Tables constructed based on results of the PSA, clinical stage, and Gleason score and associating those values with the findings at radical prostatectomy. Data involving thousands of men with PC used to predict the probability that the prostate cancer has penetrated the capsule, spread to the seminal vesicles or lymph nodes, or has remained confined to the prostate. The tables were developed by a group of scientists at the Brady Institute for Urology at Johns Hopkins Medical Center.
PATHOLOGICAL STAGE:
The extent of disease as determined by a pathologist's microscopic analysis of tissue removed at the time of surgery.
PERIPROSTATIC: Pertaining to the soft tissues immediately adjacent to the prostate gland.
PLOIDY: DNA analysis to establish whether normal or abnormal numbers of pairs of chromosomes are present in a cell.
PROCTITIS:
Inflammation of the rectum; may be an adverse effect of radiation therapy used to treat prostate cancer.
PROSCAR: Brand name of finasteride, a 5-alpha-reductase inhibitor that blocks the conversion of testosterone to DHT.
PROSTAGLANDIN:
An eicosanoid isolated from the prostate gland that acts locally, metabolizes rapidly, and has a hormone-like effect, stimulating target cells into action.
PROSTAGLANDIN E2 (PGE2):
A major metabolite of arachidonic acid, known to stimulate vascular endothelial growth factor (VEGF) and hence, angiogenesis.
PROSTASCINT:
A monoclonal antibody (mAb) tagged with a radioactive isotope that is used to detect prostate cancer, particularly within lymph nodes. The ProstaScint mAb is directed against the prostate-specific membrane antigen (PSMA). PSMA is associated with androgen-independent PC. A few centers are using the ProstaScint scan to identify PC in the prostate gland.
PROSTATE:
The gland surrounding the urethra and immediately below the bladder in males.
PROSTATE CANCER:
Adenocarcinoma of the prostate gland.
PROSTATECTOMY:
Surgical removal of part or all of the prostate gland. If the entire gland is removed, a radical prostatectomy has been performed. Transurethal resection of the prostate (TURP), performed to improve urinary difficulties, is an example of removal of part of the gland.
PROSTATE-SPECIFIC ANTIGEN (PSA):
A protein secreted by the normal epithelial cells of the prostate gland as well as by prostate cancer cells if they are present. Elevated PSA levels in the blood can be due to benign or malignant causes. After diagnosis of prostate cancer, this biomarker is typically used to monitor disease progression and/or response to therapy.
PROSTATIC ACID PHOSPHATASE (PAP):
An enzyme or biomarker secreted by prostate cells that is associated with a higher probability of disease outside the prostate when pretreatment levels are 3.0 or higher. PAP elevations connote that the disease is not organ-confined disease.
PROSTATIC INTRAEPITHELIAL NEOPLASIA (PIN):
A pathologically identifiable condition believed to be a possible precursor of prostate cancer; broken down into high-grade PIN or PIN 2 and PIN 3 versus low grade PIN or PIN 1. High grade PIN is associated with having PC.
PROSTATITIS:
Infection or inflammation of the prostate gland that can be treated with medication and/or prostate massage.
PSA ASSAY:
The means by which a blood sample is analyzed to determine its PSA content. Various assays can result in different in readings from the same sample; therefore, it is wise to use the same assay for each subsequent PSA test. Very sensitive assays that measure PSA down to two or three decimal points are called hypersensitive or ultrasensitive PSA assays. These assays play a major role in early detection of relapse after radical prostatectomy or in the assessment of the tumor cell population in response to ADT.
PSA DENSITY (PSAD):
The amount of PSA (expressed in nanograms) for each cubic centimeter of prostate volume; the serum PSA value divided by an accurate gland volume determination.
PSA DOUBLING TIME:
The length of time in months that it takes for the PSA to double in amount.
PSA LEAK:
The secretion of PSA from the cells into the blood. Low levels of serum PSA are often associated with higher Gleason scores, as an expression of less PSA leak because more aggressive prostate cancers lose the ability to secrete PSA. Thus, PSA is an unreliable marker of disease progression in high Gleason score prostate cancer, e.g., Gleason scores 8-10.
PSA RECURRENCE (PSAR):
Elevated PSA following treatment of prostate cancer, signaling that cancer cells are still present and that monitoring for disease progression is indicated.
PSA RELAPSE-FREE SURVIVAL:
Survival of the patient that relates to no evidence of a progressively rising PSA.
PSA TREND:
The slope that a series of PSA readings over time would exhibit on a graph.
PSA VELOCITY:
A statement of how fast the PSA is accelerating; the rate of change in PSA calculated per year of time.
PYRILINKS-D (Dpd):
Deoxypyridinoline, or Dpd, is a laboratory test to monitor the biologic endpoint of bone resorption activity obtained by analysis of the second-voided urine of the day.
QCT SCAN:
Quantitative CT bone densitometry; a superior way to evaluate bone density compared to the DEXA scan because it is uninfluenced by unrelated conditions such as arthritic changes and/or vascular calcifications. (Telephone numbers that may be helpful in finding QCT sites near you: Mindways, (877) 646-3929 ( www.qct.com ), or Image Analysis, (800) 548-4849 ( www.image-analysis.com ).)
RADIATION THERAPY (RT):
The use of X-rays and other forms of radiation to destroy malignant cells and tissue.
RADICAL PROSTATECTOMY (RP):
Surgical removal of the entire prostate gland and seminal vesicles.
RECEPTOR:
A docking site on the cell membrane in the cell cytoplasm or in the nucleus that interacts with a ligand. All cells have multiple receptors.
RECURRENCE:
The reappearance of disease manifested by clinically based findings, either upon physical examination or by the results of laboratory findings such as a rising PSA.
RESORPTION:
Loss of bone caused by an imbalance in the dynamics of bone formation by osteoblasts or bone loss due to breakdown of the bone by osteoclasts.
RISK ASSESSMENT:
An analysis of probabilities related to a specific patient's case, obtained by analyzing medical variables of known significance and used to derive an overall impression of how different disease management options would impact an optimal or suboptimal outcome for the patient.
SCREENING:
Evaluation of populations of people who have no symptoms of the disease for which they are being evaluated in an effort to diagnose disease in its early stages.
SEED IMPLANTATION (SI):
A treatment for prostate cancer in which radioactive seeds encased in titanium shells are permanently implanted into the prostate gland.
SELENOMETHIONINE:
A substance that shows an inhibitory effect on certain prostate cancer cell lines that appear to be independent of androgen receptor or PSA pathways.
SEMINAL VESICLES:
Glandular structures located above and behind the prostate that secrete and store seminal fluid. Seminal fluid is one component of ejaculate.
STAGE:
See CLINICAL STAGE, PATHOLOGICAL STAGE.
SYSTEMIC:
Throughout the whole body; in prostate cancer, cancer that is no longer organ-confined.
TESTOSTERONE (T):
The male hormone or androgen that comprises most of the androgens in a man's body. Chiefly produced by the testicles, testosterone is essential to virtually every male function from the brain to toenails.
THERAPEUTIC INDEX (TI):
Treatment benefit divided by treatment side effects.
THERMOCOUPLES:
In relation to prostate cancer, devices used during cryosurgery to monitor the temperature achieved by cryoprobes, thus helping to improve the therapeutic index of the procedure.
TRANSFORMING GROWTH FACTOR BETA-1 (TGF-b1):
A growth factor produced by prostate cells, as well as by cells of the bone matrix. Elevated plasma levels of TGF-b1 obtained at baseline are associated with distant disease involving bone and/or lymph nodes.
TRANSRECTAL:
Through the rectum (as in transrectal ultrasound of the prostate).
TRANSRECTAL ULTRASOUND OF THE PROSTATE (TRUSP OR TRUS):
A method that uses the echoes of ultrasound waves to image the prostate by inserting an ultrasound probe into the rectum.
TRANSURETHRAL:
Through the urethra. See Transurethral Resection of the Prostate.
TRANSURETHRAL RESECTION OF THE PROSTATE (TURP):
A surgical procedure to remove prostate tissue obstructing the urethra.
T SCORE:
A designation used in evaluation of bone mineral density that relates the patient's bone density to that found in a population of healthy women of approximately 30 years of age. The T score is in contrast to the Z score, which relates the patient's bone density to a pooled population of an age similar to the patient. The T score is the desired test result. (No T score levels have been ascertained for men as of the end of 2002.)
TUMOR:
An excessive growth of cells caused by uncontrolled and disorderly cell replacement that can be either benign or malignant.
TUMOR VOLUME:
The amount of tumor measured in cubic centimeters.
ULTRASENSITIVE PSA ASSAY:
PSA assays that are able to measure very small amounts of PSA in the blood sample, reliable to the hundredth or even the thousandth of a nanogram per milliliter of blood. Tosoh and DPC Immulite Third Generation assays are examples of ultrasensitive PSA assays.
UPREGULATING (UPREGULATION):
Turning on or increasing a mechanism of action at the biochemical level in the body.
UROKINASE-TYPE PLASMINOGEN ACTIVATOR (uPA):
A substance believed to play a role in prostate cancer invasion and metastasis that is stimulated by IGF-1 and inhibited by GLA and EPA.
UROLOGIST:
A surgically trained physician who specializes in disorders of the genitourinary system.
VASCULAR ENDOTHELIAL GROWTH FACTOR (VEGF):
A substance known to stimulate blood vessel growth or angiogenesis and hence to stimulate PC growth.
VIADUR:
Brand name of an LHRH agonist that is implanted under the skin and releases medication over the course of one year.
VITAMIN E SUCCINATE:
Substance that inhibits the growth of prostate cancer cells of certain cell lines by suppressing androgen receptor expression and PSA expression.
WATCHFUL WAITING:
Objective ongoing observation and regular monitoring of a patient with prostate cancer without actual treatment or invasive therapies.
ZOLADEX:
Brand name of one of the LHRH-agonists.
Z SCORE:
A designation of bone mineral density that relates the patient's bone density to that of a pooled population of similar age. See T Score.
SUGGESTED READING
Those seeking additional information may order a copy of A Primer on Prostate Cancer, the Empowered Patient's Guide. The Primer reflects the synergistic efforts of Stephen B. Strum, a medical oncologist involved with PC since 1983, and Donna Pogliano, a partner of a PC warrior. The Primer is in full color with many graphic images, clinical vignettes, and a comprehensive appendix replete with material that is the essence of top-of-the-line health care as it relates to PC. The Primer is a working manual and companion tool to this protocol. The Primer is to be regarded as required reading for those serious at winning the war against PC. It is your basic field guide--but much more so. The Primer is available through Life Extension at (866) 820-7457 or on the Life Extension website at www.lefprostate.org. You may fax an order to the United States at (954) 761-9199. The Primer is also available through amazon.com, the Prostate Cancer Research Institute, Us Too!, the Educational Council for the Prostate Cancer Patient, Barnes & Noble, and Borders.
ADDITIONAL READING
Books About PC
Patrick Walsh, M.D., Janet Farrar Worthington.
Dr. Patrick Walsh's Guide to Surviving Prostate Cancer
Sheldon Marks, M.D.
Prostate & Cancer. A Family Guide to Diagnosis, Treatment & Survival
Medical Journals Focused on PC
Urology
Journal of Urology
Prostate
Prostate Cancer and Prostatic Diseases
PC Newsletters
Prostate Cancer Research Institute's PCRI Insights
Dr. Snuffy Myers's Prostate Forum
ECPCP's (Education Center for Prostate Cancer Patients) Prostate Exchange
PAACT's (Patient Advocates for Advanced Cancer Treatments) Cancer Communication
Internet Websites
PCRI (www.pcri.org)
Don Cooley (http://www.cooleyville.com/cancer/)
Robert Young (http://www.phoenix5.org)
PubMed (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi)
Internet-Based Tools (Software)
PC Tools I and II (www.pcri.org)
Kattan Nomograms (http://www.mskcc.org/mskcc/html/10088.cfm)
PRODUCT AVAILABILITY
High potency genistein extracts, lycopene, gamma-E tocopherol, curcumin, selenium, silymarin, Life Extension Booster, Mega EPA/GHA, Super GLA/DHA, Vitamin E Succinate (natural), Mega GLA, Super Max EPA, PectaSol, vitamin D3, TriBoron, Bone Up, Bone Assure, vitamin K, Calcium Citrate w/Vitamin D3 and other supplements discussed in this protocol can be ordered byLife Extension Products
STAYING INFORMED
The information published in these protocols is only as current as the day the book was sent to the printer. This protocol raises many issues that are subject to change as new data emerge. Furthermore, cancer is still a disease with unacceptably high mortality rates, and none of our suggested treatment regimens can guarantee a cure.
The Life Extension Foundation is constantly uncovering information to provide cancer patients with more ammunition to battle their disease. A special website has been established for the purpose of updating patients on new findings that directly pertain to the cancer protocols published in this book. Whenever Life Extension discovers information that points to a better way of treating cancer, it will be posted on the website www.lefcancer.org.
Before utilizing the cancer protocols in this book, we suggest that you log on to www.lefcancer.org to see if any substantive changes have been made to the therapeutic recommendations described in this protocol. Based on the sheer number of newly published findings, there may be significant alterations to the information you have just read.
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