Our March 2008 speaker was Eve Prang Plews, a Licensed Nutrition Counselor, who presented a perspective on the nutritional co-management of cancer, with emphasis on prostate cancer. The following is an edited version of her presentation with editorial addenda.

She encouraged the young and old to have their blood Vitamin D level checked in order to establish a baseline. Blood levels range between 20 and 200. It has been reported that Vitamin D levels in the higher quartile are considered to be cancer protective. She stated that higher Vitamin D levels protect, particularly so, liver cells from sustaining DNA damage, which when it occurs, changes the metabolism of those cells. When such DNA damage occurs, Phase 2 liver detoxification is compromised, and toxins, many of which are common household chemicals, among others, become carcinogens.

Prostate cancer is characterized by an early and near universal loss of the Phase 2 enzymes GST (glutathione S transferase). This has been researched by Stanford University Medical Center.

Sulphoraphane bolsters defenses against carcinogens through up-regulation of Phase 2 enzymes, and is found in the cruciferous vegetable family; such as cabbage, broccoli, cauliflower, Brussels sprouts, collards, kale, bok choy, mustard greens, kohlrabi, turnips, rutabaga, arugula, watercress, and radish.

Numerous countries have studied the benefit of onions, which are considered as one of the strongest risk reducers. (European Urology)

Meat and dairy products are considered to be risk factors. Reduce your total intake!

Fatty fish and fish oil are protective against inflammation, cancers, stroke, Alzheimer’s, heart disease, dementia, psoriasis, asthma and other conditions. She recommends eating a minimum of two servings of fatty fish per week like Alaskan or Pacific Salmon, Sardines, Anchovies, Mackerel or Herring. The important essential fatty acids EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) contained in such foods should total a daily intake of 2 grams.

Not all fish oil capsules are free from contamination. Some leading nutritional authorities recommend that Fish oil products should be independently tested for environmental contaminants such as 17 dioxins and furans (ppt), 14 PCB’s (ppt), total heavy metals (ppb), Mercury (ppb), Lead (ppb) Arsenic (ppb), Cadmium (ppb). Further, they should be tested for Peroxides, Anisidines, TOTOX value, Acid value. Additionally, they should be tested for microbial contaminants such as Total aerobic bacteria, Coli forms, E. coli, Staphylococcus, Salmonella, Yeast and Mold. Such quality assurance should be made available from Independent Assays on the products you purchase.

Eve Plews recommends avoiding Atlantic farmed raised salmon. Shrimp from the Gulf of Mexico are acceptable, but avoid shrimp from the Oriental countries. Today, most shrimp are exported from Viet Nam and China. These are farm raised in pens that become contaminated and then the harvest is sprayed with an antibiotic.

She further recommended that non-chlorinated water be used for drinking which is filtered through compressed carbon or ceramic filter. No granulated carbon or silver should be a part of the filter. As to amount of water that should be consumed daily, the following formula could be utilized: Body weight divided by 2 = ounces of water per day. Avoid distilled or R/O water without mineral replacement.

She advises taking a high quality vitamin/mineral supplement daily. Nutrients are not created equal. Emphasis on Vitamins C, E and D, also selenium, folate and B-12 should be available.

Use probiotics at least three times a week, using a guaranteed strain. Learn to love to move and sweat, incorporating at least 30 minutes of activity, six days per week. This is reported to reduce all causes of age related decline. Do all three kinds of exercise, such as endurance, strength and flexibility.

Remember, you have cancer…..cancer does not have you.

*****************************************

At the April 2008 meeting, Paul Zatz made the following introduction: It is my pleasure this afternoon to introduce to you Dr. Kenneth Bregg, who is a graduate from Washington University in St. Louis; received his M.D. from Washington University in 1984 and has done internships in New York at Hospital Cornell Medical Center, and also at Memorial Sloan-Kettering Center in New York. Dr. Bregg has been on the faculty of the New York hospital as an instructor from 1990-1991. He was awarded a Fellowship in Female Urology and Incontinence, and spent 1991-1992 training at the University of California, Los Angeles. He has authored numerous articles on the field. He presently practices here in Sarasota.

Defining Incontinence

Thank you very much for allowing me to speak to you today about incontinence. Please feel free to ask any questions even those not related to incontinence. First of all just a brief definition on what is urinary incontinence. It just means the loss of urine when you don’t want it to come out. We think of it sort of like a faucet with a leaky washer. In many cases, especially after prostate surgery, there is an incompetent valve which is called the sphincter muscle. We will talk about this more. There are different kinds of incontinence that apply to men in particular, and the two most common types are what we call stress incontinence and urgency incontinence. Most patients, particularly men after prostate surgery will fit into one of these two categories. Stress incontinence means that you have leakage of urine which is related to a physical activity, coughing, sneezing, bending, or in a severe cases, just being on your feet and having gravity work against you. It does not mean any kind of a mental stress. It means a physical stress.

The other kind of leakage is urge incontinence. This also can occur and is a type of leakage that occurs when you cannot get to the bathroom in time. If you are standing at the kitchen sink and you turn on the water, and you have the urge to go, but you can’t quite make it quite there; that is called urgency incontinence. As a urologist, a physician treating incontinence, it is important for us to make the distinction as to which of these you have because they’re treated differently. Of course there can be a mixture of these two types of leakage as well.

Causes of Incontinence

Patients ask “Why am I incontinent?” Certainly in men it is often related to prostate surgery and damage to the sphincter. In men, there are different types of prostate surgery. For prostate cancer there is a radical prostatectomy. These are now being done robotically. I hope in a few years that will mean less incontinence as the technique becomes more refined. There is also the TURP which is the so called “roto rooter job”, which can unfortunately cause sphincter damage. There are other causes of leakage as well besides prostate surgery. Neurological conditions associated with diabetes, having had a stroke, can affect the bladder muscle and not allow the bladder to hold urine properly. Multiple sclerosis can affect either the spine or the brain. In some folks, just the process of aging unfortunately can damage the nerves which can as well render them somewhat incontinent.

Incontinence is a very common problem. There are billions of dollars spent a year on pads. It really is a major problem both from a social standpoint and an economic standpoint. It is very hard to say what the rate of incontinence is after prostate surgery. I tend to think its maybe between 1% and 5%, especially in good hands. Certainly no matter how good the surgeon is, there are men who develop incontinence after prostate surgery. Surgery is probably the most common cause of men having incontinence from prostate problems. But radiation can do it too.

Incontinence obviously is embarrassing. It is expensive to buy pads. It interferes with quality of life. It interferes with sexual function. There are many reasons we treat it, and no one should really just assume they have to live with it. There are common sense things that are annoying about it. Again, many people are of the assumption that is a normal part of aging, but it really is not. In many cases we can help it. There are a lot of new things which I’m going to talk about now, which for most people can improve them significantly.

First of all, when you go to the urologist, this is what we do to figure out how we can try to help you. We do a very basic history to find out about what prostate problems you might have had. Have you had surgery? Have you had radiation? Are there any other medical problems that could cause incontinence such as diabetes, or strokes. We do a physical exam looking in particular at the prostate area. We look for neurological problems. We always check a urinalysis to see if any infection could be causing things. We also check to see if you are emptying your bladder. There is one type of leakage which is not common, but it can happen where if you are not emptying, which is called overflow incontinence. We check that by seeing if you empty your bladder. These last two tests are very helpful to us. Lastly there is urine dynamics and cystoscopy.

Urine dynamics is an office procedure that we do where we have a specially trained technician or nurse and she puts a little tube into the bladder. We actually can study the way the bladder works. It allows us to get very intense evaluation of the bladder, and of the sphincter muscle. By doing that, it enables us to figure out what type of leaking you have and how we can best help it. In some cases, if the leakage is pretty obvious as to what caused it, we don’t do that. If the urologist is not sure, or if there is surgery involved, we will commonly want to do to this test to make sure we have the best possible information. It is pretty much noninvasive and is covered by Medicare. It is quite sophisticated in helping us to know what is going on.

Cystoscopy is a test where we put a little scope up the penis and look in the bladder. The new scopes nowadays are so small and soft that by being numbed up, it has really become a very simple procedure. For most men it is very simple. Years ago it was a painful difficult procedure, but that has all changed with the introduction of fiber optics and small flexible scopes. With all of these tests, we can get a pretty good handle on what type of leakage you have and how best we can best address it. When people come to us, they’re wearing pads and diapers. We don’t prescribe that. Our goal is to get rid of that. So that is what we try to do.

Medications and other devices

If you have what is called an overactive bladder, and again that could be from radiation, aging, or neurologic disease, and occasionally from surgery, there are a lot of medications that are out there for that. They all have the effect of allowing the bladder to hold more urine. They can have some side effects such as dry mouth or constipation. But, they often work pretty well for an overactive bladder. There are also exercise techniques I am going to talk about too. Obviously, if you have to wear pads, you want to wear the most comfortable, the least intrusive thing you have to.

For stress incontinence, which is the leaking you have when you’re coughing, sneezing, walking, bending, there is really no medication for that problem. Most of the medication that would be offered to help leakage is more for urge incontinence where you can’t get to the bathroom in time. The one type of medicine that does help and it is in off label use, is not approved by the FDA for this purpose. Certain antidepressants have the side effect of helping leakage. So if your doctor says I am going to put you on antidepressant because you’re leaking, it is not because he thinks you are depressed. It is because one of the side effects is that it actually can help leakage. Years ago we used to use Sudafed. You know what Sudafed is, over the counter for colds and things like that. That also actually will tighten up the sphincter but if you are prone to high blood pressure, it is not good to take that because it can raise your blood pressure. That is it for medicines for stress incontinence. Recently there have been reports of Detrol, an over active bladder medication, if used for extended periods of time, may have a side effect of affecting cognitive function. That is a very interesting study.

There are some things that are available which do not involve any surgery or medications. There is a clamp that is called a Cunningham clamp. It is unpleasant to wear. But it is functional and it does prevent the leaking. It is pretty soft. But it is unsightly and people don’t like wearing it. When you have to urinate, you just undo it. You can also undo it at night. It also can cause pressure sores. It can irritate the urethra. Plus, it is just not a romantic kind of thing. So we don’t really recommend these unless all else has really failed.

People always ask about catheters. There is what’s called a condom catheter which is an external catheter. It fits over your penis just like a condom would and hooks up to a bag. The advantage of it is that it is not invasive and it is all external. The disadvantage of it is that it is not very pleasant to wear. It will keep you dry, but you have to wear a bag on your leg. But, it is something that can be used when nothing else can work.

Internal catheters are the kind that goes into the bladder. They will also keep you dry, but we also consider these a real last resort because they are a source of infection. Any time you leave a catheter in the body it will eventually cause infection. We are not real keen on those either.

There are some behavioral techniques that can really work. These will work for either urgency incontinence or stress incontinence. The technical term is biofeedback. It is also known as Kegel exercises or pelvic training exercises. There’s actually a biofeedback center in our hospital where there are nurses who do that. They are really teaching patients how to strengthen their pelvic muscles. By doing a program of biofeedback where you strengthen your pelvic muscles, in many folks that will really help them to have less incontinence. It does take some work, but it is nice because there are no side effects, it is not invasive, and in many people who go through the program, whether they do it on their own or with a formal biofeedback center, after a few months of exercising they can really improve. It is just like playing golf. You’re not going to go out and shoot a par golf game in one day. This is an exercise. You have to strengthen your muscles, but by working at it, it can really work. Even in men who have had prostate surgery or radiation where they have had sphincter damage, the muscles are usually not totally shocked, just partially damaged. Depending on how bad they have been injured, biofeedback or training the muscles can really work.

On a very simplistic level, we just tell patients to think of it like you are trying to squeeze your bottom muscles to stop yourself from passing a bowel movement. You want to squeeze and hold it for three or four seconds, then relax for three or four seconds, and if you do that 20 or 30 times a couple times a day. Over time you can really strengthen your pelvic floor muscles. The nice thing about formal biofeedback is, you work with the nurse and she actually has a machine that can measure how much your muscle strength improves, so we can quantify if it is working for you. The way this works is there is a probe which is gently inserted up into the rectum, and as you do the technique of squeezing the muscles, it sends feedback to the machine. So the biofeedback nurse is able to judge if you are doing it properly. If you’re not doing it properly, she can have you squeeze your muscles a different way until the machine registers. You can make sure you are using the right muscle. Some people do it well. Other people have a hard time finding the right muscle. But once you get the right muscle, then by doing it on your own at home, and coming back periodically, you can assess if it is working for you. Usually if the muscle strength is improving, you will get improvement in how you are leaking. This is also covered by Medicare and it is noninvasive.

Some people drink a lot of coffee or sodas which have diuretics in them. That can irritate this kind of problem. Some folks are chronically constipated. Constipation will always make incontinence worse because when your rectal vault, where the stool stays around; when you are constipated it gets stretched, it puts a lot of pressure on the area of the prostate and the bladder. If people that are constipated go on a bowel program, whether it is with enemas, or just using something like adding fiber to their diet, have more frequent bowel movements. Often that alone can make a big difference. But the big thing is probably avoiding drinking an excess of fluid and watching your caffeine intake. I advise my patients to have a quart of fluids per day, which is 32 oz. That includes everything. That is enough fluid so as not to get dehydrated. Again, in many patients without medicines or surgery, just doing biofeedback or modification of your behavior, or avoiding constipation can have a big effect.

This is primarily for persons who have stress incontinence. They don’t work well in men. I rarely do them because they just don’t work. The success rate is 17% after prostate surgery, which is not great. That is less than one in five that have success. That is because either after radiation or surgery, there’s so much scarring, that even if you inject something to tighten up the valve, there is so much scar tissue that whatever you inject tends not to stay there. There are different materials. The current one that most of us use is carbon beads. They don’t react with the body and they tend to be permanent and stay there and they are felt to be very safe. Again, in general, injection procedures, although they are fairly noninvasive, have a poor success rate. The main advantages are it is simple to do. You don’t burn any bridges.

There are two main types of surgeries that we do. This is again for stress incontinence where you leak with activities regardless of the cause whether it is radiation, surgery, or some other reason. The main one is actually the artificial sphincter. There’s also a new alternative which has just been developed called the advanced male sling. Basically, the male sling is less invasive. It is an outpatient procedure which takes about 45 minutes. But the problem is that you have to really have mild leakage for a male sling. If you have either moderate or severe leakage, you need the artificial sphincter. The sling only works for mild leakage. So, obviously many patients by the time they come to us are in these two categories don’t really qualify for the male sling. The artificial sphincter, which is also called the AUS, is a little more invasive.

Using a visual slide presentation the artificial sphincter is described as follows: It is called the gold standard, and is what we usually do for stress incontinence in men. It is an artificial sphincter. It looks complex, but it really is not. There are three parts to it. This is the urethra, the tube where the urine comes through. The main part of it that works is this part right here. This is called the cuff. It is surgically wrapped around the urethra and that compresses it and keeps it tight so you don’t leak urine. There is a pump, which is designated here that gets implanted in the patient’s scrotum. Normally, this cuff is kept closed so you won’t leak. When you have to urinate, you press the pump and it transfers all the fluid out of this cuff, say about three minutes to urinate, and after that it automatically closes up. This way you can live your life and be fairly dry and when you have to urinate, you have a valve that allows you to open it up. It becomes second nature to work it. These things work quite well. They are not perfect, but most patients are dramatically better with them. There can be, in a minority of patients, problems like infection, or the device can leak, but for most people, they work quite well. I do a lot of them, because they just work very well.

The main point from this brief talk is that there are different options for incontinence and most urologists, particularly if they treat incontinence a lot, are very comfortable discussing these options with you and seeing if they can help you. Some doctors, such as internists don’t see incontinence as a priority. They are more interested in seeing if you have cancer or not. They will also look at perhaps what your cholesterol is, but they are not going to ask you about incontinence. So, if this is something you are concerned about and bothered by, it is something you should not be embarrassed to bring it to the attention of your doctor and that way they can help you with it.

In summary, it is a fairly common problem. Most men can be helped. There are different treatments. Some work better than others. Some are more invasive. Some are surgical. Some are medicines. Some are biofeedback. There are always new things on the horizon that are helping people to be drier.

*************************************************

The Man To Man Presentation for the Month of May 2008 consisted of a panel discussion of Prostate Cancer Survivors. Dr. Thomas Williams, a local urologist with Florida Urology Specialists, served as moderator and contributed to the discussion. Paul Zatz, Facilitator of Man To Man Sarasota introduced the panelists and described the event as follows: The format is going to be relatively simple. Each of the speakers will make a little presentation about themselves and their treatment. Before we do that, I will have Dr. Williams talk about various aspects of prostate cancer and briefly discuss robotic surgery as it applies to this condition.

Dr. Williams: It is always great to come to this session. I have moderated it before. For me it is just great to listen to the panelists and hear what is on their mind. I always come away with more than I give. But I did want to mention that I just came from this weekend in Orlando where I attended the American Urologic Society national meeting. It is the biggest meeting in the world for urologists. I believe prostate cancer is front and center in urological research. For example, Sweden has a data bank of men on whom they have drawn blood for the last 40 years. As you know PSA has been around for roughly 20 years. They can look at various lab results going back 40 years. They went back and looked at the PSA levels in men when they were in their 20s. They looked to see if there was a difference between one group of patients who developed prostate cancer in their 60s. They then compared results with a group of men who did not develop prostate cancer in their 60’s. Is there a difference at age 25? The answer is yes. There is a difference with their lab results at age 25. What does that mean? No one really knows. Does it mean that the prostate cancer starts at age 25? Well we don’t think so. Why is there a difference in their PSA? There are a lot of questions out there that we just really don’t know the answers to. There is still a lot of emphasis on the current technologies, but they are certainly looking at other possibilities with vaccines and what they call nano technology. It is gratifying to see that research is continuing in this area with data being accumulated.

Clearly, the literature shows that maintaining optimal health helps to keep prostate cancer at bay. For example, men with diabetes or obesity have more difficult issues than men who are healthy.

I am going to mention just a little bit about robotic surgery, and then I am going to sit down and listen to these gentlemen. As you are well aware, robotic surgery has come along as an option for treating prostate cancer. In my group, we have Dr. Tracy Gappin who has been doing it for several years here at Sarasota Memorial Hospital. Our new associate from the Mayo Clinic, Dr. Matt Perry, has also started doing it. Basically, as I understand it, it is technology that came out of the military of having an offsite surgeon operating on patients in the field. In Iraq now, it is the objective to get injuries off the field as quickly as you can and on a plane to Germany where you have a full hospital. The survival rate from a lot of serious trauma has been quite remarkable with the current model they have. The military was looking at a machine that would be at the battlefield and the surgeon would be somewhere else who could operate this machine that would insert these “little hands” in the body and operate. That is quite remarkable. They are still in the process of trying to find its best utilization. It seems to have some value here at Sarasota Memorial in treating prostate cancer and also in certain cardiac issues. The gynecology oncologists also are using it for some pelvic dissections.

The advantage of it is that you don’t have the incision that you have with a radical prostatectomy. The recovery time, as far as getting in and out of the hospital, is quicker. Usually you can get out in two days where most men with a radical prostatectomy will get out in three or four days. Then you still have the incision to heal. Theoretically, patients can get back to work sooner and gain their continence sooner. At the AUA this past week, I saw several papers that were pointing to the fact that you just can’t do as good of the lymph node dissection with the robot as with the standard open surgery. There is still a debate about which is the best. But it is certainly a therapy that is coming along. It seems to clearly offer advantages on some patients.

The other big question that needs to be answered: is it as good as the open surgery in terms of patients not having recurrence? Does it work as well as the standard radical prostatectomy as described at Johns Hopkins almost twenty years ago?

I saw one paper that showed that the current cohort of patients seem to have a cancer recurrence rate about the same as previous cohorts of just open surgery. The second cohort included robotic patients. It seems to be as good, but again, there are no large studies to show that it is as good. If a patient was here today that had the robot surgery, they possibly would tell you that they came in, had surgery and they went home the next morning or maybe the next day. They were able to get their catheter out within a week. Since they did not have any incisional pain, their activity levels were quite good very quickly. Sometimes there is a two-edged sword with that. They get back, and are so active, they still have leakage, and some studies show that the return of continence is about the same as the open surgery. Maybe the guys with incisions leak less because they are a little more careful about what they do following their surgery. There is still a lot of debate about that. It is a therapy that is here to stay and it is coming along. Dr. Gappin uses robotics in doing flank surgery, such as in kidney surgery, particularly where there is a kink in the kidney drainage system, and you need to go in and fix it. Rather than do a big incision and going in and do that, he is able to make a small incision and go in and fix the problem. We’ll move on now to the panelists.

Mr. Styles: I am Scott Styles. This story begins about 12 years ago when I was first diagnosed with prostate cancer back in 1996. Following a biopsy of eight samples, I was diagnosed with the cancer in about five of the eight. I had a PSA of 5 and the Gleason score of 6. It was fairly apparent that I needed to do something. I spent a little time checking out alternatives and finally decided that the best thing for me might be brachytherapy or seeds. This started in December of the year 1996 when I had a treatment with Lupron and Ulexine, which was supposed to shrink my prostate before the seeds were popped in. Three months later I had the seeds, but in those intervening three months, I had all kinds of problems. Apparently my reaction to the Lupron was pretty intense.

In any event, I lived through that three months and had the seeds and everything went beautifully. The results were as expected. I had a low level seed, a 125, and it was done at Moffitt Cancer Center.

They had a team that did the job and everything worked fine for about five years. Then my PSA began to creep up a little bit. I think it was early in June 2004 I was back up over 4 on my PSA. I had another series of 12 biopsies which this time showed only two of the 12 positive for cancer. They were both on the same side of the prostate so I had several options that I could use. First off, after going through a very detailed evaluation of my situation, because I wanted to be sure that I wasn’t getting into something over my head, or that it wasn’t going to be good for me. I have been very concerned about the quality of life.

In any event after all the tests and things I went through, I discovered that I had three options; beam radiation, cryosurgery, or hormonal therapy. Beam radiation was scratched because there was a high percentage of potential for incontinence. This was as a result of the fact that I had had the prior radiation with seeds. I skipped that when I found that there was a 25% chance that I would have to wear diapers for the rest of my life. That didn’t turn me on at all. Cryosurgery was a possibility because with the cancer apparently on only one side of the prostate. Cryosurgery can be effective without too much problem with incontinence. So I talked to Dr. Gary Onik, who has been here to speak to this group a time or two.

After an extensive discussion, he said, I think I would go to hormonal therapy because we can always come back to choose the cryosurgery. So, I decided finally that hormonal therapy would be the right way to go. The first treatment began in October of 2004. At that time my PSA was about 5 and the therapy that my oncologist suggested was a combination of Casodex 50 mg a day and Avodart 0.50 mg a day. Normally Lupron would be included with that as kind of a multiple mixture but my oncologist who had known my experience back at Moffitt with Lupron, said no Lupron. Let’s see what we can do without it. It worked pretty well. I started the treatment and for actually almost thirteen months my PSA sat at roughly 0.1.

At that point we decided that we would try the intermittent phase, which is now quite common with hormonal therapy. I stopped the treatments. In three months I had gone up to about 0.13 and then after another three months I was up above 0.5. At that point my oncologist suggested that we ought to go back on the hormones, which we did. Immediately, the PSA dropped right back down to the 0.1 level which was what we had hoped would happen. I did that for another year with again the same mixture of Casodex and Avodart. But then when we decided I would come off of the treatment, we talked it over and decided maybe we ought to try leaving me on Avodart, because for some people, they have an effect with Proscar which seems to extend the life of their intermittent therapy in the periods off. We tried it for three months, but it did not work. The PSA was starting right back up as it had the time before. However this time I decided that I wanted to wait a little longer. I have been off now for thirteen months and my PSA has moved from 0.4 to the current reading, which I had two weeks ago, at 3.92. It was a gradual rise, but still with a rapid enough halftime of the increase in doubling. I decided to call my oncologist to make an appointment to see him, and it turns out that he is in the hospital. At this point I have another few months, or at least two weeks, maybe months, to await his recovery. Then hopefully get some guidance as to whether I want to wait another notch and see if it goes up between the ranges of 5 to 10, which I think is not too unreasonable based on the experience of other physicians that I have read about. At this point I am marking time. I feel wonderful so as far as my health is concerned, because this treatment really was very noninvasive.

Nutritionally, I am taking 1400 units of vitamin D every day, 200 units vitamin E, bone, 200 mg of Selenium, and 200 mg of Celebrex. The Celebrex is partly because I have some knee problems, but also it tends to be supporting the slower growth of the cancer with hormones. I have modified my diet after listening to Dr. Charles Myers here at Man To Man a couple of times. I am eating less red meat, more fish or chicken, more legumes and that sort of things. I find that has been helpful. I try to go to the gym three times a week to keep working out. So, all in all, I have done very well on the treatment. At this point, I think I have a good chance of continuing for quite a while.

The problems I experienced with the hormone therapy included enlargement and sensitivity of the breast tissue. I understand that can be controlled with radiation. I was reluctant to do that because I have had some pretty heavy radiation doses when I was in the Service working for the Atomic Energy Commission. I decided repeating that experience would not be too pleasant. However, I also learned recently that once you have passed up this treatment, you can start it at any time, but it will not reduce the breast enlargement. As a result, I am about a C cup right now, which is just one of those things you have to live with. I also noted a mild lethargy when I was on the hormonal therapy, but not to the point where it was serious. So, all in all, I figure I have had a pretty good 12 year run at this point. I am 83 and enjoying life and having a good time.

I would like to credit a few people who have helped me get to this stage. One, of course, is my wife because she has been a very patient lady to get me from where we started on this trip to where we are today. Also I have several doctors to thank; one is my oncologist, Dr. Jay Friedland. I have also talked to doctors Treiman, Patrice, Dattolii, and a lot of people here at Man-to-Man who have been very helpful to me. I am very appreciative that this group was around. I have to mention one other lady, Jan Manorite, who is in Ft. Myers. She is with the Prostate Cancer Research Institute there. She is a wonderful, knowledgeable person who has helped her husband live through at least 12 years of this disease. I am thankful for all these people who have been with me along the way.

The one thing that worries me at this point is, suppose when I get back on hormonal therapy, whether it is in three months, or next week, or whenever, if it doesn’t have the effect it had before, what are my options then? I don’t know the answer to that completely. Obviously, one is the possibility of chemotherapy. The other thing I have noticed that Dr. Lebowitz, on the West Coast, has been working on a non-hormonal blockage, which looks promising according to his writings. It is apparently for progressive, hormonal refractive PC, and is an off-label treatment with Leucine and Revlimid. I have no other information except a couple of articles that I have read. It is another possibility and that is what I am going to explore in the next few months, no matter what happens, just so I am ready for phase 3, what ever it may be. I appreciate the chance to pass this information on to all of you.

Mr. Ardes: My name is Steve Ardes. I am age 65 and a prostate cancer survivor. You see my blue band. I am just a recent survivor. I will give you my brief story. My diagnosis took place at age 63. My initial PSA was 6.7. My first biopsy pathology revealed a Gleason score 7. But, here at Man-to-Man, as I came to these meetings and obtained the counsel of Paul Zatz, he said be sure to get a second opinion on your biopsy pathology, because it has great meaning on the future decisions that you will make with your choice of modality and the success of the outcome.

Naturally, we would all like to think a second opinion it is going to possibly bring about a more favorable report. Unfortunately, it was not my case. The second opinion that I got came back showing that I have a Gleason score 8. Not a big difference between 7 and 8 numerically, however, it is a big difference when you are diagnosed with a medium to high-grade cancer versus an aggressive cancer. My oncologist said, the last thing you want to do is under treat an aggressive cancer. Unfortunately the diagnostic imaging that is available today is not very accurate in assessing systemic changes of prostate cancer. Fortunately none of it proved positive in my case.

This prognosis of aggressive cancer was both terrifying and humbling as it would be to any man. It will knock the knees out from under you. It created great uncertainty in my life. Where am I headed? What is going to happen? It is depressing, and so the big question, what do I do? I asked God, my Creator, to be my Master Physician and give me the wisdom and the guidance to have victory over this disease. Today, I claim that victory. I took charge of my disease and started doing the research of getting credible information, not hype, so that I could make the best decisions in my interest. God has comforted me through all these past 15 months that I have battled this, Now, as my intended purpose, He expects me to comfort others. Know that I am here and I care about anybody that cares about themselves and if I can in any way be helpful or supportive, or offer 2¢ of information and some encouragement, I am available.

There is another quote that I borrow from a local world-renowned oncologist, who says that it is the informed patient who is most likely to beat the cancer odds. Bottom line is you have to get involved; you have to take charge of your disease. Don’t leave it up to just a local doctor, in all due respect to the medical profession. This is your life. It is your quality of life. Each man’s cancer is unique to himself. There are no two cancers alike.

After all my research; and the advice of my healthcare professionals, the decision was made to start initial hormonal therapy. This commenced in November of 2006. Initially, I got some reduction in PSA. My oncologist, who has me tested monthly on 10 different areas that he can read and watch for movement in these readings. In so doing, he can gauge the effectiveness of the therapy that he has me on.

So, as he observed, I wasn’t getting quite the reduction in PSA that he was satisfied with. I then started aggressive hormonal therapy which commenced in January of 2007, and continued for 14 months. Aggressive hormonal therapy, which includes Lupron, Eligard or Trelstar, and uses higher doses of Casodex, necessitates other drugs be given to protect your liver. As my oncologist reviewed these monthly reports during that 14 month period, would modify the drugs and the regimen that I was receiving. I was on every drug that just fell short of chemotherapy.

I have been on Ketoconazole, Casodex, and Leukine; and all those have side effects which I won’t go into that detail now. If anybody is interested I would be happy to discuss it with them later. The good news is that in this period of hormonal therapy, my PSA originally being a baseline of 6.7 came down to 0.06. In March of 2008, they felt that my final treatment should be external beam radiation followed by seed implant. The seed implant was done in March of this year, and already in April, my PSA is virtually undetectable at 0.01. This was confirmed by my May blood test results 0.01. I am excited. My medical team is excited. I am claiming victory.

Mr. Ratai: My name is Walter Ratai. I am 78 years old. Back when I was 65, I had a penile implant to correct a “falling organ.” In 2003, this implant failed. I talked to neighbors and friends and they recommended Dr. Winston Barzell. So I went to him to have the implant redone. After that happened, he asked me if I ever had a PSA test. And I said, “What in the heck is a PSA test?” Well, anyhow the PSA test came back and it was positive for cancer. I then had a whole body scan done to make sure that it did not metastasize or spread outside of the prostate. Then he gave me literature basically with radiation, chemotherapy, and radical procedures. Then he mentioned cryosurgery. After I went through all of this, having at least a month to make up my mind, I selected the cryosurgery. One reason was that I did not have to worry about a lack of erection. I went into the hospital in the morning and I left the hospital the next day. The recovery time was minimal. The only really negative thing was carrying that catheter bag for two weeks and emptying it. I now go for a PSA test every six months and my last one was two weeks ago and the reading was 0.2, whereas the one 6 months before that was 0.3. I selected cryotherapy basically because of my life style. That is about all I can tell you.

Dr. Williams closed this session with the following remarks: “Depending on your diagnosis, there are, as we have seen this afternoon, various options for treatment. Be informed, and with your doctor decide which approach is best for you. Some people just cannot stand the idea of surgery and look for other options. Other people are inclined to think, if I have cancer, I want it in the bucket!”

Upcoming Programs: