Prostate Awareness Foundation
Prostate Self Help
Monthly Bulletin
December, 2010
Happy Holidays: As we approach the holiday season I wanted to thank all of you for your support of the Prostate Awareness Foundation and its mission of encouraging men to take a proactive approach to prostate health. This is the first PAF Self Help Bulletin in a number of months. We apologize for this break in publication, but promise to send you a regular monthly bulletin starting with this issue.
PCRI Annual Symposium Recap: Once again Jan Zlotnick, RN and Ken Malik, executive director of PAF attended this year’s annual Prostate Cancer Research Institute Symposium in Los Angeles. Jan is on the PAF board of directors and teaches men’s health classes at City College of San Francisco. He is a long time prostate cancer veteran. He has undergone a radical prostatectomy, radiation and has been using ADT and other pharmaceuticals to stop the progression of his prostate cancer. Ken Malik is the founder of PAF. He is a 15 year veteran of prostate cancer and has been on active surveillance all that time without any conventional treatment. Ken uses diet, exercise and stress management techniques to stall the progression of his cancer. The PCRI symposium is an annual lecture series presented by some of the most respected names in prostate cancer research and treatment. Below is a recap of the lectures.
Reasons For Hope (by Ken Malik): The feeling among the prostate cancer research specialists who lectured at this annual symposium was that there were a number of reasons to be optimistic about finding more benign protocols for dealing with prostate cancer. Their feeling is that a cure for prostate cancer was possible within the next ten years.
1) More men each year are surviving prostate cancer.
2) More men each year are surviving prostate cancer longer than ever before.
3) The pace of prostate cancer research is increasing.
4) A new generation of gifted researchers is working on the problem.
5) New drugs are on their way to being approved by the FDA.
6) Improved bio-markers are on the way to better measure disease progression.
7) New Androgen Deprivation Therapy pharmaceuticals are on their way.
8) Immunotherapy drugs like Provenge will increase longevity for advanced disease patients.
9) 24 different prostate cancer strains have now been identified. Individualized treatment protocols are on the immediate horizon.
10) Patient proactive involvement is on the increase.
Dean Ornish, MD: “Can Diet & Lifestyle Changes Reverse on Prostate Cancer”? (by Ken Malik) Dr Ornish’s pioneering research was the first to show that lifestyle changes may stop or reverse the progression of heart disease, early stage prostate cancer and even change gene expression. Recently, Medicare agreed to provide coverage for his heart program, this the first time that Medicare has covered an integrative medicine program. He was recognized by LIFE magazine as “one of the 50 most influential members of his generation”. His latest book is titled “The Spectrum” and his website is located at www.pmri.org . Dr Ornish is on the UCSF Medical Center staff and has offices in Sausalito, CA.
NOTES:
The key – A sustainable change in diet and lifestyle. The degree of change can be profound. The bigger the change, the bigger the effect. As a nation, adopting lifestyle changes could reduce our healthcare costs as much as 75%. The joy of living is a better motivator than the fear of dying.
The Study: 93 men with a PSA under 10 and Gleason of 7 or less.
The Result: After 1 year, average PSA went from 6.23 to 5.98. The control group PSA went up.
The Ornish Program:
Vegan Diet – Soy based, low fat diet, low carbohydrate
Stress Management: Yoga for stress reduction and relaxation. Chronic stress impacts memory loss and compromises immune health
Regular Exercise: 30 minutes of walking, 6 days per week
Support Group Meetings: Weekly meetings reduce loneliness. Increases authenticity (being there for others), creates a common goal and enhances togetherness and seems to increase immune function.
The Outcome: Down regulation of tumor growth genes. A reduction of stress hormones that impact the immune system and stimulate disease progression. A feeling of well being overall helps sustain positive lifestyle changes.
John Mulhall, MD: Erectile Dysfunction and Sexual Health for Men with Prostate Cancer. (By Ken Malik):
Dr Mulhall’s book, “Saving Your Sex Life: How to Optimize Sexual Function Preservation Following Prostate Cancer Treatment” is a must read for every man considering conventional therapy for prostate cancer.
Fact: prostate cancer therapies including surgery, radiation and hormone therapy are all recognized to be associated with sexual function problems. Fact: Sexual function problems are not limited to erectile dysfunction but also include conditions such as Peyronie’s disease (curvature of the penis), problems with ejaculation, problems with orgasm, change in penile size and loss of libido. Optimization of sexual function preservation can be looked at in 3 stages: strategies pre-treatment, during treatment and post-treatment. The best outcomes for any given patient are dependent upon a number of factors including utilization of the best technology, best physician experience, best physician judgment, the most informed patient and the best institutional support systems. Dr Mulhall developed and manages the Penile Rehabilitation program at the Memorial Sloan-Kettering Medical Center in New York City, the only program of its type in the USA.
NOTES:
Clinical studies indicate 20-90% of men have erectile dysfunction after surgery. Only 15% of men return to 100% sexual function.
A major problem: High patient expectations, based on overly optimist prognosis from their physicians. Patients need to stand up and SHOUT in order to change things. The average doctor has only taken 2 hours of course work on sex education, most feel uncomfortable talking about sexual issues with prostate cancer patients.
Expectations vs. Reality: After surgery & Radiation – expectation: 12 months, Reality: 24 months plus. Robotic Surgery: the hype makes one feel the results are superior to regular surgery, the reality is the numbers are the same. Suggestion: only use a surgeon who has done over 250 procedures, averaging 50 per year. Hormonal therapy (ADT) for longer than 4-6 months creates irreversible erectile tissue damage. Those men undergoing ADT prior to surgery have a harder time restoring sexual function. The muscles in the penis are replaced by fat tissue.
Pre-Treatment Strategy: Have your testosterone level checked (always prior to 10am), to create a baseline. Pre-op levels are a gauge of post-op success. To reduce atrophy you must protect the endothelium cells in the penis. Viagra will help do this. Take 100mg of Viagra 3-5 times per week beginning a month or two prior to treatment, or 20mg of Cialis or Lavetra (Viagra works best in protecting the endothelium cells. Discuss with your partner the level of importance you place on sexual function, and then have the same discussion with your doctor.
Post Op Treatment Strategy: Continue the Viagra program. This will only be effective if you opt for a nerve sparing radical prostatectomy. Be alert to nocturnal erections, this is a good indication of your ability to restore sexual function. The average man has 3 nocturnal erections per night.
Additional Comments: Medicare and most insurance plans do not cover the cost of Viagra. Viagra costs on average about $14 per pill in the USA. You can buy Viagra much less expensively from a Canadian pharmacy. We have seen prices as low as $1.85 per pill on-line at a website called www.Eonhealthcare.net. Shop around and always be careful buying medications and supplements on line.
Thomas Liu, MD – UCSF Medical Center in San Francisco has had some success using stem cells to reverse penis tissue damage.
Duke Bahn, M.D. (by Jan Zlotnick, RN): Dr Bahn is the Director of the Prostate Institute of America where he specializes in prostate cancer diagnostics and cryo-therapy. He is famous for his color Doppler ultrasound technique. He told us that local tumor cryoablation can induce regressions of metastatic disease. He presented data showing that cryoablation is more effective than heat ablation for promoting anti-tumor immunity. He also presented a new treatment strategy using cryosurgery, followed by injection of a patient’s own immune system cells into the site of the tumor and an anti-immune system drug (cyclophosphamide) to lower the regulatory cells that inhibit tumor destruction (now in Phase II trials).
New Treatments for Hormone Resistant PC – Nicholas Vogelsang, M.D.
(By Jan Zlotnick, RN) Dr Vogelzang is a medical oncologist practicing at the Comprehensive Cancer Center of Nevada. Prior to that he was Director of the University of Chicago Cancer Research Center.
Sipuleucel-T is associated with significantly improved survival compared to placebo in asymptomatic or minimally symptomatic patients with metastatic CRPC (castration-resistant PC. Will the acronyms never stop?) There are lots of side effects with this drug, but the worst seems to be a flu-like syndrome. **THIS TREATMENT IS ALREADY FDA APPROVED
Cabazitaxel/prednisone is the first treatment that works when docetaxel fails. It also improved survival time over docetaxel-based treatment, and it has fewer side effects. Cabazitaxel/prednisone also significantly improved response rates and time to progression vs mitoxantrone/prednisone. Diarrhea and fever are significantly more common with cabazitaxel/prednisone vs mitoxantrone/prednisone. **FDA APPROVED
MDV3100 – This is the drug they were calling “Casodex on steroids” at last year’s symposium. It’s an androgen receptor blocker in Phase II trials that has worked on patients who failed docetaxel. What really excites to me is that early results show a long time to disease progression.
Abiraterone – This drug has a unique mechanism of action: It prevents androgen syntheses in multiple tissues. Phase II trials indicate that it works after docetaxel.
Denosumab is better than zoledrenic acid at preventing skeletal-related events (SREs, a standard of measurement for evaluating drugs that reduce bone loss). It is pending FDA approval.
Charles “Snuffy” Myers, M.D. (by Jan Zlotnick, RN) : Dr Myers is the director of the American Institute of Diseases of the Prostate in Virginia. He a medical oncologist specializing in prostate cancer and a prostate cancer veteran himself. He is also the editor of the Prostate Forum, a monthly publication on prostate health issues.
Dr. Myers was more adamant than ever about the benefits of regular exercise, both aerobic and weight training, and eating a Mediterranean diet. He also emphasized finding an optimistic physician and having a reason to live as being important to longevity with or without PC.
He feels that too many physicians move directly to chemotherapy when initial hormonal therapy fails. Dr. Myers has been using estrogen patches (patches reduce side effects), leukine (an immune system protein), and simultaneous ketoconazole & prednisone with excellent response rates. He emphasized that treatment needs to be individualized based on patient responses. And details matter, both for us and our doctors. Ketoconazole, for example, must be taken every eight hours with an acid such as citrus, soda or vitamin C.
Some of the advantages of Dr. Myers’ combination therapy:
- PSA is lowered with individualized doses of Leukine + ketoconazole
- Estrogen reduces fatigue of ketoconazole
- Estrogen rapidly reverses osteoporosis
- Estrogen reduces hot flashes
- Estrogen improves short term memory
Response rates to Dr. Myers’ combination therapy
- 75% reduction in PSA was seen in 78%
- 49% reached an undetectable PSA
- Of 104 patients, only 17 (16%) had passed away
- Bad and good news: After 5 years, it is too early to measure the full benefit.
Prostate Awareness Foundation
2166 12th Ave, San Francisco, CA 94116
www.prostateawarenessfoundation.org
415-675-5661 / kamalik@sbcglobal.net