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So you think you need prostate surgery

MagazineSeptember 2013 (Vol. 24 Issue 6)So you think you need prostate surgery

Several months ago, PulpFiction

Several months ago, Pulp Fiction star Samuel L. Jackson launched One for the Boys, an international campaign to raise awareness about male cancers to encourage men to be more open and less macho about going to a doctor if they display any suspicious symptoms. He was prompted to do this because the death rate from cancer is higher in men than women-largely, it's assumed, because men hate going to the doctor and only do so when it's too late.

And for good reason. Top of the list of cancers being targeted by the new campaign is the one men dread the most. Prostate cancer, the most common form of cancer (and surgery) for men over 40, affects the gland that lies just below the base of the bladder and produces prostatic fluid, which contributes to seminal fluid.

Today, according to the NHS, some 40,000 British men are diagnosed every year (230,000 in the US) and some 250,000 are living with the disease (2.5 million men in the US). Although the incidence of prostate cancer hasn't really gone up, the incidence of aggressive treatments like radiation and surgery has skyrocketed, but there's not much evidence that all this cutting and burning is doing much good. The death toll has stubbornly remained the same-24 deaths per 100,000-for the past 40 years, despite a 60 per cent increase in diagnoses, from one in every

1,111 to one in every 666 men.1

The raft of diagnostic procedures urged on all men aged over 50 include a digital rectal exam, where the doctor's gloved finger probes and palpates the prostate via the rectum, and a blood test that checks levels of prostate-specific antigen (PSA), plus ultrasound scans, computed tomography (CT) or magnetic resonance imaging (MRI) scans to confirm the diagnosis, as well as biopsy, where a sample of prostate tissue is surgically removed and examined for the presence of cancer cells.

If you're one of those with a positive test, read this first before consenting to go under the knife.


What doctors tell you

Doctors will offer you a choice of the following:

Watchful waiting(do nothing but keep an eye on it) for those with localized cancer (confined to just the prostate gland).

Radical prostatectomy(complete removal of the prostate).

Transurethral resection of the prostate(or TURP), where an instrument inserted in the penis either cuts or burns away both the inner parts of the gland and its capsule, using a 'nerve-sparing' technique to supposedly retain potency.

External-beam radiotherapy,which uses high-energy X-ray beams to kill prostate cancer cells (often used with permanent seed brachytherapy or temporary brachytherapy for internal radiotherapy; see below).

Temporary brachytherapy,where high-dose radiation is beamed into the prostate gland for a few minutes at a time to destroy cancer cells.

Permanent seed brachytherapy,which involves implanting tiny radioactive seeds into the prostate that will emit radiation continuously for up to a year to destroy cancer cells (often offered with external beam radiotherapy or hormone therapy).

Hormone therapy,which uses GnRH (gonadotrophin-releasing hormone) analogues such as buserelin, goserelin and leuprorelin to suppress androgen production, plus antiandrogen drugs like cyproterone acetate and/or flutamide.

What doctors don't tell you

The PSA blood test is hopelessly inaccurate,producing false-negatives a third of the time. This reliability only improves if someone reminds you to abstain from sex 48 hours prior to the test. PSA has overdiagnosed more than one million men since its introduction back in 1987.2

Chances are, prostate cancer won't kill you.Except for the rare fast-growing variety, prostate cancer is extremely slow-growing and eventually develops in most men. Autopies in the over-85s show that up to three-quarters of men have it, but only 1 per cent die of it.3

Most men are overtreated.Some three-quarters of men with low PSA levels-around 4.0 ng/mL or less, considered low-risk disease-are made to go through the same aggressive treatment as men with high PSA scores-above 20 ng/mL, the high-risk category.4

With the TURP op,you've got a 79 per cent chance of becoming impotent and a 10 per cent chance of becoming incontinent.5

With external-beam radiation,61 per cent develop permanent sexual dysfunction and one in seven will have rectal damage causing pain or urgency.5, 6

Radiation therapy increases the risk of rectal cancerin 70 per cent of cases, and men who have radiation treatment are 1.7 times more likely to develop rectal cancer, says the US National Cancer Institute after studying 85,000 men from 1973 to 1994.

Seed brachytherapy will mess up your nether regions.Some 68 per cent of men become impotent, 28 per cent suffer changes in bowel function and 22 per cent are either incontinent or require a catheter to urinate.7 When combined with TURP, up to 85 per cent become incontinent, 21 per cent may develop radiation proctitis (inflammation and other tissue damage in the colon and rectum) and 2 per cent may develop permanent rectal injury.8

Hormones increase your risk of cancer.Androgen-deprivation therapy often causes a 'flare', making the disease worse by stimulating testosterone production before shutting it down. It also helps prostate cancer cells produce a protein that encourages the spread of cancer throughout the body.9

What to do instead

Watchfully wait.The five-year survival rate for prostate cancer that doesn't spread is 100 per cent, even without treatment,4 while those with low-grade cancer have a minimal risk of dying after 20 years.10 Only those with highly aggressive cancers need consider having radical surgery.11

Don't have a vasectomy,but if you already have, get it reversed. It increases your risk of developing high-grade or lethal prostate cancer by more than 50 per cent.12

Eat tomatoes.Lycopene, which makes tomatoes red, is food's most powerful anticancer carotene, particularly when eaten with pumpkinseed oil, which helps improve absorption. Three or four servings a week dramatically cuts your risk of developing the disease, particularly when eaten with two servings per week of soy.13 Other good sources (make sure to eat them very ripe) are apricots, bell pepper, cherries, cranberries, guava, papaya, peaches, pimiento, pink grapefruit, plums, red paprika, strawberries, watermelon and raspberries.

Eat Italian with liberal sprinklings of the superherb oregano.Carvacrol, a constituent of oregano, has caused cell death in prostate cancer cells in lab studies, and probably works in concert with the lycopene in tomato sauce.14

Eat broccoli at least twice a week.This cruciferous veg interrupts 'cancer signals' to the prostate.15

Stop smoking and moderate your alcohol intake-both associated with reducing your risk of developing prostate cancer.

Get moving.Jogging, swimming, biking or playing tennis for three or more hours a week will lower your chances of dying from prostate cancer by around 35 per cent. Even just walking four or more hours a week can lower your risk of death by 23 per cent.16

Ditch statin drugs,which increase the risk of prostate cancer by one and a half times especially in those who are overweight or obese.17

Avoid grilled and broiled red meatscooked at high temperatures, especially burgers, and saturated fats, milk and eggs-all known to increase prostate cancer risk. Cook chicken and poultry in the oven to avoid similar risks.

Follow a low-carb diet.Low glycaemic-index diets like the Atkins and Montignac that avoid refined carbs increased the lifespan of animals with prostate cancer by 50 per cent-a result now being trialled in humans.18

Drink green tea,which inhibited prostate cancer cell growth and spread in both lab and animal studies.19

Drink pomegranate juice,also shown to slow progression of the disease.20

Filter your water.Oestrogenic compounds from the Pill making their way into the water supply could be triggering the rise in cases of prostate cancer.21

Get a good night's sleepin a fully darkened room. Men who sleep more than nine hours a night are half as likely to get the disease, concluded a study of some 22,000 Japanese men.22 And constant exposure to artificial light may promote prostate cancer, Israeli research suggests, by tricking the body into thinking it isn't night and so suppressing melatonin production.23 If your bedroom isn't pitch black, buy blackout curtains or sleep masks.

Get out in the sun.Men with high levels of vitamin D cut their risk of the cancer by 45 per cent. Twenty minutes is good enough-or supplement with vitamin D.

What supplements to take

Vitamin E(alpha-tocopherol) taken with lycopene can inhibit prostate cell growth and proliferation by 90 per cent.24 Take 30 mg/day of lycopene alone or 15 mg with vitamin E (400 IU).

Omega-3 fatty acids(fish oils) and selenium can reduce the progression of established prostate cancer, while omega-3s alone have reduced tumour growth, halted cancer progression and increased survival in the lab.25 Eat fatty fish too-non-fish eaters have three times the risk of developing the cancer.26

Flaxseed oilor ground flaxseed (30 g/day) plus a low-fat diet can slow cancer cell proliferation and increase cell death rates in prostate cancer patients.27

Foods high in calciumcan lower the risk of high-grade prostate cancer.28 Stick to non-dairy sources, though (dried herbs, dark, leafy green veg, fish like sardines, salmon and rainbow trout, almonds and brazil nuts and sesame seeds, for instance) as dairy has been linked with prostate cancer.

Pollen and saw palmettoextracts both can shrink an enlarged prostate, inhibit cancer cell growth in the lab, induce cell death and lower PSA counts.29

DHEA and red clover.Taking DHEA will replenish the body's natural supply, which diminishes as men age, and red clover offers a rich source of isoflavones, which also help prevent the cancer.30

Bee propoliscontains caffeic acid phenethyl ester, or CAPE, which blocks the ability of cancer cells to find sources of nutrition, at least in the lab.31

References

1. http://www.cancer.gov/cancertopics/factsheet/cancer-advances-in-focus/prostate; http://seer.cancer.gov/csr/1975_2008/results_merged/sect_23_prostate.pdf

2. J Natl Cancer Inst, 2009; 101: 1325-9

3. Lancet, 2003; 361: 859-64

4. Arch Intern Med, 2010; 170: 1256-61

5. J Natl Cancer Inst, 2000; 92: 1582-92

6. N Engl J Med, 2008; 358: 1250-61

7. Radiother Oncol, 2007; 82: 46-9

8. Eur Urol, 2002; 41: 427-33

9. Cancer Res, 2007; 67: 9199-206

10. JAMA, 2005; 293: 2095-101

11. J Clin Oncol, 2009; 27: 4300-5

12. J Clin Oncol 31, 2013; suppl: abstr 5086

13. Cancer Res, 1999, 59: 1225-30; Cancer Prev Res [Phila], 2013; 6: 548-57

14. Poster presentation at The Experimental Biology 2012 conference, April 24, 2012, San Diego, California

15. PloS One, 2008; 3: e2568

16. Presentation at the American Association for Cancer Research Frontiers in Cancer Prevention Research Conference, December 8, 2009, Houston, Texas

17. Am J Epidemiol, 2008; 168: 250-60

18. Cancer Prev Res [Phila], 2009; 2: 557-65

19. Cancer Metastasis Rev, 2010; 29: 435-45

20. Clin Cancer Res, 2006; 12: 4018-26

21. BMJ Open, 2011; 1: e000311

22. Br J Cancer, 2008; 99: 176-8

23. Chronobiol Int, 2009; 26: 108-25

24. Biochem Biophys Res Commun, 1998; 250: 582-5

25. Br J Cancer, 1999; 81: 1238-42; Br J Urol, 1998; 81: 730-4; J Clin Invest, 2007; 117: 1866-75

26. Lancet, 2001; 357: 1764-6

27. Urology, 2001; 58: 47-52

28. Prev Chronic Dis, 2012; 9: 110125

29. Cell Biol Int, 2001; 25: 1117-24; Br J Urol, 1990; 66: 393-7; Int J Oncol, 2007; 31: 593-600

30. Cancer Prev Res [Phila], 2009; 2: 134-42

31. Cancer Prev Res, 2012; 5: 788-97


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