Prostate Cancer

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Background

It is estimated that 50% to 70% of men over age 80 have histologic evidence of prostate cancer, but the majority will never develop symptoms, as many tumors are very slow growing and other comorbidities may intervene. 

African-American men have the highest incidence of prostate cancer in the world.

High dietary saturated fat intake is a risk factor and is crudely estimated to account for 10% to 15% of geographic differences in incidence. In contrast, genistein, found in soy, is believed to be protective.

Screening

U.S. Preventative Services Task Force (USPSTF) and Canadian Task Force on Preventative Health recommend against PSA-based screening for all ages of men.

American Urological Association (AUA) - Patients aged 55 to 69: Shared decision-making is recommended.  The patient should be fully informed on the risks and benefits of screening and treatments. PSA testing is not recommended for men under age 54 or over age 70 with less than 10 to 15 years of life expectancy

High false-negative rate: More than 20% of patients with prostate cancer have normal PSA levels. High false-positive rate: 30% to 50% of patients with BPH have elevated PSA levels.

Biopsied tissue will be given a Gleason Score (a measure of how differentiated the cells are).  The higher the Gleason score, the poorer the prognosis.

For patients with a PSA between 2.5 and 10, we offer the PCA-3 Urinary test. At time of writing we are the only private clinic in Edmonton offering the PCA-3. Prostate cells are recovered from the urine; abnormal cells can be identified and cancer-specific genetic material measured to help identify which patients will benefit from a biopsy. A urinary PCA3 level >35 resulted in nearly 40% of men having prostate cancer found on biopsy. Free PSA is another option.

In patients on finasteride or dutasteride, the serum PSA level is decreased and must be multiplied by two to obtain the real total PSA level

Active surveillance is used in men with a diagnosis of prostate cancer but who have decided not to undergo any active treatment (can be considered in men with low-volume, low-risk cancers) followed with PSA values, direct rectal examinations, and periodic biopsies.

Watchful waiting is generally used in a patient who has been diagnosed with prostate cancer but with significant comorbidities that would preclude active treatment interventions. Standard treatment are instituted when symptoms develop.

With either Active Surveillance or Watchful waiting we typically intervene with a protocol to keep the PSA supressed which can be oral, IV or both. We typically requisition PSA periodically to monitor our treatments specifically.

Hormonal treatment

Hormonal treatment, either by chemical androgen deprivation or orchiectomy, remains the usual choice in patients with metastatic disease; a common medication is leuprolide (Lupron) androgen flare is common phenomena we’ve seen which is an initial worsening of symptoms. Interestingly, this class of medications can cause menopausal-type symptoms. Vitamin E and Black cohosh are favorites we like to try to offset the hot flushes or we may refer for acupuncture. Vitamin D is also helpful to offset the chances of osteoporosis.

Surgery

Radical prostatectomy is usually recommended in young patients with localized disease but may result in erectile and urinary problems in some patients. To reduce risk of metastasis at any point of prostate cancer treatment but especially after prostatectomy and biopsy, we always add in modified citrus pectin (MCP). In a small study men with prostate cancer giving MCP orally prostate-specific antigen doubling time increased (progression slowed) in seven (70%) of 10 men after taking MCP for 12 months compared to before taking MCP.

MCP reduces PSA increases

Radiation

Brachytherapy (radioactive seed treatment) rival survival rates with radical prostatectomy and external beam radiation in patients with low-risk disease. External beam radiation is used for high-risk, localized disease. It is associated with altered gastrointestinal function and therefore naturopathic supports will be tailored to the patient in question depending on the damage sustained. However, we do usually add in radiosensitizers such as curcumin that can improve efficacy of the radiation while protecting healthy tissues.

Chemotherapy

Docetaxel is the treatment of choice for patients with metastatic castration-resistant prostate cancer; but chemotherapy in not typically used in prostate cancer. Docetaxel is judged compatible with IV-vitamin C and we are familiar with Docetaxel primarily because it is commonly used in breast cancer; there are many interventions that can safely offset the side effects of docetaxel without reducing efficacy.

Diet

Regardless of the standard treatments chosen we always recommend reducing saturated fat and animal fat levels in the diet and supplementing with a few tablespoons of flax seed or flax oil daily. Flaxseed supplementation in clinical trials is associated with biological alterations that may be protective for prostate cancer. We also suggest organic fruits, vegetables and meats as hormones in foods (xenoestrogens) can affect prostate cancer growth. However, soy appears to be protective despite estrogenic activity.

Advanced Treatment: Metabolic treatment

Our approach to prostate cancer can take different avenues.

At our Edmonton clinic, we do eight to twelve week trials of therapies with sequential PSA measurements requisitioned by us, to assess efficacy of treatment.

Based off of two successful case reports using a metabolic approach to cancer treatment we try and incorporate metabolic strategies into our prostate cancer protocols. One case report showing a rapid decrease in PSA with IV Alpha Lipoic Acid (with hydroxycitrate orally) demonstrate proof of concept of the metabolic approach in prostate cancer.

Our starting approach for most of our prostate cancer patients is the "metabolic approach." Agents such as ALA, Garcinia/Hydroxycitrate are often used in this treatment strategy. We have seen the most rapid PSA response using this approach above all of our other available therapies.  

Often times, we include oral hormone modulating strategies in our prostate cancer protocols alongside intravenous interventions. For instance, a broccoli extract called Indole-3-Carbinol is an effective way to reduce the action of estrogens and therefore estrogenic stimulation of prostate cancer cells. Its use has been demonstrated in tandem with green tea extract and saw palmetto in human prostate cancer patients. It can easily be incorporated along with alternative IV interventions.

Advanced Therapies: IVC and wormwood

Artesunate also appears to have activity against prostate cancer therefore a plausible combination we’ve used is Artemesinin (parent compound) and IV Vitamin C which have synergistic action. A human case report demonstrated effective PSA reduction from the combination of Artesunate and bacalitumide (an anti-androgen medication).

Our clinical experience suggests some efficacy of IVC in prostate cancer which is corroborated with data from a 2012 journal article. A 2015 study demonstrated tolerability of high dose IVC (60g) ten patients with metastatic prostate cancer over 4 weeks but efficacy was not commented on in this article. However, IVC was demonstrated to have PSA reducing effects in an analysis of 45 patients from the Riordan Clinic. Fifteen of twenty subjects, showed reduced PSA levels during IVC treatment.

However, in a 2017 clinical trial 20 castration resistant prostate cancer patients were evaluated for efficacy of IV Vitamin C after 12 weeks of treatment. The mean baseline PSA level was 43 µg/L. A median increase in PSA was found amongst these patients. For this reason we often start with a "metabolic approach" to prostate cancer as this has demonstrated rapid psa decreases in responders at our clinic.

PSA reduction from IV Vitamin C

Do You Have Questions?

Call Us 780-757-8378