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Life Extension Magazine

Life Extension Magazine December 2013
As We See It  

Prostate Cancer Prevention Controversy

By William Faloon

Overlooking More Efficient Procedures

Overlooking More Efficient Procedures  

In recommending more limited PSA-screening, the American Urological Association is tacitly admitting that conventional diagnostic and early treatment of prostate cancer is so inadequate, or performed so incompetently, that it’s better to wait for full-blown metastatic disease to manifest. Once advanced stage prostate cancer develops, however, treatments are seldom curative.

Instead of looking at physicians who are diagnosing and treating early stage prostate cancer using less invasive procedures and then emulating these skilled artists, the American Urological Association has apparently caved in to accepting and promoting mediocrity within their profession.

A big problem is that most urologists are not properly assessing PSA results, nor are they efficiently implementing further diagnostic and treatment protocols. And on the other end of the spectrum are the many men who are promptly sent for ultrasound-guided biopsies after one PSA elevation. And again, to add insult to injury, the biopsies are often not ones targeted to abnormalities within the prostate but merely targeting the prostate as a gland.

It is one issue to biopsy an ultrasound lesion that may represent the needle in the haystack, but it’s another issue, and a sad one at that, when it is the haystack that is the target. You know that this is the case when a man has had 2, 3, or 4 prostate biopsies showing no cancer cells, and then he is referred, finally, to a competent physician who uses excellent ultrasound equipment to directly target suspicious lesions within the prostate gland.

In these cases, it seems the diagnosis is magically made; but it’s not magic, it is just an issue of a far higher degree of competence. All men are not equal in talent and all equipment is not of the same quality. The unfortunate outcome is that too many aging men are being subjected to needless and incompetently administered invasive procedures that sometimes result in unnecessary suffering and premature death.

Instead of recommending that medical professionals upgrade their evaluation and treatment protocols to deliver state-of-the-art technology, the United States Preventive Services Task Force suggests that aging men not undergo PSA screening at all, while the American Urological Association limits its recommendation for PSA screening mostly to men aged 55-69.1

The media treats these authoritarian groups as being virtually infallible.

Prostate Cancer Not an Isolated Disease

Prostate Cancer Not an Isolated Disease

A common mistake made by doctors and patients is thinking that prostate cancer manifests in isolation from other pathological events occurring as a person ages. This is not the case.

Research shows that other serious pathological conditions are frequently seen in prostate cancer patients.25 These factors involved in prostate malignancy can adversely impact other parts of the body.26

For example, Life Extension has shown one way prostate cancer and coronary atherosclerosis are related is that they are both influenced by the breakdown of bone.27 As an aging man develops osteoporosis, excess calcium released into the blood contributes to arterial calcification.27 What’s lost in the bone ends up in the coronary arteries and other major vessels of the body.27,28

These atherosclerotic lesions are not vascular “calcifications” but bone growth or osteogenesis.28-30 Bone breakdown also releases growth factors into the blood that promote the proliferation of what may have been indolent prostate cancer cells.31 Therefore, it should come as no surprise that nutrients that prevent bone loss such as vitamin K2 also inhibit vascular calcification.32,33

PSA screening thus provides an important clue of a man’s overall health, with the advantage of identifying problems early enough to take effective corrective actions. That’s a LOT of benefit for assessing one’s prostate gland once a year utilizing PSA blood testing.

Where’s the Accountability?

The level of medical competency directly affects the quality and quantity of the lives of others, yet there is not enough monitoring of patient outcomes.

When it comes to treating prostate disease, there needs to be a reporting of serious side effects such as incontinence, impotence, and major blood loss or urethral strictures after a urologist performs a radical prostatectomy.

This kind of accountability is relatively non-existent in today’s bureaucratic medical environment, though the Internet may eventually enable patients to assess the degree of medical competency of a physician they entrust their life to.

What Makes Cancer Cells Propagate?

When designing prevention and treatment strategies, Life Extension focuses on underlying mechanisms of disease that are fueled by specific biological factors in the body. This is not perfect science however because you can block one factor involved in tumor development, and cancer cells will use other growth-promoting vehicles to progress.

What we seek to do is stay two steps ahead of the cancer by cutting off its many growth promoters and pathways used to escape eradication. For instance, we know that dihydrotestosterone (DHT) promotes prostate cell growth (proliferation).34 This growth affects both benign prostate cells as well as cancerous ones. In the context of a man with prostate cancer, a serial rise in PSA is circumstantial evidence that the tumor cell population is increasing. Such an increase in PSA is not only of importance insofar as prompting investigations to rule out prostate cancer. We have evidence that PSA breaks down natural barriers that keep isolated tumor cells confined to regions within the prostate gland. Remember that PSA is aserine protease, an enzyme that breaks down proteins.35 One such containment protein degraded by PSA is the extra-cellular matrix, i.e., the natural barrier that may confine cancer cells within the prostate gland.

But suppressing DHT alone is not a total solution. There are other prostate tumor growth promoters such as insulin,estrogen, prolactin, transforming growth factor beta (TGF-1 and TGF-2), and vascular endothelial growth factor (VEGF) that also should be brought under control.36-42 Fortunately, many of the nutrients Foundation members already take can help suppress growth factors used by prostate cancer cells (and other cancers) to proliferate.43-52

There are other mechanisms involved in the evolution of a prostate tumor such as 5-lipooxygenase (5-LOX)53-55 and cyclooxygenase-2 (COX-2)56 that can be markedly improved by dietary changes, along with curcumin,57,58 fish oil,59-61 boswellia,62 aspirin,63 Zyflamend®,64-68 and prescription COX-2 inhibitors like Celebrex®.69,70

Genetic factors involved in prostate cancer initiation and promotion may be favorably modulated by taking relatively high doses of vitamin D.71,72 Hormonal influences like prolactin and insulin can benefit from using prolactin-suppressing drugs like cabergoline (Dostinex®)73 or Lisuride74 and the insulin-suppressing drug metformin.75-77

The overriding goal in reversing any cancer is to induce favorable changes in the genes that regulate cell proliferation and apoptosis (cell destruction). We know that nutrients like curcumin,78-80 genistein,81-84 fish oil,85,86 and vitamin D87,88 favorably affect genes involved in carcinogenesis, as do drugs like aspirin,89,90 metformin,91-93 finasteride (Proscar®),94 and dutasteride (Avodart®).95

THE WHOLISTIC NATURE OF HEALTH IN RELATION TO PROSTATE CANCER.
THE WHOLISTIC NATURE OF HEALTH IN RELATION TO PROSTATE CANCER.

As we learn more about specific health issues we see evidence of the interconnectivity of all key processes involved in mind and body functions. This should come as no surprise since this phenomenon characterizes all living entities, from the atom to the universe.

Importance of Food Choices

Importance of Food Choices  

What one eats (and doesn’t eat) makes a huge impact on whether prostate cancer ever develops.102,103

Healthier eating patterns also improve the odds of treatment success.104,105

A rising PSA level or prostate cancer diagnosis can be the signal that it’s time to switch what you eat more towards a Mediterranean diet that focuses on fish instead of red meat, whole vegetables instead of glucose-spiking starches/sugars, foods cooked at lower temperatures, and reduced intake of omega-6 fats.106-108

Those who pioneered aggressive dietary changes to help treat cancer were decades ahead of their time. While it’s unlikely that aggressive dietary alterations will cure clinically diagnosed prostate cancer, there are strong mechanistic values to consuming foods/beverages that suppress prostate cancer proliferation (like cruciferous vegetables109-111 and green tea112,113) as opposed to continuing to eat foods that have been related to higher prostate cancer risk such as red meat,114-116 starches and sugars,117,118 excess dairy,115,119-121 and excess omega-6 fats that contribute to a high omega-6: omega-3 ratio.122,123

Vitamin D Decreases Gleason Tumor Score

If a needle biopsy of the prostate detects a malignancy, it will be graded with a Gleason score number as follows:

Under 7 (low-grade): Slow growing and not likely to be aggressive.96 Low-grade prostate cancers are seldom the cause of death in men over age 70, especially those that are in poor health.97 Low-grade are the majority of prostate tumors found and the ones where “watchful waiting” is often employed in lieu of radical procedures.97,98

Over 7 (high-grade): Fast growing, aggressive tumors that require intervention such as radical prostatectomy, radiation, androgen ablation, etc.96 High-grade prostate tumors make up less than 15%* of newly diagnosed prostate cancers.99

*Caveat: Errors in the pathology lab can result in lethal mistakes, such as issuing a low Gleason score to a high-grade tumor. These errors are discovered when a radical prostatectomy is performed and it is found to have a Gleason score of 8-10 as opposed to a 6 Gleason score found in the biopsied specimen.100

A study published in 2012 evaluated a group of men with early-stage prostate cancer who received a 4,000 IU vitamin D3 supplement each day for a year.101

Mean 25-hydroxyvitamin D blood levels at baseline were 32.8 ng/mL and increased to 66.2 ng/mL after vitamin D supplementation.101

After one year, 55% of the men showed a decrease in tumor sensitive biopsies or a decrease in the Gleason tumor score. An additional 11% showed no change (meaning the cancer had not progressed).

The study also showed that over time, supplementation with vitamin D3 led to a decrease in the number of positive cores taken during prostate biopsies. This is in stark contrast to the untreated control group who experienced an increase in the number of positive cores on repeat biopsies.101

Only 34% of men taking vitamin D progressed compared to 63% of the control group. This represents a 46% reduction in the number of men who moved to advancing disease, indicating powerful effects of taking 4,000 IU/day of vitamin D for one year.

The men in this study had not received any other treatment than vitamin D and all were in an active surveillance program that carefully measured disease progression or regression.

This study showed that just one intervention (4,000 IU/day/vitamin D) was able to reverse the clinical course of disease in a significant percentage of these prostate cancer patients.

This study helps validate the importance of PSA screening. Had these men not known they had early-stage prostate cancer, they would not have known to take vitamin D, and their disease would have likely progressed until symptoms such as bone pain manifested.

The first article in this month’s issue titled, Impact of Diet on Prostate Cancer Risk and Mortality” describes foods that promote prostate cancer and which ones protect against it. We explain how consuming the wrong foods can fuel prostate cancer growth, while following healthy dietary choices can reduce the risk that you will develop clinically diagnosed prostate cancer.

Some men instinctively start eating healthier as they mature, but it took a higher PSA reading (1.4 ng/mL) ten years ago for me to alter my diet in a healthier direction. My diet is not perfect, but it’s a huge improvement over what I consumed in my younger years. My last PSA test came in at 0.4 ng/mL…a 71% decrease in a ten-year period (PSA levels normally rise with age).

If I had not had my PSA checked annually, I may have continued making poor dietary choices and may have developed prostate cancer by now. My father was diagnosed with it around age 75. He consumed a typical diet for his era, with a daily intake of red meat and high glycemic starches like potatoes, while never touching a vegetable or fruit. He set himself up perfectly to encourage prostate cancer growth and mutation.

Even for those who aren’t sure if they are making the proper food choices, laboratory tests like the Omega Score® test (a fatty acid profile) enable one to evaluate their diet and supplement program and make changes to optimize health. You are what you eat and what you assimilate does have a bearing on your health.

Five Stages of Prostate Cancer Progression
Five Stages of Prostate Cancer Progression

As prostate cancer progresses from Stage I to Stage IV, the cancer cells grow within the prostate, through the outer layer of the prostate into nearby tissue, and then to lymph nodes or other parts of the body.