My Nurse Practitioner referred me to a urologist after feeling what seemed to her a nodule during the annual DRE (Digital Rectal Examination). He confirmed it, biopsied my prostate in November and found 1 of the 12 cores to have a well-differentiated cancer that was 10% of the core. My previous PSAs were 0.50 in 2005, 0.50 in 2008, and now 0.73, so a possible doubling time of two years. He recommended either surgery or brachytherapy, saying that active surveillance was not appropriate given my relative youth.
Initially, I focused my attention on choosing between the two treatments offered, and found myself leaning towards brachytherapy. The urologist, whom I have found excellent in terms of his ability to communicate and his command of the research to date, had strongly suggested that my wife and I visit him for a consult, and we discussed with him the comparable survival rates and side-effects, postponing a decision for a few months. Further web searching revealed to me an increasing use of active surveillance for younger men meeting certain criteria. I took this research to my urologist and an oncologist, both of whom supported me in monitoring the cancer. I will have a repeat PSA in April and a biopsy mid-2010. The main concern that I brought to them was that active surveillance would not endanger me by allowing the cancer to extend beyond the prostate between tests; I was assured this is almost completely unlikely and that monitoring the situation is both safe and reasonable, given my particular case.
Meanwhile, I have visited two complementary medical practitioners. One, a highly respected acupuncturist, was for me the opposite of what I wanted: she promised miracles, with no evidence and she denigrated conventional treatments. The second, a "naturopathic doctor," is someone I will work with on diet, supplements, and tests. While my diet and lifestyle have little room for improvement, as I have long adhered to virtually all of the usual dietary and lifestyle advice, he has ordered a number of blood tests and has already started me on a few minor changes to my diet and supplements. My attitude is that each year without treatment will be a year without the possible side-effects of treatment; also, with each year, increased knowledge and improvements in treatment will be available to me; lastly, I may have a cancer that is so indolent that I never need treatment.
Emotionally, the first month was quite intense for my wife and me, as we got a crash course in what cancer is, how it is treated, etc. While my urologist did not say an immediate treatment decision was necessary, he also had originally expressed his opinion that I should pursue treatment within 4-5 months, so this added some urgency to our consideration of the topic. The overall effect has been to increase the closeness of an already close marriage. I chose certain people to talk to during that month, and intentionally have not shared it with others, and these friends and family members have been very supportive.
Some books and web information has been tremendously helpful, others I consider pretty poor or even harmful. I have kept a list of these things for anyone interested.
At four months my PSA declined from 0.73 to 0.5, at eight months it went down to 0.48. If those levels seem ridiculously low for a diagnosis of prostate cancer, remember that it is not the absolute value but the trend up (or now down) that matters. My biopsy was based not on PSA but a DRE that revealed a nodule. My urologist considers the decline in PSA significant (regardless of all the questions about the PSA test) and will have me return in 4 months.
I am very fortunate to have found an excellent Naturopathic Doctor. He is trained in medicine, can analyze all of my blood tests, but is also able to spend ample time with me on diet and lifestyle. I am not going to spell out my entire treatment plan simply because it is specific to me and my entire health situation (not just prostate cancer but asthma, and various numbers on other tests that my N.D. felt were either too low or too high). For the prostate cancer, he confirmed my existing diet of low saturated fat, high vegetable intake, no dairy, no red meat, and lots of nuts (including specifically brazil nuts for selenium), and had me increase intake of lycopene (cooked tomato products) and pomegranate juice. Detoxing was, and continues to be, a big part of his program, through diet, a supplement, and sweating (sauna or exercise). Relaxation and spiritual practice also. Also an awareness of exposure to carcinogens in plastics and other toxics. Over the past eight months he has requested various blood tests, common enough ones that my medical doctor has routinely OK'd them. I am also pleased that he has recommended very few supplements, and those he has are almost all the simple vitamins and not expensive.
My PSA increased slightly in tests in November and February, and it was my urologist rather than my naturopathic doctor who suggested I might wish to stop all animal products other than fish, which I have done.
For the most part, I have adjusted well, giving special attention to getting good protein and fats to keep my energy up (I am very light-weight and also get a lot of exercise). In April I had my first biopsy since the original diagnosis of PC and my urologist was delighted to report to me that the pathology report now says only a "few atypical glands suspicious for a microfocus of adenocarcinoma" -- a result that 18 months prior would not have prompted him to suggest treatment. Of course a biopsy is hardly 100% accurate; however, in taking the samples my doctor did focus on exactly the area that previously showed cancerous cells. So, he told me to "keep doing what you're doing and see you in six months."
Whether this apparent "backing off" of the cancer is a result of my naturopathic program is impossible to say, as I am simply a sample of one. [Spontaneous regression is noted in all tumours, including prostate cancer. There was a discussion on the YANA Forum in December 2009 that may be of interest, and a Video by Dr. Snuffy Myers on the subject.] My program corresponds to the sort of information put out by the University of California, San Francisco (for instance Nutrition & Prostate Cancer so there is definitely a growing body of evidence for many of the dietary aspects of my treatment plan.
I am fully prepared to learn that it comes back at some point, and I will simply continue to do what I can to monitor it while staying safe from any dangerous development. I am happy to email or talk with anyone who reads this and wants more information. My N.D. (naturopathic doctor) is in Santa Cruz, California (and one week each month in the Los Angeles area).
A year later, my PSA is stable and my DRE continues to exhibit a very slight nodule. I have continued on the diet and protocol listed above. I now get the PSA test every six months, and my urologist will only suggest a repeat biopsy if changes in either the PSA or DRE cause him concern. I feel very fortunate to have avoided treatment and to think that getting the diagnosis has led to a number of changes in my diet that may serve me more generally.
At the same time I have been recently reminded that not all PC stories are like mine -- while telling an acquaintance of my experience, and while putting it in the context of recent changes to screening policy in the U.S., he informed me that his brother died last year at 61 from an aggressive form of PC. Another friend had a minor PC diagnosis (like mine) but such serious symptoms of BPH (urgency to pee but inability to pee at the same time) that surgery seemed the only option (and he has ongoing side-effects in both continence and sexual function).
A year later, I continue in excellent health with no evidence of any increase in cancerous cells. I note that active surveillance for younger men, a somewhat controversial thing when I was diagnosed, is now much more widely supported. I note the ongoing controversies about the PSA test but my feeling is that until we have a better test, I will continue to get periodic PSAs, knowing that results can be misleading. But as my case shows, sometimes the DRE rather than the PSA is what tips off a a doctor, and in my case it was a very thorough and well-trained nurse practitioner.
I will mention one development, which is that almost a year ago I went to my primary care doctor regarding an overall feeling of tiredness and lack of vitality. Among the many tests he ran was one for testosterone, however with the warning that even if I tested low, with a history of PC there would be nothing to do about it. I did test low and, just to be sure, talked to my urologist about it. To my surprise, he cited studies that parsed out certain versions of PC where testosterone replacement therapy (TRT) would definitely be contra-indicated but other situations where there was no longer any argument against it. He told me that the thinking about PC and testosterone has changed a great deal since the early days (when castration was a treatment for PC!). So, for my situation, TRT was something he could support. Although it has not given me the energy or libido of a young man, it has definitely returned motivation and enthusiasm to my life. It is a gel that I apply to my arms each morning. A word of caution: TRT is not recommended for some PC individuals, so you'd need to work closely with a knowledgable urologist about this. Also, a comprehensive testosterone blood test is more useful than just the total testosterone test -- ask for the test for "testosterone, free and total, bioavailable, SHBG" -- your doctor will know if some of those are unnecessary in your case.
Active Surveillance continues to be working for me almost five years after some cancerous cells were first found. My PSA continues to be extremely low, but any significant increase would still be a red flag and call for a repeat biopsy. As it is, I am choosing to forgo the "standard of care" two-year biopsy. I continue to exercise (high intensity interval training) and to eat vegan plus fish. Testosterone gel continues to be helpful for stamina and overall energy and seems to have no negative effect in regard to PC. I remain very glad that I rejected my doctor's initial advice to have either surgery or radiation, which five years ago was not well-accepted for someone in their late fifties. Now, urologists are much more likely to offer active surveillance for younger men, when the stage/Gleason is appropriate.
Five years after my "diagnosis" (which nowadays might not even qualify as a cancer diagnosis) my "treatment" consists only of an annual PSA and DRE, which is what I would normally have at this age. I follow a cancer-fighting diet, generally vegan+fish and take a variety of supplements and foods suggested by research. I do high-intensity interval training 3x a week and attempt to get adequate sleep every night.
The only thing I will add is that my urologist suggested an MRI of the prostate and I went ahead. This was a "non-tracking" MRI, i.e. nothing to ingest and therefore not as difficult an experience. He suggested it so that if either my PSA or DRE in future causes concern, a repeat MRI could be compared to this one and I might well have no need for a biopsy (needless to say no one likes those, and I had two of them).
Seven years since diagnosis and I remain very glad that I refused the advice given me to have either surgery or brachytherapy. By now, it is not uncommon for a 58-year-old with a Gleason 6 diagnosis to choose active surveillance, but seven years ago my doctor didn't even suggest it but fortunately supported me when I showed him the results of my web research. At this point my always-low PSA remains the same and if the doctor feels almost nothing amiss with the DRE. I continue to follow a vigorous high-intensity exercise routine, eat vegan plus fish, and follow other dietary recommendations and supplement recommendations that have some scientific basic for preventing PC.
Paul's e-mail address is: machlis AT gmail.com (replace "AT" with "@")