risk of impotence and osteoporosis.
Intelligent Watchful Waiting. Little data is available but based on Dr. Kelly's and other reports on this site, the outlook should be significantly more optimistic than for Do-Nothing Watchful Waiting. It's certainly a valid choice for many men over 70. And time may reveal that IWW is the best treatment of all.
Other Recent Prostate Cancer Findings
Several in vitro tests have shown that fish oils--with their Omega-3 and Vitamin D3 content-- help to inhibit the growth and progress of several type of Cancer, especially breast and Prostate Cancer. Meanwhile, other tests have shown that pressed seed oils (sunflower, safflower, corn oil etc) with their Omega-6 poly-unsaturated fatty acids, may help promote the growth of several types of Cancer.
Risk of PC has been found to be 70% greater in men who regularly consume red meat and most cooking oils, including canola oil. These oils are also known as "vegetable oils."
Taking anti-oxidants in supplement form provides much less protection against developing Cancer than does eating fruits, vegetables, nuts, seeds, legumes and whole grains (plus oily fish) which contain a much broader spectrum of anti-oxidants that all work together to prevent Cancer.
Tests so far have failed to prove that soy foods lower PSA levels in either healthy men or cancer patients. In animal studies, however, soy foods--which contain estrogen-like plant steroids called isoflavones--have curbed the growth of PC tumors. Despite this, soy is a healthy substitute for dairy products or meat, provided you eat actual soy products like tofu and not soy bars or soy supplements.
Tomato Sauce and Lycopene. Several recent studies have reported a 20% lower risk of PC in men who eat cooked, not raw tomatoes, such as pasta sauce cooked in olive oil. (Be sure it's "olive oil" and not just "vegetable oil.") Cooking boosts lycopene release from tomatoes. Lycopene is the deep, rich red natural dye that colors tomatoes, red citrus and watermelons when ripe. Like most other natural dyes that color fruits and vegetables, it provides a powerful defense against most forms of Cancer.
Recently, several Cancer experts have cautioned against 1) consuming flaxseed oil supplements; and 2} consuming more than 15 mgs a day of supplemental zinc.
Two even more recent reports, just in, confirm the ability of of Vitamin E and Omega-3 fatty acids to slow the growth and development of Prostate Cancer.
One study, first reported in the Proceedings of the National Academy of Sciences as far back as May 28 2002, describes how researchers at the University of Rochester, N.Y., found that a daily dose of 400 I.U. of Vitamin E appears to inhibit production of androgen receptors in Prostate Cancer cells, thus cutting off supplies of the hormone testosterone that fuels the growth and developments of Prostate Cancer and, very possible also, Prostate Enlargement. Vitamin E is best taken in the form of a single daily supplement of 400 I.U. of Mixed Tocopherols (rather than gamma tocopherols).
The other study confirmed that Omega-6 seed-pressed cooking oils such as corn, soy, canola, sunflower and safflower oils increase the spread of Prostate Cancer into the marrow of skeletal bones. It also confirmed that this metastatis appears to be blocked by Omega-3 fatty acids, suggesting that a diet rich in Omega-3 fatty acids may well inhibit the growth and spread of Prostate cancer, especially in early stage disease. The process occurs at the molecular level when the Omega-3 fats EPA and DHA slow the action of Prostaglandin E-2 which enhances the function of Omega-6 fats.
Omega-3 fatty acids are best obtained by eating low-cost canned sardines packed in water, olive oil or tomato sauce (rather than "Vegetable Oil" which is usually another name for Omega-6 fats).
Not part of the preceding items are the following comments, put together from several medical watchdog websites.
All this appears to have caused a huge decline in surgery and radiation treatment for Prostate Cancer, and many urologists are feeling the economic pinch. To restore their declining revenue, some urologists are reported to have suggested lowering the cut-off point at which a biopsy is performed from 4.1 to 2.6 ng/ml. This below-the-belt blow--manipulating levels to create new disease where there was none before-- has been tried in several major medical fields to rake in more patients and sell more drugs, particularly with high blood pressure and cholesterol levels. It could have added millions more men to the biopsy list and led to hundreds of thousands more prostatectomies and radiation treatments for tiny tumors, the majority of which would have been unnecesary.
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From Health News Digest 03-24-04
Men, if you want to help protect yourself from prostate cancer, lighten up on red meat and dairy products. These foods significantly increase a man's risk of getting the disease, which is the second most common cause of death from cancer for American men.
That's the word from William B. Grant, a researcher with the Physicians Committee for Responsible Medicine, who did a statistical analysis of diets and prostate cancer rates in 32 countries.
Here's the good news: Some vegetables, especially onions, leeks, and garlic, may help prevent prostate cancer when eaten daily. That's right, an onion a day may keep prostate cancer away. Other foods that are beneficial are cereals, grains, beans, and fruit. In addition, moderate exposure to the sun's ultraviolet-B rays is helpful.
Using cancer mortality data from the World Health Organization and dietary information from the Food and Agriculture Organization, Grant determined that the prostate cancer death rate is five times higher in the United States and in northern European countries where meat and dairy products are a major part of the diet than it is in Hong Kong, Iran, Japan, and Turkey, where diets consist primarily of vegetables, grains, and cereals, beans, and fruits.
"It is alarming. My analysis clearly shows that in countries where meat and dairy consumption are high, so are prostate cancer death rates," lead study author Grant told Health News Digest. "Countries with lower consumption of animal-based products show reduced rates of prostate cancer." Previous research has shown that animal fat and proteins can be high-risk factors for breast cancer and colon and rectal cancer.
The study findings were published in the European medical journal Urology.
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Click here to read an authoritative report on PROSTATE CANCER PREVENTION (and many other PC reports) from the database of International Health News
Click here to read the splendid new International Health News Prostate Series by Canadian Nutritionist Hans Larsen and William R. Ware, Ph.D.,Emeritus Professor of Chemistry, University of Western Ontario (www.yourhealthbase.com). Though occasionally technical in parts, these RESEARCH REPORTS are MUST reading for any man with symptoms of--or an interest in--Prostatis, Benign Prostate Hyperplasia (Enlarged Prostate) or Prostate Cancer.
A new report is currently being posted as the last item in the monthly International Health Newsletter and a fresh report will continue to appear until the entire series has been published. Click on the "Archives" Button on left side of home page to access past issues.
The reports published so far (October 2005) are as follows:-
International Health Newsletter #158, June 2005. Research Report = The Prostate: Small Gland, Big Problems by Hans R. Larsen, M. Sc., ChE.
International Health Newsletter #159, July-Aug 2005. Research Report = Benign Prostate Hyperplasia (Prostate Enlargement): a Not-so-Benign Condition. Part I--Causes, Diagnosis and Prevention. By Dr. Ware.
International Health Newsletter #160, Sept 2005. Research Report = Benign Prostate Hyperplasia--a Not-so-Benign Condition. Part II--Conventional and Alternative Treatment. By Dr. Ware.
International Health Newsletter #161, Oct 2005. Research Report = Diagnosis and Staging of Prostate Cancer. Part I--The PSA and DRE Tests. By Dr. Ware.
International Health Newsletter #168, June 2006. Research Report = Prostate Cancer: To Accept or Reject Treatment, or Compromise--Part I, by William R. Ware Ph. D., University of Western Ontario.
International Health Newsletter #169, July-Aug 2006. Research Report = Prostate Cancer: To Accept or Reject Treatment, or Compromise--Part II. by William R. Ware, Ph. D., University of Western Ontario.
These reports are now available in book form which can be downloaded into your computer.
This website is still under construction and we hope soon to post results of many more studies supporting the role of Intelligent Watchful Waiting, and the Live To Be 90 Lifestyle Plan plus the Adventist Lifestyle, in preventing PC and slowing its growth in older men.
Meanwhile, if you skipped this caveat, be sure to read it now. Recent studies have shown that, after lying almost dormant for up to 15 years or more, an apparently non-aggressive form of PC can flare up and begin to grow aggressively. A sudden change in aggressiveness is revealed by the speed of growth between a man's consecutive PSA readings. The only clue that your PC may have suddenly accelerated its speed of growth is revealed by a spurt in the speed of growth between two consecutive PSA readings.
For this reason, it is essential to include a periodic PSA reading , under your doctor's supervision, as an essential part of your "intelligent Watchful Waiting" protocol. All this will become clear as you read through this report.
And by the way, "intelligent Watchful Waiting" has become an increasingly popular option for treating PC and it is now often called Active Therapy, or Active Surveillance or Self Management. The important thing is not to leave your doctor out of the picture. Otherwise, a mild and medically-curable case of PC could quickly became a high-risk case of aggressive and non-curable PC.
CAUTION: Though these reports are based on documented studies in professional journals or on advisories from leading university medical schools and research institutes, they are intended for information only and should not be regarded as medical advice or instruction. For diagnosis and treatment of specific symptoms and diseases, disorders or dysfunctions, consult your physician. If you smoke or are over 35 or have symptoms of--or are at risk for--any chronic or degenerative disease, you should check with your doctor before beginning to exercise or making any changes in lifestyle or diet. However, fitness organizations like the American College of Sports Medicine invariably believe that the risk of NOT exercising far exceeds any risk in beginning a gradually increasing program of daily exercise. Thus if you experience any pain or problem while exercising, or making any other lifestyle change, stop and see your doctor at once.