Reprinted with permission of Life Extension®.
This year I will discuss prostate cancer (PC), using the metaphor of a military incursion -- needing to have a focused, strategic approach, deployed in a systematic, problem-solving manner. The purpose of such a metaphor is to bring to the student of this disease a different perspective that will hopefully provide new insights that will lead to victories in our battles against this disease. The reason for such a departure from the conventional formal discussion of Prostate Cancer (PC) is that this latter academic approach is not being translated into winning strategies for the man with PC. The battle is being lost because we, the generals, are not translating what has been published in medical journals and discussed at national meetings into real-time preventive, diagnostic, evaluatory, and treatment tactics. Medical pragmatism--the art of being practical and using common sense--is not being practiced.
The battle to prevent this disease, to diagnose it earlier, and to treat it effectively is also not occurring at the proper pace largely because men are not taking an active role in winning this war. As we are learning in our war against terrorism, you defeat the enemy by recognizing their presence early (not late), preventing their buildup, learning their location, and eradicating them with the proper weaponry. There are too many men, already diagnosed with PC, who are not taking an active role in their own recovery. Many believe that because they are consulting a professional with a medical degree (who may also command a generous salary), all or part of this equates with getting the very best advice and treatment. Wrong. In today's world of rapid pace, where medicine is practiced with 15-minute office visits and where physicians are too busy to read and translate much of what is being published, the patient and his partner must not take a passive role and assume that all that can be done is being done.
My recommendations, therefore, either to patients with PC or to their loved ones, will be those of a counselor or guide, offering practical advice based on 20 years of working on the front lines of PC management. I do not hesitate in telling you that for the vast majority of men diagnosed with PC, a successful outcome can be realized. But the principles you are about to learn must become part and parcel of the strategic approach used by the patient/partner/physician (PPP) team. The patient and his partner have the most to gain as well as the most to lose when encountering PC. They must expend serious energy to win this particular war. In doing so, they learn the art of battle; they are brought closer together and evolve in their lives; and other intertwined health issues are brought to light and healed. This is the beauty of such an approach. Are you willing to invest in the time to help yourself? Are you worth it?
PREVENTION AND TREATMENT
The most important take-home lesson that I can relate to you within the pages that follow relates to your ability to use concepts. It is through the use of concepts--the structural framework of our thinking--that we intelligently plan a strategy of success.
Comparison of a Military Campaign with Prostate Cancer Strategy
|Winning a Military Campaign||Defeating Prostate Cancer (PC)
|Preventing War||Preventing PC
|Basic Military Training||Getting Help to Understand Biological Principles
|Military Information (Intel)||The Importance of the Medical Record
|Early Recognition of Enemy Activity||Early Diagnosis of PC
|Assessment of the Enemy||Risk Assessment of the PC Patient
|Knowing Pros and Cons of Weaponry||Understanding Pros and Cons of Treatment Options
|Understanding Enemy Vulnerability||Learning Principles Underlying Tumor Growth
|Stopping Supply Lines to the Enemy||Antiangiogenesis Treatments, Dietary Changes
|Stabilizing Key Arenas of Conflict||Focus on Bone Integrity, Biomarkers, etc.
|Supporting the Troops||Supportive Care of the Patient
|Boosting Morale of Troops||Fostering a Will to Live, Empowering the Patient
Winning a military campaign, or a war against PC, involves concepts such as prevention, basic training, military intelligence (Intel), early recognition of enemy activity, assessment of the strength of the enemy, an understanding of the pros and cons of the weapons in our arsenal, stabilization of key areas of conflict, stopping supply lines to the enemy, supporting our troops, and other issues common to a military arena (see above). A strategy for success, be it in a military war or a war against PC, simply involves adding factual information to a sound conceptual framework.
Please refer to the glossary following this protocol to better understand unfamiliar terms that are used throughout the text.
The approaches used in a winning strategy, whether for a military campaign or a medical battle, are superimposable. That which occurs in the life of a cell is reflected in society as well.1 Cellular battles are but a microcosm of what takes place on a more macromolecular level within the individual, his community, his country, the planet, and the universe. This is reflected repeatedly throughout the entire history of man.
Preventing War: Preventing PC
- Hereditary PC: Risk Factors
- Genetic Transmission
- Intensified Surveillance
- Increased Risk with Family History of Cancer
- Tests for High-Risk Persons
- General Preventive Measures
Most students of either campaign will maintain that prevention is the key to being truly victorious. There is no argument there. However, the desire to understand the principles and importance of preventive tactics does not appear to be a top priority for most people until the harsh reality of war or cancer is present. For example, the appreciation of terrorism in America was not brought home until September 11, 2001. This appreciation of the enemy may take the form of seeing the reality of cancer up close and personal when a father, brother, or other family member is diagnosed with PC or another malignancy. Otherwise, the motivation to learn and utilize prevention tactics does not seem to be part of human reality for the vast majority of us. What can we do to foster an appreciation of the value of preventing PC?
Hereditary PC: Risk Factors
Out of every 100 men diagnosed with PC, approximately 5 will have hereditary PC (HPC).2 HPC is presently defined by any one of the following three criteria:
- Three successive generations with members having PC
- Three first-degree relatives, for example, a father and two brothers, three brothers, or a father and two sons with PC
- Two relatives with PC diagnosed before age 553
It is not surprising that the incidence of hereditary breast cancer is also about 5% of the total population of breast cancer patients--the same incidence as that of HPC.4
Genetic Transmission from Father to Son and Father to Daughter
HPC is transmitted by a gene from father to son and from father to daughter and then to her son. When HPC is present, nearly half the male offspring will have PC, and many of these will develop PC before age 55. In fact, HPC accounts for approximately 43% of PC diagnosed before the age of 55 years.3,5,6
Since the transmission of the gene may also occur from father to daughter and then to her son, a sound medical history includes information about the health of the maternal grandfather as well as maternal uncles and maternal cousins regarding any history of PC. Studies of PC within families show a stronger familial inheritance pattern than colon or breast cancer.
Value of Intensified Surveillance in High-Risk Situations
Most importantly, procedures to routinely test the first-degree relatives of those having HPC have yielded an eightfold higher detection of PC than that found in the general population.7 Soon, genetic testing for chromosomal abnormalities found in HPC may become commercially available. Patients' interest in testing similar to that available for breast cancer appears great when there exists a family history of such disease.8,9
Increased Risk of Male Breast Cancer and Colon Cancer in Male Offspring and Breast Cancer in Female Offspring
It should also be emphasized that men with a history of breast cancer (BC) in their family are also at greater risk for developing PC, just as women with a family history of PC are at greater risk for developing BC.10 Since both PC and BC share common genes, it is not surprising that men who are carriers of the gene associated with BC (BRCA1 or BRCA2) are at a greater risk for developing male BC in addition to PC and colon cancer.4,11-13
Therefore, greater vigilance is suggested when a history of PC or BC is present.
What Are the Tests for High-Risk Persons?
Currently, most physicians who focus on PC as their main specialty will recommend routine prostate-specific antigen (PSA) testing starting at age 40. This is important to establish objective findings that indicate a healthy prostate. In subsequent paragraphs, this will be shown to equate with a baseline PSA of less than 2.0 and often less than 1.0 ng/mL. In a population in which there is a family history of PC, such as has been described, PSA testing should be commenced at age 35 with yearly testing for a few years to establish a trend or profile. Then, if the PSA remains below 1.0 ng/mL, consideration for testing every 2-3 years can be considered. Vigilance on the part of the empowered patient, partner, and physician will also involve digital rectal examination (DRE) at reasonable intervals and tracking of the PSA over time. If any persistent PSA increase is noted, determinations of PSA velocity, PSA doubling times, free PSA percentage, and additional testing that will be discussed in subsequent sections must be done. Moreover, a baseline colonoscopy and stool testing for microscopic blood (Hemoccult) would be a reasonable consideration in such men starting at age 40 rather than at age 50.
Continued . . .
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