Prostate Cancer Risk Groups

The Prostate Cancer Foundation has this on its website:
Before planning your treatment, your prostate cancer doctors will take a close look at your risk group, which is a way categorizing the overall severity of a case and applying evidence and experience to determine how aggressively your treatment should be. There are 3 general risk groups based on the PSA, DRE, and biopsy, which can further be subdivided to better personalize treatment for each patient.

1. Low risk: Tumor is confined to the prostate, and the PSA is <10 and grade group 1 (Gleason 6). There is also a subset of extremely “slow-growing” tumors called “very low risk” in which fewer than 3 biopsy tissue samples contain cancer cells and the cancer is not detectable by DRE.
2. Intermediate risk: Tumor is confined to the prostate, the PSA is between 10 and 20, or grade group 2 or 3 (Gleason 7). This category is often divided into a “favorable” and “unfavorable” intermediate risk.
3. High risk: Tumor extends outside the prostate, the PSA >20, or grade group 4 or 5 (Gleason 8 to 10). There is also a subset of very aggressive tumors is called “very high risk” in which the tumor has extended into the seminal vesicles (T3b) or the rectum or bladder (T4), or there are multiple biopsy samples with high grade cancer.

These risk groups are not perfect indicators of your risk for developing recurrent, aggressive prostate cancer. Currently, there are extensive, ongoing efforts to develop tests that can aid physicians in more accurately telling the difference between cancers that will become fatal from those that will sit in the prostate without spreading.

The treatment options for each risk group are very different and you should ask your doctor which risk group you belong to so you can better understand the most appropriate next steps.

Overdiagnosis and Overtreatment

This study says: Adenocarcinoma of the prostate is probably the tumour with the greatest risk for overdiagnosis and overtreatment. During autopsy, tumours are often detected in the prostate, with older men more likely to have an indolent tumour (ie, a man aged 60 years might have a 50–60% risk of occult cancer). With repeated prostate-specific antigen (PSA) testing and 10–12-core biopsy of the prostate, often done repeatedly, small, low-grade tumours are frequently detected. Attesting to the relatively low biological potential of these lesions are the 99% and 97% disease-specific survivals at 5 years and 10 years of follow-up, respectively, for men who are simply monitored and only given treatment if they have evidence of a grade or volume increase. Despite this indolent behaviour, greater than 90% of these tumours are treated with radiation or surgery, generating morbidities of treatment (eg, sexual, urinary, and gastrointestinal side-effects, in about 15–20% of patients), increased risk of secondary malignancies (with radiation), and increased cost. Even active surveillance is hampered by the growing risk of sepsis in men undergoing repeated biopsies accompanied by increased cost and anxiety. 

In this study, Etzioni et al found that one in three prostate cancers diagnosed by screening for prostate specific antigen (PSA) is an over-diagnosis.

Here is a review of the ProtecT trial.

Source: Canceractive.com

WARNING: PROSTATE CANCER DIAGNOSED?

MEN – Do not do a thing until you read this!

A growing number of research studies shows that there is little or no survival benefit in having orthodox medical prostate cancer treatment if you are diagnosed over the age of 50. With the known and common side-effects, you are probably better off doing absolutely nothing or looking at non-invasive alternative treatments, and later in the article, we will cover some of those.

Other studies have exposed more medical mythology. Experts now view the PSA test as virtually useless, while others are clear that testosterone levels have no causal effect on prostate cancer.

And, let’s be clear, after the age of 50-55, at least 4 out of every 10 men will develop prostate cancer!

“No survival advantage in prostate cancer treatment”

In August 2016, a major research study by Professor Freddy Hamdy and his Oxford University team found that there is absolutely no survival advantage in having orthodox medical treatment for a newly diagnosed prostate cancer patient after 50 years of age.

The 2016 NHS study followed more than 82,000 men aged between 50 and 69 for a decade. And the bottom line? Only 1 per cent of the men died in that time from their cancer, whether or not they had treatment! The fact is that in the great majority of men diagnosed with prostate cancer later in life, the cancer is slow growing. You are more likely to die with it, than of it.

Importantly, this study was not the first of its kind, as you will see below, but it was the biggest, and in all such studies the results have been remarkably consistent bringing in to question the worth of orthodox medical treatment for prostate cancer in men over 55 years of age, especially in the light of its known high levels of side-effects.

PSA tests, false positives and completely unnecessary prostate cancer treatment

In 2012 there was a full report from the American Preventive Services Task Force (PSTF) on prostate cancer. This Government body concluded that PSA tests for prostate cancer were unreliable, do not offer men any tangible benefit in lifespan or quality of life, and conclude that many more men are injured than helped by PSA tests.

The PSTF research concluded that “only one man in a thousand tested would derive any real benefit, whereas a staggering 100 will receive false positives. Many of these people will then have biopsies, which can cause complications including infection”.

Prostate Specific Antigen (PSA) is a biological marker that oncologists and doctors use to detect the presence of a potential prostate tumour. However there are many other reasons why the PSA can be high; for example, you cycled in the previous 24 hours, consumed dairy, you have prostatitis (inflammation or infection in the prostate gland), or benign prostatic hyperplasia (BPH), or you went to the gym on the way to the hospital. Equally consuming lycopene (tomatoes) or eating a cooked tomato-rich meal will temporarily lower the score.

Also many prostate tumours are benign, would never cause serious health problems yet give high PSA readings.

The same study found that 90 per cent of men may then be treated with surgery or radiation for cancers that are not and will never be life-threatening, but five out of every thousand having these treatments will die within a month of initiating them. In other words, more than ten percent of all men screened for prostate cancer will generate false positives that could result in death from treatment, while a mere 0.001 percent or less will derive any sort of benefit.

“There is a small potential benefit and a significant known harm,” said Dr. Virginia A. Moyer, a professor of paediatrics at Baylor College of Medicine in Houston, Texas, and chair of the task force. She and her team are recommending that the PSA test for prostate cancer be abandoned altogether, and that patients avoid the test as part of their normal check-ups.

No link between testosterone levels and prostate cancer

Many doctors state that PSA tests might be imperfect but they are all that is available, so they might as well use them. This is actually not true. In America some experts measure the DHT levels.

DiHydroTestosterone (DHT) is the active compound, produced by the action of oestrogen on nice safe testosterone. DHT is what causes prostate cancer and the test is also a measure of cancer aggression.

Be clear: There is absolutely no link between prostate cancer and testosterone levels according to Peter Boyle, MD, of the International Prevention Research Institute, who reviewed two meta-studies and found no evidence that testosterone levels were linked in either.

No real benefit in prostate cancer surgery and hormone treatment but there are many problems

In research published in the Journal of the National Cancer Institute, Swedish researchers have concluded that if none of the men diagnosed with early prostate cancer had any treatment at all, over 97 per cent would still survive ten years or more!

After comparing a group of low to mid-risk prostate patients having no treatment with a group having the usual surgery and hormone treatments, some eight years later the death rate amongst men in the no-treatment (active surveillance) group was exactly the same as the figure for the general population!! The researchers stated that after ten years only a little over two per cent of men in the untreated group would have died from prostate cancer.

The researchers even suggested having surgery was pretty much a waste of time and made no difference to the outcome; worse, patients had to put up with often debilitating side-effects.

In a second study (New England Journal of Medicine – PIVOT study) led by Dr.Timothy Wilt of the University of Minnesota School of Medicine, 731 men were followed for ten years, after being diagnosed with prostate cancer. Some had surgery, some did nothing.

At the end of the ten years 47 per cent of the surgery men died during the study compared with 50 per cent of those having nothing. This difference is not deemed statistically significant. However, importantly, men who choose to do nothing are only half as likely to suffer from urinary incontinence or erectile dysfunction.

“We think our results apply to the vast majority of men diagnosed with prostate cancer today,” said Dr. Wilt to the Chicago Tribune.

Importantly, in this study only 3 per cent of men diagnosed with prostate cancer actually died from it, whether they had had surgery or not! The rest died of other causes!

So this study also shows orthodox prostate treatment in men over 60 does not extend life. However, men who have surgery are much more likely to suffer side-effects – overall more than 50 per cent suffer impotence, and more than 10 per cent suffer incontinence.

Over 55 and diagnosed with prostate cancer? Watch and wait

Both the US National Health Institutes and the American Society of Clinical Oncology recommend ‘Active surveillance’, or ‘Active Monitoring’. The ‘cut off’ is a Gleeson score of 6 or lower. Starting once every three months then every 6 months this may become once per year and then once every two years. 50 per cent of men diagnosed in America in 2016 with early stage prostate cancer now ‘watch and wait’. CANCERactive first recommended this strategy in 2005, 11 years ago and four years ahead of other UK charities. Five years ago in America only 10 per cent of men followed Active surveillance programmes.

One expert US oncologist Dr. Matthew R. Cooperberg, a urologist and epidemiologist at the University of California, San Francisco, is actually arguing for new terminology that says there is abnormality but doesn’t use the ‘C’ word. Cooperberg observes that life expectancy in the over 60s is 10-15 years when diagnosed, even without treatment.

IMPORTANT: Can you take your own steps to treat your prostate cancer and live longer?

The idea of simply ‘waiting’ can fill men with some horror. But then so too can the thought of prostate surgery, drugs to cut testosterone, radiotherapy and debilitating side-effects.

So can you take matters in hand? The answer is an emphatic ‘Yes’.

1. Prostate cancer risk and aggression increases the more saturated fat, such as cows’ dairy, and alcohol you consume. Higher triglyceride levels in the blood stream are known to progress the disease.

2. Conversely, diets high in polyphenols (such as pomegranate, curcumin, resveratrol and EGCG in green tea) slow growth. One supplement, POMI-T, developed by Professor Robert Thomas has been shown to reduce PSA levels in clinical trials. Thomas originally had all newly diagnosed men around his hospital on broccoli, tomatoes and light daily exercise, pushing back the need for surgery by at least three years. Oestrogen regulators like Indole 3 Carbinol and melatonin also help slow the process.

3. A good diet and lifestyle can limit prostate cancer growth rate. And there is research concluding that both curcumin and grape seed extract can reduce metastases in prostate cancer.

4. German Clinics (such as Klinik St Georg) have evidence that prostate biopsies, apart from risking infection and impotence, can spread the disease. There are UK clinical studies concluding the same. Do you really need a biopsy?

5. Rather than invasive surgery, men should look into localised hyperthermia (also called Ablation). This can melt away the tumour and hospitalisation is short with side-effects minimal. The prostate tumour can be heated using High Intensity Focused Ultrasound (HIFU) or a tube with a metal element placed in the middle of the tumour.

6. The Nanoknife IRE, which uses needles either side of the tumour and passes a current through the tumour to punch holes in the cancer cells causing them to lyse, is another potential option.
7. Instead of radiotherapy and brachytherapy, less damaging and more contained proton therapy is now increasing in popularity in America.

8. Research in 2008 linked 13 chemicals to prostate cancer. All these chemicals were ‘oestrogen mimics’. Research has shown that where selenium levels are low, supplementation of up to 200 micrograms can have positive effects. Selenium can displace chemicals and heavy metals from the body.

9. Vitamin D, the sunshine vitamin, has been shown in research to reduce both risk and aggression. Public Health, England advise everybody to go in the sun and, if you can’t, to supplement. Harvard Medical School advise supplementation at 5,000IUs per day for people with cancer.

10. Men who incorporate a higher overall ratio of plant-based foods and herbs into their diets reduce aggressive prostate cancer risk by 25 per cent according to a University of South Carolina study. Researchers claimed the benefit came from bioactive compounds called flavonoids found in colourful foods (for example, strawberries, grapes, greens, onions, citrus fruits).

11. Another study showed the higher your consumption of naturally fibrous foods the stronger your immune system; while yet another showed the same high-fibre diet slowed prostate cancer growth.

12. Maintaining a healthy gut (taking probiotics and probiotic foods like Kefir, Sauerkraut and unpasteurized milk products) can boost the immune system and lower bad triglyceride levels. Extra virgin olive oil, fish oils and consuming nuts and seeds can also help significantly.

Canceractive.com has also published the following article:

Glutamate and prostate cancer

Source: canceractive.com

Plasma glutamate levels directly correlate with the prostate Gleason score and the primary cancer’s aggression; this finding could lead to less invasive ways to diagnose prostate cancer rather than a biopsy and points to natural treatments for glutaminase rather than hormone therapy targeting testosterone.

This research study published in 2012, was very clear in its conclusion, also showing that in men with metastatic cancer, serum glutamate was considerably higher that in men with only a primary tumour.

Back in 2012, the researchers suggested that it would be a much more accurate test for prostate cancer than taking a PSA reading or having a biopsy with its risks of infection and disease-spread.

Glutamate is an alternative fuel for cancer cells after sugar. It can be made from folic acid, glucose and is involved in fat metabolism but its primary precursor in glutamine, an amino acid widely available in protein, especially animal protein.

Glutamine is also a non-essential amino acid, meaning that if your body runs short, you simply make it from other sources. You muscles are glutamine-rich; you brain holds about 25% of the glutamine in your body.

Glutamine is available in meats such as chicken, game and steak, and bone broth. It is also found in cheese. Glutamate deprivation reduces prostate growth

Another conclusion of the study was that glutamate deprivation reduced growth, invasion and migration of prostate cancer. As does glutamate ‘blockade’.

Chris Woollams, former Oxford University Biochemist said, “This last point is extremely interesting. If glutamate blockade is a benefit what they are suggesting is blocking an enzyme, glutaminase, which they did in the research with a drug. Glutaminase converts glutamine into glutamate.

We have previously covered that compounds such as Ursolic Acid, lycopene, curcumin, EGCG, resveratrol, Honokiol, valerian, ashwagandha, sulforaphanes and Graviola can all block this enzyme. We know these compounds are also very useful against prostate cancer, and most also attack cancer stem cells, which are in higher-than-usual levels in prostate cancer.

It seems such as shame that no action has really come from this research. That doesn’t stop readers though, does it!?”

In interviews Chris Woollams has said the following:
Radiation works but gives rectal cancer after a few years
Eat a Mediterranean diet
Stay away from steak, bacon, ham, salami, eggs
Cut oestrogen with melatonin or black cumin seed oil
Use lycopene + turmeric plus Piperine
Holy basil  (Tulsi) plus turmeric or resveratrol 500 to 700 mg
Ursolic acid found in pistachio nuts
Berberine.
Pomegranate
EGCG (Green Tea)
Black cumin seed oil
Zinc
IP6 800mg between meals two to three times daily
B complex supplements.

Hormone therapy can make prostate cancer worse, study finds.

Source: Science Daily / University of Toronto
Scientists have discovered how prostate cancer can sometimes withstand and outwit a standard hormone therapy, causing the cancer to spread. Their findings also point to a simple blood test that may help doctors predict when this type of hormone therapy resistance will occur…continue reading
( link to original study)

For prostate cancer patients undergoing Androgen Deprivation Therapy (ADT)

This study says: In summary, calcium and Vitamin D supplementation is a recommended complementary therapy…in men undergoing ADT…

This study of 32 prostate cancer patients undergoing ADT says diet [more vegetables and less fast/no junk foods] and exercise “resulted in significant, clinically meaningful improvements in mobility performance, muscular strength, and body composition.

This study says:

• Androgen deprivation therapy (ADT) is associated with adverse metabolic effects which can affect prognosis in men with prostate cancer.
• Progressive resistance training (PRT) is an exercise modality which can benefit both body composition and muscle function during ADT.
• PRT may exert its positive effects on prostate cancer prognosis through its modification of cancer signalling pathways.

The Prostate Cancer Research Institute advises:

Sarcopenia (Loss of Muscle Strength)

Editor’s Note: The acronym TIP describes all testosterone inactivating pharmaceuticals.

The elimination of testosterone in men leads to a deterioration of lean muscle mass, an increase in fat mass, and a subjective decrease in physical function. In other words, men get weak, gain weight and don’t feel as well when they are on testosterone deprivation therapy. These side effects become evident within the first three or four months after starting on a TIP and progress the longer a man continues treatment.

Prevention / Treatment Strategies
Research shows that strength training can often prevent or reverse the loss of muscle mass and physical well-being associated with the reduction of testosterone. The importance of regular strength training cannot be stressed enough. It should be a priority in any strategy to prevent and treat the side effects of any TIP. The essence of a successful strength-training program is lifting weights to the point of muscle failure. Programs to build muscle need to start slowly for the first few months so that no injuries develop. A professional trainer is highly desirable.
*****
Here is a very comprehensive article about treatments and dealing with side-effects from canceractive.com

Prostate Cancer – Risk of Recurrence?

Oncotype DX® Prostate Cancer Assay
Article source: Oncotypedx
Test available from: Oncotypedx

The Oncotype DX Prostate Cancer Assay harnesses the power of genomics to provide a more precise and accurate assessment of risk based on individual tumor biology. Using a minimal tissue sample from a needle biopsy, the test builds on traditional clinical pathologic factors to provide additional, clinically relevant insight into the underlying prostate tumor biology, enabling physicians and their patients to make treatment decisions with greater confidence.

Patients with newly diagnosed low-risk prostate cancer—and their urologists—need to know the aggressiveness of their tumor. The Oncotype DX Prostate Cancer Assay can help. This genomic test performed on a patient’s needle biopsy provides essential insight into the underlying biology of that patient’s prostate cancer. The result is reported as the Genomic Prostate Score or GPS, and provides a more precise, accurate, and individualized risk assessment that can help a patient and his urologist make a confident choice between active surveillance and immediate treatment.

About Cancer

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