Revisiting TIP (Testosterone Inactivating Pharmaceuticals)

BY RALPH BLUM

Why Does TIP Work?
Testosterone is the hormone that causes boys to become men at puberty. Prior to puberty, the prostate gland is roughly the size of a small marble. Then, when the teenage surge of testosterone occurs, the gland expands to walnut size and begins producing semen. This transformation occurs because the cells of the prostate gland are uniquely sensitive to the presence, or absence, of testosterone. Lowering the level of testosterone in the blood causes the cancer cells to shrivel up a die because the cancer cells are derived from prostate gland cells and retain the same dependence on testosterone for survival.

Long Term Results
One downside to TIP is that while it shrinks the cancer, it does not, ultimately, kill every last cell. However, it has been my treatment of choice for the past ten years. Studies done at Prostate Oncology Specialists, Inc. show that after twelve months of TIP the amount of residual cancer is usually too small to be detected with a lesion-directed biopsy using color Doppler ultrasound. In most cases PSA drops to near undetectable levels (mine dropped to 0.125), and TIP has the added benefit of having anti-cancer effects throughout the body.

When TIP is stopped, testosterone levels gradually return to normal, and a number of men require no further treatment. Some men require periodic treatment with TIP to keep their PSA levels under 5.  And other men, rather than continuing with intermittent TIP, decide to go for surgery, seeds or IMRT. However, even this latter group has bought themselves on average of five plus years before risking the intimidating potential side effects of more radical treatments.

Side Effects of TIP
Although no prostate cancer treatment is free of undesirable side effects, most of the side effects of TIP (weight gain, muscle loss, loss of libido)   are preventable with proper management. And loss of libido, unlike impotence, is reversible when TIP is stopped. Meanwhile, although some of the magic may be gone while on TIP, most men find that they can still enjoy sex (and give pleasure to their partners) with a little help from Big Pharma. Viva Viagra!

Final Thoughts
I can think of only three reasons why this non-invasive alternative to surgery and radiation is not more often the treatment of choice for men with Intermediate-Risk prostate cancer:

1)  Patients never hear that it is an option: Urologists usually don’t suggest TIP to men with Intermediate-Risk cancer as a viable alternative to their preferred treatments—surgery and radiation.

2)  Doctors are unfamiliar with the TIP option.  Finding an oncologist with experience in state-of-the-art methods of administering TIP is still a challenge.

3)  Most men are shocked and fearful when they are first diagnosed with prostate cancer, and it’s hard to resist the emotional appeal of “Just cutting it out”—especially when the risks of more radical treatment are sometimes glossed over.

Thankfully, in 2002, when I learned that my PSA had bumped up to 18.3, my fear of being sliced open, or fried by radiation led me to Mark Scholz, and TIP. And although I would not describe my experience as “a day at the beach,” I am deeply grateful that I chose TIP, and, more importantly, ten years later, I am still here!

The Un-Cancer

BY MARK SCHOLZ, MD

It’s easier to teach a proper golf swing to a true beginner than to someone who has previously developed bad habits that are now ingrained.  The young mind of a child learns a new language much more easily than the cluttered mind of the adult.  Good first impressions are valued so highly because we all know how hard it is to undo a bad first impression.  The biggest challenge of educating people about prostate cancer is overcoming their preconceived notions—what they already think they know about cancer.

What is prostate cancer?  Many say it’s harmless, that “you die with it, not from it.”  But how does that jibe with 28,000 deaths annually?  One reasonable conclusion is that prostate cancer occurs and acts in a variety of different ways. The Prostate Cancer Research Institute (pcri.org) recommends dividing prostate cancer up into five categories or Shades of Blue. This is helpful both for understanding the varieties of prostate cancer and for guiding the choice of treatment.

However, even though there are many forms of prostate cancer, this fact fails to convey how differently prostate cancer as a whole acts, compared to other cancers.  Why is it so important to understand this difference?  First of all, surgery—which is everyone’s first thought when they hear the word “cancer”—can have dire consequences.  For example, surgery almost always causes partial or complete impotence. Second, new research published by Dr. Timothy Wilt in the July issue of this year’s New England Journal of Medicine, shows that forgoing immediate treatment and embarking on a program of close monitoring known as “active surveillance,” has exactly the same survival rate as immediate surgery.  Bottom line: For far too many men, immediate treatment for prostate cancer is not only damaging, it is often unnecessary.

Forgoing treatment with something called cancer is certainly counterintuitive.  In order to support the case for monitoring, let’s compare the statistics for prostate cancer with those of colon cancer.

	Prostate Cancer:  The “Un-Cancer”	Colon Cancer: A “Typical” Cancer	Difference Factor
Deaths Annually	28,000	26,000	1 : 1
New Cases Diagnosed	241,000	73,000	3.5 : 1
Mortality Rate	8.5%	35.5%	4.2 : 1
Average Survival if Relapse Occurs	13 Years	13 Months	12 : 1

As the table shows, men diagnosed with colon cancer are not only three and a half times more likely to die from the disease, they die twelve times more quickly.  Unfortunately, almost all cancers—lung, pancreas, stomach, gallbladder, kidney, brain, bone, etcetera—approximate the behavior of colon cancer rather than prostate cancer.

The fact remains that it is logical for the general population to be terrified by the very idea of cancer.  When you consider all the different types combined, cancer is the second most common cause of death, just below heart disease. The risk of death from most cancers is high and if a cure is not obtained, death follows all too quickly. The unfortunate men who die from prostate cancer make the “news,” even though it may not be generally understood that it took 13 years for those men to succumb. However, the fact remains that there are 2.8 million prostate cancer survivors presently living in the U.S. That should be news too.

Ninety-one and a half percent of men diagnosed with prostate cancer will have a normal life expectancy, and will die of natural causes. The eight and a half percent who die from prostate cancer will live an average of 13 years, with this number expected to increase dramatically over the next ten years, thanks to continuing improvements in medical technology.  Treatment can definitely improve survival in selected cases.  However, it would seem that only men in the high-grade category are likely to benefit consistently.

The encouraging facts about prostate cancer outlined in this blog have been compiled to help men realize that survival rates with prostate cancer are extremely favorable compared to other types of cancer.  Now that studies show that survival with active surveillance matches that of immediate surgery, a great many men should take heart, and resist all efforts to rush into a treatment with such uncertain rewards but such predictable and devastating side effects. 

Harmony & Spirituality Practice Cultivating “Wa”

BY RALPH BLUM

Many years ago, I was invited to attend a breakfast fund raising event at the Bel Air Hotel in West Los Angeles. Ted Turner was attempting to squeeze donations from a room full of Hollywood moguls. The private dining room was filled with sunlight, and I remember sitting there, bored, zoned out and forking segments of my eggs Benedict around, when Turner’s Savannah chain gang growl poked a hole in my reverie: “I tell you, it’s spiritual,” he exclaimed. “And you know how I know it’s spiritual? Because I paid cash money for it.”

To this day, I have no idea what “it” was. But Turner’s logic—his working definition of “spiritual”—made me smile and stuck with me to this day. And while I’d rather steer the long way around when it comes to spiritual matters in general, I have become a devoted fan of harmony, as in feeling at peace. What the Japanese call Wa. Bottom line: I try not to regret anything that has already happened, and not to worry about what might happen. And in a way, I think this has played a role in my coming to terms with prostate cancer.

When discord hobbles me, throws off my vital signs, fogs up my reasoning, I feel it has a definite impact on my immune system. Efforts to counter mindless anxious behavior through breathing and light meditation may help, but in my case, only minimally. Instead, whenever I encounter discord, or more to the point, when I catch myself creating or contributing to the dissonance, I retreat from that discord as fast as I can. This happens in three steps:

First, I catch myself, recognize what’s happening, mark the moment: Blum, you’re doing it!

Second, I apply the brakes, stop what I am doing as best I can. Do whatever it takes to get into reverse and back away. I think of this step as “circuit breaking.”

Third, I substitute different behavior, consciously find a better way to look at what is disturbing my peace and serenity, my wa.

Example: Despite my expectations, my PSA has risen. And I’m suddenly scared s—tless my next Gleason score will have deteriorated from 3 + 3 to 3 + 4, and that I will start feeling pressure to “act,” to begin radical treatment. As a Remedy, I hold a conversation with myself,

Me:  How many years has your cancer been in the seminal vesicle?
Myself: About six.
Me: So six years out of the capsule?
Myself: Yup.
Me:  Is the cancer in your bones?
Myself: No.
Me: Well, how about the lymph system?
Myself: Don’t think so.
Me: So And how old are you?  

Myself: I’ve been around the sun 80 times.
Me: So in 10 years you’ll be 90?
Myself: You might look at it that way.
Me: And your cancer, basically untreated, has been stable for almost a quarter of a century.

Myself: Something like that.

Myself: So given hour history, what kind  of prognosis would you expect for the years to come. . . ?

The Q and A continues until I find myself relaxing, counting my blessings. This sounds like pretty simple-minded stuff. But not getting caught in the quicksand of negative emotions or behavior that is toxic, just staying in the “here and now,” is a spiritual practice that helps maintain Wa. I do my best to stay in the present moment. But when I slip, ASAP after the fact I review what has happened. I replay what happened in my mind with different features, focus on a better way to handle it next time. And some day perhaps I’ll find out what spiritual stuff Ted Turner paid cash money for. And place an order for myself. A baseball team. An ocean going racing yacht. A date  withJane Fonda. CNN. A day at the beach. . .

To each his own kind of Wa.

More to come.

“We Must do Better,” A Position Statement Regarding PSA Screening from Dean Foster, MD, PCRI Medical Director

Last May, the U.S. Preventative Services Task Force (USPSTF) triggered a firestorm of debate after issuing its recommendation against the use of the prostate-specific antigen (PSA) blood test to screen for prostate cancer. In her editorial responding to the controversy, Task Force Chair, Dr. Virginia Moyer summarized the committee’s findings with this sentence, “We can do better.” The Prostate Cancer Research Institute (PCRI), while disagreeing with the Task Force’s simplistic banning of PSA, does agree with Dr. Moyer’s conclusion: We can indeed do better.

“We can do better in educating men on the pros and cons of PSA,” explains Dr. Dean Foster, the PCRI medical director and prostate cancer survivor. “However, all the recent controversy is giving men an excuse to tune out about a disease that affects one in six of them. The subject of prostate cancer already makes men uncomfortable.  The controversy over the PSA test gives them one more reason not to pay attention.”

The PCRI encourages men to learn about PSA testing in consultation with their physician. When PSA screening is implemented and elevated levels are detected, further education is necessary before undergoing biopsy. For men with a high PSA, the PCRI currently recommends two additional tests prior to undergoing biopsy: PCA--3, a widely available urine test, and multi-parametric MRI. The PCRI offers free Helpline services to aid men in locating centers offering these services. 

Finally, Dr. Foster concludes: “Men can receive the benefit of PSA screening and still protect themselves from the risk of overtreatment, which is the main factor cited by the U.S. Preventative Services Task Force for giving PSA a “D” rating. The PCRI stands in agreement with Dr. Moyer and the USPSTF in that ‘we all must do better.’  However, PCRI does not recommend simply abandoning PSA screening. Through education, unnecessary overtreatment of the benign type of prostate cancer can be avoided while still using PSA to detect the aggressive form.”

Successful Mentoring Means Everybody Gets Their Needs Met

BY RALPH BLUM

The matter of finding men able and willing to guide newly-diagnosed men who attend support groups requires considerable thought. Leaders often deal with very challenging situations.  For example, how does one handle the men who are attending with a single overriding need, the need to have their personal experience and their treatment decisions validated?

These “confirmation seekers” do not understand how their need for simple black and white declarations distorts the real challenges faced in selecting treatment. The reality with prostate cancer is that it is possible to have a bad outcome even though the “best” treatment may have been selected.

All prostate cancer treatments are potentially dangerous, placing a man’s quality of life in serious jeopardy.  All that the “best” treatment can offer is better odds,  a less risky alternative compared to the options. Guarantees of success are made by charlatans and believed by suckers. 

So in Lenin’s famous words, “What is to be done?”  The dilemma support group leaders face is to address the needs of all the individuals even though their needs may not relevant to the whole group. The solution came from an old friend, David Derris, a man whose decades of experience in guiding support groups have resulted in a sensitive and bias-free skill-set.

According to Dr. Derris a support group leader needs to somehow get across to the newly-diagnosed that scientific information about different treatment options only provides general guidance, not absolute answers.  How does he go about accomplishing this? Derris provides a simple solution: If the support group begins at 7 PM, he invites all new patients members come at 6 PM, an hour earlier. By providing the newly-diagnosed patients a separate session, all options can be discussed free from any pressure from the “confirmation seekers.”

Many newly-diagnosed men have a low-risk situation—a mildly elevated PSA, or a Gleason score of 3 + 3—which makes them candidates for active surveillance rather than immediate treatment. The field of active surveillance is dynamicly changing. New studies suggest that multi-parametric MRI approximates the accuracy of a needle biopsy.  These rapid changes in the way medicine is being practiced demand an open-minded approach in a collegial environment. A low pressure situation excluding the highly opinionated enables newly-diagnosed men to think more clearly and increases their self-confidence.

At the same time, no group wants to lose those experienced men, simply because their agenda includes confirmation of their own treatment decisions. These guys who have “been there, done that” and lived to tell their story have a valuable role to play as witnesses and informants. Sharing their experiences can provide long-term perspectives for the newly-diagnosed. Dr. Derris is to be commended for finding ways to ensure that all members of the group will have their needs met.

I was pleased to learn from Mark that those who now serve, or wish to serve, as support group leaders can, thanks to PCRI, sign up for a course in  “Mentoring” www.pcrimentors.org where they can learn from  the experiences of the best advocates in the field, men like “Snuffy” Myers, Mark Moyad, and John Blasko. Good news and more to come.