THE HYPERTEXT GUIDE TO PROSTATE CANCER
ADVANCED CANCER
So far, there are no cures for advanced cancer. Once it has escaped, prostate cancer spreads to the bones and to other organs (metastasizes). These secondary tumors can cause changes in the bones that will weaken them or, by pressing against nerves as they grow, cause pain. It can, however, be slowed down, and pain can be relieved (palliated).
HORMONE THERAPY
Hormone blockade is the use of drugs to suppress testosterone, and it has the effect of temporarily slowing tumor growth. It is usually the first line of treatment if the cancer has escaped the prostate.
RADIOTHERAPY
Although radiotherapy does kill cancer cells, its use in terminal patients is basically palliative. Most pain is caused by pressure-causing tumors. Radiotherapy, either by external beam or injections of radioisotopes, kill those cells and reduce the pressure.
Vitamins and Radiotherapy
Dr. Rudolph Salganik, in a report to the annual meeting of the American Society for Cell Biology (December 1999), pointed out that “Almost all anticancer drugs kill cancer cells by way of apoptosis, and antioxidants like vitamin A and vitamin E dramatically reduce in cancer cells.” He suggested that patients avoid taking any more than a normal amount of these vitamins during, and for a while after, radiation treatment. However, review of 100 studies on the subject of antioxidants and chemotherapy was inconclusive. J Clin Oncol. 2004 Feb 1;22(3):517–28 PMID: 14752075
CHEMOTHERAPY
Cytotoxic (cell-killing) drugs are used to slow the growth of metastatic cells or alleviate symptoms caused by tumor growth. Chemotherapy is usually not given to until hormone blockade has failed, and is then given as a palliative treatment. Patients generally remain in the hospital during the first few doses of chemotherapy so that the staff can monitor them for side effects (there can be many). Following that, it becomes an outpatient procedure.
CANCER AND NUTRITION
Malnutrition is common in patients with advanced cancer. Some develop anorexia (the loss of appetite or desire to eat), others develop, which causes a loss of muscle and weight. Cancer patients do not have the same nutritional requirements as others do, and the effectiveness of their treatments depend in part on that.
Vitamins and Chemotherapy
Chemotherapy increases the levels of free radicals, which are essential in damaging the DNA of cancer cells. Antioxidants protect the DNA of cells from free radicals produced by the body. Yet many prostate-cancer patients take such antioxidant supplements as vitamins C and E, and selenium—often in amounts considerably above 100% of the Recommended Daily Allowances (US RDA). Clearly, there is a conflict for those who begin chemotherapy.
Dr. Rudolph Salganik, in a report to the annual meeting of the American Society for Cell Biology (December 1999), pointed out that “Almost all anticancer drugs kill cancer cells by way of apoptosis, and antioxidants like vitamin A and vitamin E dramatically reduce in cancer cells.” He suggested that patients avoid taking any more than a normal amount of these vitamins during, and for a while after, radiation treatment. However, a review of 100 studies on the subject of antioxidants and chemotherapy was inconclusive. J Clin Oncol. 2004 Feb 1;22(3):517–28 PMID: 14752075
The best course is to consult your oncologist well before treatment begins. Explain which vitamins, herbs, and other supplements you have been taking and let the doctor decide.
RESEARCH
CLINICAL TRIALS
Many of the advances in cancer treatment are made through clinical trials done to evaluate new drugs or treatments. Clinical research trials are not informal experiments. They must first be approved by an Institutional Review Board.
TYPES OF CLINICAL TRIALS
PHASE I: Dosage. Held to determine how much of a drug or other treatment can be given safely.
PHASE II: Tumor Response. Held to determine how a specific treatment or combination of drugs or treatments affects a tumor and to be sure that the treatment can (and should be) taken to phase III.
PHASE III: Comparison. Held to assess effectiveness. A large number of patients are divided into groups that receive traditional treatment and the treatment being studied.
SIDE EFFECTS
COMPLEMENTARY and ALTERNATIVE METHODS
Each year, Americans spend several billion dollars more on alternative and complementary therapies than they do on regular medicines. Smart Money, April,1999 This is particularly true of cancer patients, and it can put their lives in danger.
Which one is it? It is a common mistake to believe that these are two names for the same thing. An alternative therapy is promoted as a cure with no scientific evidence to support the claim. An example is shark cartilage. A complementary therapy is one that is used to complement or supplement a medical treatment. An example is biofeedback to regain control of pelvic muscles following prostate surgery.
Check with your doctors before you do anything. A survey by researchers at the University of Virginia found that 43 percent of men with prostate cancer were using some form of alternative medicine. The most striking revelation of this study was that three-quarters of them had not mentioned it to their doctors. Cancer 1999;86:2642-2648 Another researcher, from the University of Pennsylvania, reported that only 13 of 196 cancer patients interviewed mentioned using an alternative therapy. Yet, when asked about specific treatments, it turned out that 79 were using other therapies. American Society of Clinical Oncology meeting,1999
Dangers. What many patients fail to understand is that it can be very dangerous to mix treatments. Supplements of any sort may affect the levels of things physicians use to monitor the progression of prostate cancer. For example, both saw palmetto, a popular herbal supplement, and Propecia, a prostate drug that is cross-marketed as a hair-restoration product, can lower your PSA, leading to errors in assessing your cancer. Another popular herb, St. John's wort, which is believed to act as an antidepressant, can be dangerous when taken at the same time as a pharmaceutical antidepressant, such as Zoloft or Prozac.
Reliability. Another part of the problem is that the companies that sell these remedies claim that their products can treat or cure diseases even though such statements are not legal. JAMA. 2003 Sep 17;290(11):1505–9 PMID: 13129992 Moreover, herbal remedies are not regulated by any federal agency nor are they required to list the ingredients of their products.
PRACTICAL MATTERS
In addition to dealing with the pain and the mechanics of treatment, patients with a terminal disease must also deal with many emotional and practical problems. These pages deal with such needs and concerns as coping with cancer, caring for loved ones, living wills, advance directives, financial and legal matters, and useful programs and services.
Copyright © by
Bill Dyckes 1997-2004.
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