Prostate Cancer

Should men get the PSA Test? Video by Dr. John McDougall

Dr Pam Popper: Man Who Discovered PSA Says the Test is Useless

 

 

Dr Pam Popper: Man Who Discovered PSA Says the Test is Useless

THE GREAT PROSTATE HOAX

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The scientist who discovered the prostate specific antigen in 1970 explains emphatically why he considers use of the PSA test for routinely screening healthy men for cancer to be a profit-driven national disaster.With the assistance of science writer Piana, Ablin (Pathology/Univ. of Arizona Coll. of Medicine) pulls no punches in this attack on what he sees as the misdeeds of the urology community, the biotech industry and the Food and Drug Administration. The author explains that PSA is not a cancer-specific biomarker, and he asserts that the use of the PSA as a diagnostic test has crippled millions of healthy men, afflicting them with incontinence and impotence. A high PSA number leads to a biopsy, which leads to surgery. The author charges the FDA with negligence for allowing the profit-motivated biotech industry to market the PSA test as a cancer test and greedy urologists in directing frightened men to undergo unnecessary biopsies and prostatectomies. Ablin’s account is replete with names of specific individuals, companies, agencies and organizations, and he provides excerpts from documents and letters to back up his charges. Conversations with men who have undergone prostate surgery put a human face on the alarming statistics he provides. In addition to the human suffering that their stories reveal, the cost to Medicare of prostate surgery is hefty. While misuse of PSA is Ablin’s central theme, he sees this situation as representative of a larger problem: science for sale. Citing the revolving door between the FDA and big medicine, the author asserts that those charged with protecting American health care consumers are often in tacit collusion with those who come before them for approval of their products.Original article found here https://www.kirkusreviews.com/book-reviews/richard-j-ablin/the-great-prostate-hoax/

Editor’s note: The following was written in response to a blog post by Henry Rosevear, MD (“The great prostate cancer ‘hoax’: A call to arms”), which discussed the book, “The Great Prostate Hoax: How big medicine hijacked the PSA test and caused a public health disaster.” Dr. Ablin is a co-author of the book.

Dr. Henry Rosevear’s blog post about my recently published book, “The Great Prostate Hoax: How big medicine hijacked the PSA test and caused a public health disaster,” does a disservice to the readership of the Urology Times by mischaracterizing the book’s central message. I welcome healthy debate, as long as it is fact based.

As noted, the PSA test was first approved in 1986 to monitor men with prostate cancer and later in 1994 as a screening tool. Dr. Rosevear argued that after giving a historical perspective, “The book quickly leaves historical reality and begins to make unfounded, usually illogical comparisons between PSA screening and, among others, the tobacco industry.” With due respect, Dr. Rosevear needs a “historical reality check.” As I discussed in “Hoax,” in 1986, the PSA test was also used off-label and promoted illegally to screen countless millions of men each year for prostate cancer, leaving several million men debilitated by unnecessary surgical procedures. Jules Harris, MD, a member of the FDA expert advisory panel during the 1993 PSA approval meeting, said in an interview, “The misuse of the PSA test is the biggest medical story of the past 30 years.”

After that, Dr. Rosevear dismissed the rest of the book, noting that it can be summarized in one passage he lifted from the introduction: “But in a large sense, the situation dramatized by John [a patient described earlier as being harmed by PSA screening] illustrates the grim reality of the health care system itself: encouraged by perverse incentives, many of the tests and procedures that doctors do are unnecessary, and quite a few are downright harmful.”

Dr. Rosevear obviously takes exception to that statement, so I’ll clear it up for him. In the early 1990s, RAND Health reported data showing that up to one-third of health care services were unnecessary. Most recently, Donald Berwick, MD, MPP, former head of the Centers for Medicare & Medicaid Services, stated that upward of 30% of all health care was wasteful. I would argue that one-third equals many, and that our fee-for-service payment system, coupled with a bloated bureaucracy, encourages perverse incentives. The massive waste, fraud, and abuse in our health care system is not unfounded; it is a matter of public record. And yes, many unnecessary procedures are “downright harmful.”

In an attempt to jade his readers’ image of my book, Dr. Rosevear used terms like “conspiracy theories,” “unfounded,” and “illogical.” Sorry, there are no “grassy knolls” in “The Great Prostate Hoax.” In fact, every charge, whether involving a person, industry, or government agency, is backed by referenced data. To wit, there are more than 300 references in the “Notes” section. Moreover, prior to publication, my editor sent the manuscript to the New York law firm Satterlee Stephens Burke & Burke LLP for a month-long, line-by-line review to ensure that no statement was “unfounded.”

Dr. Rosevear made his own unfounded remark: “Clearly, Ablin and Piana have never seen a man expire from metastatic prostate cancer.” As detailed in Chapter Three, my father died of prostate cancer and I supervised his care from diagnosis to watching him go from a 185-pound frame to 95 pounds 1 year later at the time of his death.

At the beginning of his post, Dr. Rosevear said he’d recently read a “very disturbing book.” Rest assured, he’ll have plenty of company in that department. I wrote “The Great Prostate Hoax” to expose the public health disaster caused by the misuse of PSA and to hold the forces behind that human catastrophe accountable. So, in that regard, yes, it is a very disturbing book.

Dr. Ablin is professor of pathology at the University of Arizona, Tucson.

– See more at: http://urologytimes.modernmedicine.com/urology-times/news/richard-j-ablin-phd-dsc-hon?page=0,1#sthash.agq2bGOM.dpuf

– See more at: http://urologytimes.modernmedicine.com/urology-times/news/richard-j-ablin-phd-dsc-hon?page=0,0#sthash.wCTrcysI.dpufSerious charges voiced in strong language, certain to be met with rebuttals from those whose ox has just been gored, and a must-read for any man concerned about his prostate.

 

The Western Dilemma

What is it about Western countries that makes our men so susceptible to prostate cancer, and our women so prone to developing breast cancer? Why, as Don Coffey puts it, do those two cancers seem to go “hand in hand” — with countries having roughly the same high or low levels of both? And why, in comparison, are those diseases so rare in Asian and some middle Eastern countries? What are they doing right, and what are we doing wrong? Are Americans and Europeans — whose rate of prostate cancer is 10 times higher than that of many Asian countries — eating foods that cause these cancers? Or does the Asian diet somehow protect the prostate and breast against them? Are we dealing with sins of commission or omission?

At autopsy, “incidental” prostate cancer — small clusters of the earliest stages of prostate cancer, in an apparently latent form that resides in millions of men — is found in as many as half of men of every race and culture in the world. This means that whatever causes prostate cancer in the first place — the initiating factors or events — happens worldwide. The crucial difference is what happens next–whatever promotes these small cancers to grow and become potentially lethal. In the United States, for example, those cells seem to progress into cancer that needs to be treated in between 10 percent and 20 percent of men as they age. In AMP cancer-progression process seems to be arrested. The cancer stays put, stays benign, never poses a problem.

Unless Asians change their lifestyle. It is well known that Asian men who migrate to the West, over time, assume the prostate cancer risk of their new home country. So when Japanese men, people at low risk of developing prostate cancer, move to Hawaii or California, their rate escalates over time — to the level of an American man’s. It is no longer a question of whether diet plays a vital role in the development of prostate cancer. The question now becomes how? More specifically, which foods are good — or bad — for the prostate? And is it possible, through diet, to change or delay the onset or progression of cancer?

See 

In Asia, the cancer-progression process seems to be arrested. The cancer stays put, stays benign, never poses a problem.

The key, scientists believe, is not the fact that cancer happens in the first place; the initiation of cancer seems to be pretty much the same in men everywhere. It’s the promotion and progression of it — the factors, whatever they are, that cause cancer to grow. And the factors, whatever they are — and Hopkins scientists are hot on the trail of identifying these — that seem to stop cancer in its tracks.

full article at bottom of page or get original article at http://urology.jhu.edu/newsletter/prostate_cancer511.php

 

Dr H. Gilbert Welch and the PSA Test

 

Flaxseed vs. Prostate Cancer

 

 

 

Slow, Stop, Reverse Cancer Dr Dean Ornish

 

 

Prostate V Plants

 

Prostate vs. Plants

Some Prostates Are Larger than Others    

 

Prostate vs. a Plant-Based Diet

 Original article from Dr McDougall here https://www.drmcdougall.com/misc/2009nl/oct/acs.htm

 

The American Cancer Society Reverses Its Strong Position on Mammograms and PSA Testing

Dr. Otis Brawley, chief medical officer of the American Cancer Society told the New York Times on Wednesday, October 21, 2009 , “We don’t want people to panic, but I’m admitting that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated.” 1

How does your personal physician communicate confidence and comfort to you now? “I am sorry I recommended a mammogram that resulted in an unnecessary amputation of your breast?” How consoling do these words feel, “It is a shame you haven’t had an erection in the past 10 years due to the PSA test I insisted you get, that led to debilitating prostate treatments—I hope you and your wife understand I was just following orders from the American Cancer Society?” Tens of millions of women and men have been irreparably damaged by the universal and enthusiastic recommendations for “early detection programs,” also known as “screening,” from their personal physicians, neighborhood breast and prostate clinics, community hospitals, national medical associations and medical societies over the past four decades. Now, all that the faithful patients get is a timid apology from the American Cancer Society, evoked by an article in the October 21, 2009 issue of Journal of the American Medical Association, titled “Rethinking Screening for Breast Cancer and Prostate Cancer.” 2 Since, in my opinion, this admission of guilt is insufficient, what would be fair retribution for the harms done?

Adequate scientific evidence to stop mass screening programs has been readily available to your personal doctor for more than three decades. A flick of the “on” button of his or her computer, and a ten-minute search at the National Library of Medicine (www.pubmed.gov) would have revealed the truth. In 1976 Pietro M. Gullino presented his findings on the natural history of cancer, showing early detection is really late detection, at the Conference on Breast Cancer: A Report to the Profession, sponsored by the White House, the National Cancer Institute, and the American Cancer Society. 3 He explained: “ If the time required for a tumor to double its diameter during a known period of time is taken as a measure of growth rate, one can calculate by extrapolation that two-thirds of the duration of a breast cancer remains undetectable by the patient or physician. Long before a breast carcinoma can be detected by present technology, metastatic spread may occur and does in most cases.” This report was subsequently published in the journal representing the American Cancer Society (Cancer). 3

In more familiar words, Dr. Gullino and many other researchers have clearly told everyone listening: mammography, breast self examination, PSA and digital rectal exam are really late detection methods and cannot be expected to save lives by “catching cancer before it spreads.” Unfortunately, there is no profit in telling this truth. So, 386,560 people in the US are diagnosed annually with breast cancer (194,280) and prostate cancer (192,280); many of them through screening. 2

Cancer Mongering—the Most Successful of All Medical Enterprises

Cancer-screening businesses using two modern technologies—the mammogram and the blood test, prostate specific antigen (PSA)—have captured more customers than all other efforts combined. Campaigns have been so effective that about 75 percent of men have had a routine PSA test and about 70 percent of women older than 40 report they have had a recent mammogram. 2 More than $20 billion is spent annually on screening for these two diseases. 2

There are two customary ways a doctor-patient relationship is established. The traditional means is that you become ill and you seek out the advice of a doctor. In this case you initiate the relationship. The worth of the evidence supporting the doctor’s treatment does not need to be very solid. Your doctor is acting in his or her professional capacity to offer you the best available remedies without any real guarantee of the outcome. Remember, you asked for the help.

The second means of establishing a doctor-patient relationship became common with the introduction of programs looking for “early” cancer (screening). In this scenario the doctor comes looking for you. Life is good—you are enjoying your family, hobbies, and work. Then a knock sounds at your front door by way of a radio, TV, or magazine advertisement. Just as likely, during an office visit for an unrelated issue, such as a virus cold, your doctor admonishes you for failing to have your annual mammogram or PSA test. Through screening programs millions of people have become patients. When the doctor turns unsuspecting men and women into customers then the evidence that the outcome of this campaign will be far “more good than harm” must be unquestionable.

On October 21, 2009 the public was told by the American Cancer Society that this has not been the case for breast and prostate screening. Why now? The evidence has not changed—the only change is that now a few more people are willing to tell the truth. Why the delay? Annually, there is $20 billion at stake for screening alone and hundreds of billions more for the tests and treatments that follow. The ivory towers of your town’s cancer centers have been built from the blood of men and women subjected to harmful screening programs.

Otis Brawley, MD, Chief Medical Officer of the American Cancer Society

Dr. Brawley is a practicing oncologist, Chief Medical Officer of the American Cancer Society, professor of hematology, oncology, and medicine at the Emory University School of Medicine and Professor of Epidemiology at the Emory Rollins School of Public Health. 4

About himself he says, “I have never had a PSA and do not desire one.” 5 He compares prostate screening to the Tuskegee Experiment—research on the natural progression of untreated syphilis performed on black male patients between 1932 and 1972. 5 This study caused, as it should have, serious mistrust by the black community toward public health efforts in the United States . Currently black males are heavily targeted for prostate cancer screening and treatments.

Dr Brawley has known about the questionable benefits of screening for more than a decade. Regarding mammography, his words in the Hematology/Oncology Clinics of North America were, “There has been considerable debate about the benefit:harm ratio of mammography screening for women below the age of 50 years, and about what proportion of the observed benefit arises from screening that occurs after these women have entered their 50s.” 6 He wrote in the journalCancer (published on behalf of the American Cancer Society), “The benefits of screening and early detection, although theoretically possible, are yet unknown, whereas the risks and harms of screening and resultant treatment are definite.”7 He continued, “Although it (screening) may truly cure a few men who need to be cured, this benefit may be achieved at the cost of causing a large number of men with prostate carcinoma to undergo unnecessary treatment and resultant morbidity (illness).” 7

In 1985, 24 Years Ago, I Explained Why Early Detection Cannot Possibly Work

In my national best-selling book, McDougall’s Medicine—A Challenging Second Opinion, I presented this simple illustration and explained that breast cancer has, on average, been growing for ten years before discovery by any technique. The same picture is true for prostate cancer.

The argument for early detection of breast and prostate cancer rests on the belief that the test can discover cancer in its early stages—before it has spread to other parts of the body.  Unfortunately, this argument is groundless.  Many laypeople, and a very few physicians, believe that breast and prostate cancer goes through a series of steps in which it remains within the respective organs for some time period until it spreads to the lymph nodes and then to the rest of the body. In their minds the process looks something like this:

Step 1:  A cancer manifests and starts to grow slowly in the tissue (in this case, the breast or prostate).

Step 2:  With time, the cancer grows into a larger tumor.

Step 3:  Eventually, the cancer spreads to the lymph nodes.

Step 4:  Finally, the cancer spreads from the lymph nodes to the rest of the body.

This step-by-step progression from a harmless mass to a body full of disease almost never occurs.  Rather, cancer spreads to other parts of the body via the venous bloodstream in the very early stages of its development. The spread of cancer to the lymph nodes actually occurs simultaneously with the spread of the cancer to other parts of the body.

Normal, healthy cells multiply only when necessary, such as during childhood growth and development, or to repair damaged tissues after an injury.  Cancer cells, however, divide at their own free will at the site of origin, and spread to other parts of the body where they continue this uncontrolled growth without respect for the surrounding healthy tissues.  Like most other cancers, breast and prostate cancers begin with the mutation of a single healthy cell into a malignant one. Once this transformation occurs, the single cell begins to replicate, or divide. The time it takes one cell to divide and become two cells is called the doubling time. The average doubling time is approximately 100 days. 3,8 This means that in 100 days, a single cancer cell will have become two cancer cells. In 200 days, that one cell will have become four cells in a breast or prostate gland. By one year there are eight to twelve cancer cells lurking undetectable. Consider that one breast or the entire prostate gland consists of about 100 billion cells, and then you know why the cancer is impossible to find.

At this doubling rate, it takes about six years for the single cancer cell to become one million malignant cells, which together form a tiny tumor that is about the size of the tip of a lead pencil. A mass of this size is less than one millimeter in diameter, and is undetectable by breast self-examination or mammography (or any other presently-known technology) in the female breast, and by digital rectal examination (DRE) or by PSA (or any other presently-known technology) in the male prostate.

Even though the cancer is so tiny that it cannot be detected, it nevertheless has already spread, or metastasized (in medical terminology), to other parts of the body in virtually every case of true cancer (as opposed to the latent forms of cancer). It is the cancer cells that have spread to, say, the liver, lungs, bones, and brain, that kill the patient, and not the cancer cells confined to the breast or prostate.

After about ten years of growth, the average cancerous mass inside the breast or prostate is about one centimeter in diameter, or about the size of an eraser on the end of a pencil, and consists of about one billion cells. This is the earliest stage at which a tumor can be found. As Dr. Gullino explains, “two-thirds of the duration of a breast cancer remains undetectable by the patient or physician.” 3 As you can see, early detection is a misnomer.

Just as tragic is the devastation to the lives of the tens of millions of men and women with indolent cancers that would have never appeared in their lifetime if no one had been busy looking for them with screening programs. Once found, these nonthreatening lesions are aggressively treated with radiation and surgeries, leaving women deformed and men incontinent (wetting their pants, wearing a diaper or a catheter) and impotent. The poisoning effects of chemotherapy and the undesirable consequences of hormone deprivation treatments then follow these locally applied therapies (radiation and surgery). Thus screening leads to overdetection, overdiagnosis, and overtreatment of non-life-threatening cancers in huge numbers of people.

How Do They Say, “I’m Sorry?”

No doctor can restore the natural breast of a woman or give back a man’s sexual function. These people will remain the casualties of the war on cancer fought with unjust and ineffective weapons delivered by untruthful medical professionals. Certainly, some of your personal physicians didn’t know, but ignorance is no excuse when the truth is so easily available. In 1997 an article titled, “ On the growth rates of human malignant tumors: implications for medical decision-making.” the authors, Friberg and Mattson concluded, “Most tumors are several years old when detectable by present-day diagnostic methods. This makes the term ‘early detection’ questionable.” 8

Human traits of greed and dishonesty have prevailed. Righteousness and giving are also human traits and now is the time for these two to triumph. $20 billion (the same amount that is currently spent on annual screening for breast and prostate cancer) should now be spent annually doing the right things for saving people from cancer, the unreliable tests, and the harmful treatments. Physicians, screening clinics, hospitals, medical associations, and medical societies must be forced, under the penalty of law if necessary, to tell the truth: Their testing does more harm than good.

Furthermore, they should be made to spread the good news about diet and cancer. Presently the American Cancer Society’s dietary messages for cancer prevention are, for women to “…stay at a healthy weight throughout your life and avoid gaining too much weight,” and “men who eat a lot of red meat or high-fat dairy products appear to have a slightly higher chance of getting prostate cancer. These men also tend to eat fewer fruits and vegetables. Doctors are not sure which of these factors is responsible for raising the risk.”9These are downright timid messages about the importance of a healthy diet.

The truth is breast and prostate cancer are caused by the rich Western diet full of beef, chicken, cheese, milk, and oils, and contaminated with powerful environmental cancer-causing chemicals. A sizable share of that $20 billion must be spent on advertising, education, and subsidy programs to bring about monumental changes in our eating. The American Cancer Society needs to put meaning behind their apology by enthusiastically spreading the message that a starch-based diet with fruits and vegetables is fundamental for cancer prevention and good health.

References:

1) http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/10/21/MNNT1A8FDR.DTL&tsp=1

2) Esserman L, Shieh Y, Thompson I. Rethinking screening for breast cancer and prostate cancer. JAMA. 2009 Oct 21;302(15):1685-92.

3) Gullino P. Natural history of breast cancer. Progression from hyperplasia to neoplasia as
predicted by angiogenesis. Cancer. 1977 Jun;39(6 Suppl):2697-703.
http://www3.interscience.wiley.com/cgi-bin/fulltext/112679768/PDFSTART

4) http://www.cancer.org/docroot/MED/content/MED_2_1x_American_Cancer_Society_Names

5) http://www.psa-rising.com/upfront/otisbrawleyfeb00.htm

6) Kramer BS, Brawley OW. Cancer Screening. Hematol Oncol Clin North Am. 2000 Aug;14(4):831-48. Review.

7) Brawley OW.  Prostate carcinoma incidence and patient mortality: the effects of screening and early detection.  Cancer. 1997 Nov 1;80(9):1857-63. http://www.psa-rising.com/upfront/otisbrawleyfeb00.htm

8) Friberg S, Mattson S. On the growth rates of human malignant tumors: implications for medical decision making. J Surg Oncol. 1997 Aug;65(4):284-97.

9) ACS dietary statements: http://www.cancer.org/docroot/home/index.asp

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Surgery for Prostate Cancer Does Not Save Lives

Radical Prostatectomy versus Observation for Localized Prostate Cancer by Timothy J. Wilt, published in the July 19, 2012 issue of the New England Journal of Medicine, found, “Among men with localized prostate cancer detected during the early era of PSA testing, radical prostatectomy did not significantly reduce all-cause or prostate-cancer mortality, as compared with observation, through at least 12 years of follow-up.” The authors’ conclusion is, “Informing men of the favorable long-term effects of observation on mortality, bone metastases, urinary and erectile function, and quality of life, and increasing the use of observation may avert the harms of unnecessary biopsies, and interventions, while maintaining excellent long-term disease-specific survival.”

In this study of 731 men, 364 were assigned to radical prostatectomy, and 21 (5.8%) of this group died from prostate cancer or the treatments, as compared with 31 (8.4%) of the second group (367 men) assigned to observation. (This is an absolute risk reduction of only 2.6 percentage points.) The study population was representative of men in the community at large. Their average age at enrollment was 67 years, and as a result of this advanced age, many died of diseases commonly seen in later life, such as heart disease (rather than from their prostate cancer). The average PSA level was 7.8 ng/ml and about half of the men were classified as having higher risk cancer based on a Gleason score of 7 or greater. (The Gleason score is determined by examining the prostate tissues under a microscope.)

Comments: Unfortunately, the negative findings of this study will seldom be frankly discussed by the urologist with a man newly diagnosed with prostate cancer. Nor will their doctors explain the results of two large randomized trails involving 182,000 men in Europe and 76,693 men in the US, which showed little or no reduction of death in men with PSA-detected prostate cancer, who were subsequently treated with the best surgical, radiation, and chemotherapy treatments that modern medicine has to offer.

Surgery is painful and risky. After the operation, urinary leakage, which requires diapers, and sometimes indwelling catheters, occurs in about half of the treated patients. Problems of sexual dysfunction can be expected in as many as 80 percent of men. All combined, published scientific research should have long ago put an end to PSA testing and the treatments that follow. Unfortunately, the truth is unlikely to change this multi-billion-dollar business.

My recommendation is first for men to not get PSA blood tests or digital rectal exams to detect prostate cancer. For the estimated 241,740 men who have already been discovered to have prostate cancer in the US in 2012, nothing more should be done to them (unless they have symptoms requiring relief). The strategy of doing nothing is called “watchful waiting,” “active surveillance,” and “expectant management.” These obscure terms fail to focus on the first rule of medicine, according to Hippocrates: “Do no harm.” Doing nothing should be referred to as “humane treatment.” Read more about prostate cancer.

Wilt TJ, Brawer MK, Jones KM, Barry MJ, Aronson WJ, Fox S, Gingrich JR, Wei JT, Gilhooly P, Grob BM, Nsouli I, Iyer P, Cartagena R, Snider G, Roehrborn C, Sharifi R, Blank W, Pandya P, Andriole GL, Culkin D, Wheeler T; Prostate Cancer Intervention versus Observation Trial (PIVOT) Study Group.
N Engl J Med. 2012 Jul 19;367(3):203-13.

Prostate Cancer and Organic Milk vs. Almond Milk 

 

A Publication of the James Buchanan Brady Urological Institute Johns Hopkins Medical Institutions

Volume V, Winter 2000

Evolution and Prostate Cancer

Angelo De Marzo and Don Coffey:

Their revolutionary research has resulted in a new way of thinking about how prostate cancer develops. They may also have found an extremely early warning sign of cancer — cell changes that may be reversible.

Scientist Don Coffey, Ph.D., has taken a 4-million-year detour in his search to explain prostate cancer and learned that in the very big scheme of things, prostate cancer is an illness of fairly recent evolution. Like heart disease, it is an apparent casualty of the sedentary Western lifestyle and its notoriously unhealthy diet — rich in animal fat, processed fare, fast food an other “junk,” and poor in fresh vegetable and fruits.

In other words, it’s the dark side of progress. As resilient as we are, as remarkably adaptable as the human body is, there are some forces — the cheesesteak, for instance — that nature never equipped us to handle. How ironic that we, who have learned to defy gravity, can be brought down, incrementally, by years of supersized bacon burgers and meat-lover’s pizzas. Today’s man is far more likely to spend hours hunting for web sites or TV channels than foraging for food, his fingertips more likely stained by Cheetos than by the juices of nuts and berries.

We did not evolve and develop to eat this way, says Coffey, and he can prove it. Furthermore, he and colleagues Angelo De Marzo, M.D., Ph.D., and William G. Nelson, M.D., Ph.D., are discovering, on a microscopic level, how this drama of evolution plays out in the most primitive, fundamental cells in the prostate. This groundbreaking research may one day lead to the earliest marker yet for prostate cancer — and may help scientists prevent or even reverse cell damage before it’s too late.

There are some forces — the cheesesteak, for instance — that nature never equipped us to handle.
An Evolutionary Wrong Turn

The saga of human evolution is also a story of two male glands, both of which produce fluid that makes up semen. One gland, the prostate, is prone to cancer. The other, the seminal vesicle, is remarkably free of it.

Only mammals have prostates. By definition, only mammals have breasts, as well. Breasts and prostates seem to have evolved on parallel tracks, says Coffey: When some animals evolved into mammals — in other words, “when the female developed the breast, and fed her children by breast milk, that’s when the prostate appeared in the male.” Today, breast cancer and prostate cancer seem to be two sides of the same coin, as well: Countries with high rates of breast cancer tend to have a lot of prostate cancer; countries with low rates of prostate cancer have relatively few case of breast cancer. When people migrate from areas with little breast or prostate cancer to places with high rates, their own odds increase with time (see “The Westen Dilemma”.

In nature, animals that are carnivores — meat-eaters like lions — don’t have seminal vesicles. The only animals that have both prostates and seminal vesicles are herbivores–veggie-eating animals like bulls, apes, and elephants.

We are the huge glaring exception to this rule: Men have seminal vesicles, too. In other words, man, a meat-lover has the makeup of an animal that should be a vegetarian. The fact that men eat meat seem to be a mistake that nature never accounted for. How can this be? In exploring this question, Coffey looked a few rungs further down the evolutionary ladder and found the pigmy chimp, called the bonobo, “the closest ape to which we at distant relative.” Bonobos and humans have many things in common. Diet is not one of them: Bonobos are–as humans probably were, very long ago — vegetarians. They don’t get prostate cancer.

“Most apes only eat fruits and vegetables and greens,” says Coffey. “When we climbed down out of the trees, we became hunter-gatherers — but it’s only recently that humans started eating and processing meat in a big way. In fact, out of the 4 million years since we split off from the great primates, it’s only in the last 600,000 years that we even cooked. All that time, we were eating whatever we could scavenge and catch.” About 12,000 years ago, humans took the next big step and started producing their own food. “This was a major change in diet and lifestyle: We changed from the way we had evolved, and started eating more processed meat. We quit running after animals, started herding them, and then started breeding them in captivity. We became sedentary. We quit eating a great variety of fresh vegetables and greens from 3,000 types down to about 20. We started smoking our meat, salting it, putting nitrates on it. Now we get everything from the store, nothing from a farm. We call it fresh, but it’s not fresh, especially our meat,” which most of us prefer well-done, not raw. “Everything is cooked.”

For decades, the American Cancer Society and National Cancer Institute have urged Americans to lower their cancer risk by changing their diet: “Cut down the animal fats, cut down the dairy products,” says Coffey. “We were not big dairy people until 3,000 years ago; now, we put cheese on everything that moves. A few apes eat meat, but no ape ever cooked or put cheese on anything. We need more fiber, more fresh fruits and vegetables, more aerobic exercise. All of our experience in cancer prevention is telling us to return to the way we evolved.”

This groundbreaking research may one day lead to the earliest marker yet for prostate cancer — and may help scientists prevent or even reverse cell damage before it’s too late.

If breast and prostate cancer, as Coffey believes, are indeed developing from our evolutionary wrong turn, then how to prove it? Coffey pored over zoo records from around the world, and found that” no animal in the zoo as it ages dies from prostate cancer or breast cancer. There are only three cases of cats dying of prostate cancer. Horses do not die of prostate cancer, bulls do not die of it, only a very few primates have ever died of it.” Yet one out of every 10 American men gets prostate cancer. And the only animal to develop clinical prostate cancer with any significant incidence is the dog — the pet that eats most from our table.

An Exciting Now Finding: The Roots of Cancer In the Prostate

But how, exactly, does diet cause changes that lead to cancer? Coffey put this next question directly to the prostate, with stunning early results: In breaking research, Coffey and colleagues John Isaacs, Angelo De Marzo, Alan Meeker, and Bill Nelson have combined their efforts to implicate what appears to be a tiny garden of good and evil, tucked away deep in the prostate. A heretofore hidden nursery of thousands of “stem” cells seeds that divide and grow into mature prostate cells that accumulate. “These stem cells can make your prostate grow or shrink,” Coffey explains. “When you take away androgens (male hormones that feed and stimulate the prostate), the mature cells shrink, and when you give back androgens, those seeds of stem cells grow them back up.” Normally, these stem cells divide and then don’t divide; they turn on and off like a light bulb. When they divide, they give birth to children — tall stalks called mature epithelial cells. These epithelial cells, in turn, become little factories that produce PSA and the fluids that make up the prostate’s contribution to semen.

When all is well and good within the prostate, these fragile stem cells are cherished, sheltered and safeguarded– wrapped in velvet, as it were, cushioned by protective enzymes such as glutathione-S transferase p (see Prostate Cancer Diet) that protect against anything that might damage their DNA. However: “At the very earliest stages of prostate cancer, some of the important properties possessed only by the stem cells — most importantly, the ability to divide and grow indefinitely shift up into the mature epithelial cells, says De Marzo. Ordinarily, “this would be fine, because the epithelial cells can turn on their glutathione-S transferase p and stay protected.” But Bill Nelson has discovered that sometimes — in men who develop cancer — a destructive force knocks out the “good guy”: It obliterates glutathione-S transferase p. Without their enzyme bodyguard, the dividing epithelial cells are suddenly vulnerable. “They’ve lost their ability to protect themselves, and therefore they accumulate DNA damage,” says Coffey. The epithelial cells start replicating like crazy, churning out many different species of damaged cells — many of them cancerous.

“These cells are highly resistant to therapy, because there’s such a variation.” The errant process “creates biological diversity in your prostate at the wrong time — it turns on evolution at the wrong time,” says Coffey. “Whereas down in the stem cells, sometimes they go out of control, but they don’t have this unprotected replication. When they build up, they just make more normal cells — this is called BPH, benign prostatic hyperplasia. But it does not go on to cancer.”

So this, Coffey and De Marzo believe, may be the equation — or at least a good part of it — for prostate cancer: The absence of glutathione-S transferase p, plus wild replication in the epithelial cells. “As long as replication was in the stem cells, where the protection was, they were okay,” says Coffey. “But in cancer, these stem cells disappear, and it’s the epithelia] cells that are dividing — and they’re the ones that kill you.”

This revolutionary research — by Coffey and De Marzo, with Bill Nelson’s work on glutathione-S transferase p, and Coffey and John Isaacs’ stem cell models — has resulted in a new way of thinking about and explaining how prostate cancer and BPH develop, and how they’re different.

But remember the destructive, DNA-damaging force unleashed in the garden? What allows it in, weakening the body’s defenses, damaging the “good” cells when the enzyme glutathione-S transferase p is turned down? The Brady researchers believe the answer may be in the diet. De Marzo and Coffey have discovered a subtle change in prostate tissue, an inflammation (on a much smaller scale, and much different from the overall inflammation that characterizes clinical prostatitis). “For some reason, there’s a little auto-immune reaction. And this prostate inflammation makes highly reactive oxygen species — free radicals — which attack the DNA like crazy.”

“These cells are highly resistant to therapy, because there’s such a variation.” The errant process “creates biological diversity in your prostate at the wrong time — it turns on evolution at the wrong time.”

Glutathione-S transferase p protects against these free radicals. So does selenium–a mineral found in the soil, present in some vegetables, most over-the counter vitamins, and available as a dietary supplement. So does soy. “We did an experiment with rats,” says Coffey, “and found that when we put them on a soy-free diet, they got lots of prostate inflammation. We put them on a moderate soy diet, they got very little. When we put rats on a high-soy diet, they got none. So diet can control inflammation of the prostate. Diet can also turn those protective enzymes on and off.”

Most recently, De Marzo has identified a new lesion in the prostate–a very early area of cell damage, which he calls proliferative inflammatory atrophy, or PIA. This precedes PIN (prostatic intraepithelial neoplasia — abnormal cells, often found in a needle biopsy, which are strongly linked to prostate cancer). So PIA — the discovery is new, and Brady scientists have just begun to investigate it — may, one day, be considered pre-precancerous. The PIA cells appear to be shut down, or atrophied, and they’re surrounded with inflammation. “But they’re highly active for DNA synthesis,” says Coffey. “In other words, they’re replicating wildly.” And in this volatile area, Nelson and De Marzo have observed that levels of glutathione-S transferase pfluctuate heavily. If what the scientists are witnessing is a microscopic Alamo — the enzyme’s last stand, in effect — then “that would be the death knell for what starts the cancer process,” says Coffey. PIA might also become an extremely early warning sign of prostate cancer, and if it is indeed reversible, perhaps — one day, if caught in its earliest stages — cancer may be, as well.

The Western Dilemma

What is it about Western countries that makes our men so susceptible to prostate cancer, and our women so prone to developing breast cancer? Why, as Don Coffey puts it, do those two cancers seem to go “hand in hand” — with countries having roughly the same high or low levels of both? And why, in comparison, are those diseases so rare in Asian and some middle Eastern countries? What are they doing right, and what are we doing wrong? Are Americans and Europeans — whose rate of prostate cancer is 10 times higher than that of many Asian countries — eating foods that cause these cancers? Or does the Asian diet somehow protect the prostate and breast against them? Are we dealing with sins of commission or omission?

At autopsy, “incidental” prostate cancer — small clusters of the earliest stages of prostate cancer, in an apparently latent form that resides in millions of men — is found in as many as half of men of every race and culture in the world. This means that whatever causes prostate cancer in the first place — the initiating factors or events — happens worldwide. The crucial difference is what happens next–whatever promotes these small cancers to grow and become potentially lethal. In the United States, for example, those cells seem to progress into cancer that needs to be treated in between 10 percent and 20 percent of men as they age. In AMP cancer-progression process seems to be arrested. The cancer stays put, stays benign, never poses a problem.

Unless Asians change their lifestyle. It is well known that Asian men who migrate to the West, over time, assume the prostate cancer risk of their new home country. So when Japanese men, people at low risk of developing prostate cancer, move to Hawaii or California, their rate escalates over time — to the level of an American man’s. It is no longer a question of whether diet plays a vital role in the development of prostate cancer. The question now becomes how? More specifically, which foods are good — or bad — for the prostate? And is it possible, through diet, to change or delay the onset or progression of cancer?

In Asia, the cancer-progression process seems to be arrested. The cancer stays put, stays benign, never poses a problem.

The key, scientists believe, is not the fact that cancer happens in the first place; the initiation of cancer seems to be pretty much the same in men everywhere. It’s the promotion and progression of it — the factors, whatever they are, that cause cancer to grow. And the factors, whatever they are — and Hopkins scientists are hot on the trail of identifying these — that seem to stop cancer in its tracks.

I am furious.

For anyone hiding under a rock the last year or so, the latest recommendations about prostate cancer screening have changed from earlier iterations of “screen everyone with a prostate with a PSA (prostate specific antigen) and a DRE (digital rectal exam, where the “digital” equipment referred to is a finger) every year” to don’t do it at all.

The United States Preventive Services Task force reviewed the literature and came to the conclusion that routine prostate cancer screening does more harm than good, and should not be done. Hear the emphasis on routine. In men with a urinary problem suggestive of prostate cancer, certain men with worrisome family histories for the disease and so forth, the above does not apply. We’re talking about blindly screening all comers. And the bottom line is this: don’t.

Screening is to be offered to patients in the context of “shared decision making,” involving a detailed discussion between doctor and patient about the pros and cons of screening (generally PSA testing).

Great. No problem.

Here’s the thing, though. I just had a patient come back from a urological consult for a problem that had nothing to do with the prostate with an order for a PSA. Oh, I said. Did you have a detailed discussion with the urologist about the pros and cons of PSA screening for prostate cancer?

No.

What did the urologist say to you?

“He said that there were no urologists on the panel that made that recommendation.”

It’s a non sequitur of an ad hominem, perilously close to the barely disguised antisemitism that  discounts evidence of any medical advantages of circumcision.

But it’s the urologist’s hypocrisy that infuriates me the most. If he attributes the negative recommendation to the lack of urological involvement in the guidelines, perhaps he should check out his own specialty’s guidelines:

Guideline Statement 1: The Panel recommends against PSA screening in men under age 40 years. 

Guideline Statement 2: The Panel does not recommend routine screening in men between ages 40 to 54 years at average risk. 

Guideline Statement 3: For men ages 55 to 69 years the Panel recognizes that the decision to undergo PSA screening involves weighing the benefits of preventing prostate cancer mortality in 1 man for every 1,000 men screened over a decade against the known potential harms associated with screening and treatment. For this reason, the Panel strongly recommends shared decision-making for men age 55 to 69 years that are considering PSA screening, and proceeding based on a man’s values and preferences. 

Guideline Statement 4: To reduce the harms of screening, a routine screening interval of two years or more may be preferred over annual screening in those men who have participated in shared decision-making and decided on screening. As compared to annual screening, it is expected that screening intervals of two years preserve the majority of the benefits and reduce overdiagnosis and false positives.

Guideline Statement 5: The Panel does not recommend routine PSA screening in men age 70+ years or any man with less than a 10 to 15 year life expectancy. 

Reading the whole thing is pretty informative. Urologists should try it.

Annual PSAs on everyone from age 40 generate gobs of abnormal results, leading to biopsies galore and of course a plethora of early cancer diagnoses. “We offer watchful waiting,” they say. But once a patient hears the word “cancer,” they stop listening and start screaming, “Get it out!”

See, urologists treat prostate cancer. Find it, cut it out, nuke it, whatever it takes. Never mind that the patient would never have had symptoms from a disease that was never going to kill him. It’s cancer.

But I treat patients, men who end up incontinent and impotent from overzealous treatment by those same urologists who impugn preventive care recommendations because there are no urologists on the panel, but who can’t be bothered to follow their own fundamentally similar specialty guidelines.

Guess what. There are no foxes on the panel developing guidelines for guarding henhouses either.

 

Original article here

http://www.kevinmd.com/blog/2013/11/urologists-hypocrisy-prostate-cancer-screening.html

Lucy Hornstein is a family physician who blogs at Musings of a Dinosaur, and is the author of Declarations of a Dinosaur: 10 Laws I’ve Learned as a Family Doctor