HELP IS ON THE WAY, BUT IT WILL NOT ARRIVE SOON
Report on the 2008 Prostate Cancer Conference – Los Angeles, California, September 6-7
Filed by Daniel Meltzer, 9.15.08
More than 700 men and women attended this year’s enlightening Prostate Cancer Conference at the Sheraton Gateway Hotel in Los Angeles, California. The conference is organized and presented by the Prostate Cancer Research Institute (PCRI)
Thirteen lecturers - physicians and nutritionists - addressed the packed ballroom over two days, offering their insights and information regarding the latest recommended treatments and regimens to control this as-yet lethal and incurable condition. Hopes and frustrations were shared. New drugs and other treatments in the pipeline were discussed.
Talks ranged from the highly technical to the readily accessible. Was there a common theme to this year’s conference? If so, it might be expressed as “The good news is that hope is on the way, but the bad news is that it is not on the express track.”
Some new and highly promising treatments are now available, we were told, but not in this country, owing to the highly conservative approval process at the Food and Drug Administration (FDA). Patients must be prepared to travel, and to spend considerable sums for treatment.
The following professionals were among those who presented at the conference:
Dr. Mark Moyad, MD, MPH, Director of Preventive and Alternative Medicine at the University of Michigan Medical Center, Department of Urology, an acknowledged expert on diet and dietary supplements who has worked with the FDA and is an advisor to the World Health Organization (WHO) was the kickoff speaker Saturday morning. He is the author of several books, including “The ABC’s of Prostate Cancer” and “Promoting Wellness for Prostate Cancer Patients.”
“Less is more” is an important guiding principle, according to Moyad. Healthy eating, he stated, is key to surviving cancer, and patients should not overdo any particular food or supplement. Nutrients should be gotten from natural foods, not from supplements.
More specifically, according to Moyad, 2 – 3 servings of fresh fruits and vegetables per day are adequate, contrary to popular perception. Prostate cancer patients should consume fish twice a week for healthy Omega 3 oils, and pomegranate juice for its anti-oxidants. (Pomegranate extract provides the same benefit with less sugar.)
Lycopene should be gotten from tomatoes and other foods, not from a pill, he urged. The richest source of Lycopene, he informed the conference, is not tomatoes, but watermelon.
Overdosing on anti-oxidants (e.g. Selenium and Folic Acid) is dangerous. Excess anti-oxidants may actually feed cancer cells, he stated. Avoid the lure of commercial products. Coca Cola now advertises that its soft drinks contain anti-oxidants. They also contain very high concentrations of sugar.
If you must take supplements, as a general rule, always take the LOWEST dose, Moyad urges. The sales of dietary supplements (many of them entirely unnecessary) in the United States last year alone amounted to an astounding 38 billion dollars.
Moyad gave his ABCs of healthy living;
A Aspirin. Made from willow bark, aspirin is a miracle drug if you need it, a disaster if you don’t. It reduces the risk of heart attacks, but can increase the risk of strokes. Do not overuse.
B Belly Fat. This is a good visible indicator, an excellent sign of general health and susceptibility to disease. A Body Mass Index (BMI) of 25 to 29 indicates a person who is seriously overweight.
C Circumference. BMI is not, he says, as good an indicator as simple waist circumference. A muscular man will have a high BMI, but not be at risk. On average, 3,500 calories may be considered as contributing to a gain of one pound. Hormone Therapy slows metabolism, so patients receiving it must be especially vigilant. Cut 100-200 calories a day, Moyad states, and you will lose 10 – 20 lbs a year.
Mono and polyunsaturated fats are healthy, but patients must avoid saturated and trans-fats.
Dr. Moyad says choosing the best calcium supplement, when needed (as for bone metastasis patients) is important. Three are available: calcium carbonate, calcium phosphate and calcium citrate. He says calcium carbonate is the best and also the least expensive, and that one or two pills a day should be adequate.
Folic acid - Take no more than 400 mcg a day. Too much can actually feed the tumor.
Overdosing on multi-vitamins, he says, increases the risk of prostate cancer.
Do not take vitamin C mega doses for the same reason.
In fact, he advises prostate cancer patients to take a woman’s or a children’s-strength daily multivitamin, as men’s multivitamins have too high a concentration of anti-oxidants.
Cholesterol-lowering drugs have been shown to lower the progress of the disease. Cancer cells, he says, “like cholesterol.”
For those concerned, he advises an:
· Optimum LDL (Low Density Lipoprotein) count of less than 100
· Optimum HDL (High Density Lipoprotein) count close to 60
· Optimum triglycerides of less than 150,
· Optimum HSCRP (High sensitivity cardiac risk protein) of less than 1.0
And finally, Dr, Moyad reports, surveys indicate that single men have a lower risk of prostate cancer, but that married men have a higher rate of survival. The best advice he could offer, then, he concluded with a smile, is for men to stay single as long as possible, but to marry as soon as possible after being diagnosed PC positive.
Dr. Peter Carroll, MD is on the faculty of the Department of Urology at the University of California in San Francisco. His talk was titled “Monitoring Prostate Cancer Without Immediate Treatment.”
In brief, Dr.Carroll says roughly half of all prostate cancer patients have a PSA below 4.0. He advocates more biopsies to confirm presence of cancer, and is not in favor of “watchful waiting,” keeping an eye on the PSA but forgoing any treatment. Simply put, “treatment prevents death,” he said, and Active Surveillance can extend survival periods by 10 to 15 years.
Dr. Richard Babaian, Senior Medical Director for MD Anderson Physicians in Houston, following up on this, spoke on “Selecting Men for Active Surveillance with PCA3.”PCA3 is a genetic marker for prostate cancer and is regarded by some practitioners as a better indicator than the PSA.
A man with a PSA of 0.8 could, in fact, have prostate cancer, he claims. In general, new markers are needed, and we should limit, if not eliminate, invasive, sometimes inaccurate, and risky biopsies.
Dr. Duke Bahn, MD, Medical Director of the Prostate Institute of America and Department of Radiology at the Community Memorial Hospital in Ventura, is internationally recognized, according to the program notes, as “one of the world’s leading practitioners in the study and treatment of prostate cancer.” The title of his talk was “Lumpectomy for the Prostate.”
Dr. Bahn says he advocates “focal ablation of the index tumor,” and that “90% of secondary tumors do not require treatment at all. His goals are to “maintain QOL (quality of life,) without compromising treatment.” He believes a reasonable approach is to attack the index (primary) tumor only, and that cryotherapy (freezing) can cut down tumor volume by 90%.
Diagnoses indicate, he reports, that the degree of blood flow in the affected areas is an excellent indicator of how aggressive the cancer is. The higher the volume of blood flow, the more aggressive the cancer. A tumor volume, he says, of less than 1 cc is considered as optimum.
Cryotherapy, he says, is a safe and effective way to attack prostate cancer. It involves freezing the prostate to kill cancer cells (although sometimes high heat may also be used for the same purpose). It is most recommended, he says, for patients with a single, small, “unilateral” tumor.
Microwave thermal ablation (removal) is an alternative, as is radio frequency tumor ablation and photodynamic therapy. A laser approach is also sometimes used, Dr. Bahn reports.
A new approach of immunotherapy, still in trials, involves attacking “regulatory T-Cells.” Ordinary T-Cells (a subcategory of white blood cells) are key “good soldiers” of our immune system, Bahn says. But “Regulatory T-Cells” are their enemies, as they act to actually protect cancer cells from the T-Cells.
Verne Verona, of Coral Gables, Florida, studied traditional Chinese Medicine, cultural nutrition, and acupuncture theory at the East-West Foundation in Boston. He holds an Oriental Medicine instruction certificate and is a dynamic and engaging presenter. His talk was titled; A Diet for Stopping Cancer Growth.
Mr. Verona spoke of a “diet of inflammation,” and how a faulty diet can promote swelling. Excess protein, sugar, fat, and/or alcohol all support inflammation, he reports. Echoing, to some extent, the comments of Dr. Moyad, he advocated lowering all of the above.
The blood must neutralize excess sugar, he says, by taking minerals from the body, and this can cause an excess of acidity and, ultimately, diabetes.
A craving for sugar, he finds, results from the passage of too much time between meals, and from eating too late at night, which creates greater craving for food (and sweets), he finds, the next day.
“Make your diet more medicinal,” he says. Whole grains are better than refined grains because refined grains have been reduced to too-tiny particles that are too-easily and too-quickly assimilated into the body.
His healthy dietary template: 1/3 whole grains, 1/3 vegetables, then 5 – 10 % proteins, 5 – 10 % beans or bean products, 5 – 10 % fruits, and sea plants, nuts, oils, and 5% ferments (miso, saur kraut, pickles to aid digestion).
Beans will create gas, he warns, and beans + fruit will create major gas. Be warned.
Dairy should be avoided and he directed his audience to the web sites notmilk.org and PCFRM.org for alternatives.
Whole fruit are better for you than fruit juices, he claims, and seaweeds are especially known to constrict
He recommends morning skin brushing to “move lymph fluid,” daily aerobic exercise, eating four smaller meals a day rather than three, and meditation to promote good health in general. It is best not to eat less than three hours before bed time, and one should chew all foods thoroughly.
Yoga (“sustained stretching”) is also helpful. Complex carbohydrates, he emphasized, fight illness, and he urged all those present to “redefine” their passions, and to devote a significant amount of time “doing what you love to do.”
And, oh yes, “get off coffee.”
Daniel Margolis, MD, Assistant Professor of Radiology at the University of Southern California School of Medicine spoke on “State of the Art Scanning for Prostate Cancer.”
Dr. Margolis explained the imaging various available processes and how they help. There is, as yet, no “manogram,” Margolis, made clear, for imaging prostate cancer. We still rely, essentially, on PSA numbers, the physical (digital) exam and the biopsy to detect the presence of prostate tumors. An MRI shows cellular density (cancer cells are tightly packed).
Blood flow and concentration of certain chemicals in the body are also indicators. Cancer cells feed on blood, he says, and cancer cells actually secrete chemicals that grow new blood vessels! An MRI will see abnormal blood flow. MRI-guided biopsies are also helpful, although ultrasound, he claims, is easier and safer, while an MRI may find missed areas and is especially good for imaging bones.
He calls lymph nodes the “garbage men of the body.” Iron oxide (injected before an MRI) will show up in healthy lymph nodes, but not in ones that are already full and dense with cancer cells.
PET scans can show prostate cancer cells elsewhere in the body, he says. Other methods of searching out cancer involve injections of fluoride, which gets taken up by cancer cells, and choline, a water-soluble essential nutrient usually found within the vitamin B complex, is also a constituent of rapidly producing cancer cells, so a test for this could also be used.
Dr. Margolis told of a specific lymph node ID agent that is available and in use today, in The Netherlands, as an ultrasound imaging agent to show up cancer, but it is not available in this country, as the FDA is withholding approval, reportedly because the agent has not been shown to definitively “cure” anything.
Lobbying is said to be underway to get this decision reversed, however, while many men have already flown to Holland specifically for this important diagnostic test.
Dr. Stephen Strum, a medical oncologist from Ashland, Oregon, spoke on “Suppressing Relapsed Disease with Intermittent Testosterone Blockade” (Intermittent Hormone treatment)
Strum advocates intermittent hormone therapy as a treatment that can control cancer and provide some quality of life (QOL) enhancement.
“Biology dictates status,” Dr. Strum reports, and a consistently low PSA (below 0.5) “has been shown to harbinger long periods of remission (up to 15 years).”
In general, however, PSA higher than 0.01 following Androgen Deprivation Therapy (ADT) suggests a problem, he reports.
Quest Labs, he says, offers an ultra-sensitive “14808X” test that is generally used to detect elevated PSA in post-prostatectomy patients.
PSA numbers drop dramatically with ADT (Androgen Deprivation Therapy), which significantly reduces tumor activity. But if one’s PSA begins to rise toward the end of that first 12 month period of hormone (ADT) therapy, cancer cell mutation is indicated.
The combination of Lupron (injected monthly) and Casodex (one pill daily) is the standard ADT regimen. Lupron acts on the pituitary gland and through it, the testes, and Casodex acts directly on the testes, both of them directed to eliminate testosterone production. Proscar or Avodart is added to shrink the prostate.
The threshold for re-starting ADT during the “holiday” period (when treatment is suspended) is a PSA rising to 2.5 or higher. Avodart/Proscar “enhances the effect of ADT” and can extend the “holiday” period, when the patient is taken off ADT for some return to normal function, and general improvement in QOL (Quality of Life). The PSA nadir on ADT should be 0.5 or lower, Strum says. Anything higher indicates a mutated cancer and a worsening condition. In such cases Finasteride, he says, can extend survival by about one year.
Other speakers noted the possibility of extended “holiday” periods, with consistent monitoring of PSA levels. One suggested holiday periods could last for several years, depending on the patient’s test results.
Dr. Mark Scholz, Medical Director of Prostate Oncology Specialists in Marina del Ray, California, is also the founder, past President and currently Executive Director of the Prostate Cancer Research Institute, the host organization for this conference.
Dr. Scholz addressed the issue of various promising drugs and treatments, some still in trials, that are awaiting approval because of the protracted bureaucratic processes in Washington.
Hormone therapy, or ADT, Dr. Scholz reports, is five times more effective against prostate cancer than it is against breast cancer, although side effects of ADT include loss of libido, impotence, and weight gain.
Dr. Scholz discussed various medical approaches, including several new treatments still in trial or awaiting FDA approval, along with some whose trials had to be cancelled owing to lack of funding.
Leukine, he says, stimulates quicker recovery after chemotherapy, and also effectively “freezes” PSA levels. Unfortunately there is a medical insurance issue, as Leukine has not been specifically approved for use against cancer.
A medication called CTLA4, still in trials, is believed to have a beneficial effect on metastases.
Cytoxan has been shown to kill the harmful Regulatory T Cells in low doses with minimal side effects, and significantly lowered PSA numbers, especially in bone cancer patients.
Celebrex, Thalidomide, and Avastin are administered for rising PSA numbers in relapse situations, and to extend “holiday” periods (off months from hormone therapy).
Scholz advocates combining Lupron with Flutamide (another hormone medication) for relapse patients.
VVAX, currently in trials, is comprised of two genetically modified prostate cancer cells and is a potential vaccine against prostate cancer.
Modified Citrus Pectin (MCP), is another potential prostate cancer vaccine for advanced (metastatic) cancer patients. It is still in stage three trials at this writing.
Provenge, another drug that has shown success against Prostate cancer, is still awaiting approval from the FDA. Protest groups have been complaining, even picketing, over the slow progress of the approval mechanisms.
Provenge + Avastin is believed to be effective, he states, against bone metastases in particular.
Other possible treatments or cures not yet approved include cryoblastation with injection of dendritic cells, the use of zoledronic acid to prevent bone metastases, and administering modified citrus pectin (derived from orange peels) to increase PSA doubling time.
Charles “Snuffy” Myers, MD, medical oncologist from Earlysville, VA, speaking on “An Aggressive approach to Metastatic Disease; Diagnosing and Treating Oligo-metastasis, introduced himself as someone who has been fighting his own advanced prostate cancer for more than 9 years.
Spread of prostate cancer to lymph nodes and bone is generally very slow, he said, and a single bone metastasis can hold, without growing or spreading, for up to 10 years. He also mentioned the Cambidex scan currently available in The Netherlands but not here, that detects lymph node spread. He supports use of high dosage vitamin D and most of the treatments already mentioned in this report.
It is of critical importance, he emphasized, to “arrest the cancer stem cells from generating progeny.” Stem cells can lie dormant for up to 25 years, he claims. A key goal would be to find a way (trigger) to put them back into that dormant stage after they have awoken and begun to reproduce.
He generated enthusiastic response to his recommendations, answered many direct questions from attendees after his talk, and sold quite a few copies of his two diet books and subscriptions to his newsletter, but one hopeful attendee was disappointed to learn from his office that he does not accept any medical insurance providers at all, or Medicare.
An initial visit to his office in Virginia, outside Charlottesville, would cost $1,200.
Dr. Nicholas Vogelzang, MD, director of the Nevada Cancer Institute (NVCI) and author of more than 400 scientific publications, spoke on “Treating Hormone Resistant Prostate Cancer.”
Dr. Vogelzang listed several important markers for hormone resistance:
· PSA doubling time (the longer the better)
· Extent of bone metastasis
· Low hemoglobin count
· Higher Gleason score
· Rising PSA
· High LDH test result
· Age and “performance status” rating (general physical condition - zero is best, 4 is worst)
· Visceral diseases (e.g. liver metastasis)
· Albumin levels
Dr. Vogelzang says pain level is a key indicator of likelihood of survival. Pain increase, he says, is a sure indicator of impending death.
A patient should try a new drug if his PSA is consistently rising, the doctor recommends, but when switching from one mode of treatment to another, a patient must bear in mind, he says, that it takes at least two months to assess the benefits of the new approach.
Many new drugs are being tried in many different locations, the doctor told his audience, but the patient must be prepared to travel, and also, presumably, to pay the full cost of remedies not yet FDA-approved or accepted by health insurance providers.
On the other hand, Casodex is coming off patent this year, which will significantly lower its price, and Atracentin (Abbot) is scheduled to come off patent next year.
Avastin may come off patent next year as well, and the chemotherapy drug Texatere may come off in 2010.
New drugs in the pipeline and awaiting approval include two from Pfizer:
· Sutent, also known as CP751 (approved for renal and gastrointestinal cancer), (another form of Sutent),
· HSP90 (theoretically affects certain protein manufacture that is connected to cancer cell proliferation).
At a gala dinner Saturday evening in the hotel’s grand ballroom, three professionals who had rendered exceptional service to prostate cancer patients were honored with the first “Harry Pinchot Awards.” Pinchot, a ten-year survivor of advanced stage prostate cancer, died of the disease in January of this year. He was a much-loved founder and former Program Director of the Institute.
Pinchot was also a founding member of the Prostate Cancer Action Network, a group organized to educate and inform legislative bodies about the need for financial support for prostate cancer research. He was nicknamed “Helpline Harry” for his volunteer work with prostate cancer survivors and their families.
The event was hosted by actor Dean Jones and featured a keynote speech and video presentation by entrepreneur Peter Diamandis, known for his support for rocket engine research.
All presenters at the conference employed helpful power point materials, but we did note that there was no “signing” for the hearing impaired, which seemed unfortunate.
As stated at the top of this report, help is reportedly on the way, but it is still on the local, not the express, track, and patients will need patience and forbearance, along with strong interim support, and, of course, good luck, until those medications and treatments get here.
Daniel Meltzer, NYC, 9.15.08
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