A 16-member panel of the U.S. Preventive Services Task Force has just issued an update on its recommendations for prostate cancer screening.  The Task Force found that the PSA blood test that milliions of men undergo each year to check for prostate cancer leads to so much unnecessary anxiety, surgery and complications that doctors should stop testing elderly men, and it remans unclear whether the screening is worthwhile for younger men.  See psa test. 

The new recommendations are consistent with R Trebor's experiences and viewpoints as related in prior entries.  The dangers of medical procedures, whether screening or therapeutic, have been known for some time.  Several years ago your author came across a Scandinavian study that described the worsening effects of some of the "procedures" that prostate cancer patients undergo.  (Unfortunately references were not saved as your blogger did not foresee a time when he would be blogging.)  But R Trebor will attest to the accuracy of the following text (minus references) from the article:

Prostate Cancer
In contrast to a recent large study of U.S. volunteers, fewer than one third cases of detected cancer remained localized in the gland after pathologic staging, although 90% seemed localized before surgery.  The proportion of clinically localized cancer that was discovered in this cohort actually decreased to 71% in a second round of screening.

Transrectal Needle Biopsy
We found no evidence that routine transrectal needle biopsy reduces a man's likelihood of dying of prostate cancer. 

Their (transrectal needle biopsy) viability as a screening test is greatly limited by cost, potential illness, and patient reluctance.

Transrectal needle biopsy is mildly uncomfortable and causes minor, self-limited complications (principally infections or bleeding) in as many as 40% of patients.

R Trebor

 

A recent study concludes that men undergoing hormone deprivation therapy suffer an impairment of cognitive ability.  The study is reported in an article by Steven Reinberg in Prostate Commons.com.  The article can be seen at cognitive impairment.

There are few therapies for any diseases that do not have either short-term or long-term side effects.  The side effects can range from  temporary nuisances to serious health debilitations, including death itself.  Prostate cancer patients should be knowledgeable about the benefits and risks of any procedure suggested by their doctor before making a decision.

R Trebor

Today's entry is a departure from the subject of prostate cancer.  However, it is of such importance that your blogger thinks the departure is more important than keeping to the topic of the blog for the sake of order.  Today's TV news concerns the danger of tissue damage and/or brain tumors generated by cell phone radiation.  It is really an update of an old concern.  As a scientist working in a government laboratory, one of my colleagues was studying the effects electromagnetic radiation on liliving cells as far back as the 1960s. It is my recollection that all such studies at the time were inconclusive.  Many, if not all of the studies, however, did not study the effects of radiatiation in the millimeter wave-lengths of the microwave oven and cell phone.  The magnetron in a microwave oven emits approximately 700 to 1500 Watts of power.  The power from a cell phone is in the tenths of watts.  However, other factors, such as total time of cell phone use and brain size must be considered.

I believe the dangers of cell phones have been underestimated.  There are several reasons for this.  One is that the cell-phone-using public does not want to believe they could be doing fatal harm to themselves.  There is also the sway of commercial cell phone ads: So many smiling faces talking to loved ones.  Important factors that are not considered are the amount of time spent on the cell phone, or the age of the users.  It is very common to see young pre-teens on cell phones.  The radiation has a larger effect on a small child's brain than on an adult brain.  (Recall that the time-settings for cooking food in a microwave oven are determined by the weight of the food to be cooked.  Less weight requires less time.)  I will probably have more to write on this subject in the future.  Meanwhile, limit the use of cell phones by yourself and your children.  Use a land line whenever one is available.

You can visit the following web site for a list of phones with the 10 highest radiation outputs:

http://reviews.cnet.com/4520-6602_7-5020357-1.html

Robert Trebor

The importance of exercise can not be overestimated.  When a man has prostate cancer, the cancer and the cancer-free body are competing for vascular networks that supply blood and nutrients.  A sedentary life style places little demand for these resources by the cancer-free organs.  An aggressive cancer, however, is young and ravenous, and has often invaded a body in decline due to age and/or unhealthy living.  We know that exercise stimulates the development and repair of blood vessels that supply the exercised muscle.  I believe my own cancer has remained dormant because of a consistent regimen of daily walking.  I would add that walking (or jogging) exercises muscles in the area of the groin, not far from the prostate gland, which may enhance the benefit of exercise.  This is just a theory, of course.  But it is consistent with the old common-sense axiom that says "The squeaky wheel gets the grease."  Of course, exercise should be just one part of a healthy life style.

R Trebor



 

The author and readers posting comments here are sharing their personal experiences. Nothing printed here is represented as professional medical advice.  Visit our advertisers' sites for other viewpoints and options, and consult your physician before embarking on a watchful waiting strategy.

We have heard a lot of contradictory information about prostate cancer from the medical establishment.  We have been told that early detection is important for survival, and that early detection has not increased longevity - a contradiction.  Here are the titles of some articles that have appeared in newspapers:

             Prostate Cancer Test Vital Or Unnecessary?
             Is Treating Prostate Cancer Worth The Risk?
             Studies Report Little Benefit From Prostate Cancer Surgery
             Cancer Specialist Questions Worth Of Some Screenings

In such a situation, when there is disagreement among the “experts”, we may be able to find our way from the experiences of prostate cancer patients themselves.  (Here I loosely use the term “patient” to describe anyone with prostate cancer, whether or not he has submitted to medical treatment.  There are many “watchful waiters” in this category.)  This blog, then, is a place for those with prostate cancer, as well as family members and other interested parties, to share their experiences and knowledge with those who could benefit from it.  Identities need not be disclosed - pseudonyms or initials are acceptable.  I begin with my own story.

An Unwatchful Waiter; Johns Hopkins Visit

In 1992, at age 66, my family doctor performed a DRE that turned up a hard nodule on my prostate.  He referred me to an urologist in my HMO.  I had heard horror tales about the serious complications that often follow prostatectomies, so I wasn’t anxious to allow just any surgeon to wield the knife - if I chose to go down that road.  I consulted a copy of an AMA publication of physicians’ biographical data.  (This was before I had a computer and could go to the AMA “doctor finder” web site.)  The only information the AMA provided about the referred urologist was his name, address and phone number, all of which was available in the phone book.  I was a government employee and would eligible to change my health plan during open season, in about a month.  At that time I could join a health plan that allowed a choice of urologists.  About two months after the discovery of the nodule I went outside my HMO and scheduled an appointment with a urologist of my own choosing.  He performed a DRE and pronounced my prostate normal.  I was surprised, as well as relieved.  I asked “No nodule?”  He replied “No nodule.”  Unaccountably, he was wrong.

The nodule was in the left region of the peripheral zone.  About 80% of prostate cancers are in the peripheral zone.  One morning, six years after my family doctor said I had a nodule on my prostate gland, I got out of bed to urinate, but couldn’t.  It was a horrible experience.  I felt as though I was going to explode, but couldn’t produce a trickle.  I eventually got to an emergency room, after a 20-mile drive behind a slowly moving trailer truck on a winding two-lane road.  The urine was released with a catheter, but surprisingly, the volume was small.  I was told I had a bladder infection.  The emergency room doctor performed a DRE.  He rediscovered the nodule that my family doctor found six years earlier.  Like my family doctor, he was quite somber.  He referred me to an urologist, saying it was very important that I make an appointment.  I didn’t do so.  By this time I had become leery of invasive procedures.  (The first thing the doctors want to do is a biopsy.  Doing “procedures” is their bread and butter.)  When my nodule was discovered six years earlier it was fully formed, and could have been present 5 or 10 years earlier.  Yet I had no serious health problems.  I suspected it was a slow-growing cancer that I likened to a sleeping dog.  I was inclined to let it continue sleeping.  How-ever, I did go to Johns Hopkins Hospital where a urologist advised me to undergo a biopsy, and pitched the full panoply of treatments available.  Again, I ignored the advice. 

A description of a biopsy (which glosses over pain and side effects) can be found at
http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_How_is_prostate_cancer_diagnosed_36.asp.  The description below is taken from this site.

The Prostate Biopsy

A biopsy is a procedure in which a sample of body tissue is removed and then looked at under a microscope. A core needle biopsy is the main method used to diagnose prostate cancer. It is usually done by an urologist, a surgeon who treats cancers of the genital and urinary tract, which includes the prostate gland. Using transrectal ultrasound to "see" the prostate gland, the doctor quickly inserts a needle through the wall of the rectum into the prostate gland. When pulled out, the needle removes a small cylinder of tissue, usually about 1/2-inch long and 1/16-inch across. This is repeated from 8 to18 times, although most urologists will take about 12 samples. These are sent to the lab to see if cancer is present.  Though the procedure sounds painful, it typically causes only a very brief, uncomfortable sensation because it is done with a special spring-loaded biopsy instrument. The device inserts and removes the needles in a fraction of a second. Most doctors who do the biopsy will numb the area first with local anesthetic. You might want to ask your doctor if he or she plans to do this.

Some doctors will do the biopsy through the perineum, the skin between the rectum and the scrotum. The doctor will place his or her finger in your rectum to feel the prostate and then insert the biopsy needle through a small incision in the skin of the perineum. The doctor will also use a local anesthetic to numb the area.
The biopsy itself takes about 15 minutes and is usually done in the doctor's office. You will likely be given antibiotics to take before the biopsy and for a day or 2 after to reduce the risk of infection.  For a few days after the procedure, you may feel some soreness in the area and will likely notice blood in your urine. You may also have some light bleeding from your rectum. Many men also see some blood in their semen, which can last for several weeks after the biopsy.

Your biopsy samples will be sent to a pathology lab. There, a pathologist (a doctor who specializes in diagnosing disease in tissue samples) will see if there are cancer cells in your biopsy by looking at the samples under the microscope. If cancer is present, the pathologist will also assign it a grade (see below). Getting the results usually takes 1 to 3 days, but it can take longer.  Even with many samples, biopsies can still sometimes miss a cancer if none of the biopsy needles pass through it. This is known as a "false negative" result. If your doctor still strongly suspects prostate cancer (due to a very high PSA level, for example) a repeat biopsy may be needed to help be sure.

I could be wrong, but we may be kidding ourselves in thinking the prostate can be stabbed 8 t0 18 times with a hollow needle, withdrawing tissue each time, without consequences.  I wonder how many cancers become “aggressive” after such an insult.  As for myself, I chose to follow the “sleeping dog” principle.  I decided to let the sleeping dog lie.  Although I have been advised many times to have my prostate biopsied, I have not done so.  Then how do I know I have prostate cancer?  For starters, it is located in a peripheral zone where most cancers are found.  In addition, an urologist with many years of experience performing DREs told me the nodule bore all the physical characteristics of cancerous nodules that he has examined.  He said it was definitely not a BPH nodule.  ( BPH nodules typically originate in the transition zone and would have to grow to a very large size to be reached in a DRE.) 

With a latex glove and KY jelly, I did a self-DRE.  I found the nodule to be hard, smooth and round.  While the rest of the prostate is boggy, the nodule has the feel of wood or plastic.  These facts are consistent with a cancerous nodule. 

One Man’s Experience

I am now 82 years old and feel I have won the game.  My quality of life has been - and is - that of a cancer-free man.  If the cancer eventually takes me, I will not regret having disregarded the conventional path, which for many men is to place their fate in the hands of their doctors.  Of course, each man must choose his own response.  In many cases conventional treatment may offer the best prognosis, and Senator John Kerry and Rudy Giuliani have taken that route.  (See a recent study comparing 10-yr-survival rates for various treatments at: http://www.medicinenet.com/script/main/art.asp?articlekey=84402)  The urologist has his place in the dialogue.  But the patient should inform himself sufficiently regarding the pros and cons of prostate cancer procedures, so as not to have to rely solely on the word of his urologist.

Personal Living

I have been a vegetarian for about 10 years.  This may be in my favor, as red meat has lately been implicated in prostate cancer.  Cruciferous vegetables have been found to have anti-cancer activity, and I include several of these in my diet.  The crucifers include broccoli, Brussels sprouts, cabbage, cauliflower, collards, kale, mustard, turnip, radish and rutabaga.  Broccoli sprouts have 20 to 50 times more of the anti-cancer compound, sulforaphane, than mature broccoli.  I walk about 4 miles a day.  I consume moderate amounts of alcohol.  About a year ago I started the Dr Johanna Budwig diet.  The main active ingredients are flax oil and sulferated proteins, such as are in yogurt and cottage cheese.  For more information on the Budwig diet visit
     http://www.healingcancernaturally.com/budwig_protocol.html 

     Related site:

       blog catalog.com health/medicine

    R Trebor