Wellness: In Defense of Waiting

Why more and more men are approaching treatment for prostate cancer with caution.

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Thursday, November 04, 2010

Can an ordinary sea sponge cure prostate cancer? That is the hope of Dr. Marianne Sadar, scientist with the BC Cancer Agency in Vancouver. In recent tests, she has been able to shrink cancer tumors in mice with an experimental drug adapted from a sponge found off the coast of New Guinea.

It will be more than a year before the Food and Drug Administration permits trials on humans, but it's still major news in the world of cancer treatment, especially in the realm of prostate cancer, where a host of new questions and controversies have bedeviled those seeking treatment.

Men have a lot to worry about when it comes to prostate cancer, and not just because it ranks second to skin cancer in its attack levels on American men, claiming nearly 30,000 lives a year. If radical prostatectomy is chosen, there is the possibility of some life-changing side effects, including incontinence and decreased sexual function. Radiation therapy, which is administered by needles, seeds or other instruments, is not much friendlier.

Diagnosis: Wrong

Now there is a new worry. There have been an increasing number of reports in the last year that prostate cancer is being overdiagosed. The most serious charge leveled at the ubiquitous PSA (Prostate-Specific Antigen) screening comes from the man who discovered the test, Richard Ablin, professor of immunology and pathology at the University of Arizona. In a March, 2010 New York Times editorial, he wrote that PSA testing has become a "profit-driven public health disaster" costing the public $3 billion a year.

Far too many men hear "cancer," say researchers, and opt for surgery immediately. But PSA screening is actually not that definitive. "It can't distinguish between the two types of prostate cancer," wrote Ablin, "the one that will kill you and the one that won't."

There might be other causes for a high PSA number, such as a prostate infection or even a recent ingestion of ibuprofen. While prostate cancer will unquestionably trigger a high PSA, a high PSA alone doesn't necessarily mean cancer.
Trying New Treatments

What's a guy to do? Studies are now suggesting that not all cancers require a surgical fix. And according to the U.S. Preventive Services Task Force, doctors should not even screen men older than 75.

So men are approaching treatment with greater caution. One new option is to take an intimate picture of the area in question with a color-Doppler sonogram. This method has been advanced by Dr. Duke Bahn at the Prostate Institute of America in Ventura, Calif. He uses the sonogram images in concert with those obtained by commonly used TRUS—the transrectal ultrasound probe that is inserted into the rectum to take a picture of the prostate and identify the size and location of a tumor. This evidence is then measured against the PSA readout to detect abnormalities. Bahn has also advanced the technique of cryotherapy—freezing and destroying prostate tumors.

In tests being developed by Dr. E. David Crawford, professor of urology at the University of Colorado, 3-D mapping is being used to better see the affected area, in addition to more sophisticated genetic testing on the tumors. Crawford has found that urine analysis can open the window on one's RNA—the 'messenger' cells of one's DNA—helping to reveal how dangerous a tumor may be.

The Waiting Game

With all the information emerging about some cancers being essentially harmless, more men are opting for "watchful waiting," i.e., not resorting to surgery unless symptoms warrant.

Meanwhile, the National Cancer Institute reports some new treatments undergoing clinical trials, including: biologic therapy (taking substances from the patient's immune system to fight the cancer); high-intensity-focused ultrasound (applied through an endorectal probe); and proton beam radiation therapy (which targets the tumors with streams of protons).

Surrounded by thousands of sea sponges in her Vancouver laboratory, Dr. Sadar has high hopes for the experimental drug she has developed, EPI-001. For the nearly 200,000 men a year who are diagnosed with possible prostate cancer, the idea of avoiding needles, knives and other bombardments in favor of something made from a sea sponge would sound very comforting indeed.

Fighting Back, Naturally

While there is no miracle pill (or supplement), the right diet can help keep your prostate healthy. Among the foods that promote prostate health are:

- Cooked tomatoes, in soup or pasta sauce (for lycopene)
- Vitamin D (if you're not getting enough sunshine)
- Vitamin K2 (shown to reduce prostate cancer risk by 35 percent)
- Onions and garlic (they help to reduce benign prostatic hyperplasia, a noncancerous enlargement of the prostate gland)
- Walnuts (slow tumor growth)
- Red wine and green tea (for polyphenols and antioxidants)
- Spinach (for folate)

What's bad? High-fat, high-carb diets, which lead to too much insulin in the blood. In other words, ditch the donuts for a bag of walnuts.

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