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Latest Prostate Cancer Treatments

General Information About Prostate Cancer

Prostate cancer is a disease in which malignant (cancer) cells form in the tissues of the prostate.
Signs of prostate cancer include a weak flow of urine or frequent urination.
Tests that examine the prostate and blood are used to detect (find) and diagnose prostate cancer.
A biopsy is done to diagnose prostate cancer and find out the grade of the cancer (Gleason score).
Certain factors affect prognosis (chance of recovery) and treatment options.

Eight types of standard treatment are used:

Watchful waiting or active surveillance
Surgery
Radiation therapy and radiopharmaceutical therapy
Hormone therapy
Chemotherapy
Targeted therapy
Immunotherapy
Bisphosphonate therapy

Read the full article on the National Cancer Institute website.

Non-standard prostate cancer treatments

1. Cryosurgery

What is cryosurgery?
Source: National Cancer Institute
Cryosurgery is a treatment that uses extreme cold produced by liquid nitrogen or argon gas to destroy cancer cells and abnormal tissue. It is a local treatment, which means that it is directed toward a specific part of your body. Cryosurgery is used to treat tumors on the skin, as well as certain tumors inside the body. Cryosurgery may also be called cryotherapy or cryoablation.

Focal Cryoablation for Prostate Cancer
This 2023 study looked at 163-patients who underwent Focal Cryoablation of the prostate at a single clinic by a physician from November 2008 to December 2020.

The patient cohort included 27 patients with low, 115 patients with intermediate, and 23 patients with high-risk prostate cancers. At five years, this cohort yielded biochemical disease-free recurrence rates of 78%, 74%, and 55% for low, intermediate, and high-grade cancers, respectively. The study concluded: The extent of FC’s efficacy still remains to be established, but our conclusions demonstrate favorable PSA kinetics at five years follow-up. Common complications such as erectile dysfunction and urinary incontinence were minimal but still present in the patient cohort.

The study also included the following on other types of ablation:

Different modalities of targeted focal ablation are available, including HIFU, focal laser ablation, radiofrequency ablation, photodynamic therapy, and cryoablation. The technology for cryoablation has been present for many years; hence, it is a common modality for focal ablation of the prostate. It is, however, valuable to note the efficacy and growing body of literature around alternative focal therapy modalities. Guillaumier S et al. (2018) focused on five-year oncologic outcomes after HIFU and found 88% failure-free survival in treating non-metastatic PCa [prostate cancer] in a 625 multi-center cohort. Musunuru HB et al. (2016) support active surveillance for low and intermediate-risk PCa with 15-year metastasis-free survival rates ranging from 64% to 94%. Azzouzi AR et al. (2017) performed the first randomized clinical trial and assigned a 413 low-risk PCa patient cohort to photodynamic therapy or active surveillance. This study found that at two years of follow-up, there were lower rates of histologic progression from photodynamic therapy (28%) rather than active surveillance (58%). The study additionally found that focal therapy reduced the rate of radical therapy for PCa from 53% to 24% in four years.

2. High-intensity–focused ultrasound therapy (HIFU)

What is high-intensity focused ultrasound?
Focused ultrasound works in the same way as rays of sunlight that pass through a magnifying glass and are concentrated at a single point, causing a significant temperature rise around the focal point.
Thermal ablation is a non-invasive (incisionless and radiation-free) treatment that has been used in humans since 1993.

Focused ultrasound treatments can be performed on an outpatient basis, require no incisions, and can result in minimal discomfort and few complications, allowing for rapid recovery. Source: Focused Ultrasound Foundation

This study says:
This study demonstrates the effective long-term cancer control achieved with HIFU in patients with low or intermediate-risk localised prostate cancer.

This study says:
HIFU for localized prostate cancer offered high control of local disease with low morbidity.

This study says:
Image-guided FUS is both safe and effective in the treatment of primary and secondary tumours.

See HIFU page

3. Proton beam radiation therapy

Proton Beam Radiation Therapy
A type of radiation treatment called proton beam radiation therapy may be safer and just as effective as traditional radiation therapy for adults with advanced cancer. That finding comes from a study that used existing patient data to compare the two types of radiation.

Traditional radiation delivers x-rays, or beams of photons, to the tumor and beyond it. This can damage nearby healthy tissues and can cause significant side effects.

By contrast, proton therapy delivers a beam of proton particles that stops at the tumor, so it’s less likely to damage nearby healthy tissues.

Consensus Statement on Proton Therapy for Prostate Cancer
This 2021 study article concluded: As an established and effective treatment for patients with prostate cancer, proton therapy reduces the excess radiation delivered to healthy tissues surrounding the prostate when compared with photon-based radiation therapy. Several prospective and retrospective studies have been published documenting the safety and efficacy of proton therapy in the management of prostate cancer and some long-term follow-up data are available and are accumulating. Consequently, proton therapy should not be considered experimental in the management of prostate cancer. It is efficacious when delivered to patients with localized prostate cancer or when delivered postoperatively. It also can be delivered safely to patients requiring pelvic nodal radiation for high-risk or node-positive disease.

See Proton Beam Radiation Therapy page

4. Photodynamic therapy

What is Photodynamic therapy?
In the first step of PDT for cancer treatment, a photosensitizing agent is injected into the bloodstream. The agent is absorbed by cells all over the body but stays in cancer cells longer than it does in normal cells. Approximately 24 to 72 hours after injection, when most of the agent has left normal cells but remains in cancer cells, the tumor is exposed to light. The photosensitizer in the tumor absorbs the light and produces an active form of oxygen that destroys nearby cancer cells.

In addition to directly killing cancer cells, PDT appears to shrink or destroy tumors in two other ways. The photosensitizer can damage blood vessels in the tumor, thereby preventing the cancer from receiving necessary nutrients. PDT also may activate the immune system to attack the tumor cells.
Source: National Cancer Institute

This 2023 study concluded:
…PDT is a promising approach to treat prostate cancer that has the potential to provide a minimally invasive, highly targeted approach and negligible side effects on normal tissues when compared to conventional therapies. Several PDT approaches have already been approved by regulatory authorities including the FDA and the European Medicines Agency. Furthermore, combining PDT with other therapy modalities such as chemotherapy, radiotherapy, surgery, and immunotherapy seems to be more effective against tumor growth.

This 2022 study concluded:
PDT is a potential, minimally invasive treatment for localized prostate cancer that selectively ablates the disease with minimal effects on functional outcomes than RP, particularly on the bladder, rectum, and neurovascular bundle. Due to oncological safety, low toxicity and support by level 1 evidence from the only RCT within the focal therapy literature, PDT holds significant promise as the focal therapy of choice over other modalities for men with localized prostate cancer.

See Photodynamic therapy page

5. Melatonin

Melatonin increases survival by more than twice in patients with poor prognosis:

This retrospective study included 955 patients of various stages of prostate cancer (PCa) who received combined hormone radiation treatment from 2000 to 2019.

In the poor prognosis group, the median overall survival in patients taking the drug was 153.5 months versus 64.0 months in patients not using it. In a multivariate analysis, melatonin administration proved to be an independent prognostic factor and reduced the risk of death of PCa patients by more than twice.

6. Berberine

What is Berberine?
Berberine (BBR) extracted from Coptis chinensis (roots, rhizomes, and stems) and from several other Chinese herbal plants, chemically, is an isoquinoline alkaloid

Berberine and prostate cancer:
This study says: We concluded that berberine should be developed as a pharmacological agent for use in combination with other anticancer drug for treating metastatic prostate cancer.

See Berberine page.

7. Lycopene

What is Lycopene?
Lycopene is found in high amounts in tomatoes but is also present in watermelons, pink grapefruits, apricots, and pink guavas.

Lycopene and prostate cancer
A combination of vitamin E, selenium, and lycopene has been shown to dramatically inhibit prostate cancer development and to increase disease-free survival. Lycopene has also been shown to suppress the growth of lung cancer cells, according to this study

In this review, the authors highlight the remarkable ability of phytochemicals to decrease the replicative capacity of Cancer Stem Cells…These phytochemicals have been thoroughly studied for at least three decades…these studies provide a huge body of knowledge, which can now be applied in the development of treatments against CSCs.

8. Artemisinin (Anti-Malaria drug) and Prostate cancer

This study says: Taken together, our results suggest that artemisinin is a very potent anti-cancer compound that exhibits unique effects on the cell cycle regulation of human prostate cancer cells. As such, artemisinin has the potential to be developed as a potent anti-prostate cancer therapeutic.

9. Phellinus linteus

Phellinus linteus is a well-known Oriental medicinal fungus with a variety of biological activities, including immunomodulatory or direct antitumor activities, according to this study. Its extracts demonstrated tumor regression in three independent case reports…

We encountered a case of advanced prostate cancer that became resistant to all kinds of hormonal and radiation therapy, but improved dramatically with oral intake of an extract from the mushroom, Phellinus linteus, say the authors of this study.

10. Anti-parasite drug, nitazoxanide (NTZ)

Source: Labiotech.eu
A widely used anti-parasite drug, nitazoxanide (NTZ), is able to break down a protein called beta-catenin, which is found at high levels in prostate and colon cancer cells and supports their growth and survival. This opens up the possibility of repurposing the drug for the treatment of these cancers.

This 2023 study concluded:
NTZ is a potential therapeutic agent for bone metastasis induced by the TGF-β/Ac-KLF5 signaling axis in prostate cancer and likely other cancers.

11. Propranolol

This medication is a beta blocker used to treat high blood pressure, irregular heartbeats, shaking (tremors), and other conditions

This study concluded…we observed reduced cancer-specific mortality among prostate cancer patients taking beta-blockers. However, we did not observe any effect of beta-blocker use on all-cause mortality in this meta-analysis. Taken together with studies in other cancer types and in preclinical models, our findings indicate a beneficial effect of beta-blockers on survival in patients with prostate cancer. Therefore, beta-blockers may be considered a promising therapeutic approach for adjuvant therapy in prostate cancer.

12. Papaya black seeds

Papaya is a soft tropical fruit with a yellowish-orange color. This species of fruit — which belongs to the Caricaceae family — is round and plump and comes in larger and smaller sizes.

Studies / Reviews
Carica papaya is an important and promising natural medicinal plant which could be utilized in several pharmaceutical and medical applications because of its effectiveness, availability and safety… Papaya promotes immune system. Papaya is potent cancer fighter that is highly effective against hormone related to cancer as well as other cancer. Papaya can stop the growth of cancer cell, halt metastasis and normalize cell cycle, says this Review

This study concluded:
The black seeds from papaya may have a potential to reduce growth of prostate cells; however, consumption of white seeds should be avoided as they may stimulate pre-existing prostate cancer.

13. Pfeifer Protocol for Prostate Cancer

Source: Pfeifer Protocol
Prostate Cancer Protocol Success

Clinical studies are showing this protocol successful in 65% of the patients that Dr. Pfeifer has used it on, even though it has largely been used with patients that have either failed conventional treatments or have been unable to tolerate them. This phytotherapy treatment program has none of the harsh side effects experienced using standard therapies for this disease. The successful results of his trial have been published in the January 2005 edition of Oncology, a Swiss medical journal (www.tellmed.ch). He now lectures around the world educating cancer specialists about his protocol.

This protocol has been reported to produce 50% reduction of PSA by 6 months in up to 70% of such patients treated in Switzerland with minimal side effects (Pfeifer and Aeikens Positive Health 2006, 120:19-25/ www.positivehealth.com).

Continue reading about this treatment at Pfeifer Protocol

14. MSKE (Muscadine grape skin extract)

A nutritional supplement containing an extract of the skin of muscadine grape (Vitis rotundifolia), with anti-inflammatory, antioxidant and potential chemopreventive activities. The skin extract of the muscadine grape contains numerous phytochemicals … muscadine grape skin extract (MSKE) appears to inhibit PI3K/Akt and MAPK signaling, eventually leading to apoptosis and a reduction in tumor cell proliferation – National Cancer Institute

This study says:
Here we provide the first evidence that dietary agents, namely, epigallocatechin gallate, resveratrol, or a mixture of polyphenols from green tea (polyphenon E) or grapevine extract (vineatrol), impede prostate cancer cell growth in vitro and in vivo…

This study says:
In summary, MSKE treatment significantly inhibited the growth of metastatic prostate tumor cells in vitro [in a lab]and in vivo [in a living organism] by inducing cell-cycle arrest through the targeting of Hsp40 which is involved in cell-cycle progression and cell migration. Furthermore, we demonstrated that MSKE was safe at high concentrations and had a beneficial effect on metastatic prostate cancer. The safety of MSKE was confirmed by a Phase I clinical trial…
See more on MSKE page

Study: Sipuleucel-T, an autologous active cellular immunotherapy, has shown evidence of efficacy in reducing the risk of death among men with metastatic castration-resistant prostate cancer.

In this double-blind, placebo-controlled, multicenter phase 3 trial, we randomly assigned 512 patients in a 2:1 ratio to receive either sipuleucel-T (341 patients) or placebo (171 patients) administered intravenously every 2 weeks, for a total of three infusions. The primary end point was overall survival…
Results: In the sipuleucel-T group, there was a relative reduction of 22% in the risk of death as compared with the placebo group… This reduction represented a 4.1-month improvement in median survival (25.8 months in the sipuleucel-T group vs. 21.7 months in the placebo group). The 36-month survival probability was 31.7% in the sipuleucel-T group versus 23.0% in the placebo group.
Conclusion: The use of sipuleucel-T prolonged overall survival among men with metastatic castration-resistant prostate cancer.

15. Flaxseed plus low fat diet

This study found that prostate cancer patients on a flaxseed and low fat diet for 30 days before surgery had significantly lower proliferation rates than other patients who were not on the protocol.

16. Plant-based Diet

In 2005, Dr. Dean Ornish MD conducted an interventional study with 93 patients PROVING that you can reverse the progression of early stage prostate cancer with a plant-based diet, exercise, and stress reduction.

Metformin and Statins

Study Individual and joint effects of metformin and statins on mortality among patients with high-risk prostate cancer

Based on 12 700 patients with high-risk PCa [prostate cancer] , statin alone or in combination with metformin was significantly associated with reduced all-cause mortality … and PCa mortality…. The effects were more pronounced in post-diagnostic users: combination use of metformin/statins was associated with a 32% reduction in all-cause mortality, and 54% reduction in PCa mortality.

Some things worth considering:

1. Watchful Waiting or Active Surveillance/Active Monitoring

Source: National Cancer Institute
The general concept of watchful waiting is patient follow-up with the application of palliative care as needed to alleviate symptoms of tumor progression. There is no planned attempt at curative therapy at any point in follow-up.

In contrast, the strategy behind active surveillance/active monitoring is to defer therapy for clinically localized disease but regularly follow the patient and initiate local therapy with curative intent if there are any signs of local tumor progression. The intention is to avoid the morbidity of therapy in men who have indolent or nonprogressive disease but preserve the ability to cure them should the tumor progress. Active surveillance/active monitoring often involves the following:

Regular patient visits.
Digital rectal examinations.
Prostate-specific antigen (PSA) testing.
Transrectal ultrasound (in some series).
Transrectal needle biopsies (in some series).

Active monitoring as effective as surgery and radiotherapy.

Source: Oxford University
Active monitoring is as effective as surgery and radiotherapy, in terms of survival at 10 years, reports the largest study of its kind, funded by the National Institute for Health Research (NIHR).

Results published in New England Journal of Medicine show that all three treatments result in similar, and very low, rates of death from prostate cancer. Surgery and radiotherapy reduce the risk of cancer progression over time compared with active monitoring, but cause more unpleasant side-effects.

The ProtecT trial, led by researchers at the Universities of Oxford and Bristol in nine UK centres, is the first trial to evaluate the effectiveness, cost-effectiveness and acceptability of three major treatment options: active monitoring, surgery (radical prostatectomy) and radiotherapy for men with localised prostate cancer.

Chief investigator Professor Freddie Hamdy from the University of Oxford, said: ‘What we have learnt from this study so far is that prostate cancer detected by PSA blood test grows very slowly, and very few men die of it when followed up over a period of 10 years, – around 1% – irrespective of the treatment assigned. This is considerably lower than anticipated when we started the study.
Continue reading at Oxford University website

Here is a companion article published in the same journal.

Radical Prostatectomy or Watchful Waiting in Prostate Cancer — 29-Year Follow-up

This study says: In clinically detected prostate cancer, the benefit of radical prostatectomy in otherwise healthy men can be substantial, with a mean gain of almost 3 years of life after 23 years of follow-up. The remaining expected lifetime is important in decision making, with the reservation that it is hard to predict.

After 29 years of follow-up, at a time when 80% of all the participants had died, lower overall mortality, lower mortality due to prostate cancer, and a lower risk of metastasis prevailed in the radical-prostatectomy group.

Conclusions
Men with clinically detected, localized prostate cancer and a long life expectancy benefited from radical prostatectomy, with a mean of 2.9 years of life gained. A high Gleason score and the presence of extracapsular extension in the radical prostatectomy specimens were highly predictive of death from prostate cancer.

This 2017 study says:

The Prostate Cancer Intervention Versus Observation Trial (PIVOT) randomised 731 men from the early PSA era to RPX or observation. After a 10-year median follow-up, surgery did not reduce disease-specific mortality. There was also no significant reduction for all-cause mortality. Absolute differences were <3 percentage points for PCA and all-cause mortality. However, there was some evidence suggesting a subgroup effect favouring surgery in men with a PSA >10 ng/mL or intermediate risk disease…

Early intervention, including active surveillance, should focus on men with higher risk disease, a life expectancy of 15 years or more and who have a clear preference for early intervention. In patients with shorter life expectancy or with lower risk disease, clinicians should recommend observation or PSA-based monitoring with transition to curative treatment based on higher thresholds than used in ProtecT.4 In summary, ProtecT results add to our confidence that we improve our patients’ health by resisting the urge to ‘curatively treat’ all men with PSA detected localised PCA.