Prostate Health (cont.)

I would say for most patients, five or ten years is not uncommon and it could be even quite longer. Again, it has to be individualized and it can be short depending on the aggressiveness of the cancer, where it's coming from, and the general health and immune status of the patient.

MEMBER QUESTION:
Why would a urologist choose hormonal therapy as opposed to chemotherapy? What goes into the decision-making process as to choosing a therapy?

MARKS:
Each therapy has its pros and cons and we know which therapies are most likely to be effective and which ones have a lesser chance for effectiveness. We also look at the side effect profile.

We have known for many, many years that when we drop the testosterone level to castrate levels, which is less than 20, that the vast majority of prostate cancers stop growing and many will actually shrivel up. This is an extremely effective treatment with the side effects being mostly nuisance side effects, very few really serious side effects. Because of that hormone therapy is usually the primary treatment for advanced disease.

Chemotherapy for many years was not very good for prostate cancer and only recently has been shown to be effective in certain cases. What I like to do is initiate the hormone therapy, be as aggressive as we can with that, and try to include the medical oncologists to talk to us about whether or not they think that adding on chemotherapy will be a benefit. The down side to chemotherapy is it's basically a growth poison; it's designed to kill rapidly growing cells at critical points in the growth cycle. Because of that, there's a potential for significant side effects and a potential for serious damage to the immune system. So chemotherapy is not to be taken lightly.

Because hormone therapy is so effective and chemotherapy is less effective and has more side effects, hormone therapy is usually the No. 1 treatment. Sometimes we add on chemo, sometimes we wait. I think that with current advances, I like to at least involve chemotherapy discussions early on.

"I think that an annual PSA, an annual exam, a healthy diet and lifestyle choices are the best chances for living a long, healthy life."

MEMBER QUESTION:
Do you have any recommendations for nutritional supplements or vitamins to use for the prevention of prostate cancer? I've read articles about saw palmetto and soy protein for men.

MARKS:
This is a common question as to what supplements men can take. Before we get into talking about supplements, I'd like to emphasize that we're going to be talking about just that - supplements. Not something that's designed to replace an intelligent lifestyle and diet, but something designed to supplement and augment an intelligent lifestyle and diet. So it's essential that people not smoke, that they only drink in moderation, they get regular exercise, sleep, a little bit of sunshine every day, and they eat a general well-balanced diet.

The good news is that diets that are proven to be beneficial for the heart, such as a southern Mediterranean diet or a rural Asian diet, have also been shown to be very beneficial in preventing prostate cancer and even in treatment of prostate cancer. So assuming the man is behaving well, he is not abusing his body with chemicals and drugs and he is eating a good balanced diet, high in colorful fruits and vegetables, low in animal fat and dairy fat, then there are indeed some supplements that have shown to be beneficial.

The first one is selenium. The official recommendations of the government tend to be significantly lower than what most experts believe. Most experts are currently recommending 200 micrograms a day of selenium. This is something that in the old days was in the soil absorbed by the plants and we got it through our food. But now with controlling the water and the silt from the soils and with artificial fertilizers, we find that the diet we have tends to be very low in selenium, especially in the Northeast, the South, and the Northwest. If you supplement your diet with one selenium a day, there are many experts that feel strongly that this can dramatically reduce your likelihood of developing not only prostate cancer but colon and lung cancer. Selenium is also suggested to strengthen the heart, boost the immune system, and to slow down the damage from aging. It's shown to be a very powerful and fairly safe supplement when used intelligently. Obviously, high doses can be very toxic as with almost anything that we take so just because one is good does not mean 27 are great.

Another supplement that's been shown to be very good is vitamin E. The problem with vitamin E is that there's potential for side effects with it. Nobody should be taking the supplements without talking to their doctors first. There are some concerns about vitamin E and heart risks. Assuming your doctor gives you clearance, vitamin E, the natural version, the d-alpha, not dl-alpha, may be very beneficial as well.

We usually suggest that men also take a multivitamin with trace minerals as part of their daily regimen. In addition to that, some men like to supplement their diet with a variety of fruit and vegetable extracts such as lycopene which comes from tomatoes or saw palmetto, which really is designed mostly just to shrink the prostate, it doesn't have an impact on cancer. Some men will also use green tea extract or red grape extract.

Again, the ideal form of most of these supplements would be the natural foods and not so much the pills you buy at the store. These, in combination with a healthy lifestyle and a well-balanced southern Mediterranean diet or rural Asian diet, are the most important factors.

MODERATOR:
What do you see in the future for prostate health?

MARKS:
I think that probably we're going to find that we can detect these cancers significantly earlier in life, and we'll be able to tell which cancers are going to be a threat and which ones aren't. In addition, with the advances in radiation that we have, with the IMRT, with the chemotherapy advances, and most importantly with the vaccine therapies, what we're going to have probably is when a man is diagnosed with a cancer, they are probably going to be some treatment where they will basically stimulate the man's own immune system to identify and kill off all the cancer cells -- hopefully eliminating the need for surgery and radiation and more aggressive treatments with higher side effect profiles.

MODERATOR:
Doctor, we're almost out of time. Before we wrap things up for the day, do you have any final comments for us?

MARKS:
I would just like to encourage everybody to look at the big picture, to pursue a healthy lifestyle with a healthy diet, and to see their doctor on a regular basis and ask for the exam and the PSA.

There are some out there that say that the PSA has the potential for problems because it doesn't always guarantee that there's cancer and that is right. But I look at it that I'd rather have more information and determine what's relevant and what's not than to not have the information and hope that things are fine.

I think that an annual PSA, an annual exam, a healthy diet and lifestyle choices are the best chances for living a long, healthy life.

MODERATOR:
Our thanks to Sheldon Marks, MD, for joining us today. Thank you so much, Dr. Marks.

MARKS:
My pleasure. Thank you for having me here.



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