The speakers for the March meeting came from Venice where they have offices in the name of Axcess Diagnostics, Inc. They explained that while they are a diagnostic company, their presentation today will describe the role of imaging in cancer. Prostate imaging has been something very difficult for the world of radiology for a long time and it is only now becoming easier and easier as new technology moves forward. That will be what Dr. Miley’s message will be about. And, here he is:

Thank you for inviting us here today. In the past, imaging has had a very small role in prostate cancer because it is in a difficult place to get to and obtain good resolution. Now, and in the next few years, we have an awful lot to offer people with prostate cancer and I’ll soon tell you why.

The mortality from four leading cancers continues to fall in the U. S. Why? Because of early detection, prompt and better treatment and in close follow-up for recurrences.

In the early days, detection of prostate cancer was through the PSA test, which as you all know, is a woefully inadequate way of diagnostics. [Ed. Note: We don’t like to see the PSA spoken of that way. It may not be as sophisticated as other newer techniques (of which Dr. Miley will speak), but there are a lot of folks walking around out there today who can be thankful that the PSA test was around beginning in 1988.] We know now that there are people with prostate cancer who have perfectly normal PSAs. What is clinically suspicious is a rise in PSA. Then they try to biopsy that and it’s like putting a needle into an orange and hoping to hit the one pit that has cancer cells in it. Often the cancer can’t be found that way.

This is where the imaging process starts becoming more and more important because imaging has become a boon to doctors who treat other parts of the body It is quickly growing to be a boon to doctors who deal with urology.

There are two kinds of diagnostic imaging; structural and molecular, both of which all doctors use to be more effective in treatment. These new diagnostics actually let the doctors determine the stage of cancer and decide which modality of treatment is better for this particular patient - surgery or radiation therapy.

You’re all familiar with x-rays. X-rays were the original form of radiology, where ionization was used to look inside the body. This procedure could sometimes do more harm than good because whenever the body is radiated, it produces some long-term deleterious effects. So now we use magnetic resonance, whereby we put people in a magnet and we alter that magnetic field and are able to look inside and even create three dimensional images of the body. All of this with magnetic resonance which has no radiation. We are also using PET scans now, which use a tagged radio nuclei that goes in, finds the cancer, and then attaches itself to that cancer. It is very discreet in its imaging capabilities

Here are some pictures of an MRI scan. Basically, we use these to look at anatomical detail. Anatomical detail shows us what the structures are; CT scans and MRIs look at structure. CT scans look at it based on density of tissue by pushing a beam of radiation through that tissue and bone absorbs more than air and less than fat, so we can reconstruct a three dimensional image of the body using radiation. MRI is similar, but what it does is it looks at the physiology of the molecules. I always use my brother’s case as an example. He had a troublesome hip which a CT scan showed as normal, but an MRI showed all the inflammation by looking at the hip both structurally and physiologically as well. The MRI tells us more.

Here is another picture of our new technology; this one a virtual colonoscopy looking for colon cancers. You see on the left hand side a three dimensional reconstruction of the colon and then you see the polyp. The doctors now know where to go and which one needs to be biopsied. Structural images tell us what it is, how big it is, where it is, but does not tell us whether it is malignant or benign. It just says there’s a lump in there. Imaging can help there as well.

Now we get to metabolic imaging. You’ve probably all heard about PET scans. It’s not for dogs and cats. The acronym stands for Positron Emission Tomography. In this procedure we actually inject a glucose molecule with a small radio nuclei attached into a patient’s body. There are three things in the body that burn glucose selectively; one is the brain, the second is the heart and the third is cancer. This latter substance is, by far and away, the most important use of PET technology today.

Since cancers are hypermetabolic, they use up more glucose because they’re growing faster than the tissues surrounding them. So the glucose injection fastens itself to the tumor and then we can image it and see exactly where the tumor is. Not only does it let us confirm what that lump in the chest is, but also that it is hypermetabolic and therefor most likely cancer. It also helps us find out if it’s going to spread anywhere because we do the image to the entire body.

This procedure helps determine the treatment modality in prostate cancer, because if the body scan indicates cancer elsewhere than the prostate, surgery which is a local treatment modality, is not the treatment of choice, but a systemic treatment is. Better to find out before treatment than after.

Another thing we can do now is called MR spectroscopy. MR has typically, in the past, been used to look at just anatomical structure. Now we’ve come a little farther on the molecular composition of cells. Just as each of you has a unique fingerprint, each cancer and normal tissue has a chemical signature as well. That chemical signature allows us to look inside an area, which is called a region of interest, to see what the chemical signature is. Prostate cancer has a very characteristic signature, as do cancers in other parts of the body.

We first started using this with brain tumors. We saw people with brain tumors who were treated with radiation therapy and later they would present with a spot in their brain that could be new cancer. Or could it be a little bit of scarring that was missed earlier? They have had all the radiation they can have, so the question is, do they go after that little spot with surgery? With a spectroscope, we can take a spectroscopy of that new lesion and tell you with near 100% accuracy, is that scar tissue with a normal spectroscopic signature, or is that a new cancer. I don’t know about you, but I would rather not have someone stick a hole in my head unless they absolutely knew that it is cancer they are going after. These are some of the things that are going to allow us to really help cancer patients now, and more specifically prostate cancer patients in the future.

Right now, we have only one indication to use for PET, which is called FDG. We use this as the glucose attachment which, unfortunately, does not light up prostate cancer very well. There is a new tracer, however, which is exquisitely sensitive to prostate cancer. It is going through the FDA trials right now and in probably another year to eighteen months we will be able to use it. What this will do for the patient is tell him, without a biopsy, if he has prostate cancer, and if he does, exactly where it is. Thus he will know what treatment options are available to him and the best option for being cured.

We will talk now about combining two modalities, particularly MRI/PET fusion, where we take the molecular information and the anatomical information and fuse them together to look at them in three dimensions. It really helps to understand not only the structure of the cancer, but also where it is located. If you saw a hot spot on a PET scan, which doesn’t have the structure associated with it, and fused it with a CT or MRI, then you could tell that it is in the axilary lymph nodes, inside the chest wall. That’s really focusing on where the cancer is located.

To wrap this up, diagnostic imaging has basically two things to offer people with cancer. We can look at structure...actually the anatomy of a cancer, where it has spread to and maybe what it’s attached to; whether it is in the liver, or wherever else, with exquisite detail. As you can see in this picture of a heart, you can even see little coronary arteries which are really only 2 or 3 millimeters thin. Three years ago when we would do a chest, abdomen and pelvis scan, it would be 300 to 400 slices of extremely thin material. Just think, now we have 3000 slices and we are able to take that stack of baloney and reconstruct it into 3D imagery, and because we have so many slices we have much more data.

So, we have structure and we can do it faster with greater detail. In metabolic imaging using PET and spectroscopy, we have a new tool in the artillery that allows us to look at molecular signatures and metabolic activity. The two combined give the doctors a huge advantage in diagnosing and treating cancers.

I’ll entertain some questions if you have any.

If you have a defibrillator, you cannot. With a pacemaker you can, unless you are totally pacemaker-dependent. Actually, what happens is that the MRI deprograms the pacemaker, but we beat it to the punch by turning the pacemaker off before treatment. We’ve had people go into an MRI with a cell phone and when they come out, the phone is totally deprogrammed. With a defibrillator, you need that there for V-tac and V-fib which you cannot turn off. No, you cannot go in with one of those.

Yes.

Currently we are using a cardiac coil on our three tests because it is so much stronger than what is available in the rest of Sarasota. We are probably going to have a small disposable endorectal coil in the future.

You’ve been a good audience. Thank you for the opportunity to tell you about our imaging diagnostics.

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Jim Mullen’s Name Enshrined
In Sarasota Memorial Hospital

The Board of Directors of the James F. Mullen Memorial Fund, Inc. have arranged with the Sarasota Memorial Healthcare Foundation, Inc. that a permanent remembrance to Jim Mullen will be installed in Sarasota Memorial Hospital. Henceforth, the cancer information center on the hospital’s main floor will be named, and labeled, the James F. Mullen Cancer Information Center.

In announcing this tribute, the Mullen Foundation’s Board also stated that their organization was being dissolved after 15 years of service to prostate cancer survivors and their caregivers. A spokesman pointed out that Jim Mullen’s long term objectives have been achieved and it was fitting that a lasting reminder could be installed where he began his Man To Man movement so many years ago.

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The speaker at the April meeting came from the Wellness Community - Pamela Math1s, MEd. She has extensive experience in health and nutrition as it concerns prostate cancer. Here are her words:

I am going to offer you some suggestions about nutrition and how it relates to preventing recurrence of prostate cancer, and to you who are currently in treatment for that disease. I want to begin by giving you some fundamental guidelines for promoting healing. First, is to try to eat a diet that is very low in fat, high in fiber and nutrient rich. Also, about maintaining a healthy weight. Weight is related to many other cancers and it is also related to heart disease, diabetes and a string of other things.

Also of importance is exercise. The Surgeon General says 60 minutes, five time a week. It can be walking from the outer reaches of the parking lot, not next to the mall entrance, using the stairs instead of the elevator or using some weights while you watch TV in the evening. Do something that will maintain your muscle mass, keep your circulation going, help your heart and put more oxygen through your bloodstream.

Incorporate relaxation techniques such as massage, meditation, Qigong, T’ai Chi, reading, listening to quiet music, anything that relaxes you. So, get off the high ceiling of anxiety and stress and decrease that stress level which will benefit the function of your immune system.

The two most fundamental and important food groups we have for cancer prevention, for boosting the immune system, for improving the energy level and for preventing all sorts of other illnesses are fruits and vegetables. If you’re not eating up to nine servings a day of these, you really need to walk out of here thinking of ways to do that. Fruits and vegetables are power packed with antioxidants, fiber and all sorts of good nutrients. The richer the color, the more antioxidants and nutrients they contain. When you go to the market, look for the brightest colors -- particularly the primary colors of red, green yellow and blue. Blue? Sure, eggplant, blueberries, blackberries, black raspberries, purple grapes. Look for tomatoes and bright red apples. Look for the greens and yellows as they have the most nutrients. An example of a nutrient-poor vegetable is celery, it’s all water and fiber. Skip that and have some broccoli.

If you can afford them, the organics are better for you. There’s no need to pile more pesticides or herbicides into your body as your cells have enough to deal with. If you can only afford a few organics, choose those that are difficult to wash. Choose mushrooms and berries in particular, as they difficult to clean to remove residue. Supermarket red and green peppers that you can really get your hands on with soap, water and a brush are OK, otherwise just do the best you can in getting organic foods.

The next suggestion in my notes says to eat three servings of whole grains a day. There is a huge difference in how your body uses, assimilates and processes whole grains versus the yucky white refined carbohydrates. These include white rice, white potatoes, white pasta, white cereals, white crackers and white breads. There is a whole array of white stuff and most Americans are living on this stuff which is basically glue, causes weight gain, has very little fiber and is very low on nutritional content.

However, when you eat their whole grain counterparts, whole oats, whole millet, whole rye, whole grain cereals, brown rice and whole grains pastas, you get maximum benefits in fiber and nutrients. One of the things I would like you to take with you today, is to name two or three things in your present diet that you are willing to change. Perhaps you’re eating Corn Flakes or Rice Crispies for breakfast; they are just glue. Switch to Wheaties, Shredded Wheat or Raisin Bran and maybe you’ll also switch from white potatoes to sweet potatoes. They’ll fill you up a little better, too, so you’re not so hungry.

I’m really high on eating more cold water fish for their high Omega 3 polyunsaturated fat content. Try to incorporate salmon or organic tuna into two or three meals a week -- really pound that salmon in. People often ask me about tuna and salmon, wild versus farm raised. My suggestion to you is look for the wild salmon, as the farm-raised is said have more PCBs and mercury content. That is because of what the farm-raised fish are fed. The wild fish is definitely more expensive and that is not what they are selling at the Publix fish case. That is the farm-raised stuff. But, if you go to the frozen food department at Publix, they have wild Alaskan salmon there. I have not been able to find organic tuna fish in my Publix, but if you go to Whole Foods, or The Granary or Super Value Nutrition, they all have tuna that is raised wild.

Red meat and pork mean arachidonic acid. Do you all know what that is? It is a fatty acid that is found in red meat, pork and lamb and is the reason you should limit your intake of those foods. Arachidonic acid causes inflammation in the body and also promotes the growth and spread of prostate cancer. Best case scenario is to eliminate, but if you are a diehard read meat eater, at least limit your red meat intake. That would include venison, lamb, any beef and pork. Instead, increase your intake of chicken, turkey and fish.

Egg yolks are another source of arachidonic acid so they are to be avoided too. You can have as many egg whites as you want and that includes Egg Beaters. The yolks are not good for your cholesterol and they are bad for prostate cancer, too. Yet another source of arachidonic acid is dairy products, so I’m recommending you avoid them, or at least use the fat-free and very low fat varieties because of the content of saturated fat. And that, I’m sorry to tell you, means ice cream; whole milk ice cream. You can have low-fat ice cream and low-fat frozen yogurt too.

Sugar is a no-no of the first order. A decrease in sugar is a fundamental principle when recovering from any form of cancer, for preventing heart disease and circulation problems, for promoting anti-aging and better memory. The reason, the effect that sugar has on white blood cells. We can watch your white blood cells go down for six hours after you have had sugar - a physiological reaction. Does that mean you should worry about the small quantity of sugar in ketchup? Some people may, but no, you don’t have to.

But, I am suggesting that you decrease, or eliminate, the obvious sources of sugar in your diet; sugar in your coffee, sugar on your cereal, sugar in desserts, in cookies, etc. Sugar is actually detrimental to the effectiveness of your immune system; it slows the healing and curing of illnesses, colds and sicknesses. Often with a fever or sore throat, you feel like having some pudding or ice cream; something would go down easily. That is the worst thing you could eat because it is depleting your white blood cells.

Let’s talk about fats. There are three main kinds; saturated, polyunsaturated and monounsaturated. The saturated, as you know, is terrible for you. Those are the fats that cause heart disease, high cholesterol and can lead to multiple kinds of cancer. Saturated fats include marbling in meat, whole milk cheeses, whole milk dairy products and egg yolks. There is saturated fat in commercially made cookies, crackers, desserts, anything out of a bakery - so sorry to tell you that. Butter, margarine and a lot of salad dressings also have saturated fat. We have to work on eliminating those.]

Polyunsaturated fat is another fat that is not very healthy for you as it is thought to cause certain kinds of cancer. It does decrease your LDL, but it also kills your HDL, the good kind, so we don’t want to do that.

The best kind of fat is monounsaturated fat. The most popular foods here contain olive oil and canola oil, although there is some controversy now on canola oil. So, olive oil is the top choice for cooking and salad dressings. You can buy commercially made salad dressings that are made with olive oil. However, Kraft and Seven Seas and many other commercially made salad dressings are made with soybean oil and that is not good. Go for Paul Newman or a Ken’s Lite that have olive oil in them

In our attempt to decrease fat intake in the American people in the 80s and 90s, we advocated the elimination of all these fats. We realized some years later that we were wrong and there is a good role in the human body for monounsaturated fats. Those are what help to lower LDL and raise HDL and help to boost the immune system. So, in an attempt to get those oil in, we now recommend olive oil, olives themselves, avocados, nuts and seeds.

I’d like to get you to increase the fiber in your diet. There are only three food groups that have fiber; fruits, vegetables and grain, sometimes called breads and cereals. The goal is to increase your fiber from 25 to 35 grams per day. If you were to buy a little book at the bookstore that lists different foods and the grains of fiber per serving, and calculate how much fiber you normally take in, you’d be shocked at how little it is. When you consider that most whole grain breads are 2g. of fiber per slice, and an apple is 2g., it’s going to take a lot of effort and those nine servings of fruits and vegetables a day to get anywhere near 25 to 35g. of fiber.

Avoid, or at least limit, your dairy products as they contain a lot of saturated fat as well as cholesterol. For instance, people often say that they drink skim milk because they took the cholesterol out. No, they did not; they have not touched the cholesterol content. Remember, cholesterol comes only from animal products. When you look at peanut butter in the grocery store and you are deciding whether to get it, you can be sure there is zero cholesterol in it as peanuts don’t come from an animal.

When the fat is taken out of dairy products, like to make skim milk or low fat yogurt, the fact remains that the fat came from a cow so it is still an animal product and it contains cholesterol. You need to watch the amount of dairy products you eat, not only for your heart, but for your prostate cancer too. The fat in dairy products is saturated fat which has arachidonic acid in it which promotes the growth and spread of prostate cancer. Rather than trying to always get fat-free or low fat dairy products, why not try soy products? Soy is amazing in its ability to decrease the risk for cancer, boost the immune system, and is a great source of protein; you can use soy milk on cereal too. You can cook with soy milk and there are soy cheeses, and other kinds of soy products. Try soy as a good substitute for dairy products.

Another note about soy. Very often we think that the soy products in our diet are offering us phytoestrogen and it is this substance that is helping us with our prostate cancer. That isn’t so; it’s really the genistein, which is an isoflavone, that is contained in the soy that is so beneficial. Genistein is wonderful at decreasing the spread of prostate cancer as it stops those tentacles from reaching out from the cancer cells and spreading by stopping the oxygen flow. Soy is remarkable in its ability to decrease your cholesterol level as well as to slow cancer. So, if any of you have heart disease, high blood pressure or a heart history, soy is good for you. While it’s easy to use frozen foods like Boca Burgers and ground round and things like that, their genistein or isoflavone content is going to be a lot lower than if you use true soy milk or the actual products like tofu, meso or tempe.

You should drink plenty of water. I know all of you do that, right? Wrong. We are all in Florida where it’s hot so we drink lots of water, right? I’ll bet not. I’ll bet you’re not drinking the eight glasses a day that is recommended. 60 Minutes had a segment recently in which they reported that there is no scientific evidence that we need eight glasses of water a day. There’s no harm in telling you that, but we all need to drink more fluids, especially as we get older. And, if your intake includes any caffeine, you need it all the more because caffeine is a diuretic and it is dehydrating all your cells.

Now we’re on to supplements. These are my recommendations as they pertain to most people with prostate cancer. These are the same recommendations that I gave out when I was lecturing for the Dattoli Cancer Center. These are Dr. Dattoli’s recommendations as well. These are general recommendations and you need to apply them to your own individual circumstances. For instance, if you are on a blood thinner like Plavix or Coumadin, Vitamin E or fish oil capsules may not be for you - they are both blood thinners and Vitamin E and fish oil could change your blood levels.

There are some basic supplements that are generally recommended for people with prostate cancer; for instance good quality multivitamin. If you are taking that cheapo One-A-Day thing from the grocery store, you might just as well throw it away because you’re not absorbing most of it. I do think there is a huge difference in the quality and absorbability of the vitamins that come from a health food store. It is not always more expensive, but it is always better for you - it’s more absorbable.

For a multivitamin I recommend something that is a nice multimineral / multivitamin complex. Twin Labs is a big international company and they make a vitamin called “Daily One Cup”. They also make “Garden of Life” and their whole line is food-based. In other words, they get their Vitamin C from broccoli and carrots and other high Vitamin C foods. Solgar and Solar Ray are two more different brand names made by huge companies, and they’re both good. Do your shopping in a health food store like Super Value Nutrition, The Granary or Whole Foods.

Vitamin C is a very potent antioxidant and a very potent immune booster. [Ed. And a very, very inexpensive product too. An unusual combination.] Taking Vitamin C is an excellent way to heal, to promote good health and to decrease your risk of other cancers. The general recommendation is somewhere between 500 and 1000 mg per day. I do recommend timed release as well as those tablets with rosehips. The rosehips help the body absorb the Vitamin C more readily.

Vitamin E is surrounded by controversy at the moment, but it’s still recommended for folks with prostate cancer. However, it’s role in heart disease has become a little tainted. We always thought it was very protective, and now we come to find out it may even have caused some heart problems. As such, my recommendation right now is somewhere around 200 to 400 IU a day. Sometimes, you can find a multivitamin with as many as 200 IU in it, so the use of a supplement may not be necessary at all.

CoQ-10 is a very good enzyme. There are probably two things in my list that I would suggest very strongly for you and CoQ-10 is one and lycopene is the other. CoQ-10 is a very potent antioxidant and very good at heart disease prevention, anti aging, helps to keep your arteries more flexible, prevents plaque buildup with cholesterol, and lowers cancer risk from a variety of cancers. Very potent, but very expensive. You get it at health food stores like Whole Foods or The Granary or Richards. CoQ-10 is also called Co Enzyme Q-10. This is a substance that is found naturally in our bodies, but as we age it decreases in amount. What we are doing is putting back what nature gave us in the first place, a refurbishing, a rejuvenation.

Salmon oil capsules are recommended by Dr. Dattoli at 2000 mg and your friend who spoke here twice, Dr. Snuffy Myers, agrees with this. In my practice, I recommend 1000 mg as I’m a little hesitant because of it’s blood thinning capabilities. Fish oil is a great blood thinner. If you’re tempted to go the 2000 mg route, please check with your doctor first.

Calcium citrate is very important for your bones and as many of you know, prostate cancer treatments can bring on osteoporosis. Calcium citrate is the most absorbable form of calcium and we recommend you take it with Vitamin D and magnesium to help your body absorb the maximum calcium. If you don’t tolerate these big tablets, calcium comes in several other forms. You can buy it in a capsule, as a chewable and in liquid form. My suggestion is the liquid because they are best absorbed. The calcium liquids probably won’t be found in the grocery or drug stores, but in the health food stores.

Curcumin, also called turmeric, is the spice used to curry foods. Very potent, very good antioxidant that’s good for digestion and boosts the immune system.

Saw palmetto is one of Dr. Dattoli’s top priorities. He suggests 300 mg twice a day to inhibit the effects of arachidonic acid. There’s that bad fat again.

Selenium at 200 mg is a standard supplemental dose. You will find that strength, sometimes, in multivitamins. I know the Twin Labs multivitamin has 200 mg of selenium so you wouldn’t have to take a separate pill.

Zinc is another very potent antioxidant, as is selenium. If fact, there is a study that was done and published in 1966 in JAMA, the Journal of the American Medical Association that reported selenium, at 200 mg, reduced the incidence of prostate cancer by 63%. That is pretty powerful and even if it’s not 100%, be sure you get that.

Lycopene is on the top of my list. I mentioned that earlier. Lycopene is found in all red types of vegetables and fruits, particularly tomatoes which I’m sure you all know about. In addition, guava, pink grapefruit and watermelon are excellent sources of lycopene. This is a very potent antioxidant that is particularly good with prostate cancer and which should be in your medicine chest.

I have a few minutes for some questions if you have any.

Yes, but actually only at about midway. It is a corn cereal and not truly a whole grain cereal. While it is fortified by some fiber, I would suggest you would do better by eating Wheaties, Shredded Wheat, Cheerios, Bran Flakes, Oat Bran Flakes, Wheat Chex or Kashi.

Yes, depending on the type or method of food preparation. If you boil vegetables, they do lose a lot of nutrients out into the water. However, steaming, sautéing, and micro waving are all approved cooking methods that will help to retain the most nutrients from those vegetables.

It’s best, when available, to select locally grown fruits and vegetables. These will have more nutrient content than the frozen. However, when it isn’t the season locally, remember that the broccoli shipped in from California is already a week old before it gets to Publix and maybe as much as another week before you eat it.. It obviously will have lost a lot of nutrient value. Under those circumstances, I’d say buy the frozen because it is flash-frozen the day it is cut so it would actually have more nutrients.

For starches like potatoes and rice, the size of your fist is a good measure. That also serves for meat. Fruits and vegetables are a half a cup if they’re cooked, a whole cup if they’re raw like lettuce or salad greens. With fruits generally a serving is “one” as in one apple, one peach and one pear. A half of a banana is a serving, as is cut up fruit or fruit cocktail.

Yes, and it is delicious. There is one great brand put out and it is called Silk. Many of you have tried Silk soy milk, and this is Silk yogurt. It is found in Publix in the dairy case. However, most of our commercially made yogurts like Dannon, Yoplait and Breyers are made from skim milk so they would be a low fat yogurt.

Splenda I prefer over Equal or saccharin. I don’t like Equal or saccharin because they are too artificial. Saccharin we are pretty sure causes cancer, and Equal is a very altered chemically-made kind of sweetener. There are other natural sweeteners like Stevia and barley malt that you can buy in a health food store. I recommend them.