Men with recurring prostate cancer not dying from prostate cancer

       Prostate cancer is the second most common cancer in men (second to skin cancer). It is well established that the death rate from prostate cancer is quite low:

  • Men in the U.S. have a 16% lifetime chance of being diagnosed with prostate cancer, but only a 3% chance of dying from it.[1]
  • The five-year and ten-year relative survival rates for prostate cancer are over 99% and 91%, respectively. [2]
  • The primary causes of death of men with prostate cancer are cardiovascular disease and other cancers.[3]

After treatment for prostate cancer (either radiation or prostatectomy), prostate-specific antigen (PSA) levels continue to be monitored. If PSA begins to increase, this is called “biochemical recurrence” (BCR) of prostate cancer.

Biochemical recurrence and mortality

A study in U.S. veterans attempted to figure out how biochemical recurrence affected risk of dying from prostate cancer. Six hundred twenty three men were followed for 15 years after being treated for prostate cancer. In this study, 37% of men who were treated with prostatectomy and 48% of men who were treated with radiation experienced BCR.

Overall, a total of 387 men had died within 15 years – 48 of these men died of prostate cancer, representing 12% of total deaths. For men who underwent prostatectomy and experienced BCR, the total rate of death within five years was 34%, and the rate of prostate cancer death was 3%. For radiation and BCR, death rate within five years was 35%, and prostate cancer death rate was 11%.[4, 5]

In short, the researchers came to the conclusion that the probability of dying from prostate cancer, even after biochemical recurrence, is relatively small. They mention that their findings are in agreement with the often quoted phrase “most men die with prostate cancer, not of it.”

Since BCR is defined as an increase in PSA following treatment, this data also suggests that PSA levels may not be an accurate predictor of risk after treatment. Further studies will likely examine this issue.

Routine PSA screening

Blood vials

Routine PSA screening is known by the scientific community not to be as accurate or valuable as the public is led to believe. About 70% of men with elevated PSA do not actually have cancer, and PSA screening is not thought by scientists to reduce prostate cancer-related deaths.[6-8] Richard J. Ablin, who originally discovered PSA in 1970, recently called PSA screening a “hugely expensive public health disaster” in a New York Times editorial. Dr. Ablin supports his assertion with these facts:

  • FDA approval of PSA tests occurred largely in response to a study that found that PSA screening was only able to detect 3.8% of cancers, and that blood PSA levels may be elevated due to a number of factors, such as drug use, infections, and benign prostatic hyperplasia (BPH).
  • The U.S. Preventive Services Task Force, the American College of Preventive Medicine, and the American Cancer Society do not recommend routine PSA screening. However, PSA screening is still routinely used.[1]

Men should not rely on PSA screening as a method of “early detection” to prevent prostate cancer. Rather they should avoid the cause of prostate cancer. Diets high in vegetables (especially cruciferous vegetables and tomato products) and fruit, and low in dairy products, meat, and processed foods, are known to be protective.[9-11] Living and eating healthfully protects against prostate cancer, as well as the other chronic diseases common to Americans (such as heart disease, strokes, and colon cancer) – the same diseases that kill most men with prostate cancer. For those who already have prostate cancer, a healthy, plant-based diet is effective at halting progression of the disease.[12-15]

 

References:

1. Ablin, R.J., The Great Prostate Mistake, in New York Times. 2010. p. 27.
2. American Cancer Society. What are the key statistics about prostate cancer? 06/30/2010 09/02/2010]; Available from: http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-key-statistics.
3. Ketchandji, M., et al., Cause of death in older men after the diagnosis of prostate cancer. J Am Geriatr Soc, 2009. 57(1): p. 24-30.
4. Uchio, E.M., et al., Impact of biochemical recurrence in prostate cancer among US veterans. Arch Intern Med, 2010. 170(15): p. 1390-5.
5. Harding, A. Even when prostate cancer returns, most survive. Reuters Health 08/25/10; Available from: http://www.reuters.com/article/idUSTRE67O4RR20100825?feedType=nl&feedName=ushealth1100.
6. Esserman, L., Y. Shieh, and I. Thompson, Rethinking Screening for Breast Cancer and Prostate Cancer. JAMA: The Journal of the American Medical Association, 2009. 302(15): p. 1685-1692.
7. Coldman, A.J., N. Phillips, and T.A. Pickles, Trends in prostate cancer incidence and mortality: an analysis of mortality change by screening intensity. CMAJ, 2003. 168(1): p. 31-5.
8. Andriole, G.L., et al., Mortality results from a randomized prostate-cancer screening trial. N Engl J Med, 2009. 360(13): p. 1310-9.
9. Steinbrecher, A., et al., Dietary glucosinolate intake and risk of prostate cancer in the EPIC-Heidelberg cohort study. Int J Cancer, 2009. 125(9): p. 2179-86.
10. van Breemen, R.B. and N. Pajkovic, Multitargeted therapy of cancer by lycopene. Cancer Lett, 2008. 269(2): p. 339-51.
11. Ma, R.W. and K. Chapman, A systematic review of the effect of diet in prostate cancer prevention and treatment. J Hum Nutr Diet, 2009. 22(3): p. 187-99; quiz 200-2.
12. Frattaroli, J., et al., Clinical events in prostate cancer lifestyle trial: results from two years of follow-up. Urology, 2008. 72(6): p. 1319-23.
13. Ornish, D., et al., Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention. Proc Natl Acad Sci U S A, 2008. 105(24): p. 8369-74.
14. Ornish, D., et al., Intensive lifestyle changes may affect the progression of prostate cancer. J Urol, 2005. 174(3): p. 1065-9; discussion 1069-70.
15. Fuhrman, J., Dr. Joel Fuhrman Case Study Series: Prostate Cancer.

 

 

 

 

 

 

Prostate Cancer Over-Diagnosed - Lots of Money to Be Made

People are getting unnecessary medicals test that cost a ton of money? No, you don’t say! A new study in the Journal of the National Cancer Institute reveals large-scale screening for prostate cancer using the prostate-specific antigen, or PSA, test has resulted in mass over-diagnosis and over-treatment:

The death rate from prostate cancer has fallen in the United States, but not necessarily because of mass screening, study co-author Dr. H. Gilbert Welch, a professor of medicine at the Dartmouth Medical School's Institute for Health Policy and Clinical Practice contended. "There are a number of reasons why mortality might fall, but the most obvious is that we have better treatment," he said. "Even without early detection, I expect mortality would fall."

Results of a European study reported earlier this year indicated that "to save the life of one man, 50 must be over-diagnosed," he said.

Guidelines for screening for blood levels of PSA -- a protein produced by the prostate gland -- differ widely. The American Cancer Society does not recommend PSA screening. But, the society says a PSA test can be offered to men, starting at age 50, during a discussion with their physician. That discussion should also include an explanation of the potential benefits and limitations of such screening.

It all comes down to money! I asked Dr. Fuhrman about it and he said, “It’s true. Prostate cancer screening in general is flawed, but it is big business and the business of medicine trumps science because of the money to be made.” And Dr. Fuhrman insists the PSA test does not accurately detect cancer anyway.

An important thing to remember is prevention, prevention, prevention! Reports come out all the time highlighting the benefits of plant foods on prostate cancer prevention:

Image credit: Ranoush.

Veggie Diets Slow Prostate Cancer

Last spring, researchers determined lowering cholesterol cuts risk of prostate cancer. And now, a new study in Urology claims a diet rich in vegetable protein and low in saturated fat, dairy products and animal protein, boosts prostate-specific antigen (PSA), a biological marker for prostate cancer, resulting in slower PSA-doubling time and better quality of life. Scientists examined 36 men with prostate cancer, placing some of them on a vegetable-based diet, resulting in these men reporting more indicators of increased quality of life; Reuters reports.

Fruits and vegetables are serious cancer fighters! Eating foods like watermelon, tomatoes, pomegranate, green vegetables, red peppers and berries halt the development of prostate cancer, unlike saturated fat which increases prostate cancer risk.

Oh, and Dr. Fuhrman points out that PSA testing does not accurately detect prostate cancer if you are over 60 years old. So start eating veggies now!

Image credit: akimera