Men At Risk: Men At Risk The Dirty Little Secret Prostate Biopsies Really Do Spread Prostate Cancer Cells
MEN AT RISK
THE DIRTY LITTLE SECRET PROSTATE BIOPSIES REALLY DO SPREAD PROSTATE CANCER CELLSBy Ronald E. WheelerAuthorHouse
Copyright © 2012 Ronald E. Wheeler, M.D.
All right reserved.ISBN: 978-1-4685-4801-3Contents
Dedication.....................................................................................................................................................................................ixPreface........................................................................................................................................................................................xiChapter One Too Many Radicals ... Too Many Failures............................................................................................................................................1Chapter Two Everything You Ever Wanted to Know About Chronic Prostatitis.......................................................................................................................26Chapter Three Chronic Disease Management.......................................................................................................................................................56Chapter Four Definitive Treatment for Prostate Cancer Targets All Men with the Disease ... Inappropriately.....................................................................................85Chapter Five You Are What You Eat..............................................................................................................................................................101Chapter Six The 'Dirty Little Secret' Doctors Won't Tell You ... 'Prostate Biopsies Really Do Spread Prostate Cancer cells'....................................................................119Chapter Seven Andropause (Male Menopause)......................................................................................................................................................130Chapter Eight Testosterone Replacement or Supplementation Poses High Risk for Prostate Cancer in the Aging Male................................................................................137Chapter Nine Prostate Cancer Diagnosis in Chaos................................................................................................................................................145Chapter Ten Controversies associated with prostate health and beyond...........................................................................................................................151Chapter Eleven Controversial Male Health Studies from the Literature...........................................................................................................................164Chapter Twelve Pathology of Prostate Cancer....................................................................................................................................................183Chapter Thirteen Is it Necessary to Cure Prostate Cancer when it is Possible?..................................................................................................................212Chapter Fourteen High-intensity Focused Ultrasound for Prostate Cancer: 2006 Technology and Outcome Update.....................................................................................228A Glossary of Prostate Cancer Related Terms & Abbreviations....................................................................................................................................245References.....................................................................................................................................................................................339–356Appendix—1 ProCap Trial—A Prostate Cancer Prevention Trial.........................................................................................................................357Appendix—2 Incidence of initial local therapy among men with lower-risk prostate cancer in the United States.............................................................................365Appendix—3 New European Study Confirms Effectiveness of PSA Test.........................................................................................................................367Appendix—4 Dr. Wheeler's Commentary to US Preventive Services Task Force (USPSTF)........................................................................................................370Appendix—5 Adult Urology.................................................................................................................................................................373Appendix—6 Men's Health is in Chaos......................................................................................................................................................375Appendix—7 Patient questionnaire response: Prostate Biopsy Exposed.......................................................................................................................380Appendix—8 Dr. Schoenberg's proclamation letter related to HIFU..........................................................................................................................382Appendix—9 Unintended Deception— Observations by Dr. Wheeler.......................................................................................................................387Appendix—10 Endorectal MRI found valuable prior to salvage RP............................................................................................................................390Appendix—11 Robotic High-intensity Focused Ultrasound for Prostate Cancer: What Have We Learned in 15 Years of Clinical Use?.............................................................393Appendix—12 A Brief Description of the Ultimate Prostate Scan (UPS)—Targeting Disease ... 'One Patient at a Time'..................................................................416Appendix—13 Chronic Disease Management may be the best "first choice" when prostate cancer is diagnosed and if quality of life is important to you!......................................419Appendix—14 Why HIFU Fails...............................................................................................................................................................422Appendix—15 Heidelberg Working Group for biopsy-free diagnosis established: Decreasing the risks of prostate cancer diagnosis............................................................431Appendix—16 Long-Term Pca Control with RP is 'Excellent'.................................................................................................................................434Appendix—17 Chronic Disease Management (CDM) is a unique treatment concept that integrates traditional medicine and complementary medicine...............................................437Appendix—18 Is VB3 an Acceptable Diagnostic Alternative to EPS?..........................................................................................................................461Appendix—19 IPSS—Index Aua (BPH) Symptom Score.....................................................................................................................................464Appendix—20 Cigna Healthcare Coverage Position...........................................................................................................................................468Appendix—21 My story in brief: The clinical events in the life of Greg O'Haver...........................................................................................................489Appendix—22 My Battle To Survive Prostate Cancer.........................................................................................................................................494Appendix—23 Bryce Zender's Story.........................................................................................................................................................500Appendix—24 Ray Cunningham's Story.......................................................................................................................................................508Appendix—25 Chronic Disease Management—A Worldwide Prostate Cancer Strategy........................................................................................................512Appendix—26 Benign Prostatic Hyperplasia (BPH)...........................................................................................................................................523Appendix—27 Avoiding Prostate Biopsies is now 'State of the Art'.........................................................................................................................532Appendix—28 Biopsy Procedures are on the Rise............................................................................................................................................538Appendix—29 Jim Little's story – to his friends at the Prostate 90 chat group......................................................................................................551Appendix—30 Jack Mosier's Story..........................................................................................................................................................557Appendix—31 Letter discussing the care of Jerry Deplazes.................................................................................................................................563Appendix—32 The 8 Phrases you never want to hear from your Doctor:.......................................................................................................................566Appendix—33 For Immediate Release Aventura, Florida......................................................................................................................................569Appendix—34 Rectal wall recurrence of prostate carcinoma.................................................................................................................................572Appendix—35 Robotic Prostatectomy—A Race to Failure?...............................................................................................................................577Appendix—36 Benefits of Green Tea versus Prostate Cancer.................................................................................................................................596Appendix—37 Effects of Dietary Changes on Prostate Cancer Growth.........................................................................................................................598Appendix—38 Synopsis of Professional Achievements (Curriculum Vitae).....................................................................................................................600Appendix—39 Data Regarding Benefit of the Peenuts formula on the White blood cell count of the Expressed Prostatic Secretion (EPS); a consecutive series of patients.....................606Appendix—40 Data regarding PSA variation following the use of the Peenuts Formula at varying intervals...................................................................................610Appendix—41 Data regarding the varying improvement of Voiding Symptoms with the continuous use of the Peenuts Formula of 6-12 months or longer...........................................615
Chapter One
Too Many Radicals ... Too Many Failures
When you hear the news that you have prostate cancer, what are you going to do? Rather than panic, you must accept the facts and begin the learning process. Your exit strategy from this dilemma will be to determine how your cancer will be managed. Proven treatment options range from a conservative management program of diet, wellness management, antioxidants and specific nutritional supplements we call chronic disease management (CDM) with no impact on your quality of life to radical surgery with a major impact. Deciding how you will treat your prostate cancer will become the single most important decision you will make for the remainder of your life. Ultimately, your decision must be acceptable to you and your family and be effective while minimizing undue risk, complications and side effects.
Prostate cancer is a disease that does not discriminate, wreaking havoc on all men irrespective of age, ethnicity, education, financial or social status. When it comes to the topic of prostate cancer, all men are equally ignorant, regardless of education (obviously excepting doctors who should know the topic better than the public at large). Prostate disease in general and prostate cancer specifically is the most common and dominant disease that men face, while representing a diseased organ that must be understood and dealt with by men of all ages. Often times referred to as a disease of healthy men, prostate cancer has no boundaries, no conscience and will strike most time with no warning other than an elevated prostate specific antigen (PSA) blood test. Your only defense is to become educated on the disease, get motivated and proactive. Your goal is to maintain an optimal PSA of less than 1.0 ng/ml. Many men who fail to heed this warning will pay the ultimate price with their lives. Many more will be spared but asked to endure a life of subtraction, losing many of the qualities from life that make being a man so special.
Statistics on Prostate Cancer
While prostate disease is arguably the number one health risk that men face, prostate cancer is the most prolific organ cancer that men acquire in their lifetime as well as the second leading cause of cancer death, behind lung cancer. One in five to six men will be diagnosed with prostate cancer in their lifetime. Prostate cancer occurs most often in older men. African-American men have a rate of prostate cancer that is twice their Caucasian counterparts. According to the American Cancer Society, an estimated 218,890 men will be diagnosed with prostate cancer this year while in excess of 27,000 men will die from the disease. This translates into a new case of prostate cancer diagnosed every three minutes while a man dies from the disease every 16 minutes of every day. With the baby boomer generation aging into their 50s and 60s, at 5,000 men per day; the expectation is for 50,000 men to lose their lives annually from prostate cancer by the year 2020. While men in their 60s or older experience the news that prostate cancer has been detected most frequently, data shows 30 percent of 30-year-old men will acquire the disease only to have their lives spared initially as the cancer incubates for upwards of 15 to 20 years before the impact is realized with a rising PSA blood test. When you decide to become motivated to learn more about this disease is your decision; what you learn about the disease and how you treat the disease is the heart and soul of this book.
Radical Prostatectomy—'Gold Standard' or Educated Guess
Historically, radical prostatectomy (total surgical prostate removal) has been the most common treatment offered and rendered when prostate cancer is diagnosed. The irony of treating the most prolific male cancer most frequently with radicalp rostatectomy is that the failure rate will be unacceptably high while essentially equal regardless of the approach utilized including the DaVinci Robot technique. While prostate cancer is being detected earlier, there is no convincing data to suggest a significant survival advantage of radical prostatectomy over brachytherapy (radioactive seed implants), as example, with or without external beam radiation, cryosurgery or a treatment strategy called chronic disease management (CDM) (refer to the CDM chapter for a comprehensive review of this concept). In other words, there is significant data to suggest alternative therapies like CDM may make a better first choice of treatment if overall survival is relatively unaffected by the specific therapy selected. Why should you undergo a major radical surgery with significant complications and side effects if it's not going to make a difference in your survival? You should not!
If 10 men with prostate cancer are lined up and evaluated, doctors cannot reliably predict who will ultimately be cured and who will fail. In my opinion, this is primarily due to a lack of discrimination regarding where the disease is actually located; principally, the extent of disease. Patients showing more favorable disease characteristics may have better survival rates, but the fact remains that we cannot predict the final outcome of treatment. Some patients with "good" cancers will perish of prostate cancer regardless of any treatment we can offer, and some with "bad" or very aggressive cancers may survive even with minimal treatment. Until we have better tools (or utilize better tools, not currently accepted) that allow us to make truly reliable predictions, the best we can say is that radical prostatectomy can possibly cure 60-70 percent of prostate cancer patients. To state more clearly, we can't accurately predict who will be cured and who won't be cured using our present diagnostic and treatment modalities. To be sure, regardless of our surgical skill level, the outcome and cure rate from major radical prostate surgery is unpredictable. This point is validated by Hendrick Isbarn, M.D. and collaborators at the University Hospital Hamburg-Eppendorf in Hamburg, Germany in their research published in the British Journal of Urology (International Edition) in 2009. Specifically, they found that the biochemical recurrence (BCR) rate for prostate cancer was 40% at 10 years. Unfortunately, this is an unacceptably high rate of prostate cancer recurrence; representative of all radicals performed worldwide, in my opinion.
So why is radical prostatectomy performed so often? While this is a great question, the answer is very elusive. We hear phrases like, "that's what I was trained to do," "it's the 'Gold Standard' in prostate cancer treatment," "and it's the only way that we can be sure that all of the cancer is gone" or "this procedure gives you the best chance for a cure." When a patient asks a doctor for his best recommendation and the only procedure he performs is a radical prostatectomy, what do you expect him to say? Even if the doctor also performs seed implantation therapy and cryosurgery but believes the radical approach is best for most patients; do not expect him to give a glowing endorsement for either of the other two choices. While doctors are supposed to be unbiased in their approach, it is difficult for most physicians to remain completely objective. It's not their fault. They are just expressing what they know based on their training and experience. The Hippocratic Oath states, "We must first do no harm." This should still be the starting point for any decision related to treatment of prostate cancer. Finally, remember that treating prostate cancer is also a business. The insurance industry rewards some treatments substantially more than others. Physicians are only human and will tend to be influenced by the very high financial rewards from the insurance industry for surgery or radiation therapy over conservative treatments that aren't reimbursed well. Furthermore, physicians may own shares of radiation therapy centers that are highly reimbursed by Medicare and most insurance companies. Even given their best intentions, it's hard for many physicians to be totally objective in their recommendations when they can earn $20,000 or more per patient by referring you to their radiation center.
Physician Practice Patterns
In a survey of more than 500 urologists reported on in the Journal of the American Medical Association (JAMA), the question was asked of urological surgeons; what approach should be taken with a 65-year-old male with a newly diagnosed prostate cancer associated with a Gleason score of 7 and a PSA less than 10 ng/ml? For those unfamiliar with the meaning of Gleason score, refer to the glossary and/or the pathology section of this book for a review. For those more familiar with the term, a Gleason score of 7 represents a moderate to poorly differentiated cell type, commonly encountered in approximately 30-35 percent of all cases of prostate cancer. To the surprise of no one, a traditional urology line of thought or 'party line' was endorsed by 90 percent of the urologists polled, thereby recommending a radical prostatectomy for this patient. While this opinion from a surgeon may come as no surprise, there is minimal documentation to support the strength of such an opinion.
In an effort to establish diversity of opinion, noting that doctors would only recommend what was best for the patient; radiation oncologists were asked their recommendation for the same patient scenario with the same cancer characteristics. The majority of radiation oncologists followed the dictum of their residency-training manual and recommended brachytherapy (radioactive seed implantation) or external beam radiation or a combination of both. Patients, who seek these professional opinions, must be mindful that it may be difficult to get a totally objective opinion from a physician who is biased based on how he was trained and how he practices. It is often said and bears restating; "If all you have is a hammer, it is amazing how everything begins to look like a nail."
In this imperfect world, the burden for an improved understanding of the disease and its various treatments, unfortunately, becomes the responsibility for each patient, individually; notwithstanding their lack of adequate education. This doesn't seem quite fair to the vulnerable patient doing little to diminish the anxiety experienced when the diagnosis is made. Based on a likely rush to judgment that is commonly experienced when the diagnosis of prostate cancer is made, patients are encouraged to become increasingly aware of the peril and consequences associated with prostate cancer treatment prior to the diagnosis, not after.
Taking the time to evaluate your options is supported by a research study performed at Johns Hopkins Medical Center. What they demonstrated is that while the diagnosis of prostate cancer must be taken seriously, a delay in treatment of months or even years may not change the course of the disease and the outcome. While this will likely depend on the specific characteristics of disease identified in a given patient, the news is nonetheless heartening as the task to fully understand the disease and the various treatment options is significant. It will take a concerted effort and ample time by all who choose to be well versed.
Better Imaging, Better Decisions, Better Results
This book intends to serve the many worried men with prostate cancer and their families as a fair and objective resource to help in understanding the disease you are now facing and the options available to you. By taking a fresh look at the available scientific information and explaining it in a new and unique way, it's our intention to help you make a truly informed decision about your treatment choices and ultimately about your future.
The true nature of the disease must be completely understood before any meaningful decision is made on how to proceed when the diagnosis of prostate cancer is made. While it is critical to determine the extent of disease in order to select the best treatment strategy, it is equally important to realize the severe limitations of our present diagnostic process based upon our current outdated imaging tools and biopsy techniques. For this reason, we are very excited about Magnetic Resonance Imaging with or without Spectroscopy (MRI or MRIS) discussed in more detail later and throughout this book. MRI performed with a 3.0 Tesla magnet or equivalent alternative may well be the best diagnostic modality for the detection of prostate cancer prior to a biopsy or to establish true organ confinement once the diagnosis of prostate cancer has been confirmed by a biopsy. Intuitively, imaging must be done before a biopsy (if a biopsy ever makes sense); not after. The 3 Tesla MRI, diagnostic modality provides the most accurate cancer imaging technology available. The outstanding image quality ensures the best chance for realistic decision-making leading to ultimate success. This scan, which we call the "Ultimate Prostate Scan," provides precision prostate cancer localization allowing us to determine whether the tumor is truly organ-confined prior to any proposed therapy. If organ confinement is not reliably established, the scientific data does not support radical surgical removal of the prostate. The MRI Scan provides a true road map of objective imaging excellence to validate cancer localization while spectroscopy, when utilized as an additional sequence, allows us to understand the biochemical components of the tissue in question. Together, these scan sequences are integral to changing the paradigm relevant to the diagnosis and subsequent treatment of prostate cancer.
Chronic Disease Management
Prospective study data associated with our research treatment protocol evaluated the benefit of diet and nutrition versus prostate cancer. The study, entitled, "Is it necessary to cure prostate cancer when it is possible," represented in the Journal, Clinical Interventions in Aging, supports the concept of allowing men the opportunity to live with prostate cancer much like patients would live with diabetes or arthritis rather than undergo surgical organ removal or radiation. If men decide later to attempt to cure the disease with surgery or radiation, their chance of success should not have been significantly diminished by the delay. In other words, taking our time to evaluate all issues related to the diagnosis and treatment of prostate cancer allows us to avoid a rush to judgment. Quite frankly, by delaying the definitive decision making, anxiety is reduced and the advantages and disadvantages of every therapy can be studied in more detail and become better known. You cannot fully appreciate the consequences of your treatment decision until you completely understand the lifestyle you will have to accept when the choice is made.
The key to the success of our research treatment protocol relates to the ability to suppress or resolve the signs and symptoms of inflammation (non-bacterial prostatitis) through diet and a prostate-specific patented dietary supplement we developed called Peenuts®. This formula represents a unique and synergistic blend of vitamins, minerals, herbs and amino acids. Its special ability to reduce prostatic inflammation has been scientifically validated by improvements in white blood cell counts (a universal sign of inflammation) associated with the prostate secretion or expressed prostatic secretion (EPS) obtained at the time of digital prostate exam, as well as a decrease in PSA levels, given its success with widespread use as a stand-alone treatment for prostatitis. While diet plays an important role, the road to success without surgery or radiation requires optimizing all of our dietary and nutritional resources to fight the cancer. This will become quite apparent once you have reviewed the dietary and nutritional sections of this book.
In our prospective study, mentioned above, 30 patients with known prostate cancer were evaluated over an average time frame of 49 months. During this time, their only treatment was dietary modification and our scientifically designed prostate anti-inflammatory supplement Peenuts®. By the end of the study, 28 out of the 30 patients noted a marked improvement or decrease in their PSA levels (the recognized marker of prostate cancer disease activity) averaging 55 percent. This degree of improvement is truly remarkable and has never been reported before in such a large study group without using hormonal therapy, surgery or radiation. While we are certainly pleased with the outcome, we were not really surprised, as we have noted similar significant improvements in thousands of patients over the years while using this supplement. This concept of nutritional optimization and chronic disease management has not been studied adequately as it has never received priority funding. It is our hope that visionary philanthropists who understand and embrace our beliefs, will come together to provide the capital necessary to validate our research as well Study (PROCAP Trial), touched on above, will be described in this entirety in the Appendix.
(Continues...)
Excerpted from MEN AT RISKby Ronald E. Wheeler Copyright © 2012 by Ronald E. Wheeler, M.D.. Excerpted by permission of AuthorHouse. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
