Originally published in Alternatives, Vol. 13, No. 2, August 2009; Used with permission.
If you knew with almost 100 percent certainty that you would develop a potentially lethal disease in the upcoming years, what would you do today? To be even more specific, what if the disease were cancer? I would hope and pray that you would immediately take steps to prevent it.
If you are male, and live long enough, your risk of developing prostate cancer actually does approach 100 percent if you do nothing to prevent it.
I met up with a long-time, very close friend of mine a couple of weeks ago. I hadn't seen him in almost a year. I didn't want to pry into his personal matters, but I noticed he seemed to be making numerous trips to the bathroom during our visit and I asked if he was having any problems in that area. Sure enough, he had all the symptoms of BPH (benign prostatic hypertrophy): difficulty initiating a urine stream, interrupted and weak urine stream, more frequent urination, sudden strong urges to urinate particularly at night, et cetera.
It's only fair to say that, in and of itself, BPH isn't cancer. Rather, it's an enlargement of the prostate gland that can be triggered by age-related hormonal changes. As men age, their testosterone levels begin to wane and the testosterone-to-estrogen ratio decreases. Animal studies suggest the estrogen increases the activity of compounds that promote prostate cell growth. We also begin to accumulate a compound called DHT (dihydrotestosterone), which encourages the growth of prostate cells.
(You may remember that DHT is one of the factors responsible for male pattern baldness. It appears that some men have an inherited predisposition for hair follicles to shrink in the presence of DHT. Much of the research in preventing male baldness has been focused on the use of inhibitors or compounds that block the conversion of testosterone to DHT.)
It's important to keep in mind that many men with an enlarged prostate have very few, if any, symptoms for a long period of time.
I also need to point out that, although the two conditions have many of the same symptoms and can exist concurrently, the consensus is that having BPH doesn't increase your risk of developing prostate cancer. Although I can't support my idea with mountains of research, I can't help but disagree; chronic inflammation (BPH and/or prostatitis) could be a significant contributing factor in prostate cancer. Oncologists will tell you that inflammation or prostatitis is present whenever they see cancer.
Known risk factors include the incidence of prostate cancer in immediate family members (heredity), race (blacks in this country have higher rates than whites), hormone changes, and exposure to environmental toxins. But age seems to be the primary factor. The longer you live, the greater your odds of developing the cancer.
The test that fails
Years ago, I discussed the failure of the PSA (prostate-specific antigen) test for detecting prostate cancer.
The PSA test was developed in the early 1980s. Later, with endorsements from several celebrities and a major marketing propaganda effort, PSA testing became widespread, even though there was no legitimate research to support the idea that early detection and treatment did anything to save lives. The number of diagnosed cases of prostate cancer skyrocketed in this country.
European countries didn't adopt the PSA screening programs, because of the lack of supporting research that it actually saved any lives. Unlike in this country, their incidence rates stayed the same – and, not surprisingly, our mortality rates are still about the same as theirs.
The PSA test measures a protein that the prostate produces when it's inflamed. Although the initial research only suggested that higher PSA levels might be connected to prostate cancer, there is an ever-growing amount of research to suggest that higher PSA levels are more closely linked to an enlarged prostate and the associated inflammation than to prostate cancer. This fact, however, hasn't stopped the unnecessary treatment of hundreds of thousands of men for prostate cancer.
The cancer is often benign
The results of two very recent studies, published in the New England Journal of Medicine, shed more light on what I talked about years ago: Prostate cancer screening with the PSA test has led to some very questionable outcomes and a long list of testing victims.
One of the NEJM studies was actually a review of seven different European studies involving 162,243 men ages 55 to 69. One of the top oncologists in the world, specializing in the study and treatment of prostate cancer for over 20 years, Dr. Otis W. Brawley, said these studies were “some of the most important studies in the history of men's health.”
The review found that, using PSA screening tests, 1,410 men would need to be screened regularly for ten years and 48 additional men would need to undergo totally unnecessary cancer treatment to prevent one death from prostate cancer (N Engl J Med 09;360:1320–1328).
To make these results easier to understand, try considering them this way. Let's say you have no symptoms but get your yearly PSA cancer screening test. An elevated PSA level leads to a biopsy showing you have prostate cancer and you are subsequently treated for it. There is roughly one chance in 50 that, between now and 2019 or later, you will be spared death from a cancer that would have killed you. But there's a 49 in 50 chance that you would have been treated unnecessarily for a cancer that was never any threat to your life.
Dr. Brawley, who is currently a director at the National Cancer Institute and the chief medical officer of the American Cancer Society, summed up his feelings about this study by saying, “The test is about 50 times more likely to ruin your life than it is to save your life.”
There's a fortune being made with PSA testing, even though early screenings of this type and early treatment haven't been shown to save lives. This is simply because not all prostate cancers need to be treated. Studies have shown that at least one-third of those men diagnosed with the cancer by PSA and then “cured” by treatment would have never otherwise even known they had the disease, or been affected by it, and would have eventually died of some other cause.
The treatments are seldom benign
The second US study recently published in NEJM involved 76,693 men, roughly half of whom received yearly PSA testing. When the researchers compared the two groups, those who were “diagnosed early” with PSA tests had basically the same rate of death due to prostate cancer as those who had never had the test (N Engl J Med 09;360:1310–1319).
Another very interesting finding from this study wasn't widely reported for some reason.
The treatments being used for prostate cancer involve everything from radiation and administration of hormones to surgical removal of the entire gland. The side effects are far from minor. The long list includes such things as impotency, urinary problems, bowel problems, penile shrinkage, infertility, gynecomastia (breast enlargement), and hot flashes. Any one of these can dramatically lower one's quality of life. The emotional and social aspects alone take a toll on one's personal relationships and severely limit activities. And the treatment itself can be fatal.
Researchers found that, in the PSA screening group, 312 men with prostate cancer died from causes other than the cancer, versus only 225 in the unscreened group. Commenting on the much larger number of deaths in the PSA screening group, the researchers stated it was “possibly” due to the treatment of non-progressive cancer. In other words, it “could” have been the fact that treating cancers that didn't need to be treated killed many of those men.
Even though we know that the PSA test isn't a reliable test for cancer, at this point it's almost considered malpractice for a doctor not to have the test performed for men who have any of the symptoms I mentioned earlier. It's the recommendations based on PSA test results that become a real concern.
If you don't have any prostate symptoms, then I would strongly recommend against having a PSA screening test. For the last couple of decades the PSA test has been marketed to both doctors and patients as the means to early detection and the way to save lives. Only rarely after a positive PSA test, a positive biopsy, and any other test that indicates the presence of cancer, do men ever adopt a “wait and see” philosophy – the clinical term is “watchful waiting” – despite the fact that PSA tests aren't indicative of cancer. (Even the developer of the test, Dr. Thomas Stamey, now says it is a sign of inflammation – not necessarily cancer.)
Most doctors immediately recommend biopsies if PSA levels are elevated, even though false positives are very common. And in the unlikely event that a man actually does have prostate cancer, the biopsy itself can generate problems. First, they're very much a hit-or-miss situation; small cancers confined to various areas of the prostate are routinely missed. And in the event that a cancer is present, and the biopsy needle does locate it, individuals are facing a second threat. I've reported on the various studies showing how removing cancerous tissue with biopsies can lead to the spread of cancerous cells into the bloodstream through needle trails or other means. Prostate cancer that stays confined within the prostate is far less of a threat than one that has metastasized or spread to other areas of the body. [Editor's note: For more about the dangers of biopsies of any type, and how to protect yourself, visit the Subscriber Center of the Alternatives Web site, www.drdavidwilliams.com.]
And when cancer is found, most men proceed to the next step of treatment, regardless of whether the cancer is confined and non-threatening or fast-growing and lethal. PSA testing can't distinguish between the two.
You'll notice that nowhere here have I written anything about specific PSA levels. There are two reasons behind that intentional omission. First, as I've stressed and will continue to stress, the test is useless for its intended use: detecting prostate cancer early and so saving lives. Second, individual readings can vary depending on any number of factors, including your overall health.
With that said, there is a perfectly good use for the PSA test, and that is to track the results of any current therapy. A man with diagnosed prostatitis or BPH will likely be able to tell how well a therapy is working long before any test shows a change, but having a number to track does provide some measure of comfort.
When it isn't cancer
Remember that PSA is an indicator of inflammation. The higher the level, the greater the inflammation present. If the cancer hasn't formed, the inflammation and associated prostatitis or BPH can be treated naturally.
Prostatitis is simply any inflammation of the prostate, regardless of the cause. Obviously BPH can create inflammation, but so can infection.
Symptoms include all those common to BPH, plus the possibility of pain behind the pubic bone during urination or ejaculation; pain anwhere else “down there”; pain in the lower back or hips; impotency; bowel irregularity; and recurrent urinary infections.
Inflammation in the prostate, no matter what the cause, can inhibit the flow of prostate fluids – a condition called prostate congestion. Typical treatment for prostatitis includes a course of antibiotics. This treatment is seldom successful, likely as a direct result of the congestion. (Antibiotics need to circulate freely to reach the site of infection.)
A very effective treatment for prostatitis is prostate massage, which is exactly what it sounds like: physical manipulation of the prostate gland. This technique is consistently overlooked by even knowledgeable urologists, so it's becoming more and more difficult to find old-time practitioners who remember how to perform it. [Editor's note: To learn more about the benefits of prostate massage, visit the Subscriber Center of the Alternatives Web site, www.drdavidwilliams.com.]
This condition may be benign, but it can certainly be bothersome. Several nutrients can help relieve an enlarged prostate. None of these are news, but I thought it would be a good idea to review some of them here.
Saw palmetto is the reliable standby for prostate health. Research going back 25 years supports the use of 160 mg twice a day to provide symptom relief: improved urinary flow, reduced nightime urination, decreased feelings of urgency, et cetera. Interestingly, saw palmetto doesn't affect PSA scores. This is likely because it isn't working as an anti-inflammatory, but at the level of hormone regulation by blocking DHT formation.
Pygeum is another supplement with plenty of evidence behind it for prostate support. Pygeum does work against inflammation, by limiting the ability of cholesterol to enter the prostate and convert into inflammatory compounds known as prostaglandins. The dose used in much of the research is 100 mg taken twice a day.
Flower pollen is much less well known for relief, but it's no less effective. Studies performed in the late '80s showed that the pollen of the flowers from rye grass produced results significantly better than those from a placebo. More than twice as many men felt that their symptoms had improved, residual urine in the bladder was less (meaning that each “session” was more effective), and ultrasound measurements showed that the flower pollen substantially reduced the size of swollen prostate glands (Br J Urol 90;66:398–404).
Every man should be on a good prostate product for life. The whole idea is prevention, and if you can stop the inflammation and other symptoms that I believe can eventually lead to cancer then the time to act is right now. It makes me wonder how many men could avoid the slippery slope of PSA testing that generally leads to biopsies, radiation, surgery, or other potential nightmares when they could have avoided these issues by stopping the inflammation naturally. The nutrients I just mentioned are available in a variety of prostate products, including Pollen Aid, from www.americasnutrition.com or 800-270-9593; Prostate Care, www.healthychoicenaturals.com or 800-985-2808; and Healthy Prostate, from Mountain Home Nutritionals, www.drdavidwilliams.com or 800-888-1415.
When it really is cancer
If you're diagnosed with prostate cancer it's important to know if it's localized or has spread. Talk to the most knowledgeable doctor you can find. Observational therapy (the “watchful waiting” approach) is the first option you should discuss. Prostate cancer may be the second leading cause of cancer death in men (behind lung cancer), but it still causes only 3 percent of all deaths in men. That means you have a 97 percent chance of dying from something else. If the doctor has a different opinion on what might be best for you, then by all means listen, but also make them explain their reasoning.
When the disease is extensive, aggressive, or fast-growing, treatment is warranted. Over the years I've discussed various effective natural therapies to address prostate cancer, but the best, most effective one I've seen so far is an herbal combination called HP8. This product combines herbs in a way that takes into account their various interactions and maximizes their overall effect. It's available from The Harmony Company, at www.theharmonycompany.com or 888-809-1241.
In response to my April 23rd Health Dispatch, I received a number of e-mails from men saying that their lives had been saved because, after a PSA test, they had received therapy to address a diagnosed cancer. To those men, I'll say that you may have been among the one in 50 who do benefit from PSA testing. Or, maybe not. What physician or surgeon would recommend and implement cancer therapy, with all its potential side effects, then say afterward, “Maybe you didn't need this after all.”
Be a thoughtful patient
PSA screening is controversial, to say the least. I warned about it being more of a cash cow than a viable diagnostic tool for cancer as far back as 1992. The backlash I received at the time was unbelievable. I suspect more of the same now, since PSA testing has become more of a religion than something based on hard, scientific evidence that it actually saves lives.
The source of this faith in the test is somewhat puzzling to me. It's interesting to note that by 1998 all major organizations, including those who previously recommended PSA screening, had reassessed the scientific data and no longer recommended screening. Even the National Cancer Institute has a Web page that discusses the shortcomings of routine screening.
And while in this country we do spend more than a billion dollars a year on PSA testing, that's chicken feed to the institutions and corporations that make up the medical-industrial complex. Still, we need to spend more efforts first in prevention through natural means and then on ways to better determine exactly which cancers are aggressive and fast-growing and actually need treatment. Unnecessarily treating hundreds of thousand of cases is not what needs to continue.
The decision to participate in PSA screenings when you have no prostate symptoms is obviously a personal one. If you have no symptoms and don't have cancer, I strongly suggest avoiding mass PSA screenings – and whatever you do, immediately get on a preventive/supportive prostate product and stay on it for life. In a recent interview, Dr. Brawley was asked his own PSA level and when he started taking PSA tests. His response was that he had never had a PSA test and didn't desire to have one. Despite the fact that he had several relatives with prostate cancer, and he is black, both of which put him at an increased risk, he just didn't believe the accuracy and benefits of the tests outweighed the downsides.
We've been led to believe that all forms of cancer kill and the earlier we can find it and treat it the better the odds of staying alive. That's not the case with the large majority of prostate cancers. In the case of prostate cancer, the odds of causing serious health problems (possibly even death) from the tests and the early treatment are far greater than the odds of actually dying.