The 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-thatís 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--thatís
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 Iíll 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 PSAís. 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
physicianís 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 wasnít
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
Because of the characteristics of prostate cancer that Iíve 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 PSAís
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
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 isnít 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.
Iíll 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
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 mixtures
like the ones suggested by the late Canadian cancer
nurse, Rene Caisse, called Essiac. 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 other antioxidants like
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
Iíll conclude this series with a few case histories.
Some Examples of Prostate Cancer Patients Using Alternative
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 Ď91 and early Ď92. 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 Ď93, 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 Ď94 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 Ď95, he was diagnosed with a
stage II prostate cancer. Two urologists recommended a radical prostatectomy.
Instead he started an intensive program of amygdalin, 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 Ď94 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.