Defeat Cancer (52 page)

1. Those who want to do the most promising and effective treatments available, even if it means they will run the risk of impotence and incontinence as a result.
   
2. Those who don’t want to risk being permanently impotent. Medical castration (using drugs to impair or block the release of male hormones, which feed cancer) only causes temporary impotence.
   
3. Those who won’t accept impotency for any period of time.
   

There is currently extensive knowledge and research about prostate cancer within the medical community, and countless divergent opinions about what people should do when they get prostate cancer. Every newly diagnosed prostate cancer patient feels a deep need to obtain further information about his disease and we at Humlegaarden try to meet this need. We offer a week-long training course for prostate cancer patients every month, whereby we share the most current knowledge about prostate cancer and treatment principles. Following is some information about the latest discoveries on effective prostate cancer treatments.

First, androgens, or steroid hormones that are responsible for the development of male characteristics in humans, are also able to stimulate cancer growth later in life in prostate cancer patients. Therefore, treatments which suppress or block the production or function of male sex hormones are an important part of prostate cancer therapy. Men who have started these treatments should know that a paradigm shift has taken place on this issue after the February 2011 Genitourinary Cancers Symposium, which was arranged by the American Society of Clinical Oncology in Orlando, Florida. Intermittent, rather than ongoing, androgen-suppressing treatments are now recommended as the new standard of care for most patients who have cancer recurrences after having received aggressive anti-cancer therapies. This means that androgen-suppressing treatments should be given to patients for only eight months, and should be restarted only if their prostate-specific
antigen (PSA) values increase to levels greater than 10ng/ml. Multiple clinical trials have proven that giving patients these treatments for only eight months provides equally beneficial results as treating them with androgen suppression for longer periods—even years. What’s more, the costs and side effects of treatment are minimized by doing therapy intermittently.

What can doctors do for their patients when their PSA levels rise, despite the fact that they have undergone surgical castration,
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or been given anti-hormone substances to suppress the production of male hormones that feed their cancers?

The first thing that doctors should do is make sure that their patients are actually “sufficiently castrated.”
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For example, that their blood testosterone levels are preferably below 20 nanograms/dl (= <0.69 mmol/l). Earlier guidelines recommended 50 nanograms/dl, but today it’s recommended that doctors bring their patients’ testosterone levels to below 20 nanograms/dl.

We know that 37.5 percent of medically castrated patients
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don’t have levels of testosterone under 20ng/dl, and that 12.5 percent don’t have levels that are less than 50ng/dl.

Medical castration removes one of the body’s sources of testosterone, which is important because testosterone feeds cancer cells. But testosterone isn’t just produced in the testicles; it’s also produced in the adrenal glands and in cancer cells themselves. Ninety percent of the testosterone which circulates in the blood is bound to a protein substance called sex hormone-binding globulin (SHBG), while the other ten percent of testosterone enters prostate cancer cells and is
irreversibly converted to dihydrotestosterone (DHT) by the enzyme 5-alpha reductase.

DHT has a much greater affinity for androgen receptors on cancer cells (its binding capacity is two to five times greater than testosterone). It also has at least a fifty-fold greater affinity for androgen receptors than known anti-androgen medications such as Casodex (bicalutamide), as well as a tenfold greater ability to stimulate androgen receptor signalling to the cell’s nucleus, which in turn stimulates cancer cell growth.

Interestingly, though, if doctors measure the DHT levels of their medically castrated male patients, they often find that these levels are within the normal range (30–80 ng/dl), despite the fact that the men’s testosterone has been successfully lowered by castration.

Men that have persistently high DHT levels must be treated with a medication which inhibits the transformation of testosterone to DHT. This medication is called Avodart (dutasteride), and when given in dosages of 0.5 mg per day in tablet form, it reduces the amount of DHT to four percent of the amount that would have otherwise been present. We measure our patients’ testosterone as well as dihydrotestosterone (DHT) levels so that we can identify whether they need dutasteride (Avodart).

We try to inhibit prostate cancer growth in three different ways, using androgen deprivation therapy (ADT), which includes all of the following:

1. Gonadotropin releasing hormone (GnRH) agonists like Zoladex (which nearly eliminates the production of testosterone in the testicles)
   
2. An androgen receptor blocker like Casodex
   
3. Dutasteride (Avodart)
   

Often, androgen receptors develop hypersensitivity to even very small amounts of DHT and testosterone. Whenever this happens, cancer cells may grow rapidly, even when the serum (blood) levels
of testosterone in the body are 1/10 to 1/1000 of normal. Fortunately, a number of studies have shown that the anti-androgen medication Casodex, when given in daily dosages of 150 mg – 250 mg, can inhibit the growth of such hyper-sensitive cancer cells.

Because castration affects only testosterone production in the testicles, but not that which comes from the adrenal glands and the cancer cells themselves, we often add the anti-fungal remedy Ketoconazole (200 mg × 3), and 10 mg of the corticosteroid drug prednisone daily, to the ADT-3 treatment to reduce the adrenal glands’ production of androgens.

Because of all the aforementioned factors, it can be difficult to provide a 100 percent effective treatment to patients who have hormone-sensitive cancers such as prostate cancer, so the medical community must appreciate and be open to new ways of treating this cancer besides using the treatments that are commonly known in oncology.

In our opinion, one of the most promising therapies for “castrate-resistant”
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prostate cancer is low-dose metronomic chemotherapy. As previously mentioned, high-dose conventional chemotherapy attacks cancer cells and low-dose metronomic chemotherapy blocks angiogenesis (the formation of new cancer cell blood vessels).

Up until now, we have only done two studies which show the effects of conventional chemotherapy upon prostate cancer patients. Both studies were done in 2004 and involved giving castrate-resistant patients Taxotere, which increased their median survival from 15-16 months, to 17-18 months, thereby giving them only two more months of life.

By comparison, metronomic chemotherapy has yielded very interesting, and more beneficial, results. In one study, for example,
responders had a median survival of five years, even when the therapy was given after patients had taken Taxotere.

One very interesting metronomic chemotherapy protocol is called KEES, which originated from Sahlgrenska University hospital in Sweden. It involves the use of cyclophosphamide (an alkylating antineoplastic agent), ketoconazole, prednisone, etoposide (a chemotherapy agent) and Estramustine (another chemotherapy agent), which are all given in low doses. Many other protocols are in use today. Whenever doctors give their patients metronomic chemotherapy, the cancer cell’s sensitivity to hormones becomes irrelevant.

Other effective prostate cancer treatments include: pomegranate, resveratrol, Cool Cayenne (a chili product), artemisinin (Chinese wormwood), lycopene (a phytochemical from tomatoes), noscapine (a well known cough remedy), Vitamin D-3, transdermal estrogen, Sandostatin (a growth hormone inhibitor), milk thistle (which slows cancer cell growth), mistletoe compounds like Iscador and Helixor, as well as many others. Their mechanism of action upon the cancer varies, depending upon the substance, but all either have anti-neoplastic or immune-stimulating properties.

When prostate cancer becomes really resistant, other options, such as vaccines, may also work well for treatment. Soon, a more universal testosterone-inhibiting medication called Abiraterone will be out on the market. It is expected to be approved in most countries within the next year.

Many of the above methods are not used by conventional urologists, but many prostate cancer discussion groups on the Internet eagerly debate and comment on their effectiveness.

Today, the integrative medical community has a large group of different treatment modalities at its disposal. Cancer treatment
options can be compared to a person who is traveling from one town to another. To get to the next town, he can travel by car, bus, train, or even airplane, and can choose many alternate routes to reach his final destination. Monotherapy, or using a single treatment modality, can be compared to traveling along just one of these routes, using a single mode of transportation. If the therapy (or transportation) is effective, the cancer’s growth will be blocked for awhile, but sooner or later, it will attempt to use an alternate route. The best approach is to combine multiple therapies that block most of the cancer’s survival routes and hope that it dies from a lack of nutrition before it finds a new route. Combining multiple therapies at the beginning of treatment is also important.

Because there are a multitude of routes, or strategies, that cancer can use for its survival, it often recurs despite a multi-faceted treatment approach. Good integrative physicians, however, have a multitude of therapies to choose from, and can often succeed at blocking the new route that the cancer has taken with a different treatment approach.

Fortunately, cancer treatments can also be synergistic with one another. When two compatible therapies are given together, they can sometimes provide better results than if two non-synergistic therapies are given together. One example of an effective combination strategy would be using different androgen deprivation therapies together, each of which functions to disable the prostate cancer in a different way. For example, doctors might first treat their patients with a GnRH agonist like Zoladex to stop or reduce the body’s testosterone production. Next, they might add Avodart to their patients’ regimens, to inhibit the transformation of testosterone to dihydrotestosterone. Finally, they might block the cancer cell’s androgen receptors with an anti-androgen agent such as Casodex. In this way, they can simultaneously block three hormonal strategies that the cancer uses for its proliferation, which is clearly better than just blocking one of them.

There is no reason for people with cancer to despair if their cancers recur. Their doctors just have to block another route that the cancer has taken for its survival, which can be accomplished by effectively combining different treatments.

Over the past fifteen to twenty years, we have used tumor marker measurements extensively to evaluate our patients’ progress on their treatment regimens. Our frequent use of these markers is due partly to the fact that we have an excellent tumor marker department at the Danish Serum Institute in Copenhagen.

A tumor marker is a substance in the blood, urine or tissues that is found in higher amounts in people with cancer because it is produced by cancer cells. Many different tumor markers exist, because almost every cancer produces its own unique markers.

Tumor markers can be used to monitor the effectiveness of a given treatment, and in many cases, to detect whether the histology (microscopic anatomy) of the tumor tissue and the tumor marker match. Often they don’t, and the pathologist has to change the initial diagnosis. Tumor marker counts also provide information about the aggressiveness of a particular cancer.

The most frequent tumor markers that we use are: PSA (prostate specific antigen) for prostate cancer, CA-125 (cancer antigen 125, for ovarian cancer and sometimes adenocarcinomas); CA-19-9 for pancreatic, bile duct, and sometimes, colon and stomach cancers; CA-15-3 for breast cancer; S-100 for malignant melanomas; NSE and chromogranin A for neuro-endocrine cancers; CEA for colon cancer (and often also breast cancers); HCG for testicular cancers; alpha-phoetoprotein for primary liver cancer (and testicular cancer); and ferritin, which is a non-specific marker.

The most recent tumor marker that we have been using is called Circulating Tumor Cells (CTC). This diagnostic test collects and
identifies CTCs, which are live tumor cells that have separated from solid tumors and are circulating in the blood. It then identifies and counts the exact number of circulating tumor cells within an ordinary 7.5 ml blood sample. The cut-off limit for a positive prognosis is five, so if patients have less than five cancer cells within a given blood sample, their prognoses are far better than if more than five CTCs are found in their blood samples. For patients that have a cell count above five, the goal of treatment would be to get their CTC counts to below five, in order to substantially improve their prognoses. For patients whose CTC numbers are less than five, we can use milder and less toxic treatments, and thus save them from having to endure the severe side effects of more aggressive therapies.

With the CTC test, it’s possible to determine whether a given treatment works as early as three weeks into treatment. If it doesn’t, we can stop it immediately and replace it with another type of treatment. This saves patients valuable time because they can avoid unnecessary harsh treatments, which often have many side effects. Also, the CTC test is able to predict patients’ prognoses much more accurately than previously.

It’s important for people with cancer to establish good nutritional habits. Fatigue is the single most important symptom that doctors must address in their cancer patients, because energy is vital for recovery. For that reason, we recommend foods that will increase the body’s energy. This is an integral part of our nutritional protocols. Such foods are fresh; they are not frozen or canned, and are ideally organic and mostly vegetarian. Consuming lots of fresh organic vegetables is especially important!