Michael Schachter MD FACAMThe complementary approach to the management and treatment of prostate cancer is quite different from the conventional approach and perhaps more beneficial for some patients. In this article I will discuss the prostate gland, describe the nature of prostate cancer including how it is diagnosed and classified, discuss conventional treatment approaches and the controversies associated with the conventional treatments, and finally, outline some alternative treatments we utilize.
Before beginning this outline, let me first give you my conclusion. All prostate cancer patients should use alternative cancer therapies. In general, they should be used prior to beginning conventional treatment. When the prostate cancer patient is receiving conventional treatment, he should also incorporate alternative therapies in order to reduce the side effects of conventional treatment, improve the results, and possibly allow the patient to be able to discontinue the conventional treatments.
The prostate gland-that’s prostate, not prostrate, is found only in males and is normally about the size of a walnut in men. It is located below the bladder and in front of the rectum. Urine formed in the kidneys passes to the bladder in tubelike structures called ureters. From the bladder, urine passes to the outside through another tubelike structure called the urethra. The urethra passes through the middle of the prostate and the part of the urethra located in the prostate is called the prostatic urethra. When a portion of the prostate enlarges, it may impinge upon the flow of urine. This condition when it is benign, that is not cancerous, is called BPH or benign prostatic hyperplasia. The other major conditions involving the prostate are prostatitis and prostate cancer, which will be the subject of this series.
Just how much of a problem is prostate cancer? It is a major health problem for many reasons. The American Cancer Society estimates that in the United States one in six men will eventually be diagnosed with prostate cancer–that’s one in six men. In 1995 in the United States, 244,000 men will be diagnosed and 40,400 will die from the disease, making it the second leading cancer killer in men, behind lung cancer. More men will be diagnosed with prostate cancer than women with breast cancer, although the number of deaths of each will be about the same. Prostate cancer in men is quite analogous to breast cancer in women.
In spite of this high incidence, the problem is even greater because with prostate cancer, one must distinguish between clinical and microscopic cancer. Much of the prostate cancer that occurs in men is never diagnosed because many men with prostate cancer die of other causes, never knowing they ever had it. For example, a recent study involving careful pathological examinations of the prostate glands during the autopsies of men killed in accidents revealed some alarming figures. The incidence of microscopic prostate cancer was 80% in men between the ages 70 and 80 years old, 40% in men between 50 and 60 years old, 34% in men between 40 and 50 years old, and 27% in men between 30 and 40 years old. To me these statistics were truly amazing. Keep in mind, however, that these statistics refer to microscopic prostate cancer and not to clinical prostate cancer, which is diagnosed while the person is alive.
How Does a Doctor Diagnose Prostate Cancer?
Several years ago, the major way of diagnosing relatively early prostate cancer was through a digital rectal examination, in which the physician inserts a gloved finger into the rectum and feels a hard nodule on the prostate. A biopsy of the nodule would confirm the diagnosis. Sometimes the diagnosis would be made of advanced prostate cancer when the patient presented to the doctor with bone pain and further workup revealed that he had prostate cancer with spread to the bone or bone metastases already. Today, however, the diagnosis of prostate cancer is being made much earlier most of the time because of a simple blood test called the prostate specific antigen or PSA. Next week I’ll discuss the pros and cons of the PSA, another procedure called the transrectal ultrasound of the prostate, the pros and cons of biopsy of the prostate and the staging and grading of prostate cancer.
Diagnosis, Staging and Grading of Prostate Cancer
The widespread use of the Prostate Specific Antigen or PSA test has resulted in more frequent and earlier diagnosis of prostate cancer. The PSA is a protein produced by both benign and malignant prostate cells. In general, its value will relate to the presence of prostate disease and to some extent the type of prostate disease. Values of 0 to 4 are considered normal. Values between 4 and 10 are usually BPH or prostatitis, but may also be prostate cancer. Values of 10 to 20 are highly suspicious for cancer and values above 20 are most likely cancer. However, there is tremendous overlap and 30 per cent of prostate cancer patients have normal PSA’s. The presence of an elevated PSA usually results in a urologist recommending a prostate biopsy or series of needle biopsies.
The controversy surrounding routine PSA screening of middle aged or elderly men has to do with what I mentioned previously about the usual course of prostate cancer. Many men die of another disease never knowing they had a prostate problem. If prostate cancer is found in some of these men as a result of an elevated PSA, they may be urged into unnecessary and dangerous treatments that may actually shorten their lives or at least reduce quality of life. If, however, the PSA is used to alert the physician and patient that lifestyle changes and other complementary prevention and treatment steps need to be taken, the PSA can be very useful, in my opinion.
The presence of prostate cancer on biopsy usually results in a search to determine if the cancer is confined to the prostate gland or has spread beyond it. An ultrasound of the prostate gland or other imaging procedures may help to answer this important question. The type of conventional treatment recommended is dependent on the location of the cancer, which is described by the stage of the disease. Prostate cancer has 4 stages. In Stage A, the prostate cancer is confined to the prostate gland and their is no palpable hard swelling on the physician’s digital rectal examination. Stage is A is usually discovered when a biopsy is done because of an elevated PSA, in spite of no prostate nodule on physical examination or when the surgical specimen for BPH turns out to have some cancerous cells. In Stage B, the cancer is also confined to the prostate gland, but there is also a palpable nodule on rectal examination. In Stage C, the cancer has spread beyond the prostate capsule to one or more neighboring structures like the seminal vesicles. Finally, in Stage D, the cancer has spread or metastasized to more distant structures, such as lymph nodes, the bones, the lungs or the liver.
Generally, the more the cancer has spread the worse the prognosis and the less likely the disease will be controlled. In contrast to the staging of the disease, which refers to the location of the cancer, the grading of prostate cancer relates to how the cancer cells look under the microscope. The higher the grade, the more abnormal the appearance of the cells and the more likely a poor prognosis. The conventional treatment for stages A or B is usually either a radical prostatectomy or external beam radiation. These procedures are both highly invasive and result in significant complications and adverse reactions. For stage C or D, the appropriate conventional treatment is some type of anti-hormonal therapy, which reduces the effects of the male hormone testosterone because the removal of the effects of testosterone usually results in improvement of the patient, although this effect is generally only temporary.
Conventional Treatment of Prostate Cancer
As I implied last time, for stages A and B of prostate cancer, when the cancer is confined to the prostate gland, a radical prostatectomy is most often recommended by urologists. This surgery involves the removal of the entire prostate gland and capsule and surrounding structures, such as the seminal vesicles. The surgery results in considerable pain post-operatively, as well as many complications. Most patients will be permanently sexually impotent following the surgery and 5 to 30% will suffer from some degree of urinary incontinence. Recovery time, which is rarely complete, takes at least 6 months.
Although a high cure rate is claimed by the urologists, especially for stage A, the question becomes what would be the survival rate of these patients if they had no procedure whatsoever? The answer is not clear. It is difficult to evaluate the effects of conventional treatment for prostate cancer for the following reasons. 1) It is usually a slow growing disease and therefore it takes many years to evaluate treatment results. 2) The disease is often dormant for years and may never manifest itself during the life of the patient, who may die from an entirely unrelated cause. 3) Today the diagnosis is made more often and earlier because of the PSA test, which was introduced only a few years ago, prostate ultrasound procedures and multiple biopsies. 4) Both radical prostatectomy and external beam radiation, the two most recommended procedures have many side effects and result frequently in a poor quality of life after the procedures. And 5) 25 to 50% of clinically diagnosed stages A, B and C actually turn out to be stage D after the procedure is done. Surgery or radiation are useless for stage D. All of this has led the well known urologist from Sloan-Kettering, Dr. Willet F. Whitmore to ask the question: ” Is cure possible in those for whom it is necessary and is cure necessary in those for whom it is possible?”
External beam radiation is usually recommended for stage A and B when the patient is elderly or frail or would be a poor surgical risk. During and following this treatment at least 30 to 50% of patients experience inflammation of the bladder or rectum with diarrhea and other bowel symptoms, urinary retention and swelling of the penis and scrotum. Long term effects include sexual impotence in 40 to 75 per cent and a continuation of the acute side effects in less than 10 per cent of the patients. The problems with surgery and radiation have led to alternative conventional approaches.
The conventional treatment usually recommended for stage A or B prostate cancer is usually either a radical prostatectomy or external beam radiation. The appropriate conventional treatment for stage C or D is usually an anti-hormonal treatment. As early as 1941, Dr. Huggins found that when the supply of the male hormone testosterone available to the prostate is reduced or eliminated, prostate cancer would regress, often dramatically. This was done either by surgically removing the testes of the patient, which greatly reduced available testosterone, or by giving synthetic estrogen drugs, such as DES. This latter treatment would inhibit the pituitary from secreting hormones necessary for production of testosterone from the testes. Because of the significant cardiovascular side effects associated with synthetic estrogen drugs, new drugs have been developed to accomplish the same thing. The most commonly used in the United States is Lupron or Leuprolide, which is given as a long acting injection once a month.
Although Lupron is effective for reducing testosterone, some testosterone is still present because the adrenal glands produce the hormone DHEA, which can be converted to testosterone. In order to further reduce testosterone effects, another drug is frequently given. This drug is called flutamide or Eulexin. Two capsules are taken orally every 8 hours. This drug prevents testosterone from combining with its protein receptor, thus effectively stopping any residual effect from testosterone on the prostate cancer. This combined treatment is called either the complete hormonal blockade or combined hormonal blockade. It is abbreviated CHB. This method of treatment was championed in the early 1980’s by Dr. Ferdinand LaBrie, a physician in Canada. During the early 80’s I occasionally sent a patient to Canada for this treatment because it wasn’t available in the United States. However, in 1989, the FDA approved the use of this approach here in the United States.
The combined hormonal blockade treatment has a number of side effects, including hot flashes, nausea, anemia, and complete sexual impotency. However, if the treatment is stopped sexual potency may return. The major problem with this treatment is the fact that it is usually temporary. Prostate cancer eventually escapes the inhibition by testosterone deficiency in a few years. When it does, the disease is hard to treat and the patient often does not recover.
Because of the characteristics of prostate cancer that I’ve described previously related to its tendency to be slow growing and often not be fatal as well as the harshness of the available treatments of radical prostatectomy or external beam radiation, some physicians have taken the position that a reasonable alternative to therapy is “watchful waiting.” In other words, once early prostate cancer is diagnosed with a biopsy, rather than operating or giving external beam radiation, the patient is simply followed and observed. Treatment is only given if symptoms develop or if the patient shows evidence of spreading of the cancer. In one study carried out in Sweden, this method was used. The survival rate was no worse than in studies in which prostate cancer patients received immediate treatment.
Another approach, which is generally supported by a prostate cancer support group known as PAACT, is to administer the combined hormonal treatment early to prostate cancer patients in stages A and B, rather than in just C and D. At the end of 6 months to a year, the patient goes off the hormonal therapy and his PSA’s and clinical examination are watched closely. If their is no evidence of cancer, the patient is left alone. If their is evidence of cancer progression, then several options are considered including radical prostatectomy, external beam radiation, brachytherapy, which involves inserting radioactive implants into the prostate, and cryosurgery, a type of freezing of the prostate. Whether or not this approach of using combined hormonal blockade in the early stages of prostate cancer turns out to be useful, remains to be seen.
I give my patients the opportunity to choose a different path to “watchful waiting”. I suggest that they use an elevated PSA or a positive biopsy for prostate cancer as an opportunity to go on an alternative cancer therapy program. The patient is told that something is out of balance in his body and needs to be changed. The nature of prostate cancer, the various tests, the various conventional approaches to prostate cancer and the various options related to alternative cancer therapy for prostate cancer are discussed with him. A variety of videotapes and books are suggested for the patient to review. Then we come to an agreement as to what would be reasonable for him to do.
Alternative Therapy Program for Prostate Cancer
The elements of an alternative cancer therapy are outlined to the patient and include: our avoid list, dietary changes, oral nutritional supplements, possible hormonal balancing, possible intravenous vitamin and mineral drips, an exercise program, fresh air and some sunlight exposure, stress management training if necessary, detoxification, possibly homeopathy, and possibly various other immune enhancing activities, such as chiropractic, massage, acupuncture or dental treatment. Certain medications, such as hydrazine sulfate are considered. If their is evidence the program isn’t working, the combined hormonal blockade therapy may be added to the alternative program. In my patients who have combined the two, the positive effects of the combined program seems to last longer than the conventional combined hormonal blockade alone.
I’ll go into a little more detail on a few of the components. Regarding the avoid list, the patient is asked to reduce or eliminate as much as possible: exposure to tobacco-either active or passive, caffeine, alcohol, refined sugar and starch, hydrogenated fats, impure water-including unfiltered chlorinated or fluoridated water, artificial chemicals including pesticides, preservatives and artificial sweeteners and amalgam mercury fillings.
The dietary program stresses organic whole foods with an emphasis on plants including fresh fruits and vegetables, and whole grains, some nuts and seeds, fresh organic vegetable and fruit juices and modest amounts of animal proteins, including fish, organic eggs and chicken.
Dietary Supplements in the Treatment of Prostate Cancer
The oral supplements include vitamins, minerals, enzymes, essential fatty acids, herbs, amino acids, accessory food factors and special therapeutic foods. The vitamins we emphasize are high doses of vitamin C, antioxidants A and E, vitamin D, the B3 vitamin niacinamide, and modest amounts of other B vitamins. I consider amydalin or Laetrile to fall into the category of B vitamins and recommend it for all cancer patients. It is available in a number of foods and in tablet form from other countries. Patients are usually able to get their own supply.
Although all minerals are important, the mineral supplements we emphasize because of their strong anti-cancer properties are selenium, calcium and magnesium. Modest amounts of zinc are recommended and balanced with copper. A wide range of trace minerals, preferably in colloidal form are also prescribed. Enzymes help to digest food when taken with meals. When ingested in between meals, they have many therapeutic functions including anti-inflammatory activities and anti-cancer activities. They seem to help prevent metastases. Pancreatic enzymes and some plant based enzymes, such as bromelain from pineapple, are used. Enzymes may be given as rectal retention enemas as well.
Oral herbs include the use of a mixture suggested by the late Canadian cancer nurse, Rene Caisse, called Essiac. The brand name that we have been using is FlorEssence. Another herbal mixture we’ve used extensively is a purple mixture called Vitae Elixxir. We try to balance the essential fatty acids with flaxseed oil to increase omega three fatty acids and primrose oil to supply gamma linolenic acid, both of which have strong anti-cancer activities. We also recommend various flavonoids, coenzyme Q10 and pycnogenol. Among the specialized therapeutic foods we consider are: shark or bovine cartilage, soybean preparations, maitake mushrooms and others. Our intravenous programs consist of large doses of vitamin C, minerals, a few other vitamins and amygdalin or Laetrile. Exercise, detoxification and homeopathy are individualized. Next week I’ll conclude this series with a few case histories.
Some Examples of Prostate Cancer Patients Using Alternative Therapies
The first patient CS is using our program along with combined hormonal blockade. He was first seen in our office in Oct 93 at the age of 74 years old. At the end of 1991, a hard prostate nodule was felt on rectal examination. He was given 35 external beam radiation treatments in late ‘91 and early ‘92. However, by Nov 92, his PSA began to rise and biopsy revealed residual cancer in both lobes of the prostate. A CT scan showed enlarged lymph nodes, suggesting CA spread to them. In July 1993, he was started on complete hormonal blockade, after his PSA reached 53. Within a few months, his PSA was down to zero. In Oct ‘93, he started our program, which included amydalin, shark cartilage, coenzyme Q10, vitamin C and other oral nutrients. He also began IV infusions of vitamin C, minerals and amygdalin. Now, two years after starting our program, he feels great and his PSA is normal.
Another patient EH has been receiving our alternative treatment program instead of combined hormonal blockade. Here is his story. He had a nerve-sparing radical prostatectomy for prostate cancer in 1988 and was well until 1993, when his PSA began to rise. He was given external beam radiation–37 treatments, but soon after completion, his PSA began to rise again. Either combined hormonal blockade or removal of his testes was offered as treatment. Instead he chose our program in Oct ‘94 and had felt great since that time. His PSA has decreased and he seems to be stable.
Two other patients LG and SR have chosen our treatment program instead of conventional treatment. They are being monitored closely. SR is a 67 year old married, vigorous, retired letter carrier. In Feb ‘95, he was diagnosed with a stage II prostate cancer. Two urologists recommended a radical prostatectomy. Instead he started an intensive program of amygdalin, FlorEssence, shark cartilage, selenium, Vitamin C, CoQ10, Vitamin E, niacinamide and others. He is also receiving IV infusions of C, minerals and amygdalin. On this program, so far, he appears to be doing great. The same is true for LG, a 60 year old engineer, for whom surgery was recommended, but declined by the patient. He has been on our program since May ‘94 and has had a reduction of symptoms and improvement of his PSA. These are just a few examples of prostate cancer patients who are benefitting from alternative treatments.
Maryon Stewart
Jim Strohecker
Daniel Redwood DC
Tom Ferguson MD