Taking Charge of Your Prostate Cancer Recovery:Fast Forward From the Old Model

RALPH BLUM

In the old model of prostate cancer care, you were rushed into radical treatment--usually surgery or radiation--often without fully understanding all your options, or the risks and side effects involved. The entire process was focused on the tumor; minimal attention was given to you as a person, and little effort was made to explore the benefits of healthy lifestyle choices, immune-enhancing treatments, reasonable delays, and emotional support.  

The emerging new model of prostate cancer care recognizes the important role you can, and should, play in your recovery. The emerging model comprehends that simply attacking the cancer is not enough. Greg Anderson, who after surviving "terminal" lung cancer founded the Cancer Recovery Foundation, has said that "Retaining a medical team without doing everything you can to help yourself is like attempting to walk on one stilt."

So what do you need to know in order to take charge of your recovery?

 There are three common misperceptions about prostate cancer:

*The assumption that the disease is as dangerous as other cancers.
*The assumption that the urologist who did your biopsy is a prostate cancer expert.
*The assumption that a quick treatment decision is necessary before the cancer spreads.

First of all, prostate cancer is unique among cancers because the mortality rate is so low. Around two hundred thousand men in the U.S. alone are diagnosed with the disease every year, and less than 3% will eventually die from it, while a majority of men who have the far more common low-risk, slow-growing prostate cancer can anticipate living a normal life span, or dying of something else.

 
Your local urologist has a busy medical practice that involves treating problems like impotence, infections, incontinence, and kidney stones. He also does biopsies. But the average urologist performs fewer than five prostate removals (prostatectomies) a year--far too few to be considered proficient. He may be a talented doctor, but he is unlikely to be a prostate cancer expert. So once you have your biopsy results, it is best to consult a prostate cancer specialist, either at a major medical center, or at a high-volume prostate cancer clinic.

As for the third misperception, it is essential, before committing to any form of treatment, that you do your own research, and are convinced the treatment you choose is the right one for you.  Do not let anyone rush you into making a bad decision. Once your category of prostate cancer is identified (Low, Intermediate, or High Risk), get on the Internet and learn about every treatment option--including no treatment whatsoever--for your type of disease.  If you are over 70, and have low-risk disease, my advice to you is to find a doctor who has experience monitoring an active surveillance protocol.

Your role in your recovery, however, doesn't end with choosing your treatment. The emphasis on lifestyle changes has been one of the most significant shifts in cancer care in the last decade. A study at UCSF showed that improving your nutrition, reducing stress and getting more exercise, can lower PSA levels.  And according to a relatively new field of health psychology called "illness representation," your beliefs and expectations also impact the outcome of your disease. So take charge of your recovery, and have faith in your choice of treatment.

Advice for the Newly Diagnosed

BY RALPH BLUM

If you are recently diagnosed, the good news is that promising new drugs and therapies, as well as new thinking about when to treat and when it is not even necessary to treat, have made a diagnosis of prostate cancer far less threatening than in the past.  Having said that, remember the old rule of the desert: "Trust in God, but tie your camel to a tree." Because the same applies with a cancer diagnosis. It's not enough to depend entirely on your medical team. Now is the time to consider what you can do to support your recovery and reduce the risk of recurrence.

First, you need to be involved in each treatment decision, making certain that you are fully informed, and that you understand the risks and side effects involved. It is all too easy to play a passive role and just go along with whatever the urologist or oncologist recommends. But you need to take charge. Research your diagnosis on the Internet. Explore all your treatment options and decide whether you do, in fact, need treatment, or if active surveillance is your best option. Get a second opinion.

Next--and I'm sure you don't want to hear this--you need to examine your lifestyle. Yes, I know you would prefer just to let your treatment get rid of the cancer.  But everyone I have talked with who has done really well in the cancer wars has made good nutrition, moderate exercise, stress management, and positive engagement in their own health and healing--key parts of their recovery program.

So where to start? Anyone overweight? A new study suggests that being overweight or obese lowers the chances of successful treatment. It is also known to increase the risk for prostate cancer, particularly for more aggressive, high-risk disease.  So experts agree that losing weight is an important first step.

A study led by UC San Francisco involving 4,600 men diagnosed with non-metastatic prostate cancer found that by substituting healthy vegetable fats--olive and canola oils, nuts, seeds and avocados--for animal fats and carbohydrates, the men lowered their risk of disease progression. Men who replaced 10 percent of their daily calories from carbohydrates with healthy vegetable fats had a 29 per cent lower risk of increasing aggressive prostate cancer.

There is no doubt that certain foods are helpful in reducing cancer growth and other foods are not. High on the "not" list is sugar, especially high fructose corn syrup, and processed meat--salami, bologna, sausage, hot dogs etc. Your shopping list for "helpful" foods should include all fish and skinless chicken breast, beans, vegetables and fruit, whole grains and breads, and non-fat dairy. It doesn't mean you can never have another slice of pizza in your life, it just means cutting out the steak and fries. Because there has never been a more important time in your life to eat well.

Here are a few other simple things you can do:

 Take Vitamin D³. Credible research links Vitamin D³ deficiency to cancer growth, predominantly breast and prostate cancer. The recommended dose is 2,000 to 4,000 IU daily.

·       Hydrate. Lack of water inhibits immune function.

·       Get eight or more hours of sleep each night.

·       Laugh a lot. Laughter is the ultimate antioxidant.

·       Listen to music.

·       Stay in the moment. Don't let past regrets and future fears contaminate the present. Remember Deepak Chopra's words: "Every cell in your body is eavesdropping on your thoughts."

 

The Billion Dollar Question: Aggressive or Not?

BY RALPH BLUM

The billion-dollar question facing the approximately 240,000 men in the U.S. diagnosed each year with prostate cancer is: Do I get treated? Or not?

Overtreatment of prostate cancer is both a major problem and extremely costly both financially and physically.

Financially, because of the high cost of radical treatments and physically because most treatments can cause unpleasant and long-lasting side effects. Overtreatment was also the most important driver of the 2012 decision by the United States Preventive Services Task Force to recommend against routine screening for prostate cancer. Approximately 30-40% of men who have previously undergone surgery or other radical invasive treatment likely had indolent, slow-growing tumors that would never have become a threat to the man’s lifespan or health.  However, there is hope.

At the AACR-PCF conference in January 2014, Dr. Matthew Cooperberg, a urologic oncologist at the University of California, San Francisco (UCSF) warned, “If we don’t fix the problem of prostate cancer overtreatment, we will lose screening.” And losing screening would almost certainly mean more prostate cancer deaths—reversing a nearly 45% decline in mortality rates since screening started.

The crux of the problem is the supposed uncertainty about the accuracy of current predictors of tumor aggressiveness, leading physicians and patients alike to opt for a better-safe-than sorry approach that in turn results in extensive overtreatment. However, the vast majority of prostate cancers do not change their stripes. Cancers that appear to be slow growing when diagnosed are unlikely to cause serious problems during a man's lifetime. On the other hand, cancers that appear high-risk at diagnosis are indeed more likely to behave aggressively. So identifying them remains vital in deciding whether to treat or not to treat.

Some physicians and researchers are currently combining this clinical information with genetic information. Adding biomarker tests to clinical predictors further improves the identification of which prostate cancer patients could undergo Active Surveillance versus immediate treatment.

Now that Active Surveillance is a valid and safe way to treat low-risk prostate cancer men should not shy away from PSA screening.  We can’t return to the era prior to PSA screening.  Back then half the men diagnosed had cancer that was already outside the prostate.

In Praise of Olive Oil & Avocados

BY RALPH BLUM

Nearly 2.5 million men in the United States currently live with prostate cancer, and a recent study led by UC San Francisco has found that these men may significantly improve their survival potential with a simple change in their diet.

The study, involving some 4,600 men who had been diagnosed with non-metastatic prostate cancer, found that by substituting healthy vegetable fats—olive and canola oils, nuts, seeds and avocados—for animal fats and carbohydrates, the majority of the men in the study lowered their risk of disease progression.

In the June 10, 2013 online issue of JAMA Internal Medicine, lead author Erin L. Richman, ScD, a post-doctoral scholar in the UCSF Department of Epidemiology  and Biostatistics wrote, “Consumption of healthy oils and nuts increases plasma antioxidants and reduces insulin and inflammation which may deter prostate cancer progression.”

In our book, Invasion of the Prostate Snatchers, Mark put the spotlight on insulin in a chapter entitled, The Insulin Connection. In it he explains that insulin deficiency inhibits the development and progression of cancer. However, even more significant, Mark pointed out that excess insulin in the blood acts as high-octane fuel for cancer growth, and is associated with the development of more aggressive forms of prostate cancer.

Dean Ornish, MD, of cardiac management fame, studied 93 men with prostate cancer.  Half of these men were randomly allocated to the Ornish diet program, while the remainder served as a non-treated comparison group. After twelve months, the men on the program had a statistically significant reduction in their PSA levels. Furthermore, extracting serum from the blood of men in both groups, Ornish fed it to prostate cancer cells kept alive in Petri dishes.  The cancer cells that were fed serum from the men not on his program grew eight times faster than those cells receiving serum from men who were on the program.

 

Returning to the “fat intake” study, the authors also uncovered a striking benefit: Men who replaced only 10 percent of their total daily calories from carbohydrates with healthy vegetable fats, had a 29 percent lower risk of developing lethal prostate cancer. Ornish’s dietary recommendations were simple enough: a diet that was vegan or vegetarian, non-diary, supplemented with anti-oxydents such as lycopene, selenium and vitamin E, supported by  moderate aerobic or other exercise.

Clearly further research is needed. There is rather too much “may improve,” and “may lower the risk” in many of the existing studies on the role of diet in the treatment of prostate cancer for my taste. However for now, guys, following a heart-healthy diet seems to be the safest way to go if you want to keep your cancer in check.

 So I say bring on the olive oil and avocados!