ENCOUNTER WITH PROSTATE CANCER

How to Increase White Blood Cells | eHow.com

2011-04-13T00:17:00.000-07:00

How to Increase White Blood Cells | eHow.com

Eat the right vegetables. Certain varieties of vegetables help increase white blood cells more than others. These include broccoli, cauliflower, spinach, pumpkin and carrots.

Read more: How to Increase White Blood Cells | eHow.com http://www.ehow.com/how_5139714_increase-white-blood-cells.html#ixzz1JNwfOBA1

Diet and Food for Better Blood Counts - Caring4Cancer

2011-03-31T06:15:00.000-07:00

Diet and Food for Better Blood Counts - Caring4Cancer

Diet and Food for Better Blood Counts

This article addresses a thoughtful question that was submitted by one of our website participants. This person asked, “What types of food or diet is best for improving blood counts?” This is an excellent question, because low levels of certain types of blood cells can be a side effect of cancer treatment for many people.

Blood Counts

“Blood counts” or Complete Blood Count (CBC) refers to tests that examine the types and numbers of cells in the blood, especially red blood cells, white blood cells, and platelets. Healthcare professionals are interested in blood counts because if they drop too low, a person may become more susceptible to infections and other possible complications of cancer treatment.

Your health care team has several medical options for managing low blood counts and you should talk to your doctor if you have questions about these options. As well, you can learn much more about Blood Counts, by reading our information on Diagnosis & Testing Complete Blood Count (CBC).

In addition to medical options, good nutrition should play an important role in helping your body recover and stay healthy during and after treatment. Read on to learn how good nutrition can help you.

Food vs. Nutrition

There aren't any specific foods that are proven to improve blood counts. However, good nutrition overall absolutely is proven to help your body heal and help your blood counts recover as quickly as possible during cancer treatment. Getting good nutrition during treatment is proven to improve quality of life, decrease fatigue, decrease the risk and severity of mucositis (mouth sores) and hand foot syndrome (plantar-palmar toxicity or peeling, itching hands and feet), decrease treatment breaks, and ensure that you are able to receive your prescribed cancer treatments on schedule (1-15).

Weight Matters

One of the single most important things you can do during cancer treatment to help your body heal and to help your blood counts recover is to avoid losing weight. If you think about this a bit, it makes sense.

Weight loss occurs when you are eating fewer calories than your body needs for basic functions, such as breathing and metabolism. This forces your body to use its own tissue for energy. In an ideal world, all of this tissue that is burned for energy would be fat tissue. However, during cancer treatment your body is not living in an ideal world.

Cancer treatment puts additional stress on your body. This added stress makes it harder for your body to burn fat tissue for energy when you aren't getting enough calories to maintain weight. This means your body will dip into other areas, like muscle and other body cells to make up for the energy you are not getting from food.

When this happens, when your body is breaking down its own tissue simply to get enough energy for basic functioning, it is too busy to rebuild tissue. Simply put, if your body is busy breaking down tissue, it won't have the energy to build tissue back up, including blood cells!

In a nutshell, losing weight takes energy away from your body's ability to rebuild red and white blood cells. Keep your weight steady and your body can better use those calories you are eating to make new blood cells.

Beyond Weight

Beyond maintaining your weight, you want to focus on getting in as much healthy, nutritious food as possible. If you can give your body all of the vitamins and minerals it needs from a wide variety of healthy foods, while maintaining your weight, you are on the right track.

The key is that you don’t want to focus so much on” healthy” food that you struggle to keep your weight up. You want to make sure you eat in a way that doesn’t cause weight loss. For example, if you’re not feeling well and just don’t want to eat now is not the time for a big spinach salad! This might be a great choice when you’re feeling well, but it doesn’t have enough calories for someone who’s only able to have a few bites of food at a time. Instead, focus on foods that have more calories and protein, such as chicken, a high calorie shake or smoothie, scrambled eggs, or whatever sounds good to you.

The most important point: Avoid weight loss, if at all possible.

If you are losing weight, talk to your health care team right away about steps you can take to minimize weight loss.

Plant Power

If you are feeling reasonably well, you are not losing weight, and you are not experiencing symptoms that interfere with your ability to eat normally, you should focus on the healthiest diet possible. This means eating lean protein plus plenty of vegetables; fruit; whole grains; and legumes or starchy beans, peas, and lentils. An easy approach for healthy eating is to follow the 75% - 25% principle.

Every time you eat, make sure that 75% (three-fourths) of your plate is covered by healthy plant food, including vegetables, fruit, whole grains, and legumes. The remaining 25% (one-fourth) should be covered by lean protein, such as fish, chicken, or lean beef. If you prefer to eat a more vegetarian diet, use legumes as your lean protein source.

Following the 75% - 25% principle will help you eat plenty of healthy food without getting bogged down in counting servings or tracking exactly what goes into your mouth.

Pump Iron

If your health care provider has indicated that you need more iron to help rebuild red blood cells, there are many steps you can take to get more iron into your diet. To learn about which foods can help you pump more iron into your diet, be sure to read our information on Nutrition for Iron Deficiency Anemia.

A Final Note On Preventing Weight Loss

As I mentioned, this is an ideal way to eat, as long as you are not losing weight. If you are going through treatment and you are losing weight, the most important thing you can do is to eat enough to stop, or at least minimize, the weight loss. The bottom line is that losing weight makes it harder for your body to heal and rebuild itself, including rebuilding those important blood cells.

If you are losing weight, ask your doctor or nurse about medical options for better managing your symptoms. Ask for a referral to a dietitian, if one is available where you are receiving your cancer treatment. In addition to this, you can go to the Nutrition section. There you can click on links for information on Nutrition and Cancer Treatment, Symptom Support, and Recipes. All of these areas will give you ideas, tips, and hints for better eating during cancer treatment.

References

Andreyev HJ, Norman AR, Oates J, Cunningham D. Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur J Cancer. 1998;34(4):503-9.
Bauer J, Capra S, Battistutta D, Davidson W, Ash S; Cancer Cachexia Study Group. Compliance with nutrition prescription improves outcomes in patients with unresectable pancreatic cancer. Clin Nutr. 2005;24(6):998-1004.
Berteretche MV, Dalix AM, d'Ornano AM, Bellisle F, Khayat D, Faurion A. Decreased taste sensitivity in cancer patients under chemotherapy. Support Care Cancer. 2004;12(8):571-76.
Davidson W, Ash S, Capra S, Bauer J; Cancer Cachexia Study Group. Weight stabilisation is associated with improved survival duration and quality of life in unresectable pancreatic cancer. Clin Nutr. 2004;23(2):239-47.
Dewys WD, Begg C, Lavin PT, Band PR, Bennett JM, Bertino JR, Cohen MH, Douglass HO Jr, Engstrom PF, Ezdinli EZ, Horton J, Johnson GJ, Moertel CG, Oken MM, Perlia C, Rosenbaum C, Silverstein MN, Skeel RT, Sponzo RW, Tormey DC. Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med. 1980;69(4):491-7.
Isenring EA, Bauer JD, Capra S. Nutrition support using the American Dietetic Association medical nutrition therapy protocol for radiation oncology patients improves dietary intake compared with standard practice. J Am Diet Assoc. 2007;107(3):404-12.
Isenring EA, Capra S, Bauer JD. Nutrition intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area. Br J Cancer. 2004;91(3):447-52.
Khalid U, Spiro A, Baldwin C, Sharma B, McGough C, Norman AR, Eisen T, O'Brien ME, Cunningham D, Andreyev HJ. Symptoms and weight loss in patients with gastrointestinal and lung cancer at presentation. Support Care Cancer. 2007;15(1):39-46.
Odelli C, Burgess D, Bateman L, Hughes A, Ackland S, Gillies J, Collins CE. Nutrition support improves patient outcomes, treatment tolerance and admission characteristics in oesophageal cancer. Clin Oncol (R Coll Radiol). 2005;17(8):639-45.
Ravasco P, Monteiro Grillo I, Camilo M. Cancer wasting and quality of life react to early individualized nutritional counselling! Clin Nutr. 2007;26(1):7-15.
Ravasco P, Monteiro-Grillo I, Vidal PM, Camilo ME. Dietary counseling improves patient outcomes: a prospective, randomized, controlled trial in colorectal cancer patients undergoing radiotherapy. J Clin Oncol. 2005;23(7):1431-38.
Ravasco P, Monteiro-Grillo I, Marques Vidal P, Camilo ME. Impact of nutrition on outcome: a prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. Head Neck. 2005;27(8):659-68.
Ravasco P, Monteiro-Grillo I, Vidal PM, Camilo ME. Cancer: disease and nutrition are key determinants of patients' quality of life. Support Care Cancer. 2004;12(4):246-52.
Skipworth RJ, Fearon KC. The scientific rationale for optimizing nutritional support in cancer. Eur J Gastroenterol Hepatol. 2007;19(5):371-77.
Van Cutsem E, Arends J. The causes and consequences of cancer-associated malnutrition. Eur J Oncol Nurs. 2005;9 Suppl 2:S51-63.

Diet for Prostate Cancer Radiation | eHow.com

2011-03-26T23:57:00.001-07:00

Diet for Prostate Cancer Radiation | eHow.com

A healthy diet can help fight prostate cancer.

Prostate cancer is the most common cancer among men in the United States. In fact, of every six men in the U.S., the American Cancer Society estimates that one will develop this type of cancer. One of the most common treatments for cancer--including prostate cancer--is radiation therapy. Such treatment can be helped along when the patient consistently sticks to a balanced diet, eating plenty of fruits, vegetables, and healthy grains, beans and nuts, while avoiding fats, harmful beverages and too much sugar or dairy.

Grains, Beans, Nuts
- For those going through radiation therapy for prostate cancer, rice is highly recommended---particularly brown rice. The inclusion of other grains in one's diet, like millet, buckwheat and amaranth, can also be beneficial. Kidney beans and pinto beans are great, too, as are lentils, garbanzo beans, and mung beans. Any nuts or seeds (minus the salt) are recommended, too---though try to avoid peanuts and peanut butter.
Vegetables, Fruit
- All sorts of fruit, whether frozen and thawed or fresh from the plant, are recommended for those going through radiation therapy for prostate cancer. As for vegetables, any fresh vegetable will do. However, some vegetables are considered slightly more effective in keeping up your health. These latter include broccoli and broccoli sprouts, beets, red and green veggies, artichokes, cauliflower, and especially garlic.
Fats, Drinks
- Fatty foods are obviously out when it comes to maintaining a healthy diet during prostate cancer radiation therapy. So too is junk food, in any quantity. As a rule too, avoid coffee, other caffeinated drinks, and especially, alcohol.
Sugar
- Anything that contains sugar (look on the ingredients for corn syrup, dextrose, sucrose, or brown sugar) is usually not a good idea while undergoing radiation therapy---and that includes artificial sweeteners. Avoid dairy products as a rule, including milk, cream cheese, sour cream, butter and yogurt. Grains that contain gluten, including wheat, barley and rye, should also be avoided. The basic rule when it comes to radiation therapy--avoid the obviously unhealthy things, and keep it all balanced.

Siemens answers:www.siemens.com/answers
Early detection & prevention: Molecular Medicine.

Diet for Prostate Cancer Radiation | eHow.com

2011-03-26T23:57:00.000-07:00

Diet for Prostate Cancer Radiation | eHow.com

A healthy diet can help fight prostate cancer.

Grains, Beans, Nuts
- For those going through radiation therapy for prostate cancer, rice is highly recommended---particularly brown rice. The inclusion of other grains in one's diet, like millet, buckwheat and amaranth, can also be beneficial. Kidney beans and pinto beans are great, too, as are lentils, garbanzo beans, and mung beans. Any nuts or seeds (minus the salt) are recommended, too---though try to avoid peanuts and peanut butter.
Vegetables, Fruit
- All sorts of fruit, whether frozen and thawed or fresh from the plant, are recommended for those going through radiation therapy for prostate cancer. As for vegetables, any fresh vegetable will do. However, some vegetables are considered slightly more effective in keeping up your health. These latter include broccoli and broccoli sprouts, beets, red and green veggies, artichokes, cauliflower, and especially garlic.
Fats, Drinks
- Fatty foods are obviously out when it comes to maintaining a healthy diet during prostate cancer radiation therapy. So too is junk food, in any quantity. As a rule too, avoid coffee, other caffeinated drinks, and especially, alcohol.
Sugar
- Anything that contains sugar (look on the ingredients for corn syrup, dextrose, sucrose, or brown sugar) is usually not a good idea while undergoing radiation therapy---and that includes artificial sweeteners. Avoid dairy products as a rule, including milk, cream cheese, sour cream, butter and yogurt. Grains that contain gluten, including wheat, barley and rye, should also be avoided. The basic rule when it comes to radiation therapy--avoid the obviously unhealthy things, and keep it all balanced.

Siemens answers:www.siemens.com/answers
Early detection & prevention: Molecular Medicine.

online.x-plain.com/modules_v3/oncology/oc030202/oc039202.pdf

2011-03-22T05:23:00.000-07:00

online.x-plain.com/modules_v3/oncology/oc030202/oc039202.pdf

IMRT Versus 3D CRT For Prostate Cancer, New Long-term Data Assesses Side Effects

2011-03-17T21:07:00.000-07:00

IMRT Versus 3D CRT For Prostate Cancer, New Long-term Data Assesses Side Effects

New research findings show men have fewer long-term gastrointestinal side effects with intensity-modulated radiation therapy (IMRT) than with three-dimensional conformal radiation therapy (3D CRT) for prostate cancertreatment, despite the higher doses of radiation used in the IMRT group. These and other data, including long-term genitourinary side effects, were presented on 5-Nov-2006 at the 48th Annual Meeting of the American Society for Therapeutic Radiology and Oncology in Philadelphia.

Long-term data comparing 3D CRT for prostate cancer versus the use of IMRT is only now beginning to mature. Few other academic treatment centers have as much experience with 3D CRT and IMRT as Fox Chase.

Both techniques allow precise targeting of the cancer with multiple X-ray beams, but IMRT allows physicians to modulate the radiation dose intensity with far smaller radiation beams. Thus, doses of radiation to the bladder and rectum can be limited. Reducing radiation exposure to healthy normal tissue and other vital organs helps prevent once common side effects such as urinary frequency and diarrhea.

In the study presented on 5-Nov-2006, researchers analyzed data collected prospectively from 1,417 patients treated at Fox Chase. Of these, 928 men were treated with 3D CRT (median follow-up of 63.3 months) and 489 men with IMRT (median follow-up of 29.9 months). The IMRT patients received higher doses of radiation.

Patients were matched for PSA level (prostate specific antigen, measured by a blood test and used to determine if prostate cancer is present), T-stage (palpable size) and Gleason score (tumor aggressiveness determined by pathologic testing). The researchers evaluated gastrointestinal side effects such as short-term diarrhea and longer-term bowel dysfunction and genitourinary side effects such as urinary frequency, urgency and, rarely, painful or difficult urination or obstructive symptoms.

"There were no differences in the reporting of acute gastrointestinal or genitourinary side effects for the two treatment modalities," explained Alexander Kirichenko, M.D., Ph.D., lead author of the study and a clinical fellow at Fox Chase at the time of the analysis. "However, as the data are beginning to mature, we're seeing more long-term gastrointestinal side effects in the men treated with 3D CRT." Kirichenko is now a radiation oncologist at Allegheny General Hospital in Pittsburgh, Pa.

Even though patients treated with IMRT had higher doses of radiation, there were fewer gastrointestinal side effects three years after treatment (6.3% for IMRT; 10.4% in 3D CRT). The research showed no statistically significant difference between the two treatment types for genitourinary side effects.

Kirichenko concluded, "Despite the specific findings pertaining to 3D CRT technique and the gastrointestinal side effects, men treated with either modality have acceptable rates of side effects at this point in our analysis particularly when compared to data from surgical outcomes."

----------------------------

Radiation :: malecare.org

2011-03-15T07:41:00.000-07:00

Radiation :: malecare.org

Possible problems
Because the radiation beam passes through normal tissues-the rectum, the bladder, the intestines-on its way to the prostate, it kills some healthy cells. Radiation to the rectum often causes diarrhea, but the diarrhea -as well as radiation-induced fatigue-usually clears up when treatment is over.

Radiation can also cause a variety of long-term problems. These include proctitis, inflammation of the rectum, with bleeding and bowel problems such as diarrhea, and cystitis, inflammation of the bladder, leading to problems with urination. In addition, some 40 to 50 percent of men treated with radiation therapy become impotent.

With newer techniques, available at state-of-the-art radiation therapy centers, side effects may be fewer. Higher-energy radiation beams can be more precisely focused, while computer technology allows a radiation oncologist to tailor treatment to the anatomy of the individual patient.

Neuroendocrine Cancer

2011-03-01T23:23:00.000-08:00

Neuroendocrine Cancer

WRITTEN BY KRISTI RUNYON

THURSDAY, 17 JUNE 2010 10:55

Video Click Here

Neuroendocrine cancer has a wide range of symptoms, and is commonly mistaken for irritable bowel disease, asthma and even menopause. With aggressive surgery, patients can live for decades, but without it, they'll lose their battle in a few years.

Neuroendocrine Cancer
The neuroendocrine system consists of nerve cells and the hormone-producing cells of the endocrine system. These cells are responsible for regulation of a wide range of body functions, like speed of digestion, blood flow through the lungs and energy levels in the body.

A neuroendocrine tumor is a type of cancer that originates in the hormone-producing cells of the neuroendocrine system. It’s a rare kind of cancer. Eugene Woltering M.D., Surgical Oncologist with LSU Health Sciences Center's Neuroendocrine Tumor Program in Kenner, LA, estimates about only one in 100,000 Americans will be diagnosed with some type of neuroendocrine tumor. The cancer can occur in many different areas of the body. Researchers say, in the U.S., the most common site of neuroendocrine tumors is the lungs. The gastrointestinal tract is the second most common site of these tumors. Rarely, a neuroendocrine tumor is located in the breast or prostate gland.

Neuroendocrine tumors are classified as functioning or nonfunctioning. Functioning tumors produce extra hormones. The type of hormone produced depends on the location of the tumor. For example, neuroendocrine tumors in the digestive tract may produce excess gastrin, the hormone that regulates secretion of gastric acid for digestion, causing diarrhea and other digestive symptoms. Some patients may develop a group of symptoms, called carcinoid syndrome, which includes frequent diarrhea, stomach cramps, skin flushing, breathing problems and a rapid heartbeat. Nonfunctioning tumors don’t produce excess hormones, but continue to grow and can eventually crowd surrounding tissue or cause blockages.

Diagnosing and Treating Neuroendocrine Tumors
Woltering says neuroendocrine tumors usually grow very slowly and symptoms are often overlooked or misdiagnosed. Thus, it can take five to ten years until a patient receives a proper diagnosis.

One test that may be helpful is a blood test called chromogranin A. Another is a urine test, 5-hydroxyindoleacetic acid (5-HIAA). However, these tests do not confirm the diagnosis, nor do they tell the location of the tumor. If one or both tests suggest the presence of a neuroendocrine tumor, doctors need to perform imaging scans to look for it.

Once the location is confirmed, Woltering says the most important treatment for a neuroendocrine tumor is surgery. The goal is to remove as much of the tumor as possible. There is no cure. But since the tumors grow so slowly, surgery can be repeated again and again to keep the size of the tumor down. Sometimes patients will have chemotherapy and/or radiation therapy in addition to surgery. With aggressive monitoring and treatment, many patients with neuroendocrine tumors survive for a long time.

Woltering says it’s important for patients with neuroendocrine cancer to see a physician who has experience treating the cancer. However, because the cancer is so uncommon, most physicians may see only a few cases in their entire career. LSU has partnered with Ochsner Hospital to create the Neuroendocrine Tumor Program, a clinic specifically for patients with neuroendocrine cancer. The clinic has experts from many fields, such as gastroenterology, medical oncology, nuclear medicine, cancer surgery and liver transplantation. The team of physicians meets weekly to discuss patient cases and coordinate the best personal treatment plans.

AUDIENCE INQUIRY
For information on the program at Ochsner:
Neuroendocrine Tumor Program, 200 West Esplanade, Suite 200, Kenner, LA 70065, (866) 91-ZEBRA,http://www.ochsner.org/NETS

For general information on neuroendocrine cancer:
American Society of Clinical Oncology, http://www.cancer.net
The Carcinoid Cancer Foundation™, http://www.carcinoid.org
National Cancer Institute, http://www.cancer.gov

Hormone Refractory Prostate Cancer

2011-02-17T04:37:00.000-08:00

Psa shooting up @ 100% every month - HealthBoards Message Boards

As you no doubt know, HRPC means Hormone Refractory Prostate Cancer; in layman's language, it means that the cancer is no longer controlable by hormonal therapy. There is a small community of like-thinking doctors specializing in treating prostate cancer in North America, especially advanced disease and challenging cases, that I am convinced has become much more expert and knowledgeable than most doctors treating the disease advanced disease. In particular, they have more or less reached a consensus in applying hormonal blockade. I am in my tenth year as a survivor, doing very well, following their advice on the particular approach known as intermittent triple hormonal blockade (with a bisphosphonate drug in support, a statin drug to help my odds of success, and a lifestyle program involving diet/nutrition/supplements (keyed around a Mediterranean diet), exercise and stress reduction). At diagnosis my PSA was 113.6, Gleason 4+3=7, all biopsy cores positive, most 100% cancer; however, a bone scan, a CT scan, and a ProstaScint scan were all essentially negative. I have twice achieved a PSA of less than (<) 0.01 using an ultrasensitive PSA test before switching to the "off therapy" phase. I'm giving this background so you will have an idea of my viewing point. I am a now savvy patient, but I have had no enrolled medical education.

Was there treatment in addition to the orchiectomy? That operation eliminates testosterone that is produced from the testes, but it does not control other sources of testosterone, its docking with cancer cells, or prevent its conversion to more dangerous DHT (dihydrotestosterone). The experts I follow would not consider a patient to be in the refractory HRPC state until he no longer responded to a combination of hormonal blockade, not just an orchiectomy or its medical equivalent. Your father may be able to find a doctor who understands this approach and could put it to work now, and see how your father responds.

These experts would insist on also using a drug in the "antiandrogen" class to block most of the docking with cancer cells as well as to create other beneficial effects. In the US, the preferred drug is Casodex; it is expensive, but it is more effective, more convenient, and better in its side effect profile. The most common alternative in the same antiandrogen class is flutamide. Other options that may be available are Nilandron (nilutamide) and Androcur (cyproterone acetate - not available in the US, I believe because of greater risk of cardiovascular complications).

They would also insist on adding a third class of drug, known as "5-alpha reductase inhibitors" (5-ARI). In the US, most of the experts favor Avodart, though finasteride, formerly known as Proscar, is also available (and is the drug I have been on). A few men do not respond well to Avodart because of a genetic problem, but they will respond to finasteride. (Incidentally, the first generic version of Proscar - finasteride - that I took was manufactured by the company run by the Indian doctor known as Dr. Reddy.) These 5-ARI drugs are highly effective in preventing conversion of any remaining testosterone to DHT, and they also cut down the supply of blood needed for tumor growth.

This program combined hormonal blockade program is compatible with chemotherapy.

He was treated from Jul 2008 to Jan 2009 for HRPC by weekly Chemotherapy , and simultaneously received injections every month for bone thickening .

Most likely he was getting infusions of a bisphosphonate drug. Aredia (Pamidronate) is the infusion drug that was commonly used until a much more powerful drug, Zometa, was approved by the US FDA (Food and Drug Administration) in 2001. Now that would be the strongly preferred drug for a case like your father's. It is quite expensive, but in the US it is usually well covered by insurance. It does have some potential side effects, especially when used frequently and long-term, but countermeasures can help to a degree. He should be taking calcium and vitamin D3 daily in support of the bisphosphonate therapy.

His PSA dropped to 7.72. He was on Hormanal therapy since then till Jun 09. His PSA started risign 100 % every month from Jan itselt, and has reached 132 now.

What a great response to chemotherapy! Since he had an orchiectomy, that is a permanent form of hormonal therapy. Were other drugs added since sometime last year? This is where using the full batch of drugs might make a critical difference. If not, the experts I follow switch to a more powerful antiandrogen, specifically ketoconazole with hydrocortisone in support. If that does not work, they will often try estrogen delivered through patches that are placed on the skin (known as "transdermal estrogen"). They may also use other agents, such as leukine.

In support of this, the doctor I follow most closely, Dr. Charles "Snuffy" Myers, MD, strongly advocates a lifestyle program.

Two excellent books describe hormonal therapy, other options I've mentioned, and the lifestyle program. They are: "A Primer on Prostate Cancer - The Empowered Patient's Guide," Dr. Stephen B. Strum, MD, and Donna Pogliano, and "Beating Prostate Cancer: Hormonal Therapy & Diet," by Dr. Myers.

There's a new drug that is highly likely to be approved by the FDA in the next six months in the US for men in your father's condition. It is known as Provenge. It is given by epheresis. It is also very expensive, but hopefully for US patients, insurance should help. I have not heard anything concrete about its international availability, but I do know that Dendreon, the company that developed the drug, is working on that.

At present he has an urge to pass urine every after 1/2 an hour, but he cannot empty the bladder full. Every time during urination, a little stool also comes out.

It someone can help me to know, if there is any way to stop the PSA rising, and if frequent urination problem can be treated?

The 5-ARI drugs were originally approved by the FDA for treating benign enlargement of the prostate. It's quite possible that they might help with the urination problem, and it's also possible that the enhanced hormonal blockade therapy might reduce the cancer in a way that would help with urination.

I hope that your father finds something that works.

Take care and good luck to you and your father,

Jim

Read more at http://www.healthboards.com/boards/showthread.php?t=702324&ktrack=kcplink

Small-cell neuroendocrine carcinoma as a variant form of prostate cancer recurrence: A case report and short literature review

2011-02-16T02:52:00.000-08:00

Small-cell neuroendocrine carcinoma as a variant form of prostate cancer recurrence: A case report and short literature review

Volume 24, Issue 4, Pages 313-317 (July 2006)

Small-cell neuroendocrine carcinoma as a variant form of prostate cancer recurrence: A case report and short literature review

Received 3 June 2005; received in revised form 29 August 2005; accepted 30 August 2005.

Abstract

Background

Small-cell neuroendocrine carcinoma has been recognized as a rare histologic variant occurring in only 0.5% to 2% of prostatic primary tumors. However, recent autopsy studies suggest development to this phenotype in up to 10% to 20% of the cases with hormone-refractory disease.

Case Presentation

A case of conventional adenocarcinoma before androgen-ablation therapy but showing progression to small-cell neuroendocrine carcinoma at the recurrence. The immunohistochemistry of the tumor showed strong positive staining for progastrin-releasing peptide (ProGRP), a carboxy terminal region common to 3 precursors for gastrin-releasing peptide, but almost negative staining for chromogranin-A and prostate-specific antigen. Combination chemotherapy based on cisplatin and etoposide was effective for controlling the tumor progression for 7 months, and the serum ProGRP level correlated well to the clinical course. Neither objective nor subjective responses were observed to somatostatin analogue therapy performed in the late stage of disease.

Conclusions

The present case reminds the urologist that small-cell neuroendocrine carcinoma may be a variant form of disease recurrence during androgen ablation in advanced prostate cancer. A strategic approach for this phenotype evaluating serum neuroendocrine markers, such as ProGRP, should be taken when serum prostate-specific antigen does not reflect the disease state. This approach would allow one to choose alternative therapies targeting neuroendocrine cells other than androgen ablation.

Keywords: Prostate cancer , Small-cell carcinoma , Neuroendocrine marker ,Progastrin-releasing peptide

My channel TURP biopsy sample indicate this neuro endocrine feature & Onchosurgeon Dr.Kathiresan may decide alternative therapy after reviewing on 15th.March 2011 with PSA test.

Neuroendocrine Differentiation In Prostate Adenocarcinoma Biopsies And Its Correlation To Histological Grading

2011-02-16T02:46:00.000-08:00

Neuroendocrine Differentiation In Prostate Adenocarcinoma Biopsies And Its Correlation To Histological Grading

MĂDĂLINA MARCU⁽¹⁾, E. RADU⁽²⁾, MARIA SAJIN⁽¹⁾

Text Prostate adenocarcinoma is one of the most frequent malignant diseases in men. Patients are stratified according to disease extension: organ-confined cancer (pT1, T2) benefits of definitive therapy (radical prostatectomy, radiotherapy, neoadjuvant therapy), while extraprostatic tumor extension or metastasis are an indication for hormone therapy. Androgen deprivation of malignant cells is well established for the treatment of metastatc disease, recurrence after radical prostatectomy or radiotherapy and as neoadjuvant therapy. However, 18 to 36 month after an initial response to hormone therapy, most of the prostate carcinomas swich to a hormone resistant phenotype, entering into a more aggressive and ultimately fatal stage of disease [1].

Neuroendocrine (NE) cells are a distinct epithelial cell compartment of the normal human prostate gland. Their phenotype and range of endocrine secretion products are similar, but not identical to those of NE-like cells from prostate carcinoma. Neuroendocrine differentiation (NED) is seen in virtually all cases of prostatic carcinoma, mostly in a focal pattern; a number of studies pointed out that its extent is associated to hormone therapy refractory and aggressive disease. Yet neuroendocrine differentiation is included by the College of American Pathologists Consensus Statement 1999 in category III of prognostic and predictive factors (not sufficiently studied to demonstrate prognostic value) [2].

In prostate cancer extending beyond the organ limits, most of the studies pointed out a strog association between the extent of NE differentiation and aggressive disease, but there are conflicting conclusions regarding the value of NED as an independent prognostic factor. Increased NE differentiation was found to be associated with aggressive disease [3, 4], Gleason score [5, 6], anti-androgen thearpy failure [3] and survival [6, 7]. However, McWilliam concluded that detection of neuroendocrine differentiation in conventional prostatic adenocarcinoma is not an independent indicator of prognosis [6].

Only a few studies addressed the prognostic significance of NE differentiation in localized prostate cancer, and data collected on prostatic biopsies is even scarcer. Some results indicate that histological grade and NE differentiation seen in prostatectomy samples predicted progression in multivariate analysis [8] or disease specific survival [9]. NE differentiation was also considered an additional prognostic marker in radical prostatectomy samples [10] and a factor that significantly aggravate established adverse prognostic parameters such as nodal status, tumour stage, pretherapeutic PSA-level, and Gleason score [11]. However, other studies lead to diverging conclusions: the extent of neuroendocrine differentiation was not foud to be an independent prognostic factor for biochemical failure of therapy in multivariate analysis [12, 13].

Screening population at risk using serum PSA monitoring and clinical examination recently gained in frequency, leading to an increase in the proportion of low-grade adenocarcinoma that is diagnosed on prostate core biopsy. New prognostic factors would help identifying at this stage patients at risk for unfavorable evolution, that would benefit from alternate therapy. This study aims to find correlations between the extent of neurocrine differentiation and known factors of disease evolution such as histological grade, malignant cell proliferation and serum PSA levels.

My channel TURP surgery at Cancer Institute,Chennai

2011-02-11T21:14:00.000-08:00

I have under gone almost all tests from 10th.Jan till month end and they decided to perform Channel TURP surgery to address my urinary problems first.This problem known as LUTS (Lower urinary tract symptoms) caused due to the enlargement of my Prostate gland (84.2gms). So this procedure has nothing to do with prostate cancer treatment but clearing the urine passage of the urethra.(see the picture in my previous posting)

I was admitted on 1st.Feb & after the surgical procedure on 2nd. evening, discharged on 5th.Feb. evening.
I have to visit the institute on 15th.Feb. for the review.

Prostate normal & enlarged.

2011-01-28T01:15:00.000-08:00

Medication that relaxes the muscles that surround the prostate channel

The anatomy of the bladder and prostate is such that a special muscle surrounds the urinary channel in

its course from the bladder into the prostate. These muscles are controlled by special nerves called

“alpha sympathetics”. In many men, increased tone of this muscle occurs with aging and can be a cause

of significant blockage of urinary flow without significant prostate growth. This muscle that runs

around the prostate channel can be relaxed by taking specific medications known as “alpha blockers”.

These drugs, Hytrin, Cardura or Flomax (terazosin, doxasin or tamsulosin), also are used to lower blood

pressure in some patients with hypertension. The smooth muscles around the neck of the bladder and

prostate are relaxed by these medications, and many men have both subjective and objective

improvement of their urinary flow. These improvement usually occur within the first few weeks of

taking these medications. These medications seem to work best in patients with smaller prostates, but

work in larger glands as well.

SURGICAL or PROCEDURES TREATMENTS FOR BPH

Transurethral RESECTION of the Prostate (TURP)

Transurethral resection of the prostate (TURP) has been the primary choice of treatment for the past 50

years for BPH that is causing obstruction of the bladder outlet

Approximately 400,000 transurethral resections of the prostate are performed annually in the United

States. TURP is a safe procedure with four out of five patients experiencing resolution of their voiding

symptoms with improvement of all of their urinary flow measurements. Essentially, TURP is the

removal of the obstructing portions of the prostate with a telescopic electric knife. The TURP requires

an anesthetic and takes about 30-60 minutes to perform. A tube or catheter is inserted into the bladder

and is left in place for 24 to 48 hours. The hospitalization lasts from 1-3 days and requires two weeks of

severe activity restrictions and another two weeks of modest restrictions. No treatment to date has

bettered the long term effectiveness of TUFT in alleviating obstruction caused by benign prostatic

hyperplasia.

But because TURP is a surgical procedure with some risks, and because of the costs and time off work,

other methods of therapy are being looked at intensively by the medical community. These include

medical treatments and alternative surgical treatments which are less complicated than transurethral

resection of the prostate

Cancer Health Resources Nutrition Treatments Options Natural Health Support

2011-01-27T06:34:00.000-08:00

Cancer Health Resources Nutrition Treatments Options Natural Health Support

List of supplements, remedies, Advice that might help:
Neck, Base of Tongue, and Tonsils, health resources, to use during and after your cancer treatment

by A. M.

1. Aloe Vera Juice: You can find this at Whole Foods. I get "Lillie of the Desert" brand because it only has one other ingredient that is a stabilizer: citric acid. I try to stay away from preservatives as much as possible. Aloe Vera is great for the whole digestive tract from the mouth to the anus. You can gargle with it to get immediate results. It's good for taking care of the digestive tract as most of the immune system is located there. This is important because you are absorbing nutrients here. Regardless of where you are receiving radiation treatment it will be processed by the digestive system and destroy some of the "good" bacteria and flora in the digestive system. Aloe helps protect this. You can get Aloe Gel too to rub on the part of your body where you receive radiation in order to stop dryness.

2. Baking Soda: I get "Bob's Red Mill" brand also at Whole Foods in the baking supply section. I get this brand because I know, for sure, that it does not contain aluminum as other brands do. You can mix a teaspoon of this with water to gargle with. This will sterilize your mouth and throat. It will raise the Ph level in your mouth/throat, sterilize any soars in the mouth or prevent them altogether. Also, when you gargle keep it in your mouth for a while to get the full benefit.

3. Vitamin C: I don't think I need to say much about this. This helps your immune system fight off infections, detoxify cells. I get esther-C from Costco. It fights cancer as well. If you have trouble swallowing pills, you can get it in powdered form as well. I take between 10,000 to 15,000 mg's a day, spread out.

4. Turmeric: This is an aryuvedic herb, spice that is good for general detoxification especially of the liver. You can take a LOT of this, even to the point of turning yellow. You CAN NOT overdose on this. It helps against metastasis. Good brands are New Chapter, Organic India.

5. Proteolytic enzymes: These include pancreatic enzymes. These help digest not only food in order to get vital nutrients (because ALL cancer patients have a problem with digestion/absorption), but also to detoxify debris from tumors.

6. essiac tea: This is a highly regarded tea for fighting cancer. You can get this at a health food store, but I don't recommend it because it's too expensive to be worth it. I get it from this website: www.discount-essiac-tea.com . You have to prepare it yourself, but it is well worth it. I highly recommend this throughout treatment and after indefinitely. Follow directions carefully!

7. Vitamin D-3: More and more research is coming out all the time about the very powerful preventative and treatment of cancer with Vitamin D-3. The catch with this is that you can not supplement with vitamin A at the same time as it blocks the effects of vitamin D. It is better to get vitamin A from colorful fruits and vegetables.

8. Water: Stay hydrated! This seems obvious, but I find most people don't like to drink plain water. Make sure that it is filtered from chlorine etc. It's much better than buying water in plastic bottles. It is crucial to increase water intake in order to help with all bodily processes and to detoxify cells, tumor debris etc. Absolutely no soft drinks, especially diet soft drinks (nutrisweet is a cancer fertilizer). Although you might love coffee (I do!), it's highly discouraged because it dehydrates you and also drains minerals from your body which you need so much especially at this time. Green tea is great, any herbal tea that is good for the throat like red clover. No black tea because it dehydrates.

9. Soup: Soups are obviously easier for you to eat and digest. You can find no end to healthy recipes available on the internet.

10. Smoothies: If you find yourself discouraged from eating from pain of soars in the mouth/throat, smoothies are highly recommended. Whey protein is very beneficial for fighting cancer. It has been found, besides giving all essential amino acids, that it raises glutathione levels in healthy cells (protecting them from radiation) and depletes it in cancerous cells (making them more susceptible to radiation/hyperthermia treatment). You can add nut butters, blueberries, bananas, raw plain cocoa powder (no sugar), flax seed oil or hemp seed oil. This will give you energy and prevent weakness which not only affect you physiologically but emotionally. Even if you are eating relatively ok, I still suggest taking the whey protein to protect your body generally from the treatment.

11. Juicing: This is an excellent way to get nutrients your body is lacking and much easier than eating the same amount through chewing. Carrots, spinach, beets are at the top of the list for me. Greens are important too. You can get a decent juicer at costco. Like a Jack Lalain juicer.

12. Exercise: Walking is excellent. Especially out in nature or just a nice day. I walk in the evening for about an hour or hour and a half. Or it can be something you enjoy like tennis. This obviously helps to detoxify the body, but increases your sense of well-being. I would make this mandatory for the rest of your life! Side note: you may like swimming, but it is better to stay away from the chlorine in swimming pools. The ocean is much better relatively speaking.

13. Organic whole foods: Not the store, necessarily. I mean eat foods that are not processed. It means, to the best of your ability, get organically grown foods because non-organic foods more likely contain pesticides and/or are genetically modified. There is what is called a body burden or how much chemicals are accumulated in the body that do not come out. You can think of the body as a barrel that is being filled with these chemicals. When the barrel overflows the organs of detoxification (liver, kidneys) can not process efficiently and thus you are susceptible to disease. You are trying to help your body by eating things that are easily digestible which are whole organic foods that contain the nutrients and enzymes you need. They also help take out these chemicals that have been accumulated.

14. Relax: This is also very very important. Find a way to induce the relaxation response. You already know what the stress response and what it can cause/contribute to. The relaxation response induces healing. If you are open to meditation, yoga, praying, etc., do it! Laugh a lot, watch comedy movies, etc. Forget yourself in an enjoyable fashion everyday!

We will add three more very effective suggestions from another graduated patient:

15. Use coconut paste (oil) to lubricate throat before and after treatment. It avoids a dry throat after the low-radiation treatment

16. Drink lemon water! just add a few drops of lemon in you drinking water bottle. I makes water alkaline and also helps to avoid having a dry throat. Drink this lemon water throat out the day.

17. Try to drink alkaline water, with a pH of about 8.0. You can consider to buy an Alkaline Water machine

General Diet/Nutrition Suggestions

This article is a copy from one of our blogs, in answer to a nutrition suggestions:

"Hi, thank you so much for your reply above about your treatment being very good for tonsil cancer metastasis to the lymph node.

I have a different question: I see a lot of great info on your site about hyperthermia and low-dose radiation; what about nutrition? What nutritional treatments do you give and is this included in the price of an individual’s treatment? I’m asking more and more questions now that I’m gravitating toward your institution!!"

A. M.,

I will tell you my personal experience regarding nutrition, as well a personal research I did over 20 years talking to patients at our clinic.

“Is not much what you eat, but what you don’t eat!” All diets are good; some work for certain people and others for different people, because we all are different!

But this is the million dollars question and answer!

What is tho only common thing on ALL diets?

That all of them eliminate junk food! As simple as that!

If you watch our video testimonies, http://www.vci.org/cancer_treatments_miscell/patient-video-testimonies.htm,
when I interview those patients, they all told me they did not follow any special diet, but they eliminated sugars, because cancer cells feed on sugar (junk food #1).

They also said “I just to eat well” what ever that means for each one of them, “I try to cut on dairies” (other not too good food, believe it or not!)

They also said “I exercise, do my walks, go to the gym, run, to the beach (we are just 4 miles from the beach), and drink a lot of water.

I can also tell you that the three women with breast cnacer who turned into a raw food diet, got cured!

I’m my self vegetarian (red meat and too much meat is not advisable either) since I was 19 years old. I became vegan ten years ago, and for the last 2+ years I’m following a raw food diet with my wife; not 100% but a great percentage of green vegetables, fruits, nuts, seeds, sprouted bread, and the best chocolate deserts in town made by my wife!!!

The benefits of the raw food are just incredible:

- I don’t get sick during the holidays season any longer
- I don’t get sick during flu season either
- have more energy
- look 10 years younger, and probably my body is younger than people who follow the SAD (Standard American Diet)

Summarizing, you have to be and informed person (as you are, because you found us and you are considering this less toxic treatment as an alternative to conventional therapies!) and keep researching for what it is best for you.

We do not recommend any special diet in particular, but we can guide you to local practitioners in the area, like Dr. Dana Churchill, N.M.D., Holistic, Naturopathic, Homeopathic; you can get more information on his web site:
http://www.heartfeltmedicine.com/. I highly recommend Dr Churchill; you can even call him now and he will give you some advice.

Hoping you got some value from this answer, and you make the best decision for you,

Carlos Caridad
Administrator
Valley Cancer Institute

www.urologyatlanta.urologydomain.com/images/uploaded/AUA/Prostate_enlarged.pdf

2011-01-26T02:51:00.000-08:00

www.urologyatlanta.urologydomain.com/images/uploaded/AUA/Prostate_enlarged.pdf

UBC HKIN 191 - Bladder Anatomy

2011-01-22T03:45:00.000-08:00

How the Body Works : Release of Urine

2011-01-22T03:39:00.000-08:00

Lower Urinary Tract Symptoms in Men | Doctor | Patient UK

2011-01-18T08:31:00.000-08:00

Lower Urinary Tract Symptoms in Men | Doctor | Patient UK

Lower Urinary Tract Symptoms in Men

Lower urinary tract symptoms (LUTS) are storage, voiding and postmicturition symptoms affecting the lower urinary tract. LUTS can significantly reduce men's quality of life, and may point to serious pathology of the urogenital tract.¹ Symptoms are often nonspecific and large studies of patients have failed to show any correlation between LUTS and a specific diagnosis.² LUTS are common and not necessarily a reason for suspecting prostate cancer.³ Patients tend to fall into 3 categories:⁴

Mild symptoms: mainly require reassurance and exclusion of cancer or risk of future complications.
Troublesome symptoms, suitable for medical treatment.
Those requiring surgical treatment.

Epidemiology

Lower urinary tract symptoms (LUTS) are a common problem, especially for older men. It has been reported that 90% of men aged 50 to 80 years suffer from potentially troublesome LUTS. The prevalence of storage symptoms increases from 3% in men aged 40 to 44 years to 42% in those aged 75 years or older.¹
The prevalence of nocturia in older men is about 78%. Older men have a higher incidence of LUTS than older women.⁵
Around one third of men will develop urinary tract (outflow) symptoms, of which the principal underlying cause is benign prostatic hyperplasia (BPH).
Once symptoms arise, their progress is variable and unpredictable with about one third of patients improving, one third remaining stable and one third deteriorating.

Presentation

See also separate articles Genitourinary History and Examination (Male) and International Prostate Symptom Score (IPSS).

Filling symptoms: urinary frequency, urgency, dysuria, nocturia.
Voiding symptoms (previously 'obstructive'): poor stream, hesitancy, terminal dribbling, incomplete voiding, overflow incontinence (occurs in chronic retention).
Also enquire about: haematuria, fever, loin and pelvic pain, past history of renal calculi, past history of urinary tract infections (UTIs), sexual/erectile difficulties, constipation, medications andbone pain.
Signs: palpable bladder, rectal examination (prostate: size, tenderness, nodules), check for loin pain and/or renal masses, perineal sensation.
Lower urinary tract symptoms include frequency, urgency, hesitancy, dysuria, haematuria, reduced flow, dribbling, nocturia, incontinence and pelvic pain.
Some patients develop acute retention.
Others develop chronic retention with overflow incontinence and, on rare occasions, renal failure.

Early prostate cancer does not cause bladder outflow obstruction and any LUTS are usually due to coincidental benign prostatic hyperplasia (BPH).⁴

Assessment¹

General medical history to identify possible causes and comorbidities, including a review of all current medication (including herbal and over-the-counter medication).
Examination of the abdomen, including external genitalia (see also separate article Genitourinary History and Examination) and a digital rectal examination.
Examination should include blood pressure, signs of uraemia, enlargement of the bladder, kidneys and the prostate, and palpable nodes.
Urine dipstick test to detect blood, glucose, protein, leukocytes and nitrites.
Men with bothersome LUTS should complete a urinary frequency volume chart.
Renal function tests (serum creatinine test, estimated glomerular filtration rate) should only be performed if renal impairment is suspected.

Referral for specialist assessment

Refer men for specialist assessment if they have:¹

Bothersome lower urinary tract symptoms (LUTS) that have not responded to conservative management or drug treatment.
LUTS complicated by recurrent or persistent UTIs.
Urinary retention.
Renal impairment thought to be due to lower urinary tract dysfunction.
Suspected urological cancer.
Stress urinary incontinence.

Other indications for referral include immediate referral for acute retention of urine and acute renal failure, and urgent referral (to be seen within 2 weeks) for visible haematuria and culture negative dysuria.⁶

Specialist assessment¹

Flow-rate and post-void residual volume measurement.
Urinary frequency volume chart.
Cystoscopy and/or ultrasound imaging of the upper urinary tract only when clinically indicated, e.g. history of: recurrent infection, sterile pyuria, haematuria, profound symptoms, pain or chronic retention.
Multichannel cystometry if men are considering surgery.
Offer pad tests only if the degree of urinary incontinence needs to be measured.
Consider PSA testing if:
LUTS are suggestive of bladder outlet obstruction secondary to prostate enlargement.
The prostate feels abnormal on rectal examination.
The patient is concerned about prostate cancer.

Differential diagnosis

Benign prostatic hyperplasia (BPH) with obstruction.
Detrusor muscle weakness and/or instability.
UTI.
Chronic prostatitis.
Urinary tract stones.
Malignancy: prostate cancer or bladder cancer.
Neurological disease, e.g. multiple sclerosis, spinal cord injury, cauda equina syndrome.
Polyuria (e.g. secondary to diabetes mellitus, excessive fluid intake, diuretics, etc.).

Management¹

For men whose lower urinary tract symptoms (LUTS) are not bothersome or complicated, give reassurance, and give information and advice on lifestyle measures such as:
- Fluid intake (moderation of fluid intake is important but excessive reduction of fluid intake can cause a worsening of symptoms and increased risk of infection).
- Reduction in the intake of fluids containing alcohol, caffeine and artificial sweeteners together with avoidance of carbonated drinks is often advised.
- The patient should be reviewed if symptoms change or become worse.
For men with mild or moderate bothersome LUTS, discuss active surveillance (reassurance and lifestyle advice without immediate treatment and with regular follow-up) or active intervention (conservative management, drug treatment or surgery).
Offer men considering treatment for LUTS an assessment of their baseline symptoms with a validated symptom score, e.g. International Prostate Symptom Score (IPSS).
Surgical treatment is generally reserved for men who have failed or are unable to tolerate drug treatment, or for those who have developed complications.⁵

Conservative management

Storage symptoms:

Overactive bladder (OAB): supervised bladder training, advice on fluid intake, lifestyle advice and, if needed, containment products.
Supervised pelvic floor muscle training for men with stress urinary incontinence caused by prostatectomy. Advise men to continue the exercises for at least 3 months before considering other options.
Do not offer penile clamps.
Containment products:
- For men with storage LUTS (particularly urinary incontinence):
- Temporary containment products (e.g. pads or collecting devices) to achieve social continence until a diagnosis and management plan have been discussed.
- External collecting devices (sheath appliances, pubic pressure urinals) before considering indwelling catheterisation

Voiding symptoms:

Consider intermittent bladder catheterisation before indwelling urethral or suprapubic catheterisation if LUTS cannot be corrected by less invasive measures.
Bladder training is less effective than surgery.
Men with postmicturition dribble should be shown how to perform urethral milking.

Drug treatment

Offer drug treatment only to men with bothersome LUTS when conservative management options have been unsuccessful or are not appropriate. Do not offer homeopathy, phytotherapy or acupuncture.
Moderate-to-severe LUTS: offer an alpha-blocker (alfuzosin, doxazosin, tamsulosin or terazosin).
Overactive bladder: offer an anticholinergic.
LUTS and a prostate estimated to be larger than 30 g or prostate specific antigen (PSA) greater than 1.4 ng/mL, and high risk of progression: offer a 5-alpha reductase inhibitor (5-ARI).
Bothersome moderate to severe LUTS, and a prostate estimated to be larger than 30 g or PSA greater than 1.4 ng/mL: consider an alpha-blocker plus a 5-ARI.
Storage symptoms despite treatment with an alpha-blocker alone: consider adding an anticholinergic.
Consider offering a late afternoon loop diuretic for nocturnal polyuria.
Consider offering oral desmopressin for nocturnal polyuria if other medical causes have been excluded and the man has not benefited from other treatments. Measure serum sodium 3 days after the first dose. If serum sodium is reduced to below the normal range, stop desmopressin treatment.
If LUTS do not respond to drug treatment, discuss active surveillance (reassurance and lifestyle advice without immediate treatment and with regular follow-up) or active intervention (conservative management or surgery).

Management of retention

Acute retention (see separate article Acute Urinary Retention):
- Immediately catheterise men with acute retention.
- Offer an alpha-blocker to men before removing the catheter.
Chronic retention (see separate article Chronic Urinary Retention):
- Chronic urinary retention is defined as residual volume greater than 1 litre or presence of a palpable/percussible bladder. (see diagram):
- Serum creatinine (renal function tests) and imaging of upper urinary tract.
- If impaired renal function or hydronephrosis:
  - Catheterise.
  - Consider offering catheterisation before offering surgery. Consider offering self-administered or carer-administered intermittent urethral catheterisation before offering indwelling catheterisation
  - Surgery. If surgery is not suitable, continue or start long-term catheterisation. Consider offering intermittent self-administered or carer-administered catheterisation instead of surgery in men whom you suspect have markedly impaired bladder function.
- Normal renal function and no hydronephrosis:
  - If there are no bothersome LUTS then treat as for impaired renal function or hydronephrosis.
  - If there are bothersome LUTS then consider offering surgery on the bladder outlet without prior catheterisation. If surgery is not suitable, continue or start long-term catheterisation. Consider offering intermittent self-administered or carer-administered catheterisation instead of surgery in men whom you suspect have markedly impaired bladder function.

Surgery

Surgery for voiding symptoms:

Offer surgery only if voiding symptoms are severe or if drug treatment and conservative management options have been unsuccessful or are not appropriate.
Surgery for voiding LUTS presumed secondary to benign prostate enlargement:
- All: monopolar or bipolar transurethral resection of the prostate (TURP), monopolar transurethral vaporisation of the prostate (TUVP) or holmium laser enucleation of the prostate (HoLEP).
- Estimated prostate size smaller than 30 g: transurethral incision of the prostate (TUIP) as an alternative to other types of surgery (see above)
- Estimated prostate size larger than 80 g: TURP, TUVP or HoLEP, or open prostatectomy as an alternative.

Surgery for storage symptoms:

If offering surgery for storage symptoms, consider offering only to men whose storage symptoms have not responded to conservative management and drug treatment.

Detrusor overactivity (do not offer myectomy to manage detrusor overactivity):
- Cystoplasty: the man must be willing and able to self-catheterise. Serious complications include bowel disturbance, metabolic acidosis, mucus production and/or mucus retention in the bladder, urinary tract infection and urinary retention.
- Bladder wall injection with botulinum toxin (botulinum toxin does not currently have UK marketing authorisation for this indication. The man needs to be willing and able to self-catheterise.
- Implanted sacral nerve stimulation.
Stress urinary incontinence:
- Implantation of an artificial sphincter.
Intractable urinary tract symptoms if cystoplasty or sacral nerve stimulation are not clinically appropriate or are unacceptable to the man: consider offering urinary diversion.

Long-term catheterisation and containment

Consider offering long-term indwelling urethral catheterisation if medical management has failed and surgery is not appropriate, and the man:
- Is unable to manage intermittent self-catheterisation; or
- Has skin wounds, pressure ulcers or irritation that are being contaminated by urine; or
- Is distressed by bed and clothing changes.
Indwelling catheters for urgency incontinence may not result in continence or the relief of recurrent infections.
Permanent use of containment products should only be considered after assessment and exclusion of other methods of management.

Prognosis⁷

Men with lower urinary tract symptoms (LUTS) and small or moderate sized prostates will improve appreciably with lifestyle advice and alpha-blocker therapy.
Men with LUTS and large prostates are at significant risk of disease progression particularly if they have additional risk factors such as age >70 years or flow rate less than 12 ml/s. These men will benefit from treatment with lifestyle advice and 5-alpha reductase inhibitors (5-ARIs).
5-ARIs reduce the risk of acute urinary retention and the likelihood of prostatectomy by 50-60% compared with placebo.
The combination of 5-ARI and alpha-blocker is more effective in delaying the clinical progression of the disease and in improving LUTS and maximal urinary flow rate, than either drug alone.
After six months of treatment with a 5-ARI, prostate specific antigen (PSA) levels will be reduced by 50%. Therefore PSA values for patients on long-term therapy should be doubled to allow appropriate interpretation and avoid masking the early detection of localised prostate cancer.

Document references

Lower urinary tract symptoms, NICE Clinical Guideline (May 2010); The management of lower urinary tract symptoms in men
Abrams P; New words for old: lower urinary tract symptoms for "prostatism". BMJ. 1994 Apr 9;308(6934):929-30.
Urological cancer - suspected, Clinical Knowledge Summaries (2000)
Lower Urinary Tract Symptoms in the Male, NHS Scotland Centre for Change and Innovation, Patient Pathway, July 2005; Clinical investigation and management pathway
Boyle P, Robertson C, Mazzetta C, et al; The prevalence of lower urinary tract symptoms in men and women in four centres. The UrEpik study. BJU Int. 2003 Sep;92(4):409-14. [abstract]
Referral Advice, NICE Clinical Guideline (2001); A guide to appropriate referral from general to specialist services
British Association of Urological Surgeons; Primary care management of male lower urinary tract symptoms (LUTS). February 2004 (included in Obstetrics, Gynaecology and Urology Section of Eguidelines - requires registration and password)

Internet and further reading

Prostate - benign hyperplasia, Clinical Knowledge Summaries (March 2009)
Benign Prostatic Hyperplasia Site, Bandolier
Prostate Cancer Risk Management, NHS Cancer Screening Programmes
Benign Prostatic Hypertrophy, European Association of Urology Guideline (2004)

Acknowledgements EMIS is grateful to Dr Colin Tidy for writing this article. The final copy has passed scrutiny by the independent Mentor GP revi

Bicalutamide (Casodex®) - Cancer Information - Macmillan Cancer Support

2011-01-15T03:20:00.000-08:00

Bicalutamide (Casodex®) - Cancer Information - Macmillan Cancer Support

Bicalutamide (Casodex®)

This information is about a hormonal therapy called bicalutamide, which is also commonly called Casodex®. It is used to treat prostate cancer. The information should ideally be read with our general information about prostate cancer .

On this page

CasodexBack to top

Casodex is a type of hormonal therapy that is used in the treatment of prostate cancer.

There are several different hormonal therapies. Your doctor can discuss with you which is best for your particular situation.

How Casodex worksBack to top

Hormonal therapies interfere with the production or action of particular hormones in the body. Hormones are substances produced naturally in the body. They act as chemical messengers and help to control the activity of cells and organs.

Most prostate cancers need supplies of the male hormone testosterone to grow. Testosterone is produced by the testes and adrenal glands.

Prostate cancer cells have proteins called receptors. Testosterone attaches to the receptors and causes cancer cells to grow.

Casodex has a structure similar to testosterone. It works by preventing testosterone from attaching (binding) to the receptors on the prostate cancer cells. Without testosterone the cancer cells either grow more slowly or stop growing altogether. The cancer may shrink in size as a result.

How it is takenBack to top

Casodex is a tablet, which is taken once a day. It is available in two different strengths: 50mg and 150mg.

When it may be givenBack to top

Casodex may be used to treat prostate cancer that has begun to spread into the tissues around the prostate gland (locally advanced). It can either be given on its own or aftersurgery or radiotherapy .

In prostate cancer which has spread to other parts of the body (advanced or metastatic cancer), Casodex may be given in combination with injections of another type of hormonal-therapy drug (called a pituitary down-regulator) such as goserelin , buserelin ,triptorelin or leuprorelin . These drugs block the production of a hormone produced by the pituitary gland (leuteinising hormone), which stimulates the production of testosterone.

For men with prostate cancer that is contained within the prostate gland (early prostate cancer) Casodex may be given as a short-term treatment (a few weeks only) to prevent 'tumour flare'. This is a temporary increase in symptoms that can occur when a man first starts treatment with a pituitary down-regulator.

Possible side effectsBack to top

Each person's reaction to any medication is different. Many people have very few side effects with Casodex, while others may experience more. The side effects described in this section will not affect everyone and may be different if you are having more than one drug. We have outlined the most common side-effects. However, we have not included those which are very rare and therefore extremely unlikely to affect you. If you notice any effects that you think may be due to the drug but which are not listed in this information, please discuss them with your doctor or nurse.

You will see your doctor regularly while you have this treatment so that they can monitor the effects. This information should help you to discuss any queries about your treatment and its side effects with your doctor or nurse.

Some people may have some of the following side effects:

Breast tenderness or fullness Many men may notice breast swelling and tenderness known as gynaecomastia. Your doctor can prescribe medicines or other treatments to reduce any discomfort.

Hot flushes There are a number of ways to help reduce hot flushes and sweats. It can be useful to avoid or cut down on tea, coffee, nicotine and alcohol. Let your doctor know if hot flushes are causing you any problems, as research suggests that some treatments may be helpful in controlling this side effect.

Some men find that complementary therapies help. Your GP may be able to give you details about obtaining these on the NHS.

Itching and dryness of the skin This is usually mild. Let your doctor know if it is a problem for you. Sometimes creams or medicines can reduce this effect.

Nausea (feeling sick) If you experience any nausea it is usually mild and easily controlled. Nausea can sometimes be relieved by taking the tablet with food. Let your doctor know if you have any nausea, as they can prescribe medicines to help.

Lowered sex drive (libido) and erection difficulties (impotence) Let your doctor or nurse know if this is a problem as there are medicines or treatment that may be able to help. These effects usually return to normal after stopping hormonal treatment.

Weakness Sometimes Casodex may cause feelings of weakness.

Weight gain You may notice that you put on weight, especially around the waist or chest.

Hair changes Some men notice that their hair becomes thinner, but this is usually mild. If this is a problem let your doctor know.

Less common side effectsBack to top

General pain Some men experience pain , especially in the tummy (abdomen) or the back. Let your doctor know if you develop any new pain, as they can give you simple painkillers.

Liver changes Let your doctor know if you have ever had any problems with your liver. They may need to take regular blood tests to make sure Casodex isn't affecting your liver.

Breathlessness Rarely, Casodex can cause breathlessness. If you develop breathlessness while taking Casodex, you should let your doctor know as you may need to stop taking it.

Length of treatmentBack to top

Your doctor will discuss the length of treatment that they feel is appropriate for your situation. Casodex is often given for several months or years. Treatment may continue for as long as it is effective in controlling your cancer.

Things to remember about Casodex tabletsBack to top

Casodex may interact with other medicines, such as drugs to prevent blood clots (anti-coagulants) and some drugs that treat blood pressure and heart conditions. Let your doctor know about any medicines you're taking. This includes non-prescribed drugs such as complementary therapies and herbal drugs.

Keep the tablets in a safe place out of the reach of children.
If your doctor decides to stop the treatment, return any remaining tablets to the pharmacist. Do not flush them down the toilet or throw them away.
Don't worry if you forget to take your tablet. The levels of the drug in your blood will not change very much, but try not to miss more than one or two tablets in a row. Let your doctor or nurse know.
Remember to get a new prescription a few weeks before you run out. Make sure you have plenty for holidays.

ReferencesBack to top

This section has been compiled using information from a number of reliable sources, including:

Sweetman et al. Martindale: The Complete Drug Reference. 35th edition. 2007. Pharmaceutical Press.
British National Formulary. 57th edition. March 2009. British Medical Association and Royal Pharmaceutical Society of Great Britain.

For further references, please see the general bibliography .

Prostate Cancer Hormone Therapy – Combined Androgen Blockade

2011-01-14T01:28:00.000-08:00

Prostate Cancer Hormone Therapy – Combined Androgen Blockade

The use of an anti-androgen and a form of castration is called Combined Androgen Blockade or CAB. Combined androgen blockade may also be called combined hormone blockade or total hormone blockade. During prostate cancer hormone therapy, the most common form of CAB is an anti-androgen which is started a few weeks before a Luteinizing Hormone-releasing Hormone agonist. LHRH agonists by themselves will cause hormone flare which can be painful, or deadly, or both for patients with advanced prostate cancer with distant bone metastasis.

The hormone flare triggered by the LHRH agonist is a reaction that causes the body to flood with testosterone for 7 to 10 days. Since testosterone can help prostate cancer grow, many patients, even those in earlier stages of less aggressive prostate cancer, may prefer to avoid hormone flare. Anti – androgens block the body’s ability to use testosterone, so the flood of testosterone never reaches the prostate gland. This form of combined androgen blockade is common for patients in later stages of prostate cancer. Hormone flare is not dangerous to early stage prostate cancer patients nor will hormone flare incite a more aggressive growth of their prostate cancer.

Castration, both the surgical orchiectomy and the medical LHRH agonist and LHRH antagonist, will eliminate only 90 to 95 percent of the body’s testosterone. Some doctors may recommend that their patients opt to ablate 100% of the testosterone. Castration affects only the testosterone produced by the testicles, not the adrenal glands located near the kidneys. Taking an anti-androgen in addition to surgical or chemical castration will prevent the prostate cancer from taking up the remaining 5 to 10 percent of testosterone.

Sometimes, when orchiectomy, LHRH agonists, or LHRH antagonists are no longer effective for slowing the growth of prostate cancer, the use of an anti-androgen will keep prostate cancer hormone effective for a longer period of time. The anti-androgen withdrawal effect is where the prostate cancer cells who have adapted to no testosterone are stopped by the reintroduction of testosterone. Anti-androgen withdrawal may have some effect with patients who are using combined androgen blockade.

Estrogen is sometimes used with prostate cancer hormone therapies. The use of lower dose estrogen may lessen the severity or the occurrence of side effects caused by castration or anti-androgens.

As a prostate cancer treatment, there is much controversy surrounding the use of combined androgen blockade (CAB). There are studies that suggest that patients who opt for combined androgen blockade as their prostate cancer treatment have slightly higher overall survival rates than those who have used castration or anti –androgens alone. These studies also indicate that combined androgen blockade has higher biochemical relapse free survival rates when compared to anti – androgens or castration alone. Other studies suggest the opposite: patients who opt for combined androgen blockade have a slightly lower overall survival rates than those who opt for castration or anti – androgens alone.

Androgen Resistance, Part 1 - Prostate Cancer Research Institute

2011-01-14T01:23:00.000-08:00

Androgen Resistance, Part 1 - Prostate Cancer Research Institute

Androgen Resistance, Part 1
Reprinted from PCRI Insights November 2002 v 5.2
By Charles E. (Snuffy) Myers, M.D., Founder and Medical Director, The American Institute for Diseases of the Prostate, Charlottesville, VA, and Member of the PCRI Medical Advisory Board
Introduction
The development of hormone resistance is the event most patients with prostate cancer (PC) fear most. They fear the side effects ofchemotherapy and worry that their survival may be short. I have seen this fear cause men to simply give up and ask only to be kept comfortable. This is unfortunate because the best of modern chemotherapy can be highly effective and the side effects are usually quite manageable. What I find particularly tragic is that a majority of men who are diagnosed with hormone-refractory PC are still hormonally responsive. All too often I have seen men who have progressed on Lupron® or Zoladex® alone be diagnosed as hormone-refractory and then be placed on one of the older, toxic chemotherapy protocols, have a short response of less than a year’s duration and then be placed on hospice care. This grim state of affairs is quite unnecessary. The purpose of this article is to describe what I think is a much more effective approach.
Is Androgen Withdrawal Complete?
The basis of hormonal therapy in treating PC is the reduction oftestosterone (T) levels to a range typically found after surgicalcastration. The mechanism of action of androgens is shown in Figure 1. While there is some controversy about the specific T level that must be attained, most specialists would accept that the T level must be below 50 ng/dl. I think a more appropriate goal would be a T level below 20. When a physician is faced with a patient who is progressing on hormonal therapy, his or her first step should be to make sure that the patient’s T level is in the castrate range. Unfortunately, many physicians assume that administration of Lupron® or Zoladex® automatically means that castrate androgen levels have been attained. This is often not the case. If T levels are still elevated, the next step is to determine whether this is the result of inadequate suppression of LH by the LHRH agonist/antagonist or because of increased production of androgen precursors by theadrenal gland. In the October 2001 issue of Insights, Dr. Stephen B. Strum’s article, “Listening to the Biology of Prostate Cancer,” provided detailed information on how to determine why medical castration has failed and how to deal with it.

Androgen Receptor Mutations

Figure 2. Human prostate stained with Androgen Receptor Ab-1.
An androgen receptor (shown in Figure 2) is very specific; while it binds avidly to testosterone or dihydrotestosterone(DHT), it does not react with a wide range of other steroid hormones. For example, the female sex hormonesestradiol and progesterone are chemically similar to T, but the androgen receptor does not react with either of them. The specificity of this receptor is critical for normal biology and allows the prostate and other tissues to respond selectively to T. The specificity of these receptors for their various hormones is based on the structure of these proteins. The androgen receptor has a portion that fits like a lock and key with the T molecule.
A minor change in the structure of the androgen receptor can have profound effects on its function. For example, there is a strain of chickens called the Sebright bantam. The cocks of this strain look like hens. While they have normal T levels, their androgen receptors do not function, causing their feminine appearance. In humans, a similar genetic change causes what is called testicular feminization syndrome in which males assume the external appearance of females, including the development of breasts and female external genitalia.
The first indication that androgen receptor mutations might be important in PC came from an experiment conducted by Dr. George Wilding at the University of Wisconsin. Wilding was testing theantiandrogen Eulexin® (flutamide) against a human PC cell, LNCaP. In the test tube, LNCaP responds to T or DHT by increasing its growth rate. Wilding anticipated that Eulexin® would block the growth stimulation caused by T or DHT. Instead, Eulexin® and its active metabolite, hydroxyflutamide, actuallystimulated the growth of LNCaP as if it were testosterone.
Wilding then went on to show that progesterone and estradiol also stimulated LNCaP growth. The explanation for this unusual behavior was that the androgen receptor in LNCaP was mutated in such a way that it reacted promiscuously with androgen, estradiol, progesterone, and drugs like Eulexin®. LNCaP reacted to all of these compounds as if they were androgens, because of this altered receptor. These observations led to the prediction that Eulexin® would stimulate the growth of the cancer in a patient whose tumor possessed an altered androgen receptor like LNCaP. If the Eulexin® was stopped, the tumor might shrink. We now know that approximately 25% of men who have been on Eulexin® for several years and then develop apparent hormone-resistant PC will have a significant response when the Eulexin® is stopped.
Even while on hormonal therapy, men continue to produce the female sex hormones, estradiol and progesterone. Indeed, this is the reason men on hormonal therapy often experience breast tenderness and enlargement. The mutated androgen receptor in LNCaP that is activated by Eulexin® also responds to estradiol and progesterone. Withdrawal of Eulexin® does not remove estradiol or progesterone, and it seemed possible that its presence may have limited the number of patients who responded to Eulexin® withdrawal. At low doses, the drug Cytadren® works by blockingaromatase, the enzyme that converts T to estradiol. At high doses, it blocks the production of most steroid hormones, including progesterone and all androgens. This led us to substitute Cytadren® in men who were discontinuing Eulexin®. Close to 45% of the patients responded to this treatment.
With Cytadren®, it was not possible to determine whether these responses were the result of the ability of this drug to block estradiol synthesis because it inhibited aromatase or the result of its ability at high dose to block nearly all steroid hormone synthesis. Recently, very specific aromatase inhibitors have been developed, and we tested one of these, Arimidex®, in hormone-refractory PC. We saw no responses, and I have concluded thatthe effectiveness of Cytadren® is the result of its capacity to block nearly all steroid hormone synthesis at high doses.
Casodex® is the other widely used antiandrogen. While it is more expensive than Eulexin®, it offers the convenience of once-a-day administration with a lower risk of liver damage and diarrhea. It also appears that the incidence of androgen withdrawal response is much lower than with Eulexin®. In fact, Casodex® can successfully block the growth of PC cells bearing the mutant androgen receptor found in LNCaP. Continued
References

G. Wilding, et al. “Aberrant response in vitro of hormone responsive prostate cancer cells to antiandrogens” Prostate 14: 103, 1989

W. K. Kelly and H.I. Scher. “Prostate specific antigen decline after antiandrogen withdrawal: the flutamide withdrawal syndrome” Journal Urology 149:607, 1993.

M.A. Fenton, et al. “Functional characterization of mutant androgen receptors from androgen-independent prostate cancer” Clinical Cancer Research 3: 1383, 1997.

S. McDonald, et al. “Ligand responsiveness in human prostate cancer: structural analysis of mutant androgen receptors from LNCaP and CWR22 tumors” Cancer Research 60: 2317, 2000.

O. Sartor, et al. “Surprising activity of flutamide withdrawal, when combined with aminoglutethimide, in treatment of “hormone-refractory” prostate cancer” Journal of the National Cancer Institute 86: 222, 1994.

R.K. Tyagi, et al. “Dynamics of intracellular movement and nucleocytoplasmic recycling of the ligand-activated androgen receptor in living cells” Molecular Endocrinology 14: 1162, 2000.
Androgen Hypersensitization
In the laboratory, the most widely studied androgen-responsive human PC cell line is LNCaP. The growth of this cell line slows or stops when T is removed. Over a period of about six months, cells emerge that do grow slowly without any T. Despite adaptation to the absence of T for up to six months, these cells will invariably grow better when T is added and they still have androgen receptors. However, it now takes between hundreds to thousands of times less T to stimulate these cells to grow to their maximal potential.Instead of becoming hormone-resistant, these cells have become extraordinarily responsive to testosterone!
These results have profound implications for PC treatment. Surgical castration or treatment with drugs like Lupron® or Zoladex® typically causes a 90–95% drop in blood T levels. Interestingly, surgical castration causes only a 75% drop in the T content of human prostate tissue. Even complete androgen blockade, including medical or surgical castration plus an antiandrogen such as Eulexin® or Casodex®, does not cause a decrease in androgen in the blood or prostate much beyond 99%. The implication is that given sufficient time, hormone-responsive PC cells can adapt to grow in the small amounts of androgen remaining – even after what has been called complete androgen blockade has been achieved. In fact, a large number of drug combinations have been tested for their ability to reduce T and DHT levels in prostate tissue. None come close to reaching levels that would be effective against cancer cells able to grow in up to 10,000 times less androgen. Yet, we now know that human PC cells are able to adapt to such low androgen concentrations.
Increased Androgen Receptor Expression
There are several paths that PC cells can follow to become more sensitive to low T levels. These include increasing the number of androgen receptors and using one of several means to enhance androgen receptor efficiency. It is easy to understand the importance of increasing the number of androgen receptors. PC cell growth is controlled by the number of T- or DHT-androgen receptor complexes that are present. The higher the concentration of androgen receptors, the more likely it is that enough receptor complexes will form to fuel cancer cell growth.
Examination of the androgen receptors content of human PC specimens shows that increased expression of androgen receptors is quite common in patients who have failed medical or surgical castration. In one study, the androgen receptor content of 33 untreated PC cases was compared with 13 cases in which hormonal therapy had failed. All of the hormone-resistant tumor specimens contained androgen receptors, and the average amount was six times higher than in the untreated patients.
In another study, androgen receptor expression was measured in each patient who failed castration; the patients were then placed on complete androgen blockade. Of the ten patients with increased androgen receptor levels in their cancers, nine responded or experienced disease stabilization because of this increase in the androgen withdrawal intensity. In contrast, those patients who had no increase in androgen receptor content of their tumors were quite unlikely to respond.
While these results are quite provocative, the study involved only a small number of men with cancers that exhibited an increased number of androgen receptors. Much larger numbers of patients need to be studied to determine the effectiveness of complete androgen blockade in that group of men whose tumors have developed increased androgen receptor levels. Nevertheless, it is clear that increased androgen receptor content is common in patients on hormonal therapy, and that complete androgen blockade will provide improved tumor control for many of these patients. Continued
References:
J. Geller, “Basis for hormonal management of advanced prostate
cancer,” Cancer 71: 1039, 1993.

J.D. McConnell, et al. “Finasteride, an inhibitor of 5-alpha-reductase,
suppresses prostatic dihydrotestosterone in men with benign
prostatic hyperplasia,” Journal Clinical Endocrinology Metabolism
74: 505, 1992.

G. Forti, et al. “Three-month treatment with a long-acting
gonadotropin-releasing hormone agonist of patients with benign
prostatic hyperplasia: effects on tissue androgen concentration, 5-
alpha-reductase activity and androgen receptor content,” Journal
Clinical Endocrinology and Metabolism 68: 461, 1989.

P.S. Rennie, et al. “Relative effectiveness of alternative androgen
withdrawal therapies in initiating regression of rat prostate,” Journal
of Urology 139: 1337, 1988.

M. Linja, et al. “Amplification and over expression of androgen
receptor gene in hormone-refractory prostate cancer” Cancer
Research 61: 3550, 2001.

C. Palmberg, et al “Androgen receptor gene amplification in a
recurrent prostate cancer after monotherapy with the nonsteroidal
potent antiandrogen Casodex (bicalutamide) with a subsequent
favorable response to maximal androgen blockade” European
Urology 31: 216, 1997.
Increased Androgen Receptor Efficiency
Androgen receptor complexes form and break down rapidly. (See Figure 3.) The number of androgen-receptor complexes present at any point in time represents a balance between the rate of complex formation and the rate at which these complexes break down. A few papers have described human PC cells able to grow at low levels of T where the mechanism seems to involve the formation of much more stable androgen receptors. For example, Gregory, et al examined human PC cell lines adapted to grow at low T levels. They found that the combination of increased androgen receptor content, increased receptor stability and enhanced nuclear translocation (See Figure 1) resulted in a 10,000-fold decrease in the dihydrotestosterone concentration required for cancer growth! The information is too incomplete for me to tell whether this occurs with any frequency in patients, but it illustrates the capacity of PC cells to adapt to extremely low androgen levels rather well.

Figure 3. Dual-color FISH analysis of prostate cancer xenografts. The clustering of red signals indicates amplification of the AR gene.

There are other proteins in PC cells that bind to the androgen receptor. Some of these act to enhance and others to suppress the effectiveness of the androgen receptor. This has become one of the “hot” areas of PC research, and it appears likely that shifts in the spectrum 4 of androgen receptor helpers and suppressors play a role in allowing these cancer cells to grow at low T levels. For example, Gregory, et al reported that a majority of hormone resistant prostate cancers not only show elevated levels of androgen receptors, but also show increased levels of proteins, called coactivators, that make androgen receptors more efficient. Three activators have been identified that appear to play a role in hormone-resistance: (1) transcriptional intermediary factor 2, (2) steroid receptor coactivator 1, and (3) ARA70. Continued
References:

C.W. Gregory, et al. “Androgen receptor stabilization in recurrent
prostate cancer is associated with hypersensitivity to low androgen”
Cancer Research 61: 2892, 2001.

C.W. Gregory, et al. “A mechanism for androgen receptor-mediated
prostate cancer recurrence after androgen deprivation therapy”
Cancer Research 61: 4315, 2001.

A. Bubulya, et al. “c-Jun targets amino terminus of androgen
receptor in regulating androgen-responsive transcription”
Endocrine 13: 55, 2000.
Activation of the Receptor at Low Androgen Levels
After the androgen receptor is made, phosphate must be added to the protein at certain sites before it can form effective complexes with T or DHT.
This process of adding a phosphate to a protein is called phosphorylation. After the androgen receptor binds to T, additional phosphate groups are added to the protein to facilitate prostate cell growth. Changes in the cancer cell that significantly foster the addition of these phosphate groups can markedly enhance the ability of the androgen receptor to respond to low levels of T. This process of androgen receptor phosphorylation appears to play a major role in allowing PC cells to elude hormonal therapy.
The epidermal growth factor (EGF) is part of a family of cytokinesthat share a capacity to control the growth of cells. This family of cytokines plays a major role in the biology of prostate cells. When the T- or DHT-androgen receptor complex triggers the growth of human prostate cells, it does so, in part, because it causes the prostate cells to release the EGF-family cytokines. These EGF-family cytokines then bind to the surface of the prostate cells and trigger growth. In at least some hormone resistant cancer cells, EGF-family cytokine release can occur in the absence of T or DHT, thus supporting androgen-independent growth.
There are a series of receptors specific for EGF-family cytokines. One of these, HER-2, is expressed in both androgen-sensitive and androgen resistant PC cells. An antibody that blocks HER-2 is able to prevent the growth of hormone-sensitive and hormone-resistant PC cells in mice. One antibody against HER-2, Herceptin®, is already on the market as a treatment for breast cancer.
EGF-family members also appear to play important roles in the growth of breast, lung, head, neck, and other cancers. Consequently, these cytokines and their receptors have become popular targets for pharmaceutical companies. Several agents that block this cytokine family are in late-stage clinical testing for head and neck cancer and lung cancer. One of these, Iressa®, has received the support of the FDA advisory committee for cancer drugs and is likely to become available for the treatment of lung cancer within the next year. However, once it is on the market, physicians will be able to use it for a wide range of other cancers, including PC. I should mention that this drug is already available in Japan. This drug has two desirable features. First, it can be given orally, once a day. Second, its side effects are generally mild and usually limited to an acne-like skin rash and diarrhea.
IL-6 is another cytokine that appears to play a role in androgen receptor function. (See Figure 4.) IL-6 is a cytokine that is released during infections and other inflammatory diseases. This cytokine is also released by PC cells, especially in the more aggressive, life-threatening forms of this disease. In PC patients, elevated IL-6 blood levels occur in association with widespread metastatic cancer and the development of hormone-resistant disease. PC cells have IL-6 receptors, and the adding of IL-6 increases the phosphorylation of the androgen receptor. Simply adding IL-6 also stimulates the growth of hormone-resistant PC cells in response to T or DHT.

Figure 4. Androgen receptor sensitization by EGF and IL6.

to block the production of IL-6 by PC cells or to block the action of this cytokine on PC cells. However, the body generally produces IL-6 in response toinflammation at any site. For example, arteriosclerosis or hardening of the arteries caused by cholesterol commonly causes widespread inflammation in the arteries, causing IL-6 elevation. If you are worried about this, the cardiac C-reactive protein represents the most sensitive and specific test for widespread inflammation in the body. If it is positive, you should ask your physician to determine why your C-reactive protein is elevated and treat this. For example, if it is caused by hardening of your arteries, the combination of one baby aspirin and a statin drug, like Lipitor, can be highly effective.

Neuroendocrine Cells and Hormone-Resistance
There are a group of specialized cells, called neuroendocrine cells, which release a wide range of cytokines and hormones, includingepinephrine, serotonin, calcitonin, gastrin-releasing peptide, andparathormone-related peptide. These cells are normally found in such normal tissues as the lining of the lung airways, the gut, breast ducts, and prostate gland ducts. The products of these neuroendocrine cells promote fluid secretion and muscle contraction by the ducts in these organs.
Neuroendocrine cells are commonly found scattered throughout PC masses. In newly diagnosed patients, the greater the number of these neuroendocrine cells, the more likely a patient is to develop life-threatening PC. In men on hormonal therapy, the appearance of large numbers of neuroendocrine cells in the PC deposits commonly precede the development of hormone-resistant PC.
For several years, we have known that the cytokines and hormones produced by neuroendocrine cells stimulate the growth of PC cells in the test tube. More recently, several of these neuroendocrine cell products have been shown to activate the androgen receptor through phosphorylation, leading to a receptor able to act at low levels of T or DHT. While there is no generally accepted treatment designed to suppress these neuroendocrine cells, Sandostatin®has been used with some clinical benefit in a small series of patients.
In some men, the neuroendocrine cells become the dominant cell in the cancer and become very aggressive. These cancers are very similar to small cell cancer of the lung and produce little or no PSA. This clinical presentation has recently been characterized by Chris Logothetis and his colleagues at M.D. Anderson. These patients typically present with rapidly progressing cancer in the presence of a relatively low or normal serum PSA. While there is no treatment associated with a high response rate, individual patients have responded well to combinations of paclitaxel (Taxol®) or docetaxel(Taxotere®) with carboplatin.
It is possible to monitor the appearance of neuroendocrine cells in men with PC because these cells release markers into the blood stream. The most generally useful test is the serum chromogranin A (CgA), but neuron specific enolase (NSE), calcitonin andbombesin can be of value in individual patients.
References:
Part 2 of this article Part 3 of this article

A. Hobisch, et al. “Interleukin-6 regulates prostate-specific protein expression in prostate carcinoma cells by activation of the androgen receptor” Cancer Research 4640, 1998.

M.D. Sadar “Androgen-independent induction of prostate-specific antigen gene expression via cross-talk between the androgen receptor and protein kinase A signal transduction pathways” Journal Biologic Chemistry 274: 7777, 1999.

L.G. Wang, et al. “Phosphorylation/dephosphorylation of androgen receptor as a determinant of androgen agonistic or antagonistic activity” Biochemistry Biophysics Research Communications 259: 21, 1999.

Z. Culig, et al. “Synergistic activation of androgen receptor by androgen and luteinizing hormone-releasing hormone in prostatic carcinoma cells” Prostate 32: 106, 1997.

T. Ikonen,et al. “Stimulation of androgen-regulated transactivator by modulators of protein phosphorylation” Endocrinology 135: 1359, 1994.

C. Culig, et al. “Androgen receptor activation in prostatic tumor cell lines by insulin- like growth factor 1, keratinocyte growth factor and epidermal growth factor” Cancer Research 54: 5474, 1994.

D.B. Agus, et al. “Response of prostate cancer to anti-Her-2/neu antibody in androgen-dependent and –independent human prostate xenograft models” Cancer Research 19: 4761, 2000.

S. Signoreti, et al. “Her-2 neu expression and progression toward androgen independence in human prostate cancer” Journal National Cancer Institute 92: 1918, 2000.

N. Craft, et al. “A mechanism for hormone-independent prostate cancer through modulation of androgen receptor signaling by the HER-2/neu tyrosine kinase” Nature Medicine 5: 280, 1999.

Y. Wen, et al. “Her-2/neu promotes androgen-independent survival and growth of prostate cancer cells through the Akt pathway” Cancer Research 60: 6841, 2000.

S. Yeh, et al. “From Her2/Neu signal cascade to androgen receptor and its coactivators: a novel pathway by induction of androgen target genes through MAP kinase in prostate cancer cells” Proceedings National Academy Sciences USA 96: 5458, 1999.

CT Scan report

2011-01-06T20:04:00.001-08:00

MrVenkatesan Gemini Scan Report

problem encountered after 3 years

2011-01-06T19:27:00.000-08:00

CARCINOMA PROSTATE History & Management

27.07.07 Prof.R.P.Rajan performed bilateral orchidectomy

Prescribed Calutide-50 for 100% androgen blockade-18.08.07 to 08.1.08 (5Months)

*Calcium-shellcal-1000mg/day suggested from 04.01.08 -

08.07.10 SCAN-Prostatomegaly-enlarged-35.4cc45x38x39mms/Post void urine in bladder.Vol-115ml.-Significance

09.07.10-Calutide-50 re administered

11/10/10 Vijaya: 4.5ml/sec -60% Obstructive flow & prolonged voiding

To avoid surgery (Channel TURP) now taking (Dutas-T a combipack of Dutasteride (0.5mg) & Tamsulosin Hydrochloride (0.4mg)

PSA monitoring:

14.07.07 Bha 92.19

01.10.07 Bha 0.30

04.01.08 Bha 0.17

29.02.08 Lis 0.20

10.06.08 JVH 0.2ng

05.09.08 Bha 0.208

03.12.08 -do- 0.260

07.03.09 -do- 0.256

05.06.09 -do- 0.363

04.09.09 Bha 0.762

06.12.09 -do- 1.069

03.03.10 -do- 1.745

04.06.10 Lister 2.35

10/08/10 Lister 2.05

06/10/10 Lister 1.98 Free PSA 0.28

07/12/10 -do- 1.850.

PROBLEMS ENCOUNTERED

08.07.10 KUB SCAN revealed-Prostatomegaly-enlarged-35.4cc45x38x39mms

Post void urine in bladder.Vol-115ml.-Significance09.07.10 Calutide-50 re administered

07/10/10 DRE : Hard nodule in R lobe- Done Uroflow & LFT tests

11/10/10 Vijaya: 4.5ml/sec -60% Obstructive flow & prolonged voiding

21/10/10 Advised to continue Calutide, Dutas-T for 3 months –Repeat PSA/LFT

25/12/10 visited Dr. for pain. On return suffered urination with blood and Dr. advised Ciplox-500 for 5days. I suffered acute pain for a day till blood clots evicted through urethra. Suffered again Hematuria on2/1/2011 for 10hours.

05/1/11 CT Scan: Prostate locally enlarged in size & infiltration in to bladder base. Urologis referred to Radiation oncologist for RT or Chemotherapy.PSA is controlled.

Hematuria after Prostate Cancer Treatment

2011-01-04T04:41:00.000-08:00

Hematuria after Prostate Cancer Treatment

Hematuria refers to the presence of blood in the urine. Hematuria can be caused by benign prostatic hyperplasia, prostate cancer, benign tumors, or prostate cancer treatments. There are two types of hematuria: gross and microscopic. Gross hematuria may involve pink, red, brown colors or the presence of blood clots. Microscopic hematuria can be detected only by use of a microscope. Blood in the urine can also be caused by jogger’s hematuria which occurs when repeated jarring of the bladder traumatizes the organ and produces blood.

PROSTATE, Cancer

2010-12-21T17:38:00.000-08:00

PROSTATE, Cancer

PROSTATE, Cancer

The prostate is a gland. It helps make semen, the fluid that contains sperm. The prostate surrounds the tube that carries urine away from the bladder and out of the body. A young man's prostate is about the size of a walnut. It slowly grows larger with age. If it gets too large, it can cause problems. This is very common after age 50. The older men get, the more likely they are to have prostate trouble. Most prostate problems are not cancer. Having a problem with your prostate does not raise your chance of getting prostate cancer.

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Some common problems are
Prostatitis - an infection, usually caused by bacteria
Benign prostatic hyperplasia, or BPH - an enlarged prostate, which may cause dribbling after urination or a need to go often, especially at night
Prostate cancer - a common cancer that responds best to treatment when detected and treated early.

Acute prostatitis is a bacterial infection. It usually starts all of a sudden. It can cause fever, chills, or pain in the lower back and between the legs. It might hurt when you urinate.

Chronic bacterial prostatitis is an infection that comes back again and again.

Chronic abacterial prostatitis, also known as Chronic Pelvic Pain Syndrome (CPPS), is a common prostate problem and occurs mostly in young to middle-aged men. It causes pain in the lower back, between the legs, or at the tip of the penis. Men with this problem often have painful ejaculation and need to urinate frequently.

Prostate Cancer

Very few men die from prostate cancer. Treatment for prostate cancer works best when the disease is found early and has not spread to other parts of your body.

Your chance of getting prostate cancer may be affected by your:

Age. Being 50 or older increases your chance of prostate cancer.
Family history. If your father or brother has had prostate cancer, you are more likely to have it too.
Diet. Eating high-fat food with few fruits and vegetables may increase your chance of having prostate cancer.

Diagnosing Prostate Cancer

Prostate cancer in the begining often does not cause symptoms. As the cancer grows, you may have trouble urinating. You may need to urinate often, especially at night. Some men have pain or burning during urination, blood in the urine or semen, pain in the back, hips, or pelvis, and painful ejaculation.

To find out if these symptoms are caused by prostate cancer, your doctor will ask about your past medical problems, will perform a physical exam ( your doctor will put a gloved finger into your rectum to feel your prostate for hard or lumpy areas), may also do a blood test to check the prostate-specific antigen (PSA) level. PSA levels may be high in men who have an enlarged prostate gland or prostate cancer. You may also need an ultrasound exam that takes computer pictures of the prostate. If tests show that you might have cancer, biopsy is needed to confirm this.

Protecting Yourself

Following can be signs of a prostate problem:

Frequent urge to urinate
Need to get up many times during the night to urinate
Blood in urine or semen
Painful or burning urination
Not being able to urinate
Painful ejaculation
Frequent pain or stiffness in lower back, hips, pelvic or rectal area, or upper thighs
Dribbling of urine
If you have any of these symptoms, see your doctor right away.

Treatment for prostate cancer

AGNUS CASTUS - Discharge of prostatic juice when straining at stool.

ALLIUM CEPA - Pressive pains deep in pelvis (in prostate). Pressive pains in bladder and prostate, deep in the pelvis, the next morning and forenoon, after coitus.

ALOE SOCOTRINA - On walking, after the morning stool, many drawing stitches in the anus, more on the left side and forward to the region of the prostate gland and vesiculae seminales.

AMMONIUM CARBONICUM - Hard evacuation, followed by discharge of a milk-like prostatic fluid.

ANACARDIUM ORIENTALE - Discharge of the prostatic juice, with natural stool. Discharge of the prostatic juice, with difficult stool. Discharge of the prostatic juice, after emission of urine.

ANANTHERUM MURICATUM - Frequent seminal and prostatic losses.

ARNICA MONTANA:
Constipation : rectum loaded, faeces will not come away; ribbon-like stools from enlarged prostate or retroverted uterus.

ARSENICUM ALBUM - Discharge of prostatic juice, with diarrhoeic stool.

AURUM METALLICUM - Prostatic juice comes out of the penis, which is relaxed.

BARYTA CARBONICA - Diseases of old men; hypertrophied prostate or indurated testes.

BELLADONNA - Discharge of prostatic juice. Discharge of prostatic juice from a relaxed penis.

BENZOICUM ACIDUM - Enuresis nocturna of delicate children; dribbling urine of old men with enlarged prostate; strong characteristic odor; excesses of uric acid.

BROMIUM - Pressure in the prostate gland when walking. (Walking),Pressure in prostate gland;palpitation;stiffness in front of thigh;weakness.

CALCAREA CARBONICA - Prostatic fluid flows after the urine. Prostatic fluid is discharged after the stool, and after the urine.

CALCAREA PHOSPHORICA - Frequent and urgent desire to urinate, in the forenoon. The water pretty clear, and the aggregate quantity large. The water passed in a feeble stream, occupying considerable time. After all had passed, considerable soreness of the bladder, followed by frequent micturition. Troubles of the bladder arising from overdistension.

CANNABIS INDICA - Excessive discharge of prostatic fluid, at night, during a hard evacuation.

CANNABIS SATIVA - Swelling of the prostate gland.

CANTHARIS VESICATORIA - Feeling of heat in urethra, with slight constriction at the prostate.

CARBO VEGETABILIS - Discharge of prostatic fluid, when straining at stool.

CARLSBAD AQUA - Diminished discharge of urine, with dull sensation in the perineum, and often, during stool, drops of prostatic juice at the orifice of the urethra. Even on going to stool, there is erection of the penis, and with pressure to stool not seldom prostatic fluid is discharged.

CAUSTICUM - Passage of prostatic fluid after the stool.

CLEMATIS ERECTA - Dull transient pain in the prostate, frequently repeated through the day.

COFFEA TOSTA - At close of micturition, a slight milky discharge(prostatic), attended with a smarting or burning sensation at orifice of urethra;afterwards, cutting pains below the bladder (in sphincter vesicae, or region of prostate gland).

COMOCLADIA DENTATA - Intense itching on the scrotum and lower part of the penis, extending to the prostate gland, and also on the inner surface of the prepuce, about noon.

CONIUM MACULATUM
Great difficulty in voiding urine; flow intermits, then flows again; prostatic or uterine affections. Discharge of prostatic fluid. Discharge of prostatic fluid on every change of emotion, without voluptuous thoughts, with itching of the prepuce.

COPAIVA OFFICINALIS - Inflammation of the urinary passages and adjacent parts. It has also been known to cause inflammation of the urethra, retention of urine, phlegmasia of the bladder, of the prostate, the anus, and the rectum.

CUBEBA OFFICINALIS - Prostatitis; the gland feels enlarged to finger in rectum; perineum tender; last drops of urine passed with pain; after micturition, sensation as if bladder still contained water.

CUPRUM ARSENICOSUM - Dark-red urine;burning pain at the orifice of the urethra during and after urinating; white purulent discharge from the urethra;soreness of the penis, with pain in the prostate gland;redness of the lips of the urethra, with tingling and burning;agglutination of the lips of the urethra; perspiration of the scrotum, which is constantly moist and damp;soreness of the under surface of the penis when pressed.

CURARE - Prostatic discharge after urinating.

DAPHNE INDICA - Discharge of prostatic fluid, after urinating.

ELAPS CORALLINUS - Continued discharge of prostatic fluid.

ERYNGIUM AQUATICUM - Sexual desire suppressed, then excited, with lewd dreams, and pollutions; discharge of prostatic fluid from slight causes.

EUPHORBIUM OFFICINARUM - Discharge of prostatic fluid from the relaxed penis. Voluptuous itching on the prepuce that obliges rubbing, with discharge of prostatic fluid.

FLUORICUM ACIDUM - While thinking in a perfectly chaste and pleasant way about a girl whom he considers beautiful, there passed some drops of prostatic fluid.

FORMICA RUFA - A kind of nervous fluctuating and jerking pain in the left half of the penis, in the region of the prostate, very often repeated.

GNAPHALIUN POLYCEPHALUM - Very frequent, but slight evanescent pains in the region of the prostate.

HELONIAS DIOICA - In functional derangements of the prostate, frequent and profuse urination, the urine being very pale and watery, or containing a deposit of the amorphous phosphates.

HEPAR SULPHUR - Discharge of prostatic fluid at times during the stool.

HIPPOMANES - Soft stool, with vomiting and discharge of fluid (prostatic) from the urethra after micturition.

HYDROCOTYLE ASIATICA - Feeling of weight in the prostate gland.

IGNATIA AMARA - While urging at stool much mucus(prostatic fluid)from the urethra.

IODIUM - Hypertrophy and induration of glandular tissue_thyroid, mammae, ovaries, testes, uterus, prostate or other glands_breasts may dwindle and become flabby.

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KALIUM BICHROMICUM - Escape of prostatic fluid at stool. Sticking pain in the prostate gland, extremely violent and preventing walking, in the afternoon.

KALIUM BROMATUM - Bathing the parts in ice-water gives relief.

KALIUM CARBONICUM - Discharge of milky, odorless, flocculent fluid(prostatic fluid), after urinating.

KALIUM NITRICUM - Acute stitches in the region of the prostate gland while urinating.

LACHESIS MUTUS - Pressure upon the bladder to urinate with emission of some semen(prostatic fluid), which looked milky.

LYCOPODIUM CLAVATUM - Discharge of prostatic fluid without cause. Discharge of prostatic fluid, without erections, with great lasciviousness. Tension and pain in the prostate and urethra.

LYSSINUM - Prostatic juice passes after urinating. Without being preceded by an erection there is a discharge of prostatic fluid, smelling salty and musty; the glans penis is dry. Burning and tenesmus as if in prostatic gland and in urethra; in afternoon. Afternoon: very severe headache; dull pain in forehead, with stupid feeling; pressing in vertex and forehead; dull pain in forehead; sick headache; dull heavy pain in head; headache, with nausea and sore pain around heart; stinging pressure behind ears; ranula, with dryness of mouth aggravated ; stinging in chest, with palpitation; sour belching; erections; itching and burning on corona glandis; burning and tenesmus as if in prostatic gland and in urethra; increased peristaltic motion of scrotum; first hours pain in testicles aggravated ; pain in wounded left arm; pain in shoulder joint; whole body trembles; drowsy; starting in sleep; fever. Burning and tenesmus in region of prostate and down urethra.

MAGNESIUM CARBONICUM - Discharge of prostatic fluid during emission of flatus.

MAGNETIS POLI AMBO - Lascivious dreams, even during the siesta, with discharge of the prostatic fluid.

MEDORRHINUM - Frequent urination with slight burning at the meatus; dull heavy ache in the region of the prostate; very sore in perineum extending to rectum; frenum red and swollen.

MERCURIUS DULCIS - Acute affections of prostate after maltreated stricture.

NATRIUM CARBONICUM - Prostatic fluid passes with a difficult stool. Prostatic fluid passes with the urine .

NATRIUM MURIATICUM - Discharge of prostatic fluid, with lascivious thoughts, without excitement of fantasy or of the sexual organs, and without erections.

NITRICUM ACIDUM - Discharge of prostatic fluid after a difficult stool. Some drops of thin mucus, not stringy like prostatic fluid, are discharged from the urethra after urinating. Sexual excitement, during which there was much discharge of prostatic fluid. After stool, sticking and scraping in rectum;discharge of prostatic fluid;burning and itching in anus;smarting in rectum;nausea;exhaustion.

OLEUM ANIMALE AETHEREUM - Pressure in the region of the prostate gland.

PHOSPHORICUM ACIDUM - Burning tearing in the left testicle, and burning in the prostate gland, with frequent erections.

PHOSPHORUS - Discharge of prostatic fluid during a hard stool. Moisture in the orifice of the urethra, as from prostatic fluid. Oozing of some prostatic or urethral mucus from the urethra, while the genitals were relaxed.

PHYTOLACCA DECANDRA - A gurgling sensation in the prostate gland, repeatedly in the afternoon.

PLUMBUM METALLICUM - Induration of the prostate.

POLYGONUM HYDROPIPEROIDES - Pulsative pain in region of prostate gland, occasionally extending along the urethra, continuing for half an hour . Burning sensation in prostate gland. When voiding urine, slight pain apparently in prostate gland.

PSORINUM - Discharge of prostatic fluid before urinating. Discharge of prostatic fluid after urination, but especially after a difficult stool (also almost constant dripping of the same). Induration and enlargement of the prostatic gland.

PTELEA TRIFOLIATA - Felt a strange uneasiness in the bladder and prostate. Heat in the region of the prostate

PULSATILLA PRATENSIS - Frequent erections, with discharge of prostatic fluid. Agreeable tickling on the glans penis, followed by discharge of a colorless liquid like prostatic fluid.

SARRACENIA PURPUREA - Sympathetic swellings, extending from the groins to the knees, with prostatic flux and great wasting, as from decomposition of the blood.

SELENIUM METALLICUM - Erections slow, insufficient, too rapid emission with long-continued thrill; weak, ill-humored after coitus, often involuntary dribbling of semen and prostatic fluid which oozes while sitting, at stool, during sleep; gleet (Calad.). Dribbling of prostatic fluid. While sitting a drop of prostatic fluid passes from the orifice of the urethra with a peculiar disagreeable sensation.

SENECIO AUREUS - Prostate gland enlarged, feels hard and swollen to the touch.

SEPIA OFFICINALIS - Discharge of prostatic fluid, after micturition. Discharge of prostatic fluid with every difficult stool.

SILICEA TERRA - Dragging from the prostate gland forward. Discharge of prostatic fluid with every stool. Discharge of prostatic fluid while straining at stool.

SPIGELIA ANTHELMIA - Prostatic fluid presses out of the orifice of the urethra.

STAPHISAGRIA - Urging to urinate, has to sit at urinal for hours; in young married women; after coition; after difficult labor (Op.); burning in urethra when not urinating; urging and pain after urinating in prostatic troubles of old men; prolapse of bladder. Discharge of prostatic fluid during the evacuation of a hard stool.

SULPHUR - Dribbling of prostatic fluid in long threads from the urethra after micturition and stool. Discharge of prostatic fluid.

SULPHURICUM ACIDUM - Pain behind the symphysis, frequent desire to urinate, and cutting pains when urinating;the catheter met with an obstruction in the region of the neck of the bladder, which, on examination through the rectum, was found to be a swollen and extremely sensitive prostate.

TABACUM - Dysuria and enlarged prostate. Discharge of prostatic fluid.

TARENTULA HISPANICA - Constant sexual excitement, which nothing can control;sufferings of the prostate, debilitating sweats, unconquerable sadness, and stupidity;erotism. Lasciviousness ;constant sexual excitement at the sight of obscene objects;onanism, followed by prostatic sufferings.

THUJA OCCIDENTALIS - Discharge of prostatic fluid in tenacious threads, in the morning after waking. A tensive aching in the prostate gland and testicles. Voluptuous fancies and erection, with discharge of prostatic fluid, while lying down.

VOESLAU AQUA - Increased secretion from the prostatic glands.

ZINCUM METALLICUM - Difficult evacuation of soft stool, with emission of prostatic fluid. Profuse emission of prostatic fluid, without apparent cause.

Beyond the PSA Debate - Prostate Cancer Foundation (PCF)

2010-12-05T05:03:00.000-08:00

Reaching Beyond the PSA Debate - Prostate Cancer Foundation (PCF)

1. PCA-3 and Gene Fusion Urine Based Diagnostics of Prostate Cancer

Jack Schalken, PhD, Research Director of Urology
Nijmegen Center for Molecular Life Sciences (The Netherlands)
PCF Competitive Award Recipient

Arul Chinnaiyan, MD, PhD, Professor of Pathology and Urology
Michigan Center for Translational Pathology
University of Michigan

Jack Schalken, PhD from the University of Nijmegen in the Netherlands and Arul Chinnaiyan, MD, PhD from the University of Michigan are developing two important molecular diagnostic tests in urine for prostate cancer. One detects the presence of PCA-3 (Schalken), a prostate cancer-associated gene, and the other tests for the presence of the gene fusion TMPRSS2-ERG (T2-ERG; Chinnaiyan) responsible for up to 60% of prostate cancer cases. Both of these tests can be performed on cells found in urine. These markers are found only in cancer cell DNA, so, unlike PSA, both are specific markers for prostate cancer.

Currently, the PCA-3 test is approved for diagnostic use in Europe and is widely available at reference labs in the U.S. Schalken’s and Chinnaiyan’s findings suggest that these tests may be superior to PSA with respect to identifying patients that might need aggressive therapy. Research on T2-ERG detection in urine is at an earlier stage of development. The assays are not mutually exclusive. Dr. Schalken noted at our 2008 Scientific Retreat at Lake Tahoe that information on diagnosis and prognosis will likely increase by combining results from these molecular tests with other clinical and laboratory findings. These genetic tests are under development by Gen-Probe, Inc., led by its CEO and PCF Board member, Hank Nordhoff.

Key Findings:

PCF funding in the 1990s resulted in the discovery of the gene DD-2 which has been renamed PCA-3.
PCA-3 is the first DNA diagnostic test for prostate cancer to be discovered by comparing prostate tumor DNAs to normal DNAs.
PCA-3 is being rigorously tested in multiple clinical settings in Europe and the U.S. for the diagnosis of prostate cancer.
PCA-3 biomarker may have a significant impact on the diagnosis and staging of prostate cancer configured as a urine test.
A second molecular test under development is the detection of a gene fusion thought to be the cause of up to 60% of prostate cancers (T2-ERG).
Both PCA-3 and T2-ERG tests are receiving developmental support from the U.S.-based company, Gen-Probe, Inc.

2. Circulating Micro-RNAs as Stable Blood-Based Markers for Cancer

Muneesh Tewari, MD, PhD, Assistant Member, Human Biology
The Fred Hutchinson Cancer Center (Seattle, WA)
PCF-Arnie’s Army 2009 Creativity Award Recipient

Dr. Muneesh Tewari from The Fred Hutchinson Cancer Center at the University of Washington discovered miR-141 which is a cancer-associated micro-RNA. His focus is on the characterization of micro-RNA and the development of a micro-RNA-based diagnostic test to identify prostate cancers with a simple blood test. Tewari was studying a micro-RNA designated miR-141, and others, when he asked the simple question: Could this micro-RNA be detected in the blood of patients with prostate cancer? Tewari was aware that micro-RNAs showed unusually high stability in tissue specimens. On a hunch, he decided to test whether this stability extended to blood as well.

In Seattle, a PCF-funded group, headed by Drs. Peter Nelson and Robert Vessella, has been assisting Dr. Tewari as collaborators with prostate cancer expertise. Dr. Tewari, who was not a prostate cancer expert a year ago, is now collaborating daily with some of the world’s leading scientists whose laboratories are in immediate proximity. An important principle for biomarkers is that although PSA is prostate specific, it is not cancer specific. Both normal and malignant prostate cells produce PSA, causing PSA levels to change for a host of reasons that are not necessarily related to cancer progression.

This micro-RNA may prove to be more prostate-cancer-specific and is not changed by hormone treatment. This may allow more precise assessment of prostate cancer growth or regression after a given treatment. Dr. Tewari has developed a test to measure miR-141 and other cancer-specific micro-RNAs in human blood samples. Tewari’s work, being supported by the PCF Golf Program, Arnie’s Army Battles Prostate Cancer (www.arniesarmybattles.com) might also be applicable to patients with other solid tumors, especially ovarian cancer.

Key Findings:

Some micro-RNAs are made only by cancer cells, not normal cells.
Exosomes are membrane particles released from cancer cells that contain debris.
Small regulatory RNA molecules, termed micro-RNAs, are stable in blood and are found in exosomes.
Laboratory models proved that prostate cancer-derived micro-RNAs can be detected in blood within exosomes.
Levels of one micro-RNA, designated miR-141, identify patients with prostate cancer.

3. Nuclear-Structure-Based Serum Markers of Prostate Cancer

Robert Getzenberg, PhD, Professor, Urology, Pharmacology and Molecular Science
Johns Hopkins University (Baltimore, MD)
PCF Competitive Award Recipient

Dr. Robert Getzenberg from Johns Hopkins has developed a test for EPCA-2, a cancer-specific protein molecule. Getzenberg proved EPCA-2 was made in cancer cells, not normal cells. He has presented results related to the characterization of an EPCA-2 test in post-prostatectomy patients, and showed that patients with potentially curative surgery revert to a zero EPCA-2 value.

Studies evaluating EPCA-2 as a marker for disease recurrence, and as a biomarker to inform treatment efficacy, are ongoing. We are hopeful that Johns Hopkins will be successful in developing EPCA-2 into a robust progression biomarker, and in licensing its EPCA-2 technology in the near future for development of a commercial clinical lab test. We also hope this test will be available to patients within two years of Johns Hopkins obtaining a commercial partner.

Key Findings:

Unlike micro-RNAs, or DNA tests like gene fusions, EPCA-2 is a prostate-cancer-specific biomarker protein.
Antibodies have been produced to develop a lab test to detect EPCA-2 being released from early prostate cancer.
Applications of an EPCA-2 test include: (1) risk stratification for prostate cancer detection and (2) identifying individuals with elevated PSA levels and/or positive digital rectal exams that will have a high probability of a positive biopsy of the prostate.
EPCA-2 might be useful as a biomarker of disease progression and for measuring therapeutic response.

4. Detecting Circulating Prostate Tumor Cells with Microfluidic Device

Gerhardt Attard, MD, PhD, Senior Clinical Research Fellow
Royal Marsden Hospital (London, U.K.)
The Susan and James Blair - PCF Young Investigator Award Recipient

Howard Scher, MD, Chief, Genitourinary Oncology Service
Memorial Sloan-Kettering Cancer Center (New York, NY)
Competitive Award Recipient
PCF Challenge Award Recipient 2008-2011
Charter member and leader of the PCF Therapy Consortium

Daniel Haber, MD, PhD, Director
Massachusetts General Hospital Cancer Center (Boston, MA)
PCF Challenge Award Recipient 2008-2011

In some patients, tumor cells circulate prior to metastasis. A novel microfluidic device, developed by Drs. Daniel Haber and Mehmet Toner of Massachusetts General Hospital Cancer Center, enables a blood test to isolate circulating tumor cells (CTCs). Although it is not yet approved for clinical use, it may eventually play a key role in numerous aspects of cancer diagnosis and treatment, including detecting and evaluating metastatic disease, selecting and individualizing initial surgical and medical therapies, monitoring disease progression, detecting the occurrence of therapy-induced mutations and the consequent development of resistance, and understanding the fundamental biology of metastasis.

Current detection methods successfully detect CTCs in only half of samples known to contain them. The new device consists of approximately 80,000 micro posts covered with antibodies against the epithelial cell adhesion molecule (EpCAM), permitting them to selectively bind CTCs. The bound cells are visualized with fluorescent staining and optical microscopy. The device has been used to detect CTCs from prostate, lung, breast and gastrointestinal cancers. Staining techniques for specific molecules, such as prostate specific antigen (PSA), provide reliable confirmation of the source of the CTCs.

The PCF is funding the next phase of research being conducted with the microfluidic CTC chip developed by Drs. Haber and Toner. Using the device, Drs. Rick Lee and Matthew Smith at the Massachusetts General Hospital Cancer Center, are directing clinical trials to analyze CTCs in prostate cancer patients. The research seeks to validate prostate cancer applications for CTC analysis similar to those already shown for lung cancer. The clinical trials include correlating CTCs with borderline or rising PSA levels, pathological and histological analysis, and the likelihood of post-operative recurrence, rapidly measuring therapeutic responses, detecting the development of resistance and genetic changes, such as translocation and androgen receptor mutation, and understanding the disease process to identify diagnostic markers and novel therapeutic targets.

This technology provides a minimally invasive technique for early detection of tumors and metastasis. A single cancer cell can be isolated from over a billion red blood cells in a routine blood test using this new convergence of microelectronics, material sciences, and molecular biology. We call this approach at the PCF a “liquid biopsy” for prostate cancer biomarkers. We have an enormous amount to learn about the strengths and limitations of these liquid biopsies and how to apply them to routine daily care of patients. Analysis of CTCs can indicate the type of cancer, its aggressiveness, and its susceptibility to particular treatments. New biotechnologies allow a single isolated tumor cell in a patient to be analyzed for genes that can help predict response to drugs before they are used.

Also, it may be possible to measure remissions earlier using liquid biopsies than to use conventional CT scans and other radiology tests. Although the absolute number of CTCs in the blood so far has not correlated well to tumor size, variations in CTC levels over the course of treatment do correlate with X-ray evaluations of progression and remission, providing an important and responsive means of monitoring the efficacy of standard or experimental regimens. In fact, ongoing research at Memorial Sloan-Kettering Cancer Center (Dr. Howard Scher) and the Royal Marsden (Dr. Gerhardt Attard, the Susan and James Blair - PCF Young Investigator) is validating CTCs in a Phase 3 clinical trial as a surrogate for survival. These studies employ an FDA-approved CTC device produced by Veridex, a J&J company. The microfluidic CTC chip should prove to be a major advancement in this technology with great increases in sensitivity and specificity of detecting these important cells.

Key Findings:

Microfluidic CTC chips is a new technology for measuring circulating tumor cells (CTCs).
CTCs are detected in the blood from patients with a variety of solid tumors.
In lung cancer, this test provides a noninvasive serial monitoring method for clinical response, and for the detection of the molecular cause for drug resistance.
In prostate cancer, it is being tested as a progression biomarker and as a surrogate endpoint for survival in clinical trials.

5. Genomic Alterations and Prostate Cancer Risk

William Isaacs, PhD, Professor of Oncology, Urology
Johns Hopkins Medical Institutions
PCF Gene and Family Consortium Awardee

William Isaacs, PhD, has led a global consortium of geneticists in the discovery of genomic alterations that predict prostate cancer risk. Most recently, a panel of ~20 genomic changes that can be detected in a blood test, distinguish prostate cancer risk from the population of approximately 6% to over 50% when the individual also has a strong family history. This assessment could be used for a 20-year-old person with a family history, and genomic alterations, to predict risk for prostate cancer at a much older age.

As significant as risk prognosis might be, this analysis still does not inform the individual or his physician if the resulting prostate cancer will be clinically meaningful in his lifetime.

A recent and hopeful development from a Johns Hopkins’ study is the identification of a DNA-based genomic alteration associated with aggressive prostate cancer. Although the association is relatively weak and not yet a proven diagnostic for lethal prostate cancer, the hope is that ongoing analysis of large patient populations (thousands) will reveal additional genetic markers associated with aggressive disease. These hypothetical markers, in conjunction with the previous risk markers and family history, hold the promise of identifying those individuals appropriate for intensive clinical surveillance for aggressive prostate cancer.

Key Findings:

The ability to identify genomic alterations in a biopsy with DNA sequences that are associated with prostate cancer clinical behavior is rapidly advancing.
DNA markers are available today that differentiate individuals at low and high risk for developing prostate cancer in their lifetimes.
More than 20 genomic alterations have been associated with prostate cancer risk.
The Promise of New Prostate-Cancer-Specific Biomarkers

The development of new clinical laboratory tests will ultimately deliver a better diagnosis for every patient that is capable of predicting aggressive cancers and identifying those that will never take the life of a patient. These enhanced tools for monitoring disease progression will save countless lives and spare countless men from unnecessary treatment.

PCF is working daily with the PCF-funded Therapy Consortium to have the patient samples in place in order to rapidly test these new biomarkers as they become available for validation. In this way PCF should be able to reduce the time to realization of better tests for patients. A secondary use for some of these biomarkers will be to assess patient response to experimental treatments during clinical investigation. Progression biomarkers (such as CTCs) are already being tested in clinical trial surrogates at this writing. If successful, the surrogate would inform investigators months, if not years, earlier of positive effects in certain patients of new anti-prostate cancer medicines.

The field is advancing rapidly and we are monitoring progress weekly in our research briefings and journal clubs. We will provide updates on a regular basis on progress made in the above biomarker research projects. Also, we will formally review how much progress has been made in the last year - along with the most recent data - in our 2009 Scientific Retreat (September 24-26, 2009).

Salve taken internally kills cancer at Prostate Cancer Alternatives Support (ThreadID: 841925)

2010-12-05T04:19:00.000-08:00

Thread: Salve taken internally kills cancer at Prostate Cancer Alternatives Support (ThreadID: 841925)

Taking Black Salve Internally

I have not posted any info as of yet about internals but after many request and reports from many people who have used it that way, I am doing so now. One man in TX was on his death bed so to speak with lung cancer when he started to take the internal black salve. Within a week he was actually up and around and was expected to leave the hospital! My friend knows this man, and I am hoping to get a testimonial from him sometime soon, which I will post here.

I am still a bit hesitant to put info up about it because all black salve is not the same and some use different fillers that I would not want to take internally. The old cansema was good stuff but they have been shut down for over 3 years now. I use the salves from www.bestonearthproducts.com because to date they have shown to be all high quality.

Please realize, this is not medical advice, only reports of what others have been experiencing. Make sure you consult with your health care provider before starting any form of treatment. Also, this protocol is for internal black salve, NOT BLOODROOT SALVE. Here is the way most people have taken the salve internally with the best results.

Take a small pea size amount of black salve 1x a day, either placed into an empty capsule or into a piece of bread, then eat a full meal to avoid nausea.

This is to be done everyday for 10 days, then take 10 days off. Repeat this cycle until you have completed a full 30 days of the salve, meaning 10 days on 10 off, 10 on 10 off, then 10 more on.

IMPORTANT: When abnormal cells (cancers) in the body are being destroyed, it will stir up a lot of chaos and the person taking the internals will feel like garbage, but not as bad as if they took chemo! If the person has never done so before, it would be a good idea for them to do a colon cleanse and possibly a liver cleanse before taking the internal salve (If time permits) because there will be a lot of debris from the dead cancer being pulled through the major organs like the liver, kidneys, and intestines. They will want to make sure that the pathway for the debris is clear before the internal protocol is taken.

Email me for specifics about cleanses and I will point you in the right direction. BlackSalveInfo@yahoo.com

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Prostate cancer prevention and health

2010-12-05T02:35:00.000-08:00

Prostate cancer prevention and health

What is the Prostate?
The prostate is part of a man's sex organs. It's about the size of a walnut and surrounds the tube called the urethra, located just below the bladder. The urethra has two jobs: to carry urine from the bladder when you urinate and to carry semen during a sexual climax, or ejaculation. Semen is a combination of sperm plus fluid that the prostate adds.

What are the various Prostate problems? What are the symptoms?
For men under 50, the most common prostate problem is prostatitis. For men over 50, the most common prostate problem is prostate enlargement. This condition is also called benign prostatic hyperplasia or BPH. Older men are at risk for prostate cancer as well, but this disease is much less common than BPH. More information about prostate cancer is available from the National Cancer Institute.

Problems with the Prostate can also interfere acutely with a man's sex life.

What is Prostatitis?
To put it simply, prostatitis is inflammation of the prostate gland. Typical symptoms are:
Pain in lower back or rectum
Relapsing urinary tract infections
Painful urination or other voiding problems
Genital pain
Difficult or painful urination.

In some cases, (not all), Prostatitis is caused due to bacterial infection and can be treated with antibiotics.

What is BPH?
BPH is the enlargement of the prostate, frequently occurring in men over the age of 50. The enlargement can result in a gradual squeezing of the urethra, sometimes causing difficulty in urinating. Typical symptoms are:
Weak urinary stream
Difficulty starting urination
Frequent urination
Frequently awakening at night to urinate.
Painful ejaculation during sex.

Also, blockage of the urethra from BPH may lead to repeated urinary tract infections, a sudden inability to urinate, or gradual bladder and/or kidney damage.

What is Prostate Cancer?
Prostate cancer is a group of cancerous cells (a malignant tumor) that begins most often in the outer part of the prostate. It is the most common type of cancer (excluding skin cancer) diagnosed in American men. In 2003, an estimated 220,900 new cases of prostate cancer will be diagnosed in the U.S. Early prostate cancer usually does not cause any symptoms. However, as the tumor grows, it may spread from the prostate to surrounding areas. Change in urination, including increased frequency, hesitancy or dribbling of urine may be experienced. Prostate cancer can spread from the prostate to nearby lymph nodes, bones or other organs. This spread is called metastasis. For example, as a result of metastasis to the spine, some men experience back pain.
Top

How can I maintain and improve prostate health?
For years, the practice of medicine for the health and treatment of Prostate problems in men, has had a less than stellar record. This exists even to this day.
Quote...
"Since Huggins showed in 1941 that castration (removal of testicles) slowed progression of prostate cancer, physicians have assumed that it was the resulting lack of Testosterone that slowed the cancer, and ever since then have relied on suppresion of testosterone to control the disease. However, the testosterone suppression benefit only lasts 2 to 3 years, and then the prostate cancer progresses to an Androgen (male hormone) insensitive state and continues to spread. Despite this, metastatic cancer patients are treated with androgen blockade through castration (orchiectomy) and/or hormone suppressing drugs." - Source - Dr. John R. Lee - Harvard.
Studies from nearly 40 years ago and more recently (1996 and published in the Proceedings of the National Academy of Science) indicate that testosterone shrinks prostate tumors and testosterone supplementation actually kills prostate cancer cells. The benefit of castration in prostate cancer stemmed from Estradiol reduction - not Testosterone reduction. And yet, castration, antiandrogen therapy, and drugs that reduce the production of testosterone are still the prevalent forms of treatments for cancer patients. Go figure....

So what should a man do to maintain the health of their prostate or improve its health if they are already afflicted?

Perhaps one should start by asking why prostate problems including prostate cancer become so prevalent in aging men. It is not a disease that afflicts virile young men! Consider the changes in testicular hormone production as men age.

Testosterone levels fall.
More testosterone is changed to dihydrotestosterone (DHT) by 5-alpha-reductase-enzyme - which in turn actually stimulates prostate growth.
Progesterone levels fall - causing both an estrogen dominance and an increase of activity of 5-alpha-reductase of which progesterone is potent inhibitor.
At the Gene Level....
"Embryology teaches us that the prostate is the male equivalent of the female uterus. The two organs differentiate from the same embryonic cells and share many of the same genes such as oncogene, Bel-2, and the cancer protector gene 'p53'. It is not surprising then that the hormonal relationships in endometrial cancer will be the same in prostate cancer; that is, both are very sensitive to the harmful effects of unopposed estrogen and are protected by progesterone."
Source - John R. Lee - MD.

Based on a rational unbiased assesment of the body of medical knowledge and backed by years of medical practice, a therapy for maintenance of prostate health as well as treatment of prostate afflictions, that seems highly effective and safe, is outlined below:

Intake of 8 to 10 mg. of Progesterone and 1 to 2 mg. of testosterone daily - through transdermal means.
Lowering estrogen intake in foods (most meats and dairy products), along with lower sugar and starch intake.
A good intake of anti-oxidants.
Exercise and an active sex life also appear to contribute to prostate health. Regaining progesterone and testosterone levels of course, has the happy effect of also enhancing libido and sex drive.
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What is Saw Palmetto Extract? Is it effective in treating BPH?
Saw palmetto (Serenoa repens) extract has long been used in Europe to treat an enlarged prostate or benign prostatic hyperplasia (BPH). American use lags far behind Europe in part because Americans are not aware of the extensive European research on the herb. The most cited journal article is by G. Champault et al. 1984. American physicians generally don't prescribe any drug other than Finasteride (Proscar®), Terazosin HCI (Hytrin®), or Doxazosin mesylate (Cardura®) for BPH. But unlike these drugs, particularly Proscar®, saw palmetto usually kicks in quickly. With the saw palmetto extract most men obtain relief of symptoms within the first 30 days. It also has far fewer and gentler side effects than the commonly prescribed drugs mentioned above.

What is Prostate Massage?
Prostate massage is a term often used to describe prostate drainage that is produced by the application of pressure on the prostate. The pressure is either applied by a finger, or by a mechanical device, that is inserted into the rectum. The objective of prostate massage is to use the pressure applied to the prostate to force debris from the prostate and out through the urethra. The forceful passage of that debris relieves built up pressure inside the prostate and provides relief for a man suffering from a prostate disorder such as prostatitis. This procedure however, can sometimes be dangerous because it could result in trauma to prostate tissue. Prostate debris can be dense, hard and of irregular shape. If forced from the acini of a prostate by external pressure, it can sometimes result in trauma to the surrounding prostate tissue.

Prostate massage can be effective in providing temporary relief but, as mentioned above, there is some risk involved. It does not seem to improve long term prostate health and requires the services of a knowledgeable person, hopefully a medical professional. The practitioner inserts a gloved (usually latex) and lubricated finger into the patients rectum. The prostate is located by feel and finger pressure, in a rolling motion, is applied to the prostate so that some of the prostate contents are squeezed out into the urethra..

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What is Natural (Bio-identical) Progesterone?
Progesterone is the name of a hormone made by the human body - by both men and women though women produce a lot more of it during their fertile years. It does not exist in nature outside living mammals.
Why is it referred to as "Natural Progesterone?"
It is called "Natural" or "Bio-identical" if it is identical to the molecule manufactured by the human body.
The Bio-identical or Natural Progesterone used in our products is actually derived via some elegant chemistry from extracts of wild Mexican yams. It is most effective when administered transdermally or through the skin. (Click for more information).

Yam or Soy extracts as they exist in nature, is NOT Progesterone and does not contain any Progesterone - and as a result has no effect.
Progestins are analogs of Progesterone developed by several pharmaceutical companies - that is they are similar but NOT the same. Their chemical composition is different to the Progesterone produced by the human body and as a result the body reacts violently to them as it treats them like the foreign substance they are. They tend to be of limited benefit and can have very severe adverse side effects.

Progesterone is not a generic name but is the name of the hormone produced by both men and women - by the corpus luteum after ovulation in women and also in smaller quantities by the adrenal gland - and by the testes and the adrenal gland in men. It is synthesized in humans in a biochemical pathway leading from cholesterol to pregnenolone to progesterone. In turn, progesterone is the precursor of corticosteroids and testosterone.
CLICK FOR MORE DETAILS

How Does Progesterone (or lack of it) affect Prostate Health?
As men age, the production of progesterone (and also testosterone) by the testes decreases. The production of an estrogen hormone called Estradiol also decreases but not by as much, resulting in a hormonal imbalance - called "estrogen dominance." Both progesterone as well as testosterone serve to suppress the effects of estradiol. Progesterone also suppresses the effects of 5-alpha-reductase-enzyme, which as mentioned earlier, lowers testosterone levels further by converting it to DHT. It is this imbalance (which is not prevalent in younger men) and its consequences, that leads to problems with this important sex gland.
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What is Prosta-Health? How effective is it? How is it used?
Prosta-Health is a very carefully formulated unscented cream designed to deliver the appropriate dose of both bio-identical progesterone as well as "Saw Palmetto" extract - both of which have been proven to be very effective and safe therapies for Prostate health. It is manufactured under demanding controls in a FDA approved facility and packaged in a special airtight pump container (3 oz.) that delivers the required dose with a single squeeze.

It should be applied to the skin once per day (preferably in the region of the prostate) for 25 days, with a break of 5 days (to maintain progesterone receptor sensitivity) before starting the cycle again. Doing Saliva Hormonal tests for Progesterone and Testosterone removes the guess work.

It is a truly effective and safe product when used properly. It has been known for some time that natural progesterone enhances libido (sex drive) in men. Sufficient balances can improve a man's overall well being and sexual performance. Research also shows natural progesterone increases apoptosis - referred to as "the key to staying young."
Click here for detailed information on this product....

Why Transdermal Delivery?
In the case of natural supplements as well as many medications, it is important to first understand why we feel strongly about transdermal delivery - absorbing nutrients through the skin. Doctors around the world are calling transdermal delivery "the delivery system of the future." It has been discovered that a high absorption rate of many supplements can be achieved when delivered through the skin - usually as a cream. (The physical size of the supplement's molecule plays an important role). The reason for this is when supplements are delivered transdermally, they go directly to the blood-stream, initially bypassing the liver. The result can mean as much as 95% of the supplements get to the cells where they are needed.* Conversely, studies have shown when some substances are taken orally, as little as 5% make it to the cells where they are needed. This is because of the stomach, liver and digestive system excreting and discarding much of them.
* Source: Department of Pharmacology, University of Dublin
Click here to learn more about Transdermal drug delivery.

Pictures of Prostate Cancer

2010-12-05T02:29:00.000-08:00

Pictures of Prostate Cancer

ENCOUNTER WITH PROSTATE CANCER

How to Increase White Blood Cells | eHow.com

Diet and Food for Better Blood Counts - Caring4Cancer

Diet and Food for Better Blood Counts

Blood Counts

Food vs. Nutrition

Weight Matters

Beyond Weight

Plant Power

Pump Iron

A Final Note On Preventing Weight Loss

References

Diet for Prostate Cancer Radiation | eHow.com

Grains, Beans, Nuts

Vegetables, Fruit

Fats, Drinks

Sugar

Diet for Prostate Cancer Radiation | eHow.com

Grains, Beans, Nuts

Vegetables, Fruit

Fats, Drinks

Sugar

online.x-plain.com/modules_v3/oncology/oc030202/oc039202.pdf

IMRT Versus 3D CRT For Prostate Cancer, New Long-term Data Assesses Side Effects

Radiation :: malecare.org

Neuroendocrine Cancer

Hormone Refractory Prostate Cancer

Small-cell neuroendocrine carcinoma as a variant form of prostate cancer recurrence: A case report and short literature review

Small-cell neuroendocrine carcinoma as a variant form of prostate cancer recurrence: A case report and short literature review

Abstract

Background

Case Presentation

Conclusions

Neuroendocrine Differentiation In Prostate Adenocarcinoma Biopsies And Its Correlation To Histological Grading

Neuroendocrine Differentiation In Prostate Adenocarcinoma Biopsies And Its Correlation To Histological Grading

My channel TURP surgery at Cancer Institute,Chennai

Prostate normal & enlarged.

Cancer Health Resources Nutrition Treatments Options Natural Health Support

List of supplements, remedies, Advice that might help:Neck, Base of Tongue, and Tonsils, health resources, to use during and after your cancer treatment

General Diet/Nutrition Suggestions

www.urologyatlanta.urologydomain.com/images/uploaded/AUA/Prostate_enlarged.pdf

UBC HKIN 191 - Bladder Anatomy

How the Body Works : Release of Urine

Lower Urinary Tract Symptoms in Men | Doctor | Patient UK

Lower Urinary Tract Symptoms in Men

Referral for specialist assessment

Specialist assessment1

Conservative management

Drug treatment

Management of retention

Surgery

Long-term catheterisation and containment

Bicalutamide (Casodex®) - Cancer Information - Macmillan Cancer Support

Bicalutamide (Casodex®)

CasodexBack to top

How Casodex worksBack to top

How it is takenBack to top

When it may be givenBack to top

Possible side effectsBack to top

Less common side effectsBack to top

Length of treatmentBack to top

Things to remember about Casodex tabletsBack to top

ReferencesBack to top

Prostate Cancer Hormone Therapy – Combined Androgen Blockade

Prostate Cancer Hormone Therapy – Combined Androgen Blockade

Androgen Resistance, Part 1 - Prostate Cancer Research Institute

CT Scan report

problem encountered after 3 years

Hematuria after Prostate Cancer Treatment

Hematuria after Prostate Cancer Treatment

PROSTATE, Cancer

Beyond the PSA Debate - Prostate Cancer Foundation (PCF)

Salve taken internally kills cancer at Prostate Cancer Alternatives Support (ThreadID: 841925)

Prostate cancer prevention and health

Pictures of Prostate Cancer

List of supplements, remedies, Advice that might help:
Neck, Base of Tongue, and Tonsils, health resources, to use during and after your cancer treatment

Specialist assessment¹