[Hopespringpcsg] FW: FYI From nytims.com Topic: A Watch-and-Wait Prostate Treatment

[Glen Tolhurst]

Hi all:

An interesting article.

Take care,

Glen Tolhurst

Co-facilitator PCCN Waterloo

 


Personal Health


A Watch-and-Wait Prostate Treatment


By JANE E. BRODY
<http://topics.nytimes.com/top/reference/timestopics/people/b/jane_e_brody/i
ndex.html?inline=nyt-per> 


Published: November 14, 2011 


 

With controversy raging over whether men should be screened for prostate
cancer with the PSA blood test
<http://www.nytimes.com/2011/10/07/health/07prostate.html> , the experience
of one man in his 80s suggests an alternative to a simple yes-or-no
response, as well as options for prevention and treatment that men of all
ages might consider. 

The man, a prominent New Yorker who for professional reasons asked that his
name not be published, knew that the PSA was not recommended as a screening
test for men over age 75 or for any man with less than a 10-year life
expectancy. But although he was then 82, he said: “I insisted. I felt that
age had nothing to do with it.” 

Now 85, he explained in an interview: “It’s about how you feel, not how old
you are. I feel like 60. I’m full of beans. With my energy level, my view of
life, the 12 hours of work I do every day and the many cultural activities I
enjoy, I ignore my age. And I didn’t want to take any chances that prostate
cancer would get in the way of all this.” 

He had the test, and when his PSA reading came back close to 5, he elected
to have a biopsy
<http://health.nytimes.com/health/guides/test/biopsy/overview.html?inline=ny
t-classifier>  (4 is the cut-off at which doctors usually recommend the
procedure). It found an early-stage cancer
<http://health.nytimes.com/health/guides/disease/cancer/overview.html?inline
=nyt-classifier>  on one side of the gland. Further analysis revealed a
Gleason score of 7, suggesting that the cancer was somewhat more aggressive
than slow-growing. 

He was not considered a candidate for surgery and would not have wanted it
in any case, but neither was he thrilled by the prospect of radiation
treatments. 

Instead, he consulted Dr. Aaron E. Katz, director of the Center for Holistic
Urology at Columbia University Medical Center and author of “The Definitive
Guide to Prostate Cancer.” Dr. Katz’s approach to this disease might be
described as “more is less” — for most men with early-stage cancers that are
not particularly aggressive, take the least invasive approach. 

That could be what Dr. Katz calls “active surveillance with possible delayed
intervention” should the cancer start to grow, or for someone like the
elderly New Yorker who wanted the cancer out, a relatively new procedure
called cryosurgery. 

What Is Active Surveillance? 

Prostate cancer is extremely common. The disease can be found in up to 30
percent of men over age 50. Most men who develop it do not die of it;
rather, they die with it, often without knowing that it was present. 

The development of the PSA test and its widespread use greatly increased
diagnosis of this disease, often of cases that would never have become a
clinical problem. 

In such cases, doctors may suggest “watchful waiting” — repeated monitoring
of the prostate with no treatment unless the cancer begins to progress. 

Active surveillance, according to Dr. Katz, can be applied to men with a PSA
under 10 and Gleason score under 7 who have early-stage disease and no
evidence of cancer beyond the prostate. He describes the somewhat
unconventional approach as follows: 

¶ Making dietary changes that include reducing or eliminating red meat and
dairy and eating lots of vegetables. 

¶ Taking supplements of omega-3 fatty acids, vitamin D
<http://health.nytimes.com/health/guides/nutrition/vitamin-d/overview.html?i
nline=nyt-classifier>  and herbal anti-inflammatory agents. 

¶ Adopting an exercise
<http://health.nytimes.com/health/guides/specialtopic/physical-activity/over
view.html?inline=nyt-classifier>  program that includes aerobic exercise
three times a week. 

¶ Practicing a method of stress reduction like yoga
<http://topics.nytimes.com/top/reference/timestopics/subjects/y/yoga/index.h
tml?inline=nyt-classifier>  or meditation. 

¶ Getting a PSA test every three to four months and digital rectal exam
every six months. 

¶ Repeating a biopsy of the prostate every 12 to 24 months. 

While definitive proof is lacking, the dietary and behavioral changes he
suggests are based on both observational and clinical studies that have
linked them to a reduced risk of developing an aggressive cancer and dying
of the disease. For example, in 1993, Dr. Edward Giovannucci and colleagues
at the Harvard School of Public Health documented a relationship between
high intake of red meat and a greater risk of developing advanced prostate
cancer <http://jnci.oxfordjournals.org/content/85/19/1571.abstract>  among
51,529 men who had initially been cancer-free. 

In another study of the same group of men followed for up to 16 years, Dr.
Giovannucci and co-authors found a reduced risk of advanced and fatal
prostate cancer among those who consumed lots of tomato sauce
<http://onlinelibrary.wiley.com/doi/10.1002/ijc.22788/pdf> , a rich source
of a protective substance called lycopene, and those who engaged in higher
levels of vigorous physical activity. 

To patients who choose active surveillance, Dr. Katz recommends fish,
particularly oily ocean fish like salmon, Arctic char, Atlantic mackerel and
sardines, as the best source of omega-3 fatty acids. Among other protective
foods that he said can stabilize or reduce PSA levels and cancer progression
are deeply colored fruits like pomegranates, red grapes, green tea, flaxseed
and walnuts. 

He also urges men to greatly increase their consumption of vegetables,
especially the cruciferous vegetables like broccoli, cabbage, brussels
sprouts, cauliflower and kale, and other dark green leafy vegetables like
spinach and Swiss chard. 

This dietary approach can foster weight loss, important because obese men
are more likely to develop aggressive prostate cancers, and also protect
against heart disease, the leading killer of American men. 

For supplements, Dr. Katz said that with more than 75 percent of men
deficient in vitamin D, he starts with a daily intake of 2,000 to 3,000
international units a day to normalize blood levels. Other supplements he
has found to be clinically helpful include AHCC, a combination of medicinal
mushrooms that enhance the immune response
<http://health.nytimes.com/health/guides/specialtopic/immune-response/overvi
ew.html?inline=nyt-classifier> , and Zyflamend, a combination of 10 herbal
extracts with anti-inflammatory properties that, based on laboratory and
early clinical trials, he and others believe can counter precancerous
prostate lesions and reduce cancer spread to bones. 

Cryosurgery, a Therapy Option 

Many men found through PSA testing to have prostate cancer are reluctant to
delay definitive treatment. Yet, the most common procedures — surgical
removal of the prostate and radiation — can be overkill for men with
early-stage disease and often result in two debilitating problems:
incontinence and impotence
<http://health.nytimes.com/health/guides/symptoms/erection-problems/overview
.html?inline=nyt-classifier> . 

Dr. Katz is one of about 50 urologists in academic centers around the
country who specialize in cryosurgery, an outpatient procedure covered by
Medicare
<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics
/medicare/index.html?inline=nyt-classifier>  in which just the diseased part
of the prostate is frozen, sparing healthy tissue and avoiding serious side
effects. Should the disease recur, the procedure can be repeated. 

The 85-year-old New Yorker had cryosurgery and continues to follow Dr.
Katz’s recommendations, so far with no evidence of cancer recurrence or
spread. 

“We’re overtreating so many men in this country with nine weeks of radiation
that costs Medicare $50,000 and with robotic surgery using machines that
cost $2 million,” Dr. Katz said. “This has got to stop. We need guidelines
as to who should be treated. And before a PSA test is done, patients need to
be educated about what the test really means and where it can lead.” 

These latter words were echoed in four articles recently published online by
The New England Journal of Medicine
<http://www.nejm.org/doi/full/10.1056/NEJMcp1103642.%20http:/www.nejm.org/do
i/full/10.1056/NEJMp1111894> , suggesting a more discriminating use of the
PSA
<http://www.nejm.org/doi/full/10.1056/NEJMp1112140.%20http:/www.nejm.org/doi
/full/10.1056/NEJMp1112191> . 

 

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