BLOGGERS: MARK SCHOLZ, MD & RALPH H. BLUM

The co-authors of Invasion of the Prostate Snatchers, blog alternate posts weekly. We invite you to post your comments.

Tuesday, May 19, 2015

When “No Action” Can Be “Right Action”

BY RALPH BLUM

Back in 1990, when a suspicious lump was discovered on my prostate, my ignorance of the prostate gland and the possibility of prostate cancer was monumental. No one in my family or even among my close friends had ever had prostate cancer, and it never occurred to me that I might one day have the disease.

Now, 25years later I am still alive, the average man over 50 is more aware of prostate cancer, and also many less toxic and more effective treatment options are available. And yet one thing has not changed: just hearing the doctor say, “I’m afraid it’s cancer,” can leave even the most pragmatic man planning the music for his funeral.

Truth is there is still a lot of misinformation and misunderstanding out there about this disease. So here are some facts that I hope will alleviate some of your fears, and also clarify why I still contend that if you have to have cancer, prostate cancer is the best deal in town.

Prostate cancer is unique among cancers because the mortality rate is so low. According to the American Cancer Society, more than 2 million men who have been diagnosed at some point are living with the disease in the U.S. It’s difficult to determine actual prostate cancer survival rates because most men are around 70 years old when diagnosed, and many of them will die from medical problems unrelated to the disease. But if you check out the “relative” 5-year survival rate of all stages of prostate cancer, you will find it is almost 100%. And that almost 100% of men with low-risk or  intermediate-risk disease live more than 10 years after diagnosis.

Why is it that the statistics for prostate cancer are so much less frightening than for other cancers?
 
1)    The PSA test is an early warning system that other cancers don’t have.
2)    It can easily be diagnosed at an early stage.
3)    In most cases it has an exceptionally slow growth rate.
4)    Extremely effective monitoring and treatment is now available.
5)    It has a pattern of spread that spares critical organs like the brain, lungs and liver.
6)    There is a safety net like no other called “hormone blockade” that induces remissions lasting more than 10 years in men with relapsed disease after surgery or radiation.

So instead of thinking about your funeral, what you really want to be focusing on is not rushing into some form of radical treatment that will virtually guarantee  some degree of impotence or incontinence.

It appears that patients and doctors alike struggle with the idea of “watching” anything called cancer. But unless you have the less common high-risk form of the disease, my advice to you is to consider “Active Surveillance” really carefully, especially if you are over 70. Because bottom line—and it bears repeating—out of over 200,000 men in the U.S. diagnosed annually with prostate cancer, the overwhelming majority will die with the disease, and not from it.

Tuesday, May 12, 2015

Metformin and Statins for Prostate Cancer

BY MARK SCHOLZ, MD

As an internist and an oncologist, throughout my long career treating prostate cancer patients, I have periodically been asked by patients, “What do you do?  Surgeons (urologists) operate, and radiation doctors give radiation, but what do prostate oncologists do?”  My day-to-day, bread and butter is giving medical advice and prescribing oral medications. Unfortunately, I think this leads to some patients seeing me as a “pill pusher.” As such, I think I need to explain my motives for recommending the use of metformin and statins to my patients with prostate cancer.

One of the things that the last 20 years of my career treating prostate cancer has taught me is that a good diet has a favorable effect on inhibiting prostate cancer progression.  What converted me from a nonbeliever to a believer?  My patients.  A number of men have come to me through the years whose PSA was rising after surgery and who subsequently embarked on stringent vegan or macrobiotic diets. Lo and behold, as long as they stayed on their diets their PSA levels would stabilize. Subsequently, T. Colin Campbell published a very convincing book called The China Study that evaluated the connection between increased animal protein intake and cancer rates.  His findings conclusively demonstrated that high animal protein intake increases cancer risk.

How can diet make such an impact?  We don’t have all the answers but there are some very logical suppositions.  First, cancer cells “hurt” people by the process of cellular multiplication, ultimately spreading throughout the body and causing organ malfunction. It’s logical to assume that “better fed” cancers, the ones that get plenty of protein and energy, will grow faster and better than cancers that are relatively deprived.  Animal protein not only provides all the necessary amino acids for the construction of new cells, animal protein is invariably accompanied by substantial amounts of a potent energy source—fat (People forget that the average hamburger is over 50% fats). High protein diets also increase the level of insulin in the blood. And high insulin levels drive sugar and protein uptake into the cancer cells, further promoting growth. And lastly, dietary cholesterol is not only a type of “fat,” but it is also a hormonal precursor, a building block for DHEA and testosterone.

Unfortunately, few of us have the ability to follow strict vegan diets. It’s a lot of work and requires constant self-denial.  Certain medications, however, can achieve some of the same effects. Metformin, a generic medication approved for the treatment of diabetes, suppresses insulin levels in the blood. Studies in diabetic men with prostate cancer who are treated with metformin have shown lower prostate cancer mortality rates compared to diabetic men who are treated with other types of diabetic medications besides metformin.  Statins pills, medications such as Lipitor and Crestor, dramatically lower cholesterol levels.  Numerous studies have reported higher cure rates in prostate cancer patients receiving radiation who are treated with statins compared to radiation-treated patients who don’t receive a statin.

Regular exercise prolongs life in cancer patients.  If we had a pill that could accomplish what exercise can do—improved energy levels, sleep, digestion, memory, longevity and less depression—everyone would take it.  Many patients are lukewarm about prescription pills like metformin and statins, probably mainly due to concerns about side effects.  But side effects can be anticipated with careful monitoring.  When a medication side effect occurs it can be detected early and when the medication is stopped the problem is almost always resolved.  Following a rigorous macrobiotic diet for the rest of your life is beyond the reach of most of us. Taking an FDA-approved pill, while using careful precautions against potential side effects, is achievable for almost all of us. 

WANT TO LEARN MORE ABOUT PROSTATE CANCER?
Register now! Join PCRI, September 11-13, 2015 for The 2015 Prostate Cancer Conference - providing educational sessions on the latest prostate cancer treatment options, lifestyle changes, and quality of life issues presented by world-renowned physicians and researchers. Hosted at The Los Angeles Airport Marriott. For more information: http://pcri.org/2015conference/
 

Tuesday, May 5, 2015

Oxygen Therapy: In the Absence of Evidence

BY RALPH BLUM

Since Mark and I published, Invasion of the Prostate Snatchers, I have been getting a surprising number of questions about the use of oxygen therapy as a vigorous anti-cancer technology. Based on all the inquiries one would think there must be evidence of a widespread belief that oxygen therapy acts to retard or even halt the spread of prostate cancer.

I regret to say that, as of this writing, that is almost entirely untrue, or at best, unproven, except in one situation: Hyperbaric treatment is used to accelerate healing of tissue damaged by radiation therapy. Available scientific evidence does not support claims that increasing oxygen levels in the body will kill or even inhibit the growth of cancer cells.

How is Oxygen Therapy Promoted for Use?
Different varieties of oxygen therapy are effective for treating multiple conditions, including carbon monoxide poisoning, certain kinds of wounds, injuries and skin infections, delayed radiation injury and certain bone and brain infections. However, the FDA sent a warning letter to at least one manufacturer about promoting  oxygen treatment for unproven uses such as certain types of cancer, asthma, emphysema, AIDS, arthritis, heart and vascular diseases, multiple sclerosis and Alzheimer’s disease.

Proponents of oxygen therapy claim that cancer cells thrive in low-oxygen environments. They believe adding oxygen to the body creates an oxygen-rich condition in which cancer cells cannot survive. They also claim that a high oxygen environment increases the efficiency of all cells in the body, increases energy, promotes the production of antioxidants and enhances immune system function.

Other oxygen aficionados believe that immersing an affected body part can cause tumors to separate from the body so that a cancer can be “wiped away.” There is little evidence that this is the case. And yet, a considerable number of men are committing to a variety of oxygen treatments. And that concerns me. So I will give you a brief survey of the oxygen therapy field.

What is the History of Oxygen Therapy?
The history of putting oxygen-releasing substances into the body follows several tracks. Interest in ozone dates back to the mid-1800s in Germany, where it was claimed to purify blood. During World War I, doctors used ozone to treat wounds, trench foot and the effects of poison gas. In the 1920s, ozone and hydrogen peroxide were used experimentally to treat the flu.

One of the earliest accounts of the medical use of hydrogen peroxide was a short article by I.N. Love, MD, in 1888 in the Journal of the American Medical Association. Dr. Love recommended using hydrogen peroxide as “a stimulator of healing." Unlike most current articles, the 1888 report in that prestigious journal did not include details that would be required today, such as whether patients treated with peroxide lived longer than those receiving placebo, or whether there was any solid evidence that peroxide caused cancers to shrink or disappear.

During the 1930s, Otto Warburg, MD, a winner of the Nobel Prize in 1931 for his research on respiratory enzymes, discovered that cancer cells have a lower chemical respiration rate than normal cells. He reasoned that cancer cells thrived in a low-oxygen environment and that increased oxygen levels might therefore harm and even kill them. Many of the beliefs held by oxygen therapy proponents are based on Dr. Warburg’s theories concerning cancer, even though technical advances have since offered a great deal more information about how cancer cells really use oxygen.

Negative Reviews
According to Dr. Stephen Barrett, who writes about health fraud, reviewed a researcher from the Dominican Republic who claimed that his clinic used ozone gas to cure thirteen people with cancer. An investigative news group later learned that two of the patients died of cancer, three could not be found, two refused to be interviewed, three were alive but still had cancer, and in three cases it was not clear if the patients actually ever had cancer.

Furthermore, a 1993 review article found some evidence that too much oxygen in the body’s tissues may damage genetic material and promote abnormal growth. And a 2001 review of ozone therapy concluded that "… few rigorous clinical trials of the treatment exist. Those that have been published demonstrated no evidence of effect . . . Until more positive evidence emerges, ozone therapy should be avoided."

Conclusion
Although oxygen therapy has its benefits, it is the subject of a great deal of controversy, and I could not find credible evidence that it either halts or slows cancer growth. Nor does depriving tumors of oxygen stimulate their growth.  Nevertheless, oxygen therapies continue to be widely promoted as alternative treatment for cancer and other serious illnesses, and are offered at clinics in Mexico, the United States and Europe. These clinics are attracting men with prostate cancer, men hopeful that the therapies provided will benefit them.

The lack of randomized clinical trials makes it difficult to judge the value of oxygen therapy for many of its claims, and we need to expand our knowledge on the effect and mechanisms behind tumor oxygenation.  Meanwhile it continues to be big business south of the border.

But let the buyer beware.

Tuesday, April 28, 2015

New Ways of Using “Old” Technology

BY MARK SCHOLZ, MD

My old professor from USC, Dr. John Daniels, once told me that most “new inventions” are usually the result of “old invention” being repurposed in a new way.  His own company was an example.  Dr. Daniels developed a process for extracting collagen from cow hides (before Botox came along, collagen was injected into wrinkles for cosmetic reasons). Collagen was FDA approved for injection into wrinkles, but Dr. Daniels readapted it for treating cancer.  He performed studies that injected collagen into the blood vessel feeding liver tumors to block the blood supply.

A couple weeks ago at the PCRI’s midyear update, Dr. Margolis spoke about the possibility of readapting multiparametric MRI (MP-MRI) for cancer screening in men with high PSA as an alternative to random biopsy. For those of you who don’t know, MP-MRI has already gained widespread acceptance as a backup plan for finding prostate cancers in men with high PSA levels when an initial 12-core random biopsy fails to detect cancer.

Any logical person would think that, “If the MRI is more accurate, less invasive and less expensive, why not simply do the MRI first, before the biopsy?”  Then, if the MRI is clear a biopsy can be avoided altogether. (And when the MRI does show a suspicious spot, only one or two cores are needed to biopsy it.)

However, the medical community, which has been doing random biopsy for the last 25 years, patiently awaits the results of studies to evaluate the accuracy of random biopsy and MP-MRI in head to head trials.  Unfortunately, these studies will take many years to complete.  And in the meantime, should we keep doing random biopsies in a million men every year?

We are all well aware of how quickly the development of new medical technology is accelerating.  So in this blog, my goal is to point out that as all these new treatments are becoming available, it creates new uncertainties about how to use them in the most optimal fashion.

Newly-approved, more powerful hormone treatments like Zytiga and Xtandi are a good case in point. Studies clearly validate their superiority over traditional hormone shots and pills in men with advanced disease.  But doctors are reluctant to prescribe such procedures for men with earlier-stage disease, even when the cancer is unequivocally high risk. Once again they cite, “The absence of clinical studies to support this new and expanded role.”  

One question always seems to arise when proposing to use a new treatment in an expanded role. The question is “Maybe we should reserve the new treatment in case the traditional treatment fails.  After all, don’t we need a backup plan?”  The problem, at least as far as treating relapsed cancer is concerned, is that most cancer “backup plans” can’t bring about a cure. The best chance for curing cancer is always with the first treatment.  And it’s not like this question hasn’t been already looked into.  Numerous studies have addressed the question of sequencing treatments versus using the same treatments simultaneously in combination.  Almost every time the cure rates are improved by using the treatments in a combination, “up-front” approach rather than trying one treatment and waiting to see if it fails before starting the second treatment.

So in summary, this is a new era of hope and discovery. I’m sure none of us are complaining about having a whole bunch of new and effective treatments available.  However, with this privilege come new responsibilities. But doctors and patients will need more flexibility in their thinking. In this era of rapid technological progress the standard preconceived notion that every treatment recommendation must be backed up by a scientific study will need to be reconsidered.