Worried About Prostate Cancer?

My own recent experience with prostate cancer may be useful to you in sorting out the options. I am an investment, not a medical, professional. But for that very reason, I have no biases, no axe to grind, and above all, no income that would be put at risk from progress in medicine.

We live in a world of government enforced medical monopolies. The general rule is that doctors will recommend whatever they do, and either they or insurance companies will seek government help in thwarting competition from new and often better approaches. Getting up to date and objective advice in this environment is a challenge.

Cutting through the thickets of misinformation or incomplete information and getting the right answers is important.  Prostate cancer is the leading male cancer, but it is not easy to determine if you actually have cancer buried deep inside this very interior gland. It is also difficult to tell if it is an “indolent” cancer likely to stay contained or an “ aggressive” cancer likely to spread outside the gland and kill you.

A tendency toward prostate cancer may be inherited. My father and uncles all had it, so I was forewarned.  On the other hand, my two brothers have had low prostate-specific antigen ( PSA) numbers and my own were within the “reference” range for most of my adult life. Sometime in my sixties, however, that began to change. My PSA numbers started climbing.

A government sponsored medical panel recently recommended against routine PSA tests. This was allegedly because the test is not specific to cancer—a rising PSA level may reflect prostate injury, inflammation, enlargement, or cancer, and too often leads to unnecessary prostate biopsies which in turn lead to unnecessary treatments which may result in blood clots, heart attacks, impotence, and incontinence. Many doctors have responded by eliminating PSA tests.

Unfortunately, this particular government recommendation, like so many others, was pretty much throwing out the baby with the bath water. The  problem was not the PSA test itself but the runaway biopsies. It is particularly ill-judged in that taking the PSA over time can help determine whether the pattern of rising is consistent with inflammation ( up and down) or with cancer  (steady rise or more up than down).

There are also newer and more sophisticated tests that rely not simply on PSA but on particular PSA metabolites. And there are other, often newly developed, tests that look for particular enzymes in urine or blood that are related to prostate cancer. It is very unlikely that your doctor will know about these newer tests or, if he or she knows about them, actually use them, because most doctors wait for the blessing of the medical society, and that can take years, even decades.

Meanwhile,  your insurance company will almost certainly not pay for new tests. Medicare will not pay for more than one test a year, new or old, that is not linked to a specific medical diagnosis and treatment!

In the absence of PSA or other testing, men are physically examined. But the physician’s finger cannot reach all of the prostate or, in the case of enlargement, even most of it. If the doctor feels a lump or lesion on the gland, the next step today is the blind biopsy.  This involves sticking a variety of needles into the prostate from the rectum and taking a sample from each needle. Unless the doctor has located a particular lesion, the location of the needles is completely random, and even if a lesion has been found, its location can only be guessed at.

Blind biopsies are a huge industry. They are the “standard of care.” They are also completely outmoded and should be relegated to the dustbin of medical history. Not only are they painful, lead to unnecessary infections, miss many cancers, and could conceivably spread existing cancers. In addition, they have been rendered obsolete by the MRI exam.

A high-powered MRI aimed at the prostate and taking the right sequence of images can now detect cancer with up to 90% accuracy. So why stick needles blindly when it is possible to locate the suspicious area in advance with precision?

The problem here is that, once again, the government/ medical industry complex will take its time.  MRI’s are expensive and in the meantime the blind biopsies are a lucrative business. The welfare of the patient takes second or third place in our “Soviet-style” medical system, even though many medical professionals are dedicated individuals who want to do what is best for the patient.  If they get too far in front of the system, they can lose their licenses and with it all their years of expensive education. The government regulation that supposedly protects us actually strangles them and us.

There are, however, some issues worth noting about MRI’s. On the plus side, they do not flood your body with massive radiation, as Cat and Pet Scans do.  Some studies have suggested that all the radiating doctors and dentists do so casually, and with little knowledge of what other doctors are doing or how it is cumulating, may be a significant cause of later cancer.  On the other hand,  the Food and Drug Administration ( FDA) has finally put a black box warning ( the strongest possible) on the label of a drug used with MRI’s called Gadolinium.

This drug is used as a “contrast agent” but can cause fibrosis of the kidneys. It would not be a good trade off to get an accurate prostate picture and in the process destroy your kidneys. And do not expect urologists or radiologists to warn you about this. In my case, I had an MRI without the drug and got a good picture anyway. But I had an expert MRI prostate interpreter.

Given all the issues, discordant voices, and potential pitfalls, where can you get objective advice? In my own case, I relied on Dr. David Zeoli, a four year trained naturopathic doctor located in Charlottesville, Va who runs the Phydos Clinic there with an associated MD.  (Full disclosure: I became so enthusiastic about the clinic that I became a backer of it).

Dr. Zeoli does not diagnose or treat prostate cancer.  But he is an expert prostate “coach” who knows all the tests and issues and can objectively review the complicated  choices with you.  He can also suggest the leading specialists.

Dr. Zeoli  trained for many years under one of the leading “integrative” MD’s in the US, Dr. Jonathan Wright, whose Tahoma Clinic is located near Seattle. In the medical field  “integrative” means that the doctor combines natural remedies based on food, supplements, and lifestyle, along with the latest high-tech tests, with conventional medical therapies.  Dr. Zeoli continues to consult with Dr. Wright, so I had the benefit of his knowledge as well.

Natural therapies can often control “ indolent” prostate cancers. In addition to information from Drs. Zeoli and Wright, I often consulted Mercola.com, the leading natural health website. (Dr. Mercola is a frequent contributor to lewrockwell.com). And as the board president of the Alliance for Natural Health-USA  (anh-usa.org), I had access to additional information and to other leading integrative physicians as well.

My cancer was not sufficiently “indolent” to treat with diet, supplements, and lifestyle alone, so I had to decide on the next step. I chose focused ultrasound to eliminate ( burn away) the tumor. High intensity focused ultrasound (HIFUS) has been approved and used for cancer treatment in Japan and Europe for 15 years, but was only finally approved by the US FDA recently. Despite the tremendous advantages of this non-invasive technique, which is much less likely to produce the often horrific side effects of prostate surgery, the doctors sitting on the FDA committee were themselves using other methods and may have been reluctant to approve a therapy that would obsolesce their own approach.

Although now FDA approved, HIFUS is still not covered by Medicare or by insurance. It is strictly out of pocket for the patient and is expensive. Approval itself will not make this therapy widely available; it must be covered.  Medicare and insurance companies will drag their heels as long as they can.  Meanwhile, lack of coverage means that doctors are not being widely trained in the technique, and this is a technique that requires very extensive physician training. It is clearly not safe for an untrained physician to be doing it.

Focused ultrasound worked well for me. One week after the procedure, I was jogging again. But how long will it take for this new procedure to become widely available for the millions of men who would benefit from it?  How many million more blind biopsies will be done to men who simply do not know that there are other and better choices? And what about using more MRI and/or HIFUS for breast cancer? The latter is not even FDA approved yet.

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