by Harry Chrissakis, M.H. M.T. Natural Medicine
Some stats on Prostate Cancer are as follows. There were 268,000 cases diagnosed last year along with 34,000 deaths. Rate of cases goes up about 1% per year. Average age of diagnosis is 66. Life time risk is 1 in 6. Of the 4 leading cancers that constitute the majority of cancer cases (Lung, Breast, Colon, and Prostate) prostate cancer has the slowest doubling time. This is a really important point in terms of treatment. Doubling time is how long it takes cancer cells to double in number. Average doubling time for Prostate Cancer is 2 years (Breast Cancer is 3 months: average age of diagnosis is 50). Most men with prostate cancer die with it rather than from it. It is generally a slow cancer. These last 2 points are also really important in terms of setting protocol and treatment methodology. Generally a man does not have to rush into aggressive therapies because of the previously mentioned points.
Testing for prostate problems is done with a PSA (Prostate Specific Antigen). PSAs need to be grafted against each other from year to year. Comparing this way, even small jumps seen (even within the normal range) are significant and need a closer look. PSA results do not determine cancer. It could be an infection or just inflammation in the prostate. PSA is highly sensitive but not highly specific. An example of that lack of specificity would be that one man can have PSA of 10 and have a very aggressive cancer while another man whose PSA is 20 has a very slow moving cancer. To help determine a possible problem a Prostate Acid Phosphatase (PAP) needs to be given along with a PSA as a backup. PAP was the Prostate test that preceded PSA as a screening procedure for Prostate problems. PAP is highly specific but not highly sensitive, so that PSA and PAP complement one another. Generally only a PSA is given. If PSA is elevated, a biopsy may be given. Only 25% of men biopsied actually had cancer. Biopsies are quite invasive as they extract 10 tissue samples at once. There may be ways around this problem with the use of new technologies, some of which are out there and some still waiting for approval. A Liquid Biopsy is one of them. A Liquid Biopsy is a blood test that can determine the possibility of cancer through the presence of cancer DNA in the blood stream. Another great tool is a Para Metric MRI, specifically for Prostate Cancer.
If a man has Prostate Cancer it is graded by a Gleason score. A Gleason Score is graded on two sets of scales ranging 1 to 5. Each set is a sample taken from both the primary predominant cancer cell population and the second most predominant cancer cell line respectively. Both scores are added together equaling the Gleason score for that person. As an example, if in the first set of cells the rating was 3 and the second set of cells the rating was 4 than the Gleason Score would combine both ratings and in this case the finale Gleason Score would be 7. Six and above is considered higher grade and more troubling. Having a Gleason score of 6 or less makes sense for watching and waiting, which should translate into watching and waiting while doing extensive testing (amount of info gathered generally way too short: to properly evaluate a Prostate patient you need at least 25 different markers) and treating to normalize any aberrant drivers of cancer like Insulin Resistance or inflammatory markers like CRP or Homocysteine while in the watching and waiting period. Generally in the watching and waiting period nothing is done to assist the person, when in fact this is the perfect opportunity to do a lot of good for the patient. Unfortunately, many men with Gleason Score of 6 or less are still treated aggressively. Approximately 50% of men with a Gleason score of 6 or less are treated aggressively. One of the ideas that I am trying to illustrate, is that we need to use more of the diagnostic tools available to determine which Prostate Cancer patients need to be treated more aggressively. Along with that is the idea that when more aggressive therapies are used, they are modified through a different approach (different conceptual structure) based on the idea of cancer management (as opposed to cure) while increasing the general health of the patient.
A new test which is waiting for approval is P.U.R. (Prostate Urine Risk). This test was developed by examining the genetic markers in the urine of prostate cancer patient. One hundred and sixty seven genes were looked at. From that pool of 167 genes, thirty five were chosen that kept coming up on the prostate cancer patients who had a more aggressive disease. This kind of a non invasive test could really help separate those who need a more robust approach, compared to those who do well with something like watching and waiting.
Modern players in the development and progression of Prostate Cancer and Cancer in general. Many of these markers can be accessed from pretty inexpensive tests.
Insulin Resistance (Elevated Insulin and Glucose) is a major driver for all the top killers. Insulin Resistance induces a state of systemic inflammation, which Cancer (as well as most diseases) thrives on. Very common and easy to see in blood work.
Elevated Homocysteine from the incomplete conversion Methionine in the folic acid cycle. Homocysteine is directly damaging to the bones, nervous cardiovascular system and helps induce clotting. Again, this is common marker to find elevated. Homocysteine is inflammatory .
Elevated Copper and Iron. Both oxidative nightmares and once again common to find.
Elevated Estrogens. So much so that 1% of breast cancer deaths are men (that equals about 450 men per year). Estrogen overload in men happens in a few ways which can and often are happening simultaneously. There are both alpha and beta estrogen receptors on the prostate, which makes it pretty sensitive to estrogen. The female breast has only alpha receptors.
In men that are overweight (2/3 of the U.S. population are overweight or obese), fat cells will covert androgens (like Testosterone) into estrogens. This process is called aromatization. Normally, this is how a woman gets her post menopausal estrogen. In a man this can be a pathological process. This can help lead to low testosterone in men which is highly detrimental to a man’s heath in lots of ways and is often found in higher grade Prostate cancers. That is, lower testosterone levels mean greater risk of a more aggressive prostate cancer. In fact, low testosterone is found in many of the high grade prostate cancer patients. Low testosterone is found to be contributory to a number of disorders affecting men. Higher estrogen loads (from aromatization) push cell division and induce clot formation. The ingestion of plastic by products (Bisphenols) in food or drink due to soft plastic wrappers or soft plastic drink containers pushes the process of aromatization. There is a whole class of toxic environmental pollutants that are known as endocrine disruptors. These foreign chemicals affect how our hormones work in a big way. Testosterone affects over 3oo tissue sites, so you can see the large impact that these strange chemicals can have on our bodies. Testing for Estrone Sulfate and Estradiol in the blood and estrogen metabolites in the urine will yield info on overload as well as how the body (liver in particular) is handling the breakdown and elimination of estrogens. Ratio of Estrone to Estradiol needs to be 2 to 1 or less.
Constipation and the recycling of estrogens. Estrogens can be reabsorbed in the Colon if stool retention is too long.
Lowered Testosterone from the conversion of Testosterone into Dehydrotestosterone (DHT). A Common find in elevated PSA score is high DHT. DHT pushes cell division (5 times stronger than testosterone) and directly affects Prostate tissue growth. Endocrine disruption pushes DHT production. DHT is a major player in the development of Polycystic Ovarian Syndrome in women. About 10% of Breast Cancer patients have DHT as one of the drivers of their cancer
In terms of growth factors for all types of cancers, Modern Oncology has decided that only certain growth factors go with certain cancers. Her2 nu is a growth factor that is looked at in breast cancer profiling (pretty much exclusively). Her2 nu occurs as a growth factor is 75% of all cancers. Testing for growth factors for all cancers needs to be greatly expanded in order to get enough info to set protocol properly.
Low DHEA to Cortisol ratios indicating tired adrenals.
Low Thyroid (Hypothyroid) is a common find in many Cancers
HPV Infection. This one is not so well recognized. The fact that virus can initiate and drive cancer has been known since the 50’s. It is well established that HPV causes cervical cancer in women. What about their male partners. HPV is highly communicable.
Excessive Sitting. Not uncommon that a man sits all day at his job, producing impeded circulation in the pelvis. Cancer loves stagnant blood and lymph, and does its best to create that stagnation. Cancer does it through creating high amounts of fibrin (clot forming) and reducing oxygen level in the bloods stream through something called Hypoxia Inducible Factor (H.I.F.). Excessive sitting is the mechanical version of this. As an aside, if H.I.F is elevated in a tumor it will be radio resistant (Radiation Therapy will fail)
Liver Stagnation/Exhaustion. Hormones have to be detoxified, broken down and eliminated by the actions of the liver. The Liver has a duel phase detox system. There is a translation between phase 1 and 2. If that translation has a problem (reasonably common) than the hormones that go through the liver for detox get thrown back into the blood stream in more damaging configurations, which can be 50x more toxic than the original hormone. Normally, when we make our hormones, a percentage of them are bound with a binding protein which has to be removed in order for the hormone to be active. In this case there are no binding proteins, so that all these intermediate toxic hormone metabolites are active and ready to attach to hormone receptors
Pathological stress response. A big player in all modern diseases. Pathological stress response is stress response layered upon stress response without a physiologic resolution, resulting in excessive amounts of cortisol. Excess cortisol does so many down things that there is a section in Wilson’s Book of Endocrinology (Medical Text) dedicated to the results of excess cortisol in our blood stream.
Low levels of Vitamin D and Zinc
Shift work and the altering of circadian rhythms.
Standard of Care for Prostate cancer is with surgery (Prostatectomy), ADT (Androgen Deprivation Therapy), Radiation, Cryotherapy , watching and waiting, or HIFU(High Frequency Ultrasound). HIFU is relatively new and is showing good results.
These are some of the stats post treatment from long term studies on Surgery, ADT, and Radiation. Long term studies on many treatment modalities are hard to find.
Surgery
In a 20 year follow up study of men who had a prostatectomy (vs observation) it was found there was no significant difference in rates of mortality between the 2 groups. Those who had the surgery had a higher frequency of adverse events in the long term.
In a study of 1655 men who had surgery aged 55-74 with a 15 year follow up the following results
19% had urinary incontinence, 22% had bowel difficulties, 87% had erectile dysfunction
That same study followed men who received radiation with the following results
10% had urinary incontinence, 36% had bowel difficulty, 94% had erectile dysfunction
Men who receive prostatectomy have a higher percentage of cardiovascular disease and other types of cancers compared to non surgical patients.
Men who get surgery or radiotherapy for Prostate Cancer will experience urinary, bowel and or sexual function at some point in the long term.
Follow up study for 23 years of men who received a prostatectomy found that the gain in life expectancy is 3 years with a much reduced quality of life.
ADT (Androgen Deprivation Therapy)
This form of therapy is generally given to men who have a recurrence of prostate cancer after being treated with surgery or radiation. ADT can also be used as a primary therapy for older patients with Prostate Cancer. Recurrence rates in Prostate Cancer are not that clear in numbers. Estimates were as high as 50%. In any case it appears to be much higher than we would like.
ADT consists of 3 drugs; Lupron, Casodex and Avodart. Basically ADT shuts down steroid hormone production. This therapy is very hard on a man’s body. Impact on the Cardiovascular and Neurological system is big. Bone integrity suffers a great deal with a six fold increase in fracture rate.
More than 500,000 men a year are treated with ADT.
As a primary therapy ADT does not show any improvement in long term survival.
Cardiovascular disease as a result of ADT is high. Heart attack rates go up.
Some of the side effects of ADT are as follows. Hot flashes, Sexual dysfunction, Anemia. Cognitive dysfunction including Depression, and Anxiety.
The goal of many of the aggressive therapies in modern cancer treatment is to drive a cancer cell line down to zero. Through these therapies being applied as they are (they can actually be applied differently) an interesting law has been elucidated. If you drive a cancer cell line down to 0 with ADT, Chemo or Radiation, then that environmental pressure put on that particular cancer cell line forces the cancer to mutate and become a stronger and drug resistant strain. (As 1 oncologist said to me “Cancer is the perfect machine”). If this one law was properly understood it could change the whole style of approach to Cancer in general. The idea of getting rid of cancer through the frontal approach with these therapies gets dubious results. The same tools can be applied in a different way, in order to keep the cancer at bay and manage it. The idea of managing Cancer with the use of Western Oncology and Natural Medicine is very doable in many cases. Using Standard Practice Medicines amazing diagnostic technology can help keep us ahead of the curve. That, along with well structured protocols based on Natural Medicine and if need be, both drugs and Natural medicine to prevent the cancer from evolving into a more intelligent and deadly foe.
Pulse dosing may be a way to use the drugs and not give the cancer the opportunity to mutate, become drug resistant or metastasize. Pulse dosing in this case would be implemented by using Chemo to bring down the cancer cell line to 20% of its original cell concentration, then backing off while doing many other things with Natural Medicine or with the combination of Natural medicine and drugs to help manage the cancer. If the cancer cell line comes back up again the procedure can be repeated. This way the cancer cell line remains sensitive to the same drugs and the chances of the cancer developing resistance and/or becoming a more aggressive cancer are challenged. The idea of managing cancer seems to possess way more practicality than trying to cure cancer. The only way Cancer can be cured (at this time) is by the immune system recognizing it for what it is and eliminating it from our bodies. If that recognition happens it does not take an overwhelming amount of Natural Killer cells to do the job. The problem is how difficult a job it is to get the immune system to do that from the outside in. Therefore management becomes primary. How to keep the cancer at bay so that it does not evolve (become more intelligent and deadly) and still keep the patient in good shape.
HIFU or High Frequency Ultrasound is pretty new. In a 5 year study of patients with non metastasized Prostate cancer who used HIFU, 98% remained non-metastasized. HIFU can be used repeatedly with no down sides.
Unless Radiation Therapy is worked with properly before, during and after, it will always induce fibrosis. The tissue never recovers. Radiation in and of itself is a known carcinogen. Some Docs are using a drug called Trental, which along with 1000 mg of Vit E to help with radiation damage.
Watching and Waiting. This is not intended to be a passive period, even with that name. Never trust Cancer. Watching and Waiting is a great idea when given to the right patient. During the watching and waiting period, the cancer needs to be bird dogged by watching closely through the blood stream. The blood stream will show that the cancer is making moves to become stronger and or metastasize or that it is maintaining stability.
A test that should be run before any Prostate Cancer or Breast Cancer patient gets a surgery is called TGB1 ( Transforming Growth Factor Beta 1). If that marker is elevated, the chances of a recurrence post surgically go way up. TGB1 can and should be reduced pre-surgically in order to avoid that negative potential. Unfortunately this test is rarely done.
Harry Chrissakis, Herbalist, M.H. M.T. HerbalistandHerbs.com 530-933-8244