When I was 69 -years-old back in 2003 I was diagnosed with prostate cancer. In a routine physical examination my PSA was found to be just above 4. So there was a visit to the urologist. A biopsy confirmed that there was cancer in the prostate. My Gleason score was 3 + 3 or 6.
The urologist recommended surgery. He suggested that for a man with the good health that I enjoyed, surgery would offer the best hope of nipping the cancer at an early stage. He said he had this new laparoscopic surgery that was much less invasive and would offer a faster recovery. I asked him how many had he done and he said he got training last summer and he had done 10 of these surgeries. I said to myself, whoa, I don’t want to be number 11 or 12 while he’s learning how-to-do-it.
A good friend recommended a radiation oncologist who had a large practice treating prostate cancer. The radiation oncologist suggested that surgery would be a bad choice for me because I had a previous surgery for BPH (prostate enlargement without cancer). He suggested the best alternative for me would be external radiation followed by radioactive seeds implanted in the prostate. He said he had the equipment right there and I could have the treatment next week. I got nervous.
I could see there was a diversity of opinion. By searching on the internet I found an annual 3-day conference for laymen on prostate cancer in California that was about to take place.. I attended the conference and listened to presentations from leading practitioners of the major forms of treatment: surgery, radiation, hormone therapy, cryosurgery, diet, and so-called watchful waiting or Active Surveillance. I learned for the first time that treatment can be tailored to the individual’s clinical situation.
Also, I learned that long-term studies showed that with either surgery or radiation there was a significant recurrence after 10 years and both surgery and radiation carried the probabilities of serious risks, such as incontinence, impotence and rectal bleeding.
After the conference and much reading I had my case reviewed by some specialists and I began considering a program of Active Surveillance. I was seen at a medical oncology practice in California by two physicians. It was recommended that I first have some additional diagnostic tests before deciding what to do.
Verifying the Gleason Score
I obtained a second pathology report on my original biopsy specimens. I sent the slides to Bostwick Labs in Virginia, a lab specializing in analyzing prostate biopsies. I found out that a percentage of original Gleason scoring often changes upon review. However, my original scoring of 3 + 3 or 6 was confirmed.
The next step was to have the tumor measured by the color Doppler ultrasound at the Prostate Cancer Institute of America in Ventura, California. Dr. Bahn measured both the tumor and the prostate gland and calculated the amount of PSA that a gland of that size should produce. The excess of the PSA above the estimate is the PSA that the tumor is producing. In my case, the PSA was 3.9 and the estimated PSA that my prostate should produce was 2.5. Thus, the tumor appeared to stimulate an extra 1.4 PSA. The key measure of the color Doppler is to determine the extent of the blood supply to the tumor. If there is a good blood supply, the lesion has a better chance to grow rapidly and metastasize. In my case there was no major blood supply to the cancer, so I was advised that there was a good chance the cancer’s growth could be contained with diet and relatively mild drugs.
The second measure of the tumor’s rate of growth was MRI spectroscopy. I had learned about this diagnostic tool from Dr. Kurhanowitz of the University of California San Francisco Medical School. He had worked with GE to develop a method of measuring the chemical marker that prostate cancer produces. In short, the more of the prostate cancer marker, the more aggressive the malignancy. The procedure involves placing a probe in the rectum and the chemical can be measured by MRI spectroscopy. In my case, the MRI found the chemical marker but only in a “moderately aggressive” amount.
Bone Scan Negative
I also had a bone scan and it did not show any spots of metastasis anywhere in the body.
Choosing Active Surveillance
I now had various measures of the cancer activity plus I had a level of PSA that was only slightly over the projected amount of PSA that the gland should normally produce:
My doctors reviewed the tests and the various treatment options and said that the cancer didn’t appear to be aggressive and that one option would be to try medications and diet to control the disease. This Active Surveillance approach involved monitoring the PSA every three months, bi-annual digital rectal exams, and annual measurements by color-Doppler ultrasound to assess the gland. Periodically, I would also undergo a prostate biopsy to make sure that the cancer didn’t develop into a higher Gleason grade. The baseline data would be closely monitored against the regular tests.
Medications for Active Surveillance
In my case, the medications Avodart and Celebrex were added to my regimen. Avodart, is a potent medication that blocks the conversion of testosterone to dihydrotestosterone (DHT). Although both testosterone and DHT can stimulate prostate cancer cell growth, DHT is more potent. By lowering DHT levels while maintaining testosterone levels, Avodart can inhibit cancer cells without causing many of the side effects associated with traditional androgen deprivation therapy.
Celebrex was initially approved as an anti-inflammatory drug for arthritis. It now appeared that the medication slows cancer cells via various mechanisms. It’s hypothesized that the drug can promote apoptosis (programmed cell death) and inhibit angiogenesis (blood vessel formation). Celebrex was approved for use in preventing colon polyps from forming; it is being studied in prostate, lung, and colon cancer. In fact, early studies found that Celebrex can control the PSA levels in some relapsed cancer patients. One caveat, patients who have impaired circulation (i.e. coronary artery disease or stroke risks) should not be on high doses of Celebrex.
Diet Helps Fight Cancer
From a dietary standpoint, my doctors recommended a book – Verne Varona’s Nature’s Cancer Fighting Foods. The fundamental message – avoid sugar and foods that rapidly convert to sugar. It may be that sugar is one of the most deadly substances in society today. Not only does it lead to diabetes and obesity, it supports cancer big time. Normal cells are adaptive – they will get by on less sugar. Cancer cells, on the other hand, love a sugar-rich environment.
The Varona book encouraged a diet of whole grains, a wide variety of vegetables, beans, moderate amounts of fish and limited fruits.
In my case, I went part-way. I still eat lots of fish (for the good oils and other nutrients) and the occasional white meat of chicken and turkey – but I avoid all dairy products and red meat and sugar whenever possible. There are many reasons to avoid dairy, but the two principle reasons are the weakening affect that dairy molecules have on immune function, and their fat content.
This diet meant no concentrated sugar desserts, but I found berries and fruits a great dessert substitute for sweet cravings. Berries also contain cancer fighting elements. With a whole foods approach and eating frequently, the desire for desserts seemed to disappear. This was a welcomed surprise.
I Followed Simple Dietary Rules
- Avoid all red meat.
- Avoid all dairy, including cheese.
- Avoid egg yolks.
- Use only olive oil, sesame, and grape seed oil for cooking and in salads
- Emphasize colorful varieties of vegetables (minimizing nightshade varieties such as potatoes, tomatoes and peppers), whole grains (minimize white rice and corn) and go easy on flour, avoiding breads made with sugar.
- Broccoli, kale, collard greens, cauliflower, and brussel sprouts are a reliable cancer-fighting family.
- Avoid white or brown sugar, fructose and honey.
- Enjoy a moderate amount of nuts.
- Substitute soy milk for dairy milk, but don’t go overboard.
- Reducing meats and eating more frequently can help reduce sweet cravings.
- Eat lots of cooked or raw daikon radish (this is a variety of white radish), and go heavy on the onion family (leeks, scallions, onions and chives).Make fish or chicken your occasional protein with beans and bean products on your vegetarian days.
This diet seems like it might be difficult but it wasn’t. Whole grains like oatmeal are easy to cook and eat. Soups and salads are plentiful – just avoid cream based soups or soups with meat. Hummus and bean dips and nuts make easy snacks. At restaurants it’s easy to ask the waiter to hold the potatoes and white rice and double the vegetables. Once you decide to minimize sugar fat and meat you still find plenty of food. The key is to eat food with a low glycemic index. It is hard to eliminate sugar completely because it is built into so many products but it’s easy to minimize it. Once I decided my life depends on it, a healthy diet was easy to follow.
Besides the diet and drugs, I took daily supplements — Life Extension two-per-day vitamins, one booster cap, decaffeinated green tea tablets, and resveratrol. I also took daily fish oil tablets.
As further support of the treatment, I maintained a vigorous exercise program. Most days I started with a 2-1/2 mile hike up Camelback Mountain with a 1,300 foot elevation gain. Three days a week I also swam for about an hour. On the weekends I tried to have at least one day with four hours of hiking. I lost 20 pounds and went down to 160 which was a good weight for my 5 foot.6 inch height.
After about one year on this program, I went back for another color-Doppler ultrasound. The one-year post treatment measurements showed a decline of 40% in the volume of both the prostate gland and the tumor, which had shrunk. There was less blood supply to the prostate.
The PSA had been steadily declining. From a peak of 4.1 at the time the cancer was found, the PSA had declined to 1.2 in a little over a year. They say the Avodart initially lowers the PSA by about 50%. As an important side benefit, my general health improved.
Use Of The Word “Cure” Is An Oversimplification
I learned that the term “cure” is an oversimplification. To assume that you can be cured with surgery or radiation does not acknowledge that microscopic levels of cancer can still exist.
The common assumption with most prostate cancer treatment is that if the cancer is confined within the prostate it can be either removed surgically or killed with radiation and that procedure will be the end of the cancer. Unfortunately, there is no test to measure cancer at the microscopic level. It’s possible that some minute amount of cancer may have already moved beyond my prostate, but this could not be measured.
On the other hand, although not curative, diet creates an environment less conducive to prostate cancer growth. Even someone who has had surgery or radiation should consider adjusting his diet for those errant cancer cells that may have escaped eradication. I also found that a healthy diet builds a feeling of well being.
Seven Years Later – Hormone Therapy
For 7 years of Active Surveillance I didn’t have any problems but I was watching a very slow, incremental increase in my PSA. I remained focused on my diet and exercising. I had become more fit. I was doing things that we all know we should be doing anyway… but I was doing it because I had prostate cancer
Over the seven years my PSA crept up from a low of 1.2 to a 3. At the seven year point, one of my doctors, (Dr. Lam), felt we ought to do another biopsy to see if the Gleason score had changed.
Dr. Bahn did the biopsy in Ventura, California and the biopsy showed an increase in the size of the lesion and a second small lesion appeared in the biopsy. I had a new Gleason score of 3 + 4 or 7. I knew it was time to take the step to treatment.
My doctors recommended a period of triple hormonal blockade for six months. That’s what I did. Although hormonal therapy is not without side effects, I didn’t experience much side effects. I didn’t have any weight gain or hot flashes or any other bad effects. Later, everything returned to normal in terms of sexual activity.
Six months after the hormone therapy a followup color-Doppler didn’t find any evidence of the cancer. There may still be some residual cancer that doesn’t appear visually. That doesn’t mean it won’t come back, but it may take a while for it to come back.
My PSA has been down to .02 – a low number. My hormone therapy knocked the cancer back. Perhaps in some years it may reoccur but by that time I’m confident that we’ll have improved drugs and treatments for dealing with prostate cancer.
I am 77-years-old now. Looking back, I’m pleased that I didn’t jump into anything and I took my time to find the right choice for my situation. If there’s anything I would say to a newly-diagnosed patient it would be to take your time and find the right doctor for yourself. On a personal level, over the years, I’ve heard too many stories from people I know about poor outcomes from surgery and radiation where doctors didn’t clearly disclose the risks and these guys suffered severe complications. There are so many wonderful doctors and so many good programs around that there’s no reason to jump into something early. This is not the type of condition where you need to schedule a surgery the next day. Take time to find the right solution.
A Nice Benefit
I love hiking and I’ve written a couple of books about a place I hike a lot, Camelback Mountain here in Scottsdale, Arizona. Recently I spent 2 days with my son-in-law on the Pacific Crest trail in the San Jacinto mountains in California. We did a total of 44 miles in two days, going up to 5,000 feet in one day and up 6,000 feet the second day, doing about 22 miles per day. Even though I’m 77 I’m able to move at a good pace that’s a result of following the discipline that I know is good for keeping the cancer under control and it’s also good for general health. For me, Active Surveillance is kind of a twofer – you feel better today and have more tomorrows.
Disclaimer: Individual patient regimens may vary and any information provided by a patient should be used to expand your knowledge for discussion with your own physicians and others and should not be considered as actual medical advice.
With permission, this interview was edited and updated from a previous report by Mr. Driggs published in PCRI Insights in 2004. Author Verne Varona and Drs. Mark Scholz and Richard Lam from Protate Oncology Specialists in Marina Del Rey, California, contributed to the original report.
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