Contents

Introduction

Who am I?

A History of My Disease

What Did I Do?

Education

The Theory

Vitamins and Herbs

Diet and Exercise

Alternative Practitioners

Secret Weapons

Bottom Lines

Bibliography

Glossary

Appendix A: The Nature of the Beast - The Course of the Disease

Appendix B: Current Medical Treatment Options

Appendix C: Future Therapies

Apendix D: Change Log (What's New)

Introduction

This is my attempt to flesh in the details and history "once and for all". That is, to write it down in a more complete and narrative style than the slides and also to have a base for keeping my story current, as time and my medical history evolve.

This is a living, evolving document, with continual minor changes, new references, new test results, and ocassional major revisions and additions, although it is based on that talk of hope in November 1999.

The slide show's main page is noted above.
 

Who am I?

Most of the work I have done professionally has involved some sort of scientific or engineering applications (see my web pages for details), including the past several years (since late 1996) in biotechnology and genetics. With this all, I can claim scientific literacy and an analytical approach, a belief that I can master most areas of knowledge, and a sense of numeracy, an appreciation of numbers and statistics. While I have not had much training in biology and none in medicine, I was able to educate myself about prostate cancer and the available treatment modalities in a very intense couple of months immediately after my diagnosis.

I was diagnosed in July 1999, just before my 54'th birthday. I have always been quite healthy, in reasonably good physical condition, slim, and with a good diet.

And I have usually had a take-charge attitude with regard to my own well-being. I view doctors as partners, well trained technicians who should be working for me and with me. I have little regard for those who try to elevate themselves to god-like status or view their patients/clients as slabs of meat to be treated as objects rather than as people with whom they are collaborating. The ultimate responsibility for my health lies with me.

And finally, I have humility in the face of cancer. It is a very serious disease (or set of diseases) with extremely serious consequences and should not be denied, ignored, or trifled with. Being diagnosed was a great shock that was counter to the myth I have lived by, that of Good Health and Immortality (which really translates to a long and healthy life). And it took a little while to hear the diagnosis and its implications and to mobilize myself in the midst of the rest of my life.

A History of My Disease

In about 1993, a friend of mine who was just 50 at the time, was diagnosed with prostate cancer. His PSA was about 142 when diagnosed (normal range is 0.0 to 4.0 ng/ml) and 180 when he received a radical prostatectomy at Stanford University Hospital by the fabled Dr. Freiha, who has since retired and then resumed practice at the Palo Alto Veterans' Administration hospital. Since then, my friend has been on and off hormone therapy and seems to have his cancer under control. (In late 2005, after 12 years of intermittant hormonal blockade [which will be discussed in Appendix B], he seems to have developed hormone refractory prostate cancer and is exploring chemotherapy options.)

I thought that his cancer might be correlated with his work and where he has been living for some time. My impression is that the synthetic estrogenergic chemicals used in pesticides and herbicides by agribusiness to increase their yields and profits at the expense of the health of farm workers and the rest of us is correlated with the sharp rise of breast and prostate cancer in the decades since the Second World War. (See reference, below). And my friend was involved in the food processing industry and lived in lovely rural areas where heavy industrial agriculture took place. I thought his exposure was probably higher than normal, hence a likely contributor to the cancer. I don't know if the epidemiology supports this or not, yet we are all, urban and rural, exposed to enormous amounts of toxic and teratogenic chemicals in our air, water and food, things to avoid, yet things impossible to avoid. I have also found out that he has a genetic predisposition, since his father and uncle have had prostate cancer. There have been no cases I know of in my family except an uncle who had a mild case in his mid-80's.

But somehow, I thought I was immune. Even so, in my periodic physicals, I had to insist that my physician do a PSA test in addition to the usual DRE (digital rectal exam, where a gloved finger probes for irregularities on the back wall of the prostate gland).

The PSA's were normal. The last normal one was in December of 1997, when it was 1.9 ng/ml.

In late April 1999, I had another "annual" physical. The PSA came back as 5.4 ng/ml. This was alarming for two reasons. First, the absolute number was above the "normal" range of 0.0-4.0 ng/ml. And second, the rate of increase seemed rather steep. This is also a sign that there is a cancer that is beginning to grow rapidly. In fact, a conservative estimate of the growth rate is to assume that it was linear and started just after the last "normal" reading. In that case, in these 16 months it increased by 3.5 ng/ml, which is a rate of 0.21875 ng/ml/month. If it started increasing (linearly) after that time, its rate of increase must have been even higher.
 

It took until mid-June to get an appointment with a urologist at Stanford, one recommended by my physician, also at Stanford. We chatted and he recommended an ultrasound (TRUS, a trans-rectal ultasound), combined with a biopsy, which was scheduled for early July. With the TRUS, an ultrasound probe is inserted in the anus and moved around. It creates crude images of the interior of your pelvis, especially of the prostate gland. I couldn't see much there, but a trained radiologist (ultra-soundist?) can see abnormalities in the organ and surrounding tissues, if they are bigger than some minimum (and crude) resolution. The prostate volume can also be measured, which helps in determining whether there is enlargement due to BPH or other conditions.

My TRUS showed nothing out of the ordinary.

At the same time, the ultrasound probe can be used for taking biopsy samples. The ultrasound image can guide the doctor to point the tip to particular locations on the gland (for example, left upper, left mid, left lower, etc.). A spring loaded hollow needle can be fired through the rectal wall into the prostate to draw a cell sample about 1 mm in diameter and 10 to 15 mm long. These samples are stained, fixed, and sent to a pathology lab for examination under a microscope. The procedure takes maybe 15 minutes. It is uncomfortable and unpleasant but tolerable. In my case, 10 samples were taken.

A week and a half later, my wife and I went to meet the urologist at Stanford for the results. In my first two visits, he was punctual, pleasant, if drabbly efficient. This time, the bean counters at the hospital, in their increasing quest for milking money from both doctors and patients, had overbooked him, and he was over an hour late getting to see us. This was creating problems since my wife had clients of her own to see that afternoon, and I had business obligations. We were not pleased when he finally had time for us, with a couple of residents hanging out in the back of the room to observe.

The results were kind of ambiguous. The Pathology Department had seen nothing awry in the samples. The Urology Department pathologist (Dr. John McNeal, a world-class master of the art of reading and interpreting slides) had re-examined them and found that in one core from the left midsection, there was a 1 mm square region that seemed as if the cells might be cancerous. I was to come back for some additional sampling in that region.

As soon as he said that, I stopped being able to hear. I was stunned by the news and furious at our mistreatment. He must have talked for a while longer, but I did not remember what he said. I made an appointment for the next week, when 4 more cores were taken from the left-midsection. The results came via a phone call on 27 July: one of these also had a 1 mm square group of cancer cells. The Gleason score was 3+3, a value found in about 2/3 of new diagnoses, meaning a not very aggressive cancer. I had time to think and learn and make some decisions.
 

What Did I Do?

After the initial shock wore off a bit, and I gave myself a week or so to assimilate the bad news, I decided that I had to educate myself about the disease and about my options. My understanding, from a conversation with the Stanford urologist who delivered the news, was that my cancer was still rather small and not very aggressive. This gave me some time to learn, some time to collect my thoughts, some time to explore and find the best practitioners in the Bay Area.

My experience, explorations and evolving program of treatment will be discussed in greater detail in subsequent sections, but the major components should be mentioned here:

• Self-education
• Augmenting the vitamins/nutrients and herbs I was already taking
• Modifying my diet
• Exercise
• Finding a physician I could work with
• Seeing alternative practitioners
• Getting two "secret weapons"
• Deciding that the medical approach that made the most sense to me was a radical prostatectomy, to be done by the physician I had found
• Deciding that aggressive monitoring of the state of my disease was important
• Deciding that if I could avoid surgery or any other medical treatments forever or for as long as I could, that would be even better.

Education

Books

• Prostate Cancer - What Every Man - and His Family - Needs To Know, David D. Bostwick, MD, Gregory T. MacLennan, MD and Thayne Larson, MD, American Cancer Society, Villard (New York), 2nd edition (1999) ISBN 0-375-75319-2
• The Prostate Sourcebook, Steven Morgenstern, MD and Allen Abrahams, PhD, Lowell House (Los Angeles), 3rd edition (1998) ISBN 1-56565-871-X
• The Prostate, A Guide For Men and the Women Who Love Them, Patrick C. Walsh, MD and Janet Farrar Worthington, Warner Books (New York), (1997) ISBN 0-446-60432-1
• Man to Man - Surviving Prostate Cancer, Michael Korda, Vintage Books (New York), (1997) ISBN 0-679-78123-4
• Prostate and Cancer - A Family Guide to Diagnosis, Treatment & Survival, Sheldon Marks, MD, Fisher Books (Tucson, Arizona) 3rd Revision (1997) ISBN 1-55561-078-1
• The ABCs of Prostate Cancer, Joseph E. Oesterling, MD and Mark A. Moyad, MPH, Madison Books (New York), (1997) ISBN 1-56833-085-5 (hardback), ISBN 1-56883-097-9 (paperback)
• A variety of pamphlets from the National Cancer Institute (call 1-800-4CANCER). Also see their web site, http://www.nci.nih.gov

Web

Early on in the process I came across Andy Grove's 1996   Fortune Magazine article on his experience with prostate cancer. And, for a while, his choices (high dose seed implants and removal followed by external beam conformal X-radiation) made a lot of sense to me. His is a very well written and important story.
 

MDs

I consulted at first with the Stanford urologist. I knew I did not want him to be my primary physician in treating my cancer, but he could recommend people. Naturally, the several top US institutions came up:

• Memorial Sloan-Kettering Cancer Center in New York City. (See http://www.mskcc.org/)
• Johns Hopkins near Baltimore, where Patrick Walsh, the inventor of the nerve-sparing radical prostatectomy, practices. (See http://prostate.urol.jhu.edu/)
• The Swedish Medical Center in Seattle which specializes in radioactive seed implants (brachytherapy), pioneered there by John Blasko and his colleagues. (See http://www.swedish.org/)
• Stanford University Medical Center for external beam conformal X-radiation. (See http://www.med.stanford.edu/medcenter/)
• University of Texas M. D. Anderson Cancer Center in Houston. (See http://www.mdanderson.org/)
• Loma Linda University, in southern California, where proton beams have been used for external beam radiation for the last 5 years or so. (See http://www.llu.edu/proton/)
• Harbor-UCLA Medical Center (See http://www.humc.edu/)

My wife has a cousin who was a urologist in Southern California. We spoke with her a few times. She was supportive but rather traditional in her approach: being a surgeon, she believed surgery to be the most appropriate thing for me to do. But she was still supportive of my desire to try to avoid both surgery and radiation, if possible. Unfortunately, she was not familiar with Bay Area practitioners.

I called an old college friend who is now a Professor in the Medical School at the University of Virginia. When we had spoken about his research a year or two previous, it seemed as if he were onto something that could be very clinically useful in addressing all kinds of ailments, including cancer. Unfortunately, it still seemed 5 to 10 years out. However, he had a former colleague, an MD/PhD who did post doctoral research with him, who was now a urologist at the University of Chicago. And he was involved with surgery as well as other research. He had been trained at UCLA and did a residency in urology at Stanford, so he was familiar with the players in the Bay Area. And he was open to the possibilities of alternative treatments.

So I called Professor Mitchell Sokoloff in Chicago and he was gracious enough to spend a lot of time on the phone with me, and then kept up an email correspondence. He also recommended Professor Peter Carroll, chairman of the urology deparment at UCSF as a world class surgeon and good person. I felt good getting an independent, knowledgeable person with no axe to grind or self-interest to promote as a foil to my ideas and discoveries.

I spoke with Steven Hancock, MD, at the Stanford Radiological Oncology facility. We spoke of the different forms of radiation, of what they did there, and of survival rates, long term and short term, as well as the side effects of the treatment. When he finally showed up, an hour and a half late for our appointment, he was willing to spend as much time with us as we needed as well as to provide reprints of research he had been involved with on long-term survival rates.

I spoke with Dr. Gill, the Stanford urology surgeon who inherited Dr. Freiha's mantle as the most skillful surgeon there. But he was a rather closed individual, unwilling to even look at some research we had brought for his consideration. He may have been a skilled mechanic, but I wanted to be treated as a person rather than as a slab of meat.

I spoke with Professor Peter Carroll at UCSF, first a long telephone conversation and then in person. He is not only an expert on the nerve sparing forms of radical prostatecomy, but is involved in various kinds of research on prostate cancer, including some studies with colleagues on dietary approaches, including Dr. Dean Ornish's program at the  Preventive Medicine Research Institute in Sausalito, Calif. He was very open to following along with my program, although he also felt that, at best, I'd only be postponing the inevitable. My wife and I felt that we could work with him as a partner, whether I opted for surgery in the end, or if I could avoid it forever.
 

Talking

Radical Prostatectomy

Side effects of incontinence and impotence, however, are significant, even with the best of nerve sparing surgeries and surgeons. (A recent study [Siegel, et al., Journal of Urology, vol 165, no 2, pp 430-435 (Feb 2001)] found that "Erectile dysfunction develops in greater than 80% of the patients treated for prostate cancer" whether by surgery or external beam radiation.)

Radiation therapies (seed implants of various types, external beam Xrays or proton beams) as well as cryotherapies are less invasive, but also lead to similar complications and side effects. They come on a bit more gradually, but in the end roughly 30-50% of men who have undergone either approach are impotent (depending on whose statistics you read) and 10% have some form of incontinence, whether mild and annoying or severe and limiting.

The downside of radiation is the long-term survival statistics relative to surgery. Both are comparable out to about 10 years for "best practice". (Reference) After that, folks who have had radiation do not, on the average, survive as long or have as a high a percentage who remain prostate cancer free. This may not be as great a consideration to, say, an 80 year old with heart problems, but to me, with my intent to live another 40 or more years, it is an important consideration.

Another consideration is that surgeons do not like to operate on someone who has had radiation, if their prostate cancer recurs. This is because the radiation has toughened the tissue of and surrounding the prostate, which makes the surgery a little more difficult. Such "salvage surgery", however, is done by some surgeons.

In the end, physical removal of the organ and the cancer seemed like it would be more effective than trying to kill the cancer cells via some other modality. With improved surgical and post-operative techniques, I had hoped that the negative consequences of the procedure could be minimized, if not eliminated. And having found Dr. Peter Carroll gave me some assurances that I had found a master craftsman with a lot of experience and who I could work with, if or when I chose that route.
 

Aggressive Monitoring

The answer is, figure out what techniques and technologies allow one to "see" what is happening with the cancer and sample often enough to follow its course and fluctuations. And do so with a greater frequency than the physicians might recommend. Again, you must be your own best advocate.
 

PSA

Another consideration with PSA is that herbs such as saw palmetto, one of the things I started taking, tend to lower the levels. This is probably a good thing. But is it just masking the cancer or is it really fighting it? I haven't heard any answers to that question.

So, this is one easy step in following how things are going. By and large, since I started my program and PSA monitoring, it has been 2.0 ng/ml +/- 10%, the fluctuation range I was told to expect and within the "normal" reading I had pre-cancer.
 

DRE

TRUS

MRI Spectroscopy

The spectroscopic part is done simultaneously. Here the returned radiofrequency radiation is analyzed and the energy in various frequency bands calculated. There are particular regions indicative of the amount of activity in the citrate cycle (one path of cellular energy utilization), of choline metabolism, creatine levels, and of some other distinct cellular metabolic processes. Combined, these are very sensitive to the nature of the cells in the voxel (volume element) being sampled. The sampling can distinguish among

• normal prostate cells
• malignant prostate cells
• cells involved in BPH
• prostatitis
• populations of necrotic (dead or dying) cells (say, as a result of previous radiation treatments or brachytherapy)

With the 3 Tesla machine, under development since 2003 (and still in test as of Aug 2004), the spatial and volumetric resolution is much better: voxels are now 0.16 cc, translating to a cube with sides roughly 5.5 mm.
 

September 1999 Imaging

April 2000 Imaging

November 2000 Imaging

And, there is no sign of any disease outside the prostate nor at the capsule (the boundary of the gland).
 

April 2001 Imaging

There was one voxel of borderline cancer metabolism. In previous images, there were several voxels of borderline metabolism, all within the right mid gland. "The spectroscopic abnormalities are much less evident on the present study." And later, "The spectroscopic findings are much less apparent on the present scan, suggestive of positive treatment response."

And again, there was no sign of any disease outside the prostate nor at the capsule (the boundary of the gland). All good news, indeed.
 

January 2002 Imaging

This imaging showed a number of voxels in the right midgland with abnormality, changes in all 3 markers (decreased citrate, elevated choline, ...[?] polyamines). Prostate volume was 33 cc (smaller than previous images). The radiologist's report states "The focus at the right base is more apparent as compared with the prior examination....MR spectroscopy demonstrates interval development of a small focus of tumor metabolism at the right base."

Further discussions, informed by my experience with asymptomatic prostatitis in May 2001, led to my being told that an acute infection could lead to these signals. [Most men with prostatitis have chronic infections, which present differently in the MRIS. The primary researcher said he had seen acute prostatitis only 2 or 3 times out of the several thousand images he had looked over in his career. However, he declined the opportunity to reimage me immediately after my course of antibiotics, foregoing the possibility of developing a before and after to allow better discrimination between acute prostatitis and cancer.] In order to rule that out, or to deal with it, I started on a 2 week course of Cipro, a powerful antibiotic, on 23 January 2002, followed by a second 2-week course. As one can see from the graph and table in the beginning of this paper, my PSA came down to around 2.4 after 3 weeks, stayed there for a couple of months, and then returned to my "normal" levels of about 2.0 ng/ml. I conclude from this that the anomolous readings in this set were another episode of asymptomatic prostatitis.
 

July & September 2002 Imaging

There was no evidence of any metabolic abnormality in the Spectroscopic analysis. That is, no evidence of any cancer. The radiologist concluded that all abnormalities seen in the previous image of 9 Jan 2002 were due to prostatitis rather than cancer, and that all had resolved themselves in the interval. The gland measured 36 cc; using the Stanford PSA of 2.16 ng/ml, my PSA density was 0.060 ng/ml/cc.

My previous images will hopefully be of some help in allowing the research team t come up with a scheme for differentiating prostatitis from cancer. Since they have few unambiguous images of acute infection, all the data they can get will help.

This finding does not necessarily mean all my cancer is eradicated. Rather, it has regressed to the point that this imaging technique is unable to see it amidst the surrounding healthy tissue. As a consequence, I do not plan of changing my regimen.

On 9 September 2002 I had a color doppler TRUS by Dr. Katsuto Shinohara at UCSF. Absolutely no abnormalities or suspect areas were seen. Dr. Shinohara said that "power doppler ultrasounds" that I had heard of were exactly the same as what he was using. It was a relief to have both imaging modalities confirm that any remnant cancer is too small and inactive to be picked up by these techniques. Prostate size was estimated to be about 40 cc; using the previous PSA of 2.08 ng/ml, my PSA density was 0.052 ng/ml/cc. He also noted "about 14 cc of transient hypoplasia", something I need to have clarified.
 

June 2003 Imaging

The MRI images both showed no abnormalities. In the right midgland region, the images were a little darker than normal, but nothing notable. (Recall that previous imaging and the biopsies indicated cancer metabolism in the left midgland, where there is now no evidence of cancer.) The gland volume was estimated to be 38.0 cc; using the PSA value of 2.18 ng/ml, the PSA density was 0.057 ng/ml/cc.

Spectroscopically, in both images, in the right base to midgland, there was an alteration in the expected normal metabolism. Here, however, there was no elevation of the choline signal, there was a loss of some SNR [signal to noise ratio], and there was a loss of citrate levels. These are less a sign of cancer than a possible signal of chronic prostatitis, especially considering how these signatures come and go from image to image over the years.

I had another power doppler TRUS on 04 August 2003 with Dr. Shinohara at UCSF for an independent corroboration of the MRSI results. Again, no signs of cancer were apparent. The gland had grown some (see table below), but showed no signs of malignancy. The left midgland showed a persistant hypervascularity (increase above normal of amount of blood vessels). This is the same area that the June 2003 MRSIs showed signs of lingering possible prostatitis. Recall that the positive biopsies were originally in the right midgland, far from this region.

On 07 June 2004, I had my next power doppler TRUS with Dr. Shinohara at UCSF. The prostate volume was about 48 cc; the year before it was about 46 cc by TRUS. This was essentially the same size. Dr. Shinohara stated that the MRSI underestimates the size by about 20% relative to the TRUS. [The corresponding MRSI volume would thus be about 37 cc.]

He also saw a small protrusion of the prostate into the bladder on one side, indicative of mild BPH. There were a couple of small areas of hypervascularization [that is, increased blood flow], one on each side, but he did not feel that they were large enough or strong enough to be of concern. And he mildly suggested another biopsy, which I resisted and we discussed.
 

August 2004 Imaging

The 3 Tesla images provided a much higher spatial resolution than the 1.5 T images, and both sets were in concordance. The news again was good - no signs of cancer, no changes from the previous imaging, to the limits of the technique's resolution. Recall that my biopsy found some small amounts of cancer in the right midgland in July 1999. None of that has appeared in the images for quite some time, so is not growing, if still present at all.

Again, the radiologist noted "a small focus of decreased T2 signal within the right midgland with equivalent signal on MR spectroscopy." In this region of the gland there is a mix of stromal cells and glandular cells. The glandular cells create the prostatic fluid which flows down the local ducts, eventually accumulating in the seminal vesicles and the ejaculate. This fluid has lots of free water. The T2 imaging measures the morphology or anatomy by looking at water. Lots of free water implies a very long T2 relaxation time.

In prostate cancer, the glandular cells are the ones that become malignant, in general, and the ducts get filled with cancerous growth. This leads to less water being present and a darkening in the T2 weighted image. However, other things can cause this as well, and so spectroscopy is used to try to differentiate what is going on. In my case, this same area has "equivocal metabolism", the same as in previous images, though different from when I was imaged during a bout of prostatitis. So there is no obvious cancer signal and no changes over several years, all good news. Only a biopsy of that region could serve to differentiate histologically what is really going on there, but for me there is currently no incentive to do so -- the potential gain of knowledge would not inform any decision to do anything. If any cancer is still invisible to MRSI and TRUS and my PSA levels are relatively static, I should just keep on doing what I'm doing.
 

March 2006 Imaging

I received a CD-ROM of the non-spectroscopic images, along with WindowsXP software for looking at them, when I left the imaging session, and a more complete CD-ROM with all my images from all MRSIs by mail a week or so later. The CD-ROM now includes a Windows-based image viewing program, with an on disk manual for how to use the software. Still, interpreting the images is another issue altogether, and guidance should be provided there, too. The CD-ROM should also include the spectroscopic images, which take additional processing, but are now also available to the subject.

The radiologist report took about a week to be drafted. It contained very little information -- seemingly, less and less each time -- but the bottom line is that there have been essentially no changes since my previous images, in fact, almost no changes for several years. This is good, as there are also no signs of cancer. On the side opposite where my biopsy found a little cancer, there are some changes again, likely due to inflammation. ("A small band-like area of decreased T2 signal is seen in the left mid gland, which extends towards the apex. This may represent prostatitis.")

The rise in my PSA (at Stanford) to 3.27 ng/ml on the day of the exam is of concern. It may be the beginnings of another round of asymptomatic prostatitis. I doubt that it is an artifact of a URI (upper respiratory infection, a cold) I was just getting over at the time.
 

March 2007 Imaging

The results were the best yet. Essentially, there were still no signs of cancer, a small region of ambiguous signal previously seen in my images was even smaller and more difficult to discern. There were no detectable metabolic abnormalities.

February 2008 Imaging

The written radiology report also noted that the "[p]reviously described focal area of low T2 signal within the right midgland is no longer seen in the current study... MR spectroscopy demonstrates no definite abnormality.... No definite MR or MRS evidence of tumor."

The biopsy I had in 1999 found tumor in the left midgland, which never showed up in the MRSI imaging I have had. However, there have been low level ambiguous signals in the right midgland in all images up until the February 2008 imaging. I take this to indicate some improvement in an undefined irregularity there.

After the imaging, I also was interviewed by a Product Manager from MedRad, a company that makes the transrectal probe used in the MRSI procedure. The videotape is to be used in educational videos on the process and technology from a patient's point of view.

The next imaging, probably to be done around March 2009, should again be easy to compare with the current images and a progress/regress of the cancer should be discernible.
 

UCSF Protocol

• PSA every 3 months
• free PSA every 6 months
• TRUS every year (power doppler color TRUS)
• MRSI every year
• biopsy every two years

The important point in this is not to remain passive and ignorant, but to keep track of how well life style and other changes are keeping the cancer in check, to buy time for better medical approaches to emerge, and to avoid, as long as possible, the side effects of any medical treatments, noting that many prostate cancers are overtreated and may likely remain indolent for the rest of your life.
 

The Theory

The basic idea is that cells are constantly undergoing division in the body. Statistically, it is likely that some small fraction of these divisions are incorrect, producing malignant cells. This can be due to a variety of factors, including

• random events
• radiation damage (just due to natural background radiation)
• exposure to toxic chemicals (which are more and more around us, in our food, air, water, and environment in general)
• age-related cellular issues
• inflammation
• etc.

In general, the immune system is capable of finding and killing all these cells since cancer is a rather rare disease compared to all the cell divisions that occur in a body over its lifetime. What I was seeking to do was augment and increase the functioning of my cellular immune system, since my malignant load was higher than the "normal" background and additional help was needed. But, if I could succeed at that, I could, at best, eradicate the cancer; at the middle, keep it at bay and treat it like a chronic, non-life threatening disease; and at worst, buy some time for medical techniques and options to improve, as they have been rapidly over the past few years.

Vitamins and Herbs

As a background, this is what I had been taking for years:

• 6 gm vitamin C per day (3 in am, 3 in pm)
• 400 units vitamin E per day (am)
• 16000 units vitamin A per day (am)
• 120 mg gingko biloba per day (60 mg in am, 60 mg in pm)
• "B-100" pill (am)
• Calcium-Magnesium-Zinc tablet (am)
• aspirin (1 in am)

Vitamin C is one vitamin that you cannot overdose on. Any extra amount that your body cannot use is excreted, so it is useful to spread out the dosages over the day. It should also be noted that if you increase the amount you take too rapidly, a possible side effect is diarrhea, so a gradual increase is to be recommended, allowing one's body to adjust.

The vitamin A was suggested to me some years back by my dermatologist to clear up a minor skin problem. It also has good anti-oxidant effects. However, one can overdose on A, and so should be careful about the doses taken.

Gingko is noted as helping increase blood flow. This is why it is often referred to as a memory enhancer (blood flow in the brain). But any improvement in circulation should also help the body function more appropriately.

The "B-100" is a multi-B-vitamin pill with the following ingredients:
 

The Ca/Mg/Zi tablet was for general health. I don't remember when or why I started taking it. I had been taking one aspirin per day as a general prophyllactic for heart and circulatory problems; it is well-known that such a regimen decreases one's risk for heart attacks (combined, of course, with not smoking, eating properly and getting sufficient exercise) as well as colon cancer [studies that came out in 2002].
 

This is what I added to my regimen in the first month or so:

• grape seed extract (proanthocyanodin) - 50 mg am & pm
• CoEnzyme Q10 - 50 mg am & pm
• Selenium - 100 mcg am & pm
• generic prostate health pill (see below)
• lycopenes

The Selenium amd the lycopenes were recommended by Dr. Carroll at UCSF. Lycopenes are a chemical found in cooked tomatoes (as well as some other foods, including strawberries and watermelon) that are thought to be especially helpful in fighting prostate cancer. I get most of mine in one 8 ounce glass per day of a V-8-like juice (Knudsen's Very Veggie is an organic product, Trader Joe's has Garden Patch, and there is always V-8 itself and lots of other variations. I don't know the lycopene content of these, since only Knudsen publishes it on their label.) [Research published in the May 2006 Journal of Nutrition (Vol. 136, pp. 1287-1293) indicates that lycopene is most effective when taken along with viitamin E. (See http://www.biospace.com/news_story.aspx?StoryID=15426.)]

Selenium is noted as helping the anti-oxidant activity of vitamin E and should be taken with it. To quote the Life Extension Foundation,

"As an essential cofactor of glutathione peroxidase, selenium is an important antioxidant. It is also involved with iodine metabolism, pancreatic function, DNA repair, immunity and the detoxification of heavy metals. Studies have shown that selenium can help prevent some cancers and cataracts."

The generic prostate health pill was suggested by my daughter, who is an advocate of alternative medicine. These are its ingredients
 

In March 2001, I added the following items to my regimen:

• Green tea extract (1 capsule = 250 mg ~= 4 cups green tea), one in am and one at night
• NAC (N-acetylcysteine, 600 mg), one in am and one at night

In March 2002 I added this to my regimen:

• Alpha-lipoic acid (one 100 mg capsule in am and one in pm), another potent anti-oxidant.
• Soy isoflavones (one 50 mg capsule in am and one in pm)

On 10 March 2007 I started using Peenuts, 2 pills daily, as part of a study at UCSF to investigate whether this herbal supplement can help alleviate prostatitis and its consequent underlying chronic (if asymptomatic) inflammation. Peenuts contains the following ingredients per capsule:
 

Peenuts was created by a Florida Urologist, Dr. Ronald Wheeler (see http://www.peenuts.com), who claims significant success in reducing prostatic fluid inflammation in men taking this pill. He has at least one peer reviewed paper on these studies and is collaborating with UCSF on another study, where MRSI of both men and their expressed prostatic secretions (EPS) will be used as measuring modalities. That is, microscopic evaluations of the EPS as well as MRSI imaging and analysis of the EPS as well as the men it came from will look for indications of inflammation over time. (See the discussions below for my history of recurrent prostatitis and for current theories of how chronic inflammation may give rise to cancer.)
 

These are the things I stopped taking in September 1999:

• aspirin
• Ca/Mg/Zi pill

Dr. Carroll noted that some cancers feed on Calcium and suggested I stop taking it as a supplement. I haven't changed the amount I do (or do not) get from my food, however. (See http://www.docguide.com/news/content.nsf/news/391BD0B73B4A876C85256ACE00516B45? OpenDocument&id=7ED78FC79E323C75852569CB00019463&c=Prostate%20Cancer&count=10 - "High Calcium Intake May Increase Risk Of Prostate Cancer", for example.)
 

statins
In the autumn of 2000, I also started taking Zocor (simvastatin), 10 mg per day, since I had mildly elevated cholesterol (starting about 230). http://www.zocor.com

In June 2002, my MD switched me to Lipitor (ataorvastatin calcium) http://www.lipitor.com, since my liver enzyme tests had begun to creep up the to high normal boundary. Changing statins is a way to control these, frequently.

I stopped Lipitor after about 9 months, resumed 10 mg of Lipitor in Decemeber 2004, and stopped again in February 2005. Blood tests showed good lipid control with the 2 months on Lipitor, and rising levels in the following 2 months off (early April 2005). In mid-April I began taking Niacin (750 mg each evening, increased to 1000 mg per evening after 2 months, and then to 1500 mg each evening 8 months later [Feb 2006]; to 2000 mg each evening as of e Feb 2007) to see if that would correct my lipid levels, which it has, for the most part.

These statin drugs, aside from affecting cholesterol and lipid and trigyceride levels, also seem to have some anti-cancer properties. I don't have references available, and I have been on low doses.
 

Naturopath
In October 1999, I saw a Naturopath near Vancouver, British Columbia. I'll discuss him below, in the section on Alternative Practitioners. He also gave me a bunch of stuff to take that I added to my regimen after my PSA test of 27 Oct 1999.
 

Diet and Exercise

My diet has gone through a couple of modifications. At first, the general tendency was to more vegetables and fruit and tofu and less meat. My lunches consist of a smoothie and some salad and sometimes a small amount of leftovers from the previous night's dinner. I cut back my coffee to one cup per day (from 2).

In December 1999, my wife saw Dr. Diana Schwarzbein, a Santa Barbara endocrinologist, for help with her diabetes. Dr. Schwarzbein has a dietary approach to dealing with diabetes that seems applicable to health in general. It is well described in her book, The Schwarzbein Principle. So for our meals at home, we began following this program, where I would eat more carbohydrates than my wife.

It was pretty consistent with our general approach although it involves eating more protein or meat than we were used to. The general principles are

• Stay away from "plastic" foods - anything artificial or processed (junk food, margarine, sodas, etc.) in order to decrease the toxic load on your system
• Eat as much organic and natural food as possible
• Eat food that is in season and fresh and grown locally ("Anything that you could pick, grow, hunt, fish for yourself.")
• Balance what you eat at every meal in terms of proteins, natural oils, vegetables, carbohydrates
• Use only "good" oils, like olive oil and butter and salmon oils in your food and cooking.
• Any carbohydrates consumed should be whole grain, not processed
• Avoid altogether alcohol, tobacco and caffeine as well as over-the-counter medications

By and large, we've always eaten pretty much this way except that we've increased the amount of organic food in our diet.

Alternative Practitioners

However, there are some things lost in its reductionist approach. One is the realization that the patient is a person rather than a bag of symptoms. Another is that the person comes from a complex web of history and social interactions and beliefs. And another is an appreciation of the ability of the body to heal itself given the stimulus and opportunity and help to do so. And another is a dismissal of things that do not fit into its mechanistic picture.

Acupuncture
So I sought to augment my care by seeing three kinds of alternative practitioners. The first is an acupuncturist. The one I chose was trained as an MD and came highly recommended. I see him in order to enhance the functioning of my immune system, to enable it to fight off the cancer. At first I saw him weekly, but after a couple of months, I am down to once a month. I continued with this practitioner until August 2004.

In February 2005 I started seeing a Japanese acupuncturist (a somewhat different style than Chinese acupuncture).

Chiropractic
The second practitioner I saw was a chiropractor. The idea here was that if I had any structural issues, subtle or otherwise, that prevented proper innervation of my organs, that would subtract from my systems' optimum performance and health, including that of my immune system. The chiropractor I initially chose was a friend who had recently graduated Chiropractic College and been licensed. His practice was just starting out so he had a lot of time to work with me and explore various possibilities. I saw him about once a week or so for about 3 months and then stopped when he felt there was nothing more he could do for me structurally.

In July 2000 I started being treated by a Network Chiropractic practice. This is a more subtle form of manipulation, more frequent than standard chiropractic practice, also designed to fully and properly align the spine and permit proper flow of nerve energy, hence better health and healing, including enhanced immune system functioning. In March 2001, the practice moved to another city, which was inconvenient to get to, and I decided to stop going there and focus instead on more active pursuits, such as resuming my yoga practice.

Naturopathy
This is a more interesting story. At the first Prostate Cancer Support Group meeting I went to in September 1999, I replaced another fellow as the youngest in the group. We got to chatting after the meeting and he mentioned that he had a friend in Vancouver who is successfully controlling his prostate cancer through dietary and holistic means.

I contacted the friend via email and then in a long phone conversation. He had also been trained as a physicist and worked as one for some years before drifting into the field of government science and development policies. He was associated with Simon Fraser University in Vancouver and also did work for the Canadian government as well as consulted with other governments on these issues. Obviously a person coming from the same Western analytical approach as I did, at least originally, not one to be easily bamboozled by various forms of mumbo-jumbo. He had decided upon his diagnosis three years earlier (1996) that he too wished to avoid surgery and radiation and their attendant side effects, so sought alternative approaches. Among other things, he increased the amount of organic and healthy food in his diet. And he found a local Naturopath as one of his practitioners, an older Dutch physician who originally trained and practiced as a neurologist for many years. Eventually, Pieter became a psychiatrist and later on retrained again as a naturopath and homeopath.

On this recommendation, we booked a business/pleasure trip to Vancouver, one of our favorite cities, for mid-October 1999. The doctor took some medical history, and then used an interesting device attached to his PC to measure balances and imbalances in my body. There are references in the Bibliography. The technique used is popular in Europe, unknown in the US, and is called ElectroAcupuncture according to Voll (or EAV), after its inventor, a German physician named Voll. He then gave me this list of things noted above. He also gave me an injection of dead and diluted prostate cancer cells to boost my immune response, a homeopathic approach.

We saw him again over Christmas 1999. He said I was better but not cured yet and did more of the same, keeping the medications almost the same.

As I ran out of his supplements during the month of April 2000, I stopped taking them. We had noted that my PSA had gone down for 2 months before I started the naturopathic treatments, and so determined that whatever good they might be doing, they were not crucial to my good health. It was also expensive and inconvenient to travel to Canada, even a few times a year (he would have preferred every 2 months). So the next part of the experiment has been to omit the naturopathic treatments and supplements. I always have the option of resuming them.

Secret Weapons

pau d'arco

My younger daughter spent the 1998-1999 academic year studying in Costa Rica, with an emphasis on alternative medicine techniques. Part of the time was spent doing an internship on a farm where medicinal plants are grown using organic, sustainable agriculture. And pau d'arco is one of the plants grown there. She brought some back to the U.S. and suggested I take it as a tea when I was diagnosed. Since then, we've bought a pound at a time directly from the source. It goes a long way. We've found the tea to be available in some health food stores in California and over the web, but we've also found that it is difficult to vouch for the quality of what you're getting. Since  pau d'arco comes from the inner, living, bark (the phloem) of the tree, often it is adulterated with other barks.

The mixture I get is mixed with some ginger and tumeric, spices also noted for their medicinal qualities as well as interesting tastes. I bring a quart of water with 1 teaspoon of the mix to a boil, them simmer 10 minutes and strain. The suggested dosage is 2 to 3 cups a day, although I seem to average one to two a day.

One can also buy the tea without the ginger and tumeric or use it to make an infusion. I don't mind the taste as it is and haven't experimented with it.

In October 2001 I sent in another order for pau d'arco to my source in Costa Rica. Six weeks later, my letter was returned for having an insufficient address, though it used the same address I had been successful with several times before. Email did not bounce nor did it receive a reply. And a fax also went through, again with no reply. I had no direct phone number to call. As I was running low, I decreased the amount I was drinking to a few cups a week, and gradually stopped taking pau d'arco as the year ended, with no apparent effect on PSA. I can only conclude that this tea is not crucial in my program. It may well have helped, but was not the "Secret Weapon" I originally hoped it might be. In early 2002, my Costa Rican contact resumed communications (new email address, more complete postal address) and I am again able to get an ongoing supply.

I stopped taking pau d'arco in July of 2003. I noticed no change in my condition or numbers without that tea and have come to believe that it was not an essential element of my regimen.
 

Mother's Milk

In brief, about 1994 Anders Håkansson, then a graduate student in Catharina Svanborg's laboratory at Lund University, found by accident that adding human mother's milk to a cell culture of cancer cells caused them to all die. This was true for a wide variety of human cancer cell types. On the other hand, normal cells were unaffected.

So they injected human tumors into rats. When the tumors started growing, they started treating the tumors with mother's milk. In most cases the tumors shrank or died. What seems to be happening is that there is some combination of factors in the milk that causes "programmed cell death" or apoptosis in cancer cells and not in non-malignant cells.

Why would this work? One speculation is that the time of most rapid post-natal cell growth is the months and year just after birth, when the normal infant should be nursing. Since rapid cell growth is fraught with the dangers of bad replication and malignant transformations, a natural mechanism that would kill such new cancer cells is a reasonable thing to have developed evolutionarily. In fact, it should be common in all mammals, one might conjecture.

In fact, it is well known that nursed infants have 1/9 the probability of contracting any kind of childhood cancer as infants who are not nursed, as well as having fewer allergies, less asthma, and fewer childhood diseases.

The Swedes then turned the focus of their research into understanding the cellular and molecular basis of these observations, doing some good science in the process. It seems as if the major factor is something called MAL, multimeric Alpha-Lactalbumin, along with some potentiating factors. They found that pastuerization destroys the multimeric character of this compound and also its cancer-killing abilities. Their focus, however, is to isolate and patent the factors, then to license them to drug companies and live well on the royalties.

My reasoning was quite the opposite. If the potent parts of mother's milk can get into the infant's body via his/her gut, it is very likely that the same is true for an adult who ingests it as well. True, with a much larger body weight and size than an infant, there would be a greater dilution, but any apoptosis than can be induced over as long a period of time as the milk is available would help keep the cancer under control or even, in the best of worlds, eliminate it.

I contacted Dr. Håkansson by email and received copies of three of their research papers (in English).

Shortly after we found the New York Times article, we reconnected with a colleague I had worked with some years previous. His wife was nursing an 8 month old and she herself was a cancer survivor. She agreed to pump her breasts for me. So from late August 1999 for almost a year, I had a supply of mother's milk, which ended when my donor weaned her child. I am endeavoring to continue having a supply from healthy, health-conscious women.

Almost every day (depending on the supply), I took about 2 ounces of mother's milk mixed into a smoothie (orange juice, yogurt, tofu, various fresh and frozen fruits) as part of my lunch. It is a simple, healthy, and palatable way to take this part of my regimen.

I believe that these two items, but mostly the mother's milk, have made the difference for me in keeping my cancer under control and my PSA scores down in the mid-normal range. Everything else has helped, to a greater or lesser degree, but these "secret weapons" have been the crux of it all.

While pau d'arco is mildly difficult to get, it is available. Mother's milk, on the other hand, requires some luck or connections. It is a hypothesis I made that the same positive anti-cancer effects can also be obtained from certain kinds of raw mammal milk, perhaps goat or cow, perhaps some more closely related species. The key word here is "raw", since pastuerization (heat) destroys the effect, and raw milk might come with its own health concerns. It would be interesting and quite useful if some academic, less motivated by greed, would pursue this line of inquiry.

In July 2000, my source of mother's milk told me she was planning on weaning her child, which was a perfectly reasonable thing to do. My wife found a possible source via a Milk Bank, but they needed a prescription from an MD to give me the milk, only because providing milk to adults was not a usual course of action. So, in mid-July I asked my urologist for one.

In the meantime, I had received the April 2000 PNAS paper from the Swedish researchers. In it, they had isolated the essential cofactor in human mother's milk that caused multimeric alpha-lactalbumin to undergo its shape changes into the form that kills cancer cells. This cofactor is oleic acid, which I then discovered was abundant in olive oil. While waiting for the prescription, I experimented using raw cow's milk from a health food store instead of the no longer available mother's milk, adding in about 1 cc or so of olive oil. I also increased the amount of cow's milk to 4 ounces a day, from the 1 to 2 ounces of milk that my donor had been pumping, on the average.

This did not work. After about 1 week of the new regimen, the PSA on 10 August was a consistent 2.2. About 4 weeks later, on 8 September, it had increased to 3.8! This is a doubling time of about 6 weeks.

Again, I requested a prescription from my urologist, but he wrote back

	"...I have no experience with prescribing mother's milk and do not 
	feel comfortable prescribing something I know little about...."

Within one week, my PSA had dropped to 2.5 ng/ml, and I was greatly relieved. Since nothing else had changed in my regimen, it became abundantly clear that the crucial factor in controlling my cancer was the milk. Everything else may help, but nothing else was sufficient unto itself to keep my PSA down and the cancer under control.

(According to their papers and personal communication, the oleic acid, in the warm, acid environment of the human gut, transforms the physical conformation (or shape of the molecule) of the multimeric alpha-lactalbumin molecules into another form they call HAMLET [for Human Alpha-lactalbumin Made LEthal to Tumors], which induces apoptosis in malignant cells.)

This experience leads to some additional questions:

• Was the amount of oleic acid I used too little?
• Are cow and primate alpha-lactalbumin different enough so that the bovine variant is not transformed into HAMLET?
• Are other necessary but so far unidentified cofactors present in primate milk but lacking in bovine milk?

The milk from the Milk Bank is pasteurized. According to Dr. Håkansson, the process they use, required by California state law, will degrade some, but not all, of the apoptotic activity of the milk. For that reason, I was using 7 ounces a day of the Milk Bank's pasteuerized mother's milk.
 
 

Strange PSA values in May 2001

I went back two days later, on 11 May 2001, to repeat the test. It came back as 14.0 ng/ml. Curiouser and curiouser. Is a drop of 5.6 ng/ml in two days reasonable? The numbers were frightening and did not make a lot of sense until I got the MRI report. As noted above, it showed (marginally) less cancer than in previous images, but also noted evidence of prostatitis, something which could account for these PSA values. My urologist suspected prostatitis as the cause of these readings and put me on antibiotics. After one week, the PSA went down to 4.0 ng/ml. We decided, after a week break, to do another week's worth of Cipro (500 mg), which brought the PSA back to 2.5 ng/ml, roughly where it had been before the infection. Apparently, prostatitis may be asymptomatic, though rarely. Reviewing the original biopsy report of July 1999, it stated that there was evidence for my having had prostatitis (apparently it permanently affects some noticeable characteristics of the prostate cells it infects) and I may well be harboring a latent infection which occasionally flares asymptomatically. There is some sense of relief, but also one of mystery.

By the way, the Milk Bank claimed no changes to its processing/pasteurization protocol.
 

Raw Milk Again

The Milk Bank routinely screens all donated samples for bacterial count. The biochemist had started sequestering samples with extremely low counts for me. The bacterial levels in these is equivalent (or almost) to those in pasteurized samples. Naturally, all donors are screened via blood tests, when they sign on, for an array of potentially transmissable diseases. So the milk, raw or processed, is likely quite clean. I have no need to fight off cancer to catch some other disease.

A week and a half later, a PSA test gave the value of 1.9 ng/ml, equivalent to my "normal" value of December 1997 and among the lowest values I have had, even though I halved the quantity of milk I was using (from 7 ounces/day of pasteurized to 3.5 ounces/day of raw milk). This is very encouraging.
 

Strange PSA values in January 2002

It is apparent to me that cancer and BPH do not behave this way, spiking and dropping, as my PSA did in May 2001 and again in January 2002. Certainly, Dr. Carroll also seemed unable to explain this behavior. And Dr. Kurhanewicz pointed out that the increased activity in the MRIS of 9 January 2002 might be attributable to an acute stage of prostatitis rather than increased cancer metabolism. He mentioned that he had only seen this twice in the 4000 or so images he has looked at over the years, since most prostatitis he sees is chronic, and so has less metabolic activity. This seems to be the explanation.
 

Strange PSA values in the winter and spring of 2005

About 10 days after I finished the Cipro, I had the symptoms of a prostatitis attack, including painful and frequent urination. Blood work showed a raging infection. So I started a 2 week course of Floxin, another antibiotic in the same family as Cipro. It took a few days for the symptoms to abate, but they did around mid-February.

On 28 March 2005, I went for another PSA and my first free PSA measurement. The result is expressed as a ratio of free (or unbound PSA) to total PSA (that is, to bound plus unbound PSA). Values below 10% are indicative of cancer (>40% probability of active PCa); values above 25% are indicative of no active cancer (<10% probability), for PSA values in the range of 4-10 ng/mL. Mine was 15%, in the ambiguous range.

Since Stanford sends the Free PSA to an outside lab to be processed, I figured the PSA value was not comparable to most of the others, so I redid my PSA on 05 April 2005. It was significantly elevated from the value of the previous week, indicating to me that I was still harboring an infection (which was thankfully asymptomatic). Further followup was due with a power doppler TRUS on 11 April and a consultation with my urlogist the following week.

The TRUS showed no changes from the previous year or the year before and no obvious signs of cancer, which was reassuring. My uroligist agreed that I still had prostatitis, that I was lucky to be symptom free, and that chronic infection was problematic for several reasons:

• it masks my "true" PSA levels, making it impossible to track the state of my cancer via blood tests;
• it makes any MRSI invalid since prostatitis signals in the spectroscopic images look too much like prostate cancer to be able to clearly differentiate the two; and
• chronic infection itself can lead to cellular and DNA damage and hence possibly more normal prostate cells making a transition into a malignant state. (See a discussion below on this issue.)

My PSA values continued to jump wildly about, 4.42 in June, 18.3 in July, and then settled back to normal at 2.44 in early August, for reasons that elude me. Somehow, the infection has (hopefully) run its course and is done.
 

Dosage Summary

• August 1999 - July 2000: raw milk from my donor, approximately 2 ounces per day; the amount varied
• August 2000: organic cow's milk mixed with olive oil for the oleic acid, about 4 ounces per day. This did not successfully emulate human mother's milk.
• September 2000 - June 2001: pasteurized milk from the Milk Bank, 7 ounces per day (two 3.5 ounce bottles) during most of this time, one bottle per day during some of this time.
• July 2001 - December 2002: raw milk from the Milk Bank, one 3.5 ounce bottle per day; 2 bottles per day for a few months during this time.
• January 2003 - September 2003: one bottle of raw milk from the Milk Bank every other day.
• October 2003 - present: one bottle of raw milk from the Milk Bank two times a week.

Bottom Lines

PSA Improvement

Instead, it came down to "normal" (1.9 ng/ml) right away and more or less has stayed at 2.0 +/- 10%. This was quick; I was suprised and pleased.

What is the "magic bullet"?

Since I started the Naturopathic remedies relatively late in the game (at the end of October 1999, when I already had 2 or so low PSA's), I know that these were not decisive. They may well have helped sustain the effects of everything else, but were not the crucial elements in controling my PSA levels.

My experience in August and September 2000, when I did not have access to human mother's milk but everything else in my regimen stayed constant, as discussed above, leads me to now believe that the mother's milk is the crucial aspect of my program, the "magic bullet". It seems insufficient, so far, to eliminate the disease, but capable of holding it at bay, as indicated by my monthly PSA results and validated by the semi-annual MRI/MRIS imaging.

I stopped taking the pau d'arco in July 2003, with no noticeable effect on my TRUS (Aug 2003) or subsequent PSAs. I currently don't think this is a "magic bullet", although it may well have some positive medicinal effects.
 

How General is This?

How Long Will it Last?

What should you do?

You need to understand your own health, your own unique personal conditions and values, the stage and aggressiveness of your cancer, and what all the (rapidly changing) medical options that are available to you may be. And you may often have to fight an unresponsive medical bureaucracy or HMO or insurance company that has only its owners' bottom line at heart, not your well-being or even survival. A large and daunting task for anyone, no doubt, but do-able.

Another caveat is that if you have any Gleason 4 or above in your biopsy samples, you will need to do more than only lifestyle changes. According to a paper by Professor Thomas Stamey of Stanford University Hospital [ref needed!], the strongest negative indicator of survival time is the percent of Gleason 4 or higher in one's biopsy samples. In this case, informed medical action is appropriate along with lifestyle and dietary changes. Even in this case, give yourself enough time to get past your shock, to become informed enough about all alternatives, and to find the best practitioner of the approach you decide upon.

In any event, do not try my approaches instead of medical modalities if your cancer is spreading, growing, creating symptoms, or otherwise showing signs of aggressiveness. All of this can be used as an adjunct to more conventional therapies, if necessary. Remember, I am not practicing medicine, I am presenting my own personal story and discoveries and you are, in the end, the only one responsible for your own health, along with those experts you hire to inform and assist you.

Aggressive Monitoring

Other tests are available. These include the DRE (digital rectal examination), the TRUS (trans-rectal ultrasound), biopsies and other blood work. In my case, I don't think these would tell me anything, mostly because they didn't before. That is, my cancer was so small and early stage, it was invisible to the DRE and TRUS I had in July 1999. And the biopsies are like poking into a haystack with a needle, looking for a pingpong ball. Or perhaps a marble. If the target is small enough, one has a very small likelihood of poking into it with a few at random stabs. Finally, the blood work (such as Free PSA and other enzymes) merely serve to indicate the likelihood of cancer; since we know that cancer exists, these also would not yield new information.

I have more confidence in the MRIS, in my case, because it can image everything (bigger than some minimum, of course) and differentiate cancer from non-malignant tissue. I also have a "before" for comparison, a "before" that showed the location and extent of cancer, so we will be able to see its progression or regression.

Simple Conclusion

Bibiography

• Overviews
  • The Dilemmas of Prostate Cancer, Marc B. Garnick, Scientific American, pp 72-81, April 1994
  • Combating Prostate Cancer, Marc B. Garnick and William R. Fair, Scientific American, pp. 75-83, December 1998
  • Prostate Dilemmas, Susan Brink, U S News & World Report, pp. 66-81, 22 May 2000. URL for most of the article is http://www.usnews.com/usnews/issue/000522/nycu/prostate.htm  
  • Early Detection and Treatment of Prostate Cancer: Case Study and Commentary, Timothy J. Wilt, MD, MPH and Melissa R. Partin, PhD, JCOM, vol 7, No 4, pp 55-68 (April 2000)
    Available on the web until 30 April 2001 at a very long URL. Includes references on 5 and 10 year survival and recurrence rates for various treatments.
  • Localized Prostate Cancer, Patrick C. Walsh, MD, Theodore L. DeWeese, MD, and Mario A. Eisenberger, M.D., New England Journal of Medicine, 357:26, pp. 2696-2705 (27 December 2007). [Available at http://content.nejm.org/cgi/content/short/357/26/2696 after 27 June 2008 to registered users; registration is free]
    This is a summary of the dilemmas of treating prostate cancer, the side effects and relative effectiveness of the primary medical approaches -- Expectant Management (or watchful waiting), surgery, and radiation. Dr. Walsh invented the nerve sparing surgical techniques.
    Download from ftp://www.cohensw.com/pub/pca/Walsh_NEJM_20071227.pdf
  • Systematic Review: Comparative Effectiveness and Harms of Treatments for Clinically Localized Prostate Cancer, Timothy J. Wilt, MD, MPH; Roderick MacDonald, MS; Indulis Rutks, BA; Tatyana A. Shamilyan, MD, MS; Brent C. Taylor, PhD; and Robert L. Kane, MD; Annals of Internal Medicine, Vol 0, Issue 2008, pages 000605-200803180-00209-E-209 (18 March 2008). Available at http://www.annals.org/cgi/content/full/0000605-200803180-00209v1
    This is a thorough meta-analysis of all relevant peer reviewed studies of the standard treatments for prostate cancer, their relative effectiveness, and their side effects. The conclusions are that there are few good randomized clinical trials to differentiate between treatments (their "success", survival rates, and side effects, as appropriate for men in general or for specific subpopulations of those diagnosed with PCa).

    An excellent summary of this study may be found in a New York Times Health blog: htpp://well.blogs.nytimes.com/2008/02/05/no-answers-for-men-with-prostate-cancer

  • http://www.businessweek.com/magazine/content/06_22/b3986001.htm
    "Medical Guesswork -- From heart surgery to prostate care, the health industry knows little about which common treatments really work", John Carey, Business Week, 29 May 2006 cover story.
    An earlier and more accessible discussion of the issues raised in the previous two items, including a short discussion on prostate cancer.
  
   
• Standard web sites
  • http://www.nci.nih.gov
    The National Cancer Institute of the National Institutes of Health. Call 1-800-4CANCER to speak with knowledgeable and friendly people about your case and concerns, to get their literature and further references.
  • http://www.capcure.org
    CapCure, The association for the Cure of Cancer of the Prostate
  • http://www.submitterassistant.com/Capcure2001/
    Slides and notes from CapCure 8th Scientific Retreat, Lake Tahoe, NV, 6-9 Sept 2001
    Looks like lots of good talks.
  • http://www.capcure.org/publications/CaPCURE_Monograph.pdf
    A downloadable copy of the CapCure monograph on Nutrition and Prostate Cancer. It may also be ordered as a paperback.
  • http://members.aol.com/MikeA60/pc.htm
    Mike Ausloos' Prostate Cancer page. Lots of good references and links, information about support groups in the Silicon Valley.
  • http://www.prostatepointers.org/
    Another rich source of links and information.
  • http://www.hypertext.org/maintext.html
    An excellent guide, with lots of references. To quote, "[This Guide] was created by a patient who spent a lot of time reading, asking questions, searching the internet - and learning some things the hard way. The main page of the Guide is essentially an outline of the entire subject, and it can be read in less than half an hour."
  • http://rattler.cameron.edu/information.html
    Another copious set of references and links put together by a prostate cancer survivor.
  • http://www.ustoo.com/
    One of the main prostate cancer advocacy and support organizations
  • http://www.cancerfacts.com/
    Another source of cancer information for physicians as well as consumers.
  • http://www.bccancer.bc.ca/
    The British Columbia (Canada) Cancer Agency. Also includes a set of pages about alternative (unconventional) treatments for cancer. (See the link under the pau d'arco references, below.)
  • http://www.prostate-cancer.org/ or
    http://www.pcri.org
    The Prostate Cancer Research Institute. They also have a telephone helpline (800.641.PCRI or 800.641.7274).
  • http://www.prostate-cancer.org/resource/pdf/
    A location from which the PDF files of all issues of PCRInsights can be downloaded. This is a very useful publication, in my opinion, with lots of in depth yet accessible articles about various aspects of prostate cancer and some appropriate medical treatments at various stages of the disease. The PCRI is an advocate of triple hormone blockade, but all articles are well balanced with no axe to grind.
  • http://www.pslgroup.com/PROSTCANCER.HTM
    The Doctor's Guide Prostate Cancer Information and Resources pages. Lots of references & links, updated with great frequency.
  • http://www.prostate-online.com/
    Virgil's Prostate On-Line, A Guide to Fighting Prostate Cancer
  • http://www.cancer.med.umich.edu/prostcan/prostcan.html
    The University of Michigan Medical School Comprehensive Cancer Care prostate cancer top page.
  • http://www.cancernews.com/male.htm
    Another extensive set of links
  • http://prostate.urol.jhu.edu/
    Johns Hopkins University's Brady Urological Clinic home page. JHU is the home of Patrick Walsh, MD, the inventor of nerve sparing radical prostatectomy, and a site of much related research.
  • http://oncolink.upenn.edu/disease/prostate/
    University of Pennsylvania site on Prostate Cancer, frequently updated.
  • http://www.jurology.com
    The Journal of Urology provides a searchable web site for highly technical articles. Titles and references are available. Some few issues have full text available without a paid subscription.
  • http://www.moffitt.usf.edu/pubs/ccj
    The Moffitt Cancer Control Journal devotes issues to particular forms of cancer. All articles are downloadable as PDF files. For example, the November/December 2001 issue is devoted to prostate cancer, with review articles on Radical Prostatectomy, Brachytherapy, External Beam Radiation Therapy, Cryosurgery, and Chemotherapy for hormone refractory disease, as well as 2 articles about dealing with side effects of treatment.
  • http://www.prostatecalif.com
    The web site of the California Prostate Cancer Coalition.
  • http://www.paactusa.org/
    The web site for PAACT or Patient Advocates for Advanced Cancer Treatments, Inc.
  • http://www.medsch.wisc.edu/pca/  Prostate Cancer Answers
    This is a service of the University of Wisconsin Comprehensive Cancer Center. It provides accurate and up-to-date information about prostate cancer research, prevention, detection, diagnosis and treatment.
  • http://www.canadian-prostate.com/  The Canadian Prostate Health Council
    An affiliate of the Canadian Urologic Association, whose mission is "to create awareness; stimulate interest; gather, assess, and disseminate knowledge on diseases of the prostate, current and innovative therapies, the consequences of untreated disease and the differential diagnosis of benign prostate hyperplasia, prostate cancer and other diseases of the prostate."
  • http://www.roblesmar.com/Prostate/proslink.htm
    An extensive set of links contributed by Wil de Jong, a prostate cancer survivor in Holland.