~Prostate Cancer, part 3 - Prevention and Getting Help

Vitamin E Isomers Alpha- and Gamma-Tocopherol plus Selenium Combine to Reduce PC Risk. A large-scale study of almost 11,000 men in Maryland showed that the protective effects of high selenium levels, and similarly that of the alpha-tocopherol isomer of vitamin E, were only observed when the concentrations of the gamma tocopherol isomer of vitamin E were also high.58 In this study, the risk of PC declined with increasing concentrations of alpha-tocopherol, with the highest concentration associated with a 68% PC risk reduction. For gamma-tocopherol, men with levels in the highest fifth of the distribution had a fivefold greater reduction in the risk of developing PC than men in the lowest fifth (p = .002). The observed interaction between alpha-tocopherol, gamma-tocopherol, and selenium suggested that combined alpha- and gamma-tocopherol supplements, used in conjunction with selenium, should be considered in future PC prevention trials.

Vitamin E Succinate Inhibits PC Cell Growth and PSA Expression

In another study, vitamin E succinate inhibited cell growth of PC cells in the LNCaP line by suppressing androgen receptor expression and PSA expression. The combination of Eulexin (flutamide) with vitamin E succinate resulted in a more significant inhibition of LNCaP cell growth.59 The same investigators demonstrated that selenomethionine also showed an inhibitory effect on LNCaP cell growth but that this appeared to be independent of androgen receptor or PSA pathways.

Vitamin E Reduces Incidence of PC in Smokers in Two Separate Studies. A study of over 29,000 male smokers in Finland, ages 50-69, disclosed a 32% decrease in the incidence of PC (95% confidence interval [CI] = -47% to -12%). This was observed among the subjects who had received 50 mg a day of alpha-tocopherol (n = 14,564) in contrast with those not receiving it (n = 14,569). Mortality from PC was 41% lower among men receiving alpha-tocopherol (95% CI = -65% to -1%). Among subjects receiving beta-carotene (n = 14,560), PC incidence was 23% higher (95% CI = -4% to 59%) and mortality was 15% higher (95% CI = -30% to 89%) compared with those not receiving it (n = 14,573). In this study, long-term supplementation with alpha-tocopherol substantially reduced PC incidence and mortality in male smokers.60

An important issue is whether this benefit of alpha-tocopherol, and possibly other tocopherols, is limited to smokers or those who have recently quit smoking. A report by Chan et al. (1999) showed significant benefit only to smokers or those recently quitting smoking in a study involving 47,780 U.S. male health professionals who received at least 100 IU of supplemental alpha-tocopherol. In this population, the risk of metastatic or fatal PC was reduced 56%. In the nonsmoking population, there were no beneficial findings of statistical significance.61 In a study on the relationship of green and yellow vegetable consumption to risk reduction in cancer development, a significant reduction was again found to occur only in smokers. The cancers studied included those of the mouth and pharynx, esophagus, stomach, liver, larynx, lung, and urinary bladder.62

Vitamin E Reduces VEGF Levels. A follow-up study involving the Finnish smokers compared VEGF levels in patients receiving alpha-tocopherol with those in the placebo group. There was an 11% reduction in VEGF levels in the alpha-tocopherol group as compared with a 10% increase in the placebo group (p = 0.03).63

Vitamin E Lessens Adverse Effects on PC Growth Due to Dietary Fat. Basic research studies have shown that vitamin E reduces growth rates of PCs resulting from LNCaP cell lines that had been transplanted into mice and stimulated by a high fat diet. Tumor growth rates were highest in the animals fed a 40.5%-kcal fat diet (the typical American diet). Tumors in animals fed 40.5%-kcal fat plus vitamin E experienced statistically indistinguishable growth rates from those fed a 21.2%- kcal fat diet (a more ideal dietary fat consumption).64

One Recommendation for Implementing Some of the These Findings. Each Life Extension (LE) Booster softgel contains 210 mg of gamma-tocopherol plus 200 mcg of selenium in addition to 10 mg of lycopene. Combining one LE Booster softgel with one LE Vitamin E capsule containing 400 IU of d-alpha-tocopherol succinate, in conjunction with the dietary approaches detailed in previous paragraphs, should contribute significantly to both the prevention and active nutritional treatment of PC.

High Consumption of Dairy Products and Calcium Increase Risk of PC

A study in Sweden examined the relationship of dairy products, dietary calcium, phosphorus, and vitamin D with risk of total, extraprostatic, and metastatic PC. The results indicated that calcium intake was an independent predictor of PC [relative risk (RR) = 1.91] for calcium intakes of greater than or equal to 1183 mg a day versus less than 825 mg a day. This was especially the case for metastatic tumors with a RR equal to 2.64, controlling for age, family history of PC, smoking, and total energy and phosphorus intakes. The authors concluded that high consumption of dairy products was associated with a 50% increased risk of PC.65

A second study in the United States involved 1012 cases of PC among 20,885 men over an 11-year follow-up period. Men consuming greater than 2.5 servings a day of dairy products had a RR of 1.34 for PC after adjustment for baseline age, body mass index, smoking, exercise, and randomized treatment assignment in the original placebo-controlled trial. Compared with men consuming less than or equal to 150 mg calcium a day from dairy products, men consuming greater than 600 mg of calcium a day had a 32% higher risk of PC. The results support the hypothesis that dairy products and calcium are associated with a greater risk of PC.

Also noted was that at baseline men who consumed greater than 600 mg of calcium a day from skim milk had lower plasma 1,25(OH)(2)D(3) concentrations than did those consuming less than or equal to 150 mg of calcium a day (71 compared with 85 pmol/L or 30.06 pg/mL compared with 35.64 pg/mL; p = 0.005).66

The RR for the diagnosis of advanced PC was noted to be 2.97 in men with daily calcium consumption of greater than or equal to 2000 mg a day versus intakes of less than 500 mg a day.67 The same was true for the risk of metastatic PC, but with a stronger RR of 4.57. (A RR of 4.57 means a 4.57 times greater risk of contracting PC.) Calcium from food sources and from supplements independently increased risk.

High Fructose Consumption Decreases Risk of PC

In the same study referenced above, high fructose intake was found to be related to a lower risk of advanced PC (multivariate RR, 0.51). Fruit intake was associated with a RR of advanced PC (RR = 0.63; 5 versus %1 serving a day), and this association was accounted for by fructose intake. Nonfruit sources of fructose similarly predicted lower risk of advanced PC.67

Boron Consumption Lowers PC Occurrence

Men who ate the greatest amount of boron were 64% less likely to develop PC compared to men who consumed the least amount of boron. This information was presented in the annual Experimental Biology Conference in Florida in 2001 (not published, to my knowledge). The study was led by Zhang et al. from the UCLA Medical Center and compared dietary patterns of 76 men with PC with those of 7651 males without cancer. The more boron-rich foods consumed, the greater the reduction in risk of being diagnosed with PC. Those men in the highest quartile of boron consumption had a 64% reduction in PC, while men in the second quartile had a 35% reduction in risk and those in the third quartile reduced their risk by 24%. Men in the lowest quartile of boron consumption ate roughly one slice of fruit a day, while those in the highest quartile consumed 3.5 servings of fruit a day plus one serving of nuts. Boron-rich foods include plums, grapes, prunes, avocados, and nuts such as almonds and peanuts. A serving of 100 grams of prunes (6 dried prunes) has 2-3 mg of boron and 6.1 grams of fiber.68

Diet and Supplement Studies Versus Cancer Risk: Confounding Findings Affecting Interpretation

The lifestyle characteristics of supplement users are certainly a potential bias in studies investigating the benefits versus risks of vitamins, minerals, and dietary habits. A study by Patterson et al. evaluated supplement users and found that, among men, supplement users had the characteristics detailed in the table below.69

The health-minded nature of users of vitamins, mineral supplements, and dietary plans may well confound what we think we know about the relationship of such integrative health measures and investigations dealing with relative risks (RR) and odds ratios (OR) of diseases such as PC as well as other malignant and nonmalignant processes.

Basic Military Training: Getting Help to Understand Biological Principles about Prostate Cancer

  • Support Groups
  • Field Guides
  • What Specialist to Choose
  • What Does This Mean for Patients

To master the tactical approaches and be victorious in your battle with PC is challenging. In such a context that involves a major crisis in your life, you need to have guidance in multiple shapes and forms.

The Profile of Vitamin/Mineral Supplement Users

Characteristic of Supplement UsersOdds Ratio
95% Confidence Intervals
Twice as likely to have had a PSA test2.21.3-3.7
Take aspirin regularly1.71.1-2.6
Statistically significantly more likely to exercise regularly1.71.2-2.4
Eat 4 or more servings of fruits and vegetables a day2.41.6-3.8
Follow a low fat diet pattern1.71.1-2.6
Believe in a connection between diet and cancer1.91.4-2.9

Support Groups

If you belong to an interactive support group, this can be a great beginning. These are some of the largest:

The level at which each support group functions is highly variable. Some are informal meetings--more akin to chat groups relating personal experiences. Others are more scientific, with guest speakers involved in the diagnosis and treatment of PC. I hope that more support groups evolve into workshops that focus on each of its members--one at a time--using a scientifically objective approach with working forms. In such an idealized setting, an invited professional speaker would be asked to orient his or her talk around selected case histories (called clinical vignettes) pertaining to individuals in the support group.

Let's face it. Everyone at the support group meeting is there because of a perceived threat involving his or her life as it relates to PC. They are present because they are seeking answers to their problems. Therefore, every PC patient-oriented meeting should have patient outcome as the prime directive. Patients should understand that they learn about their particular problem through the understanding of concepts that, more often than not, also apply to them. When such lessons are taught as a story of an actual human being, the lesson is reinforced and becomes memorable. Such an approach translates science into practical issues of value that are more understandable to the individual man with PC and his partner.

Resolution of problems and prevention of problems unrecognized (or yet to develop) should be the prime directive of such organizations. Working together as a team (or army) to help one another is an effective way to teach all members of this platoon some valuable lessons about PC and hopefully about the spirit of human unity. Those that approach PC in such a manner will increase the likelihood that critical crossroads will now be approached in an intelligent fashion and crossed successfully. Instead of hearing about patients and physicians making the same mistakes repeatedly, we would hear more and more success stories. We do not want to fulfill the warning that the philosopher Santayana posed when he said: Those who cannot remember the past are condemned to repeat it.

In my 20 years of counseling patients and physicians about PC, the same mistakes are made far too often. Using an objective format to gather data and presenting such data to your support group veterans should be the modus operandi of support groups.

Also, and of great importance, working together elevates the individuals and the group. The mindset of the man with PC changes from "me against the disease" to "we against the disease." This fosters feelings of human unity. It is within this human unity, or humanity, that hope for mankind lies: Our humanity lies in our human unity.

Without it, we are all individuals fighting a lonely battle. With it, we can conquer anything. Support groups, then, should elevate and evolve the individuals within them. Support groups should have a task force mentality, objectify patient information, and resolve critical issues for the individual, while at the same time accomplishing this for the group. How can this be done?

Field Guides

If we are striving to develop a group mentality and can pool our individual talents, we can now enter the phase of synergy. This can be facilitated by using the skills of those who can organize thought and details and share such organizational thinking with others. Manifestations of this are in books, medical articles written for the PC patient and partner, PC-specific newsletters, websites, and Internet-based tools. Suggestions for these elite materials, the field guides, are provided at the end of this protocol.

To summarize these points, a winning strategy for the individual soldier and his corps is to understand as much as possible about his situation in the context of the battle. His PC-fighting training, if you will, mandates his reading the manuals and doing his homework. The only place where success comes before work is in the dictionary.

The concept of synergy empowers this foundational tactic. Therefore, the individual man with PC, his partner, and corps of patients in his support group must be working in the spirit of harmony. In essence, at this crossroads, the motivation for the patient and his partner is simply survival and quality of life. It comes down to the same old story: "We are only as strong as we are united, as weak as we are divided."70

A Key but Often Missing Link

There is no doubt whatsoever that the outcomes of patient longevity and quality of life can be changed for the better with the relatively simple first steps described earlier. The major drawback, as I see it, is bringing the professional healthcare team into the equation: the third element of PPP. There are reasons for this difficulty that are worthy of some speculation.

The education of the physician is based on competition for scholastic grades in college and in medical school. The ego--the unhealthy aspects of ego--is encouraged by repetitive challenges to the student, intern, resident, and junior staff regarding esoteric information and medical trivia. Individuals selected out of premedical candidates are often those who are accomplished at memorization of such material. The deans of medical schools are not accomplishing their mission in finding great numbers of outstanding physicians. This lies in the failure of not selecting more students who are driven by the passion to fix the individual and society. True physicians--sincere healers--all have a common denominator: a caring soul that is awed by the wonder of creation and the study of life. With such a constitution, these individuals have a passion to fix problems. This said, the fortunate patients are those able to find the real physicians.

Added to this demanding situation is another serious issue. A physician involved in the totality of cancer medicine cannot adequately cover the waterfront as it relates to all the different types of cancer. A physician must realize his limitations. In the first 10 years of my life as a general medical oncologist diagnosing and treating adult malignant conditions, I have strived to succeed in the impossible task of understanding how to best treat cancers of the breast, colon, lung, stomach, pancreas, ovary, head and neck, and brain, as well as sarcomas, lymphomas, and leukemias.

A man has got to know his limitations. I should have realized from my medical school and postgraduate work on Hodgkin's disease that understanding one malignancy was in itself a formidable task. Becoming a master of 20 different malignancies is an impossible task that does not allow for an optimal outcome for the patient presenting with one particular type of cancer. How can this not be realized by the medical profession and the medical societies? It is as clear as day. Therefore, my advice to the man and his partner faced with a diagnosis of PC is to undertake the challenge of learning as much as possible about the disease, ideally in concert with a proactive and interactive support group and to do this while working with an M.D. copartner who is hopefully specialized in the management of PC.

What Specialist to Choose?

Patients and their partners routinely ask me, "Should I seek care under the aegis of a urologist, medical oncologist, or a radiation oncologist?" My initial response is to select an outstanding physician (no matter what his or her label or tag is) who manifests the characteristics of a real healer. With this said, I must be forthright in stating that there is a reality--in general--that the amount of time and focus spent on the patient will be such that the following ranking will most often be found to be true.

Medical Oncologist > Radiation Oncologist > Urologist

Medical oncologists (medoncs) and radiation oncologists (radoncs) are internists who have subspecialized in medical oncology and radiation oncology, respectively. Urologists are specialists in surgery. The nature of these specialties, their modus operandi, is quite different. During the junior and senior years in medical school, while we puzzled about which specialty to choose, one of the classic jokes was:

Surgeons do everything, but know nothing.
Internists know everything, but do nothing.
Psychiatrists do nothing and know nothing.
Pathologists know everything and do everything, but too late.

As silly as these stereotypes are, this joke always brings smiles to the faces of all physicians because there are inherent elements of truth present; surgeons are indeed oriented around operating--that is their modus operandi, literally and figuratively.

Therefore, in the best of all worlds, find a medical oncologist that is intensely focused on PC. Such a physician must have the patient's best interests at heart. This is the ideal teammate for the PC patient and his partner. To paraphrase Scott Peck, M.D., in A World Waiting to Be Born, a good act is that which appears good to an ideal observer, "a being who is more knowledgeable than you, more objective than you, yet who still cares."71

As with breast cancer care or any life-threatening illness, the primary intervention of the man diagnosed with PC or suspected to have PC should be with an objective, caring, and highly informed physician--the medical oncologist trained in the area of PC. He or she is the least biased concerning which treatment the patient should be considering. He or she has a broader scope of knowledge regarding oncology and internal medicine. He or she will spend more time dealing with concepts as they relate to PC rather than with procedures.

"The good physician knows his patients through and through, and his knowledge is bought dearly. Time, sympathy, and understanding, must be lavishly dispensed, but the reward is to be found in that personal bond which forms the greatest satisfaction of the practice of medicine. One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient."

- Sir Francis Weld Peabody, Lecture to Harvard Medical Students, 1927

Some of the statements made above will meet with disapproval by some of my colleagues. Nevertheless, they are true. In today's world, we desperately need more integrity.

Assuming that medicine evolves to a point where physicians specializing in areas such as PC become more plentiful, the PC patient and partner must find a like-hearted and like-minded physician.

The real challenge then is for the medical profession and society to foster an increasing population of physicians meeting these qualifications, for the number of such physicians is far too small to meet the demands of 170,000-200,000 men in the United States each year who are newly diagnosed with PC. An estimate of the number of men with PC in the United States today is somewhere in the 6-9 million range.

What Does This Mean for Patients?

  • To win this battle, you must foster an understanding of the basic biological principles involved in PC. Just as a new recruit into the army becomes savvy by means of education from experienced field officers and fellow soldiers, the new patient with PC (the newbie) needs to obtain information from a supportive cast.
  • The PC patient and partner must act as a team, reinforcing its growing understanding and, in time, sharing its knowledge with the community of other PC patients and partners.
  • Reality is a tough concept, but an understanding of the limitations of the current medical care of the PC patient is mandatory to prevent major and minor casualties. The diagnosis and initial care plan is often made by the urologist and not a more integrative physician such as a medical oncologist focused on PC. To win a war, one needs a strategist familiar with all aspects of the battle.
  • PC necessitates organizational thinking, with strategy and serious focus on biological events as they relate to tumor/host interactions. A successful military campaign requires sound military intelligence. Similarly, a successful medical campaign requires organizational thinking which is rooted in solid medical intelligence.

Continued . . .

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