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Some Considerations for Supportive Care Involved in Radical Prostatectomy, Radiation Therapy, Cryosurgery, and Watchful Waiting
Suggestions that can be discussed with your physician(s) to prevent adverse effects of any of the major therapies for PC (note that ADT and its supportive care were discussed in earlier sections).
PC-Related Complication Strategy for Resolution of Adverse Effects
Radical Prostatectomy
Need for blood transfusions Pre- or perioperative use of Procrit1 or Aranesp1 and iron (only if biochemically indicated)
Incontinence Kegel exercises (National Association for Continence at www.nafc.org); penile clamp, artificial urinary sphincter, urinary sling procedure
Impotence Use of Viagra1, Muse1, combination therapy, injections of PGE1, visual aids
Penile atrophy Viagra1 and other similar new agents; PGE1
Anastomotic stricture Avoidance of surgery if history of exuberant scar formation (keloids); use of Pentoxifyllene1 and vitamin E3
Radiation Therapy (Any Kind)
Urinary obstructive symptoms Pre-RT use of ADT to reduce gland volume plus use of Cardura1 or Hytrin1; for post-RT problems, use of Hytrin1 or Cardura1 and, if severe, supra-pubic tube; possibly transurethral laser surgery if scar tissue
Radiation injury to rectum (proctitis) Rowasa1 suppositories, SOD3 (Orgotein1 or superoxide dismutase3), vitamin E3, Pentoxifyllene1, Sears' Omega Rx Zone approach3
Radiation injury to bladder (cystitis) Rowasa1 suppositories, SOD 3 (Orgotein1 or superoxide dismutase3), vitamin E3, Pentoxifyllene1, Sears' Omega Rx Zone approach3; avoid spicy foods, alcohol, coffee; use of Prelief 3; trial of Elmiron1
Impotence Use of Viagra1, Muse1, combination therapy, injections of PGE1, visual aids
Incontinence Kegel exercises (National Association for Continence at www.nafc.org ); penile clamp
Cryosurgery
Urinary obstructive symptoms ADT prior to cryosurgery to reduce gland volume; post-cryosurgery use of supra-pubic tube; Cardura1, Hytrin1
Incontinence Kegel exercises (National Association for Continence at www.nafc.org ); penile clamp, supra-pubic tube
Impotence Use of Viagra1, Muse1, combination therapy, injections of PGE1, visual aids
Watchful Waiting (Objectified Ongoing Observations)
Progressive disease that is clinically out of control Interval testing and physical examination (DRE); graphing trends in PSA dynamics (velocity, doubling time); Sears' Omega Rx Zone approach3; modified citrus pectin3, dietary supplements3
1Doctors prescription is required to obtain medication
3Available from health food suppliers, e.g., Life Extension Foundation.
11. BOOSTING MORALE OF THE TROOPS: FOSTERING A WILL TO LIVE, EMPOWERING THE PATIent
The previous 10 sections have presented strategic issues that need to be addressed in our battle with prostate cancer. And, make no mistake, it is a battle--but one that can be won. There is much to be gained, by many people in viewing this medical confrontation using a military metaphor. Such tactical thinking undoubtedly plays a pivotal role in achieving an optimal outcome for any life-endangering encounters.
However, all the good science and all the outstanding medicine in the world will not achieve its true goal of healing without the presence of spirit. This may not seem relevant to the man feeling the immediate threat of prostate cancer because of its philosophical orientation. But, I assure you, over the course of your journey, at some important crossroad in your life, it will be seen as the take-home lesson for all that has been written here. Your spirit, your will to live fully, is the crust of the holistic pie of life. Without this esprit, it is unlikely that you would have accepted the challenge of reading this chapter.
Out of the night that covers me, black as the Pit from pole to pole,
I thank whatever gods may be for my unconquerable soul.
- from Invictus by William Ernest Henley
The basis for any victory must therefore involve morale--a state of spirit of a person or group as exhibited by confidence, cheerfulness, discipline, and willingness to perform assigned tasks. Morale, as defined in this fashion, and in the context of a war against prostate cancer, is embodied in acts reflecting empowerment of the patient and his partner.
Empowerment in this context becomes a process by which people assert control over factors that affect their health. This comes as a result of sharing resources and collaboration, which in turn lead to a more complete understanding of all aspects of a health issue.308 My perspective developed through thousands of patient encounters each year with prostate cancer is that the empowered patient is better able to decide on treatments, and better able to choose physicians to guide him on his medical journey. The empowered patient is less anxious and more secure about his clinical course.309 Empowerment, by its very nature, links people with resources.310
The empowered patient will explore options, look for new trials, participate in adjunctive or complementary therapies to enhance treatment outcomes, and be interactive in support groups. The empowered patient will take a politically active stance to increase funding, research, and awareness of the disease. The empowered patient is the purveyor of his medical records. The empowered patient views the physician as co-navigator, companion, and friend on his medical journey. An empowered patient expects bidirectional communication with his medical team to be the rule and not the exception.
In the process of opening channels of learning to the patient, we foster his empowerment and that of his partner, and that in turn encourages further learning. This extension of the physician as educator to the patient at a time of need is a manifestation of love. From this love comes wisdom in many walks of life.
How do you choose to learn love?
How do you choose to learn authentic empowerment--
through doubt and fear, or through wisdom?
- Gary Zukav
Those of you with prostate cancer are focused on your lives--your life is in jeopardy and what you took for granted before is no longer guaranteed to be there in the years to come. But
Out of crisis comes opportunity.
- Old Chinese saying
or
A smooth sea never made a skilled mariner.
- English proverb
During this crisis of prostate cancer, you will be provided multiple opportunities to overcome many obstacles. This is part of the lesson of life, of living, and of evolving. Remember that there are many out there without prostate cancer who will live their lives, day after day, without the appreciation to see the beauty of a tree or a sunrise; to say I love you; to smell the flowers; to marvel at the innocence of children; and to appreciate the uniqueness of your humanity. But this journey you are on should not be just an appreciation of life at a time of crisis, which is conveniently forgotten once the crisis is over. There are lessons here, crucial to your well-being and to that of your family, friends, community, and to all life forms.
Life is the ultimate prize and it takes on ultimate value
when suddenly we discover how tentative and fragile it can be.
The essential art of living is to recognize and savor its preciousness when it is free of imminent threat or jeopardy.
- Norman Cousins
Louis Armstrong said: "It's a wonderful world." The creation is wonder-full. We are part of that creation. We are also the caretakers of this wonderful world. Prostate cancer should change your life; it should make you aware of this creation--not just the natural wonders, but the wonder of you and your fellow humankind--all are linked together in a system longing for balance and communication. This is the essence of health for all biological systems. This is the heart of all that has been discussed in this chapter and throughout this book.
Our humanity lies in our human unity.
- Strum
This statement is not a political one. It is a sociobiological expression of what should be the underlying theme of virtually all life forms. On a biological level we are multicelled organisms that seek to achieve and maintain high levels of communication to remain in balance. It is a restatement of yin and yang. On every level of existence, from that of cellular interactions to the complexity of the individual human being to societies and governments, the call is the same: communication and balance. Without this, our health declines. Without this, our world dies.
My vision is for an empowered patient, who now enters the new millennium with an ability to use technological enhancements that provide the patient/physician team with far-reaching insights into the natural history and treatment of disease. At the same time, this empowerment embraces human unity--humanity--a realization that we are all in this together. The empowered patient shares his newfound understanding with others. He leaves the world of "I" and enters the world of "we."
The objective of this chapter on prostate cancer has been to provide specific and critical data that are an integral part of the comprehensive care of a patient with prostate cancer. The use of military metaphor has not been used simply as a literary tool, but more as a unique perspective--a different way of looking at things--that may yield new approaches in thinking about what tactics we could employ in our war against cancer. What may surprise the reader is the enormity of published information that is not routinely incorporated into the prevention and active treatment of prostate cancer. Much of this involves an understanding of what encourages tumor growth and what enhances its rate of growth and its ability to metastasize. The reader is encouraged not to look for a paragraph or two that summarizes all of what has been presented here; this is not realistic. Instead, read one section at a time and ask yourself: "Is this applicable to my situation?" If so, then take this information to your physician(s) and provide him with the appropriate references. Providing information in this manner improves your situation and that of all patients under the care of such physicians.
The first part of this chapter dealt with prevention. This is of importance not only to family members (and others) concerned about contracting prostate cancer, but also to patients seeking to slow disease progression and enhance the odds of a successful long-term outcome. As was discussed, many of the lifestyle changes that reduce prostate cancer risk also interfere with existing cancer cell proliferation.
Understanding the biological principles of the disease is crucial to understanding why such meticulous attention should be paid to keeping an accurate medical record of all test results, lifestyle changes and therapeutic interventions. The medical record provides a basis for determining the status of the disease and what therapeutic modalities should be considered if adequate control of the disease has not been achieved.
By precisely assessing all of the measurable individual risk factors, a prostate cancer patient can better decide on the treatment options that offer the greatest opportunity for long-term control or cure, while minimizing potential side effects.
The knowledge base of how prostate cancer cells propagate and what can be done to interfere with these processes is colossal. This is good news for a prostate cancer patient who seeks a comprehensive scientific approach to eradicating his disease. Contrast this with a pancreatic cancer patient, who has little hope of survival beyond 12 months.
Prostate cancer can easily be diagnosed at an early curable stage. Recurrence of existing disease can also be readily monitored. This is different from other cancers, in which a patient often waits for a dreaded physical symptom before learning the cancer has occurred or recurred. The bottom line is that a prostate cancer patient can exert a tremendous amount of control over his disease. What has been written here provides a systematic guide to taking advantage of the many technologies available today.
The Life Extension Foundation has identified an extensive array of integrated prostate cancer therapies based on published scientific findings and the clinical experience of practicing oncologists. While this protocol provides information in a practical format, the cooperation of the attending physician is crucial.
WHERE TO GO FROM HERE
Nutritional Aspects
While this chapter on prostate cancer provides an abundant quantity of life-saving guidance, many patients will need additional information to address their particular type and stage of disease. A special website has been established (www.lefprostate.org) to provide comprehensive updates, along with information specific to different stages and treatment options. The following reports were posted on this website as of the writing of this protocol:
a)Prostate Cancer: Early-Stage
b)Prostate Cancer: Late-Stage
c)Prostate Cancer: Chemotherapy
d)Prostate Cancer: Adjuvant Therapy
e)Prostate Cancer: PSA Parameters and Heredity
f)Prostate Enlargement: Benign Prostate Hypertrophy
For specific information about implementing some of the adjuvant drug therapies discussed in this chapter, refer to the Cancer Treatment: The Critical Factors protocol in this book. Please remember that everything that is read should be done so with the conscious thought of how this could apply to the current situation.
Those who have prostate cancer are urged to log on to www.lefprostate.org to read in-depth discussions that pertain to their stage of the disease and the different therapeutic modalities to consider.
Nutritional Aspects of Prostate Cancer
Vitamins, minerals, and supplements that prevent PC or decrease mortality
Selenium and vitamin E
• Genistein
• Vitamin D
• Minerals
• Green tea
Lycopenes
• Caloric restriction and reduction of carbohydrate intake
The eicosanoid pathway in relation to cancer promotion versus prevention
1. Early-Stage Prostate Cancer
Biology of prostate cancer
Staging
• PSA dynamics (PSA velocity and doubling time)
• Gleason score and the PSA leak
Clinical stage
• Risk assessment and algorithms
Ingredients for successful outcomes
1. Androgen Deprivation Therapy (ADT)
Biology of ADT and its rationale
• Combination ADT (ADT2 and ADT3)
• Biomarkers to assess ADT efficacy
• Side effects of ADT: the androgen deprivation syndrome (ADS)
• Late-Stage Prostate Cancer
Androgen-independent prostate cancer (AIPC)
• Androgen receptor mutation (ARM)
• Antiandrogen withdrawal (AAW)
• Effective therapies for AIPC
Ketoconazole
Estrogens (including PC SPES)
1. Chemotherapy for Prostate Cancer
Principles of chemotherapy
• Supportive care of the patient
Bone marrow support
Nausea and vomiting avoidance
• High-response chemotherapy regimens
Anthracyclines, for example, Adriamycin and Mitoxantrone
• Cytoxan
• Vinca agents, for example, Velban and Navelbine
• VePesid or VP-16 regimens
• Taxanes, for example, Taxotere and Taxol
• Carboplatin
5-Fluorouracil
Small cell prostate cancer
1. Hereditary Aspects of Prostate Cancer
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