HIGHLIGHTS FROM THE SEPTEMBER 2008

PROSTATE CANCER RESEARCH INSTITUTE SYMPOSIUM

By Jan Zlotnick, R.N., M.Ed., Ed.S.

 

DIAGNOSTICS

 

  1. Peter Carroll (UCSF Urology Department chairperson) estimated over-detection rates for PC to be 27-56%, and that active treatment (vs. surveillance) is more common today than previously. In addition, 92% of the best candidates for active surveillance get aggressive treatment instead. A few centers are gaining considerable expertise with active surveillance, using delayed, selective and curative therapy. Dr. Carroll has recently completed his Masters in Public Health degree, increasing his credentials as a urologist who is more focused on quality of life issues than most.
  2. According to Dr. Carroll Gleason scores and PSA don’t necessarily correlate.
  3. Change in Gleason score from 3/3 to 4/3 has no impact on survival.
  4. The V.A. system is using more active surveillance than private insurers.
  5. Color doppeler ultrasound was greatly praised by Drs. Myers, Strum and Bahn.
  6. Several docs expressed dismay that the Combidex MRI scan has not been approved by the FDA, necessitating them to send patients needing this to Holland.

The Combidex test is used to determine whether prostate cancer has traveled out of the capsule and metastisized.

  1.  Daniel Margolis indicated that current MRI equipment in the U.S. is easily adaptable to the Combidex, which is a contrast medium like those commonly used here for CAT/CT scans. Drs. Myers and Strum were adamant about the usefulness of this for staging newly diagnosed men. Dr. Margolis still sees ultrasound as the best tool for guiding biopsies.
  2. Dr. Margolis emphasized that MRIs for PC are best done with a rectal probe, contrast dye and a glucagon injection (to decrease bowel activity).
  3. Dr. Nicholas Vogelsang indicated that metastases in bone marrow are seen with MRI long before they appear on bone scans.
  4. While new markers are being explored, all the docs who spoke about diagnostics indicated PSA is still the gold standard.
  5. According to Dr. Vogelsang LDH – a blood marker for liver, heart and other problems – correlates better with survival than PSA. It seems to correlate with PC stem cell activity, an area of study that other doctors present were excited about.

 

TREATMENTS

  1. A June 2008 UCSF study indicate diet can change the microenvironment for PC growth.
  2. There should be new, hopefully encouraging, data on Provenge by year’s end.
  3. According to Mark Moyad the most consistent theme for preventing and slowing PC growth has been reducing calories.
  4. Dr. Moyad indicated this year’s flu vaccine is the best in 20 years, and that flu vaccines in general can boost immunity in other ways as well. Dr. Moyad’s training is the reverse of Dr. Carroll’s, and his substantial background in public health, which focuses more on large populations than individual patients, provides an interesting counterpoint to the conventional doctors who dominate PC research. He encourages all of us to pay more attention to ‘negative’ studies, i.e. ones that show what does NOT work.
  5. Dr. Stanley Brosman told of a new urethral sling for incontinence that can be done on an outpatient basis. Robotic surgery is resulting in less incontinence.
  6. Duke Bahn spoke about a new protocol of injecting low-dose chemotherapy (e.g., Cytoxan) and dendritic cells (a type of white blood cell) into the cryoablated  area before and after surgery. A small study indicates an increased cure rate using this procedure. FYI - Dr. Bahn is a highly-acclaimed cryosurgeon and diagnostic specialist.
  7. Mark Scholz, PCRI’s director, presented a number of potential ways to suppress relapsed PC without blocking testosterone. He emphasized that using multiple interventions simultaneously would likely effect a better result. While all of these require further research, ones he presented as promising were: leukine, T-cell regulators, low-dose Cytoxan, cancer-sensitive dendritic cells, pomegranate juice, Zometa  and VEGF. Promising combinations include: thalidomide + leukine; leukine + Cytoxan + Celebrex; Provenge + Avastin.
  8. Hormone-refractory PC is no longer considered to exist. PC cells just become better at utilizing what little androgen is present. The new term for PC that no longer responds to Lupron and similar drugs is CRPC – castration-refractory prostate cancer.
  9. Drugs under development for CRPC include: abiraterone, which blocks testosterone better than ketoconazole, a common CRPC treatment, and with fewer side effects; Avastin (bevacizumab), which blocks vascular endothelial growth factor (VEGF) to stop tumor blood supply; MDV 3100, described by a few docs as ‘Casodex on steroids’.
  10. Taxotere AND (Avastin, sunitinub, thalidomide, capecitabine, DMXAA and others) was given by Dr. Richard Lam as the best chemo for increasing survival.
  11. Dr. Myers emphasized that radiation should be given to the prostate bed immediately after surgery with most or all patients, rather than start it when there is a rising PSA. This is because he believes that virtually all men have systemic disease upon diagnosis, and unlike most stem cells, PC stem cells are radiation-sensitive. So, kill the stem cells before they have a chance to leave the area.

 

DIET & SUPPLEMENTS

 

  1. Mark Moyad reinforces what many other experts have said about calcium supplementation: the cheapest kind is just as good as the most expensive. He recommends 1200 mg/dy for men with PC. We’ve all heard different amounts from various healthcare practitioners, but none of the esteemed PC docs at the symposium openly disagreed.
  2. Vitamin D deficiency is universal. We should all get the 25 (OH) test for Vit. D and supplement to reach 40ng/ml in our bloodstreams. Vitamin D3, also called cholecalciferol, is the safest supplement form (It’s what we make from sunlight).
  3. According to Moyad 10% of money spent on supplements is for ED (erectile dysfunction). Most supplements (for many issues) are bogus, but for ED he sees promise in Maca (1-2 gm/day) and Korean Red Ginseng (no dose given).
  4. Ever the public health clinician, Moyad reminded everyone that more guys who already have PC will die from cardiovascular disease than PC. He recommends fish oil capsules for heart-healthy fats, and presented a study indicating Kirkland (Costco) brand was the best overall. 
  5. Moyad presented a study showing powdered flax seed decreases PSA growth? But he didn’t seem convinced, and I’ll need to see corroboration before I take this seriously.
  6. Always take the lowest workable dose of a supplementation, according to Moyad. Less can be more, as evidenced by studies such as one that showed more than

400 mcg of folic acid (Vitamin B9) doubled PC fatalities.

7.   Snuffy on dairy – According to Dr. Myers’ wife Snuffy believes nonfat dairy is

fine. Apparently, the casein (a milk protein that he used to avoid) no longer bothers him. It’s the arachidonic acid, which is only found in the fat.

8.   Dr. Myers indicated that supporting stem cell dormancy is a hot area of study. He suggested some dietary means that can do this: Vitamin D3 (cholecalciferol) at a dose of at least 2000 units/dy; pomegranate juice; resveratrol, found in red grapes; and a Mediterranean diet (sounds familiar).

 

Jan Zlotnick teaches nursing and health science at City College of San Francisco. He developed the first college-credit men’s health issues class in the country.