May, 2004 Vol.9, Issue 5 May, 2004 … by Thomas Dorman, M.D. Exploring Issues of Philosophy, Principle and Conscience in Contemporary Health Care The Prostate This article was excerpted from Dr. Ronald Wheeler’s writing and reproduced with permission of the McAlvany Health Newsletter’s editor. This article will explore the dangers to American men from prostatitis and prostate cancer; approaches to treating this problem that work and don’t work - and what you can do to keep a healthy and functioning prostate for the rest of your life. INTRODUCTION Prostate problems will become a reality for all men during their lifetimes, with manifestations usually beginning between ages 40 and 50 and accelerating from that time forward. Cancer of the prostate is responsible for the deaths of about 40,000 men each year in the United States and is the number two cause of male cancer deaths after lung cancer. (It is actually the most commonly occurring form of cancer in men. ) An additional 300,000 American men will be diagnosed with prostate cancer each year (according to the American Cancer Society). For men over 50 years of age, the probability is 40% that they will ultimately contract prostate cancer; at 60, the probability is 50%; at 70, it is 70%; at 80, it is 80%; at 90, it is 90% and at 100, it is 100%. In other words, if you live long enough, the medical statistics indicate that you will get prostate cancer and perhaps die from it. Almost all men above 40 develop chronic prostatitis (i.e., inﬂammation or infection of the prostate), which may or may not have overt symptoms (i.e., pain, frequent urination, impotence, infertility, etc.). Very few doctors know how to effectively diagnose, treat or manage prostatitis and this ultimately becomes a serious problem for the patient, since prostatitis often sets the stage for or is the forerunner of prostate cancer. Most prostatitis (and prostate cancer) is treated by outdated and largely ineffective means, (i.e., antibiotics, surgery, radiation, etc. ) which leave the individual with continuing pain or other symptoms and a progressive slow slide toward prostate cancer, or crippling surgery which can eventuate in no sex life, use of “Depends,” and other very unattractive lifestyle changes. But the good news is that most of the prostatitis and prostate cancer can be avoided, arrested, or managed by diet and lifestyle changes; by supplementation, which is very speciﬁc to prostate health; and by alternate medical approaches, which in all but the most severe or advanced cases can avoid crippling surgery, radiation, prostate freezing (i.e., cryosurgery), etc. It is possible that most prostate cancer can be avoided, and that most prostatitis can be reversed, minimized, or managed. Though prostatitis may have no symptoms, some patients report severe pain. An individual’s PSA test (which is the most widely used test for men’s prostate health) may register over 4. However, close examination typically does not indicate prostate cancer. Nevertheless, an elevated and rising PSA can be like a falling barometer, which warns of (or forecasts) a coming storm (in this case, the approach of prostate cancer). An elevated PSA is a major red ﬂag or barometer for coming problems, but is not always associated with prostate cancer. Several standard procedures for treating the prostatitis (including antibiotics, prostate massage, hydrotherapy, dietary changes, etc. ) were employed, in the example given, and the symptoms diminished - but the PSA remained elevated at about 4. In this person, Dr. Wheeler (director of the Prostatitis and Prostate Cancer Center of Sarasota, Florida) suggested a new herbal formulation called PEENUTS for the care and feeding of the prostate. After about six months of taking this formulation, this person’s PSA dropped from over 4 to 0.7 (and has remained under one for over six years). The American Cancer Society publicizes that the “normal” range for PSA is 1. 0 - 4. 0. However, recent studies have suggested that a more conservative number, probably 3. 0 be used as the maximum normal range. In light of the Johns- Author: Thomas A. Dorman, MD. Copyright © 2004 by DORMAN PUBLISHING, 929 S. 291st Street • Federal Way, WA 98003-7300 Page 1 Fact, Fiction & Fraud in Modern Medicine Hopkins recent study suggesting that PSA of greater than 0.7 in ages 40-50 leads to a 300-400% greater likelihood of prostate cancer in ages 60-70, a better target number would be 1.0. Some urologists use “age-correlated” PSA numbers, which has not been universally embraced. Another way of looking at this number is that in any male the PSA, when over 0.7, bears a correlation to the risk of the two important prostate diseases, i.e., prostatitis and cancer. Chronic prostatitis (inﬂammation or infection of the prostate) is common to all adult men. It’s associated with virtually all cases of prostate cancer and present in every prostate biopsy regardless of other ﬁndings. Chronic prostatitis may not cause signiﬁcant symptoms in many men, but in others it can be a devastating disease that severely affects the quality of life of those afﬂicted. It’s difﬁcult to diagnose and even more difﬁcult to treat. A wide variety of therapies are available but few actually work in more than a small percentage of cases. None of the standard treatments is able to improve the health and wellness of the prostate but a promising new approach may accomplish this. We’ll review the current knowledge about chronic prostatitis, its treatment and a possible connection to prostate cancer. I. THE PROSTATE Dr. Wheeler writes, “the prostate gland is a walnut sized mucus-producing organ that lies just below the urinary bladder. All men are born with a prostate that grows and enlarges throughout life. There is a channel through the prostate which carries urine from the bladder to the outside. This is why prostate problems often cause difﬁculties in urination. The only known function of the prostate is to produce a secretion that nourishes and protects the sperm during reproduction. It has no other known purpose. Prostatitis is deﬁned as inﬂammation or infection of the prostate. While prostatitis may be acute, associated with systemic ﬁndings of fever, chills and rigors, most cases of prostatitis are chronic and tend to be incurable with relatively frequent recurrences despite optimal standard therapy. A. THE CLINICAL PRESENTATION The most common symptom of chronic prostatitis is pelvic pain, followed by various voiding symptoms, impotence and infertility. Pain from prostatitis is usually located in the groin, testicles, penis, just above the rectum, or in the suprapubic area over the bladder. Pain is frequently associated with ejaculation. Typical voiding symptoms produced by prostatitis include getting up at night to void (nocturia), frequency, urgency of urination, incomplete voiding, decreased force of the urinary stream, intermittency of the stream and a need to push or strain to void. Impotence or erection difﬁculties and male infertility are also associated with prostatitis. Prostatitis is a troubling disease that remains a health risk to most of the adult male population. John Krieger, M.D. and Richard Berger, M.D., [Urologists at the University of Washington], believe that all men will acquire prostatitis in their lifetimes. Historically, men under 50 years old with voiding symptoms or pelvic pain had prostatitis until proven otherwise. Men over 50 years old with the same symptoms were assumed to have enlarged prostates. A recent study has shown that most men with voiding symptoms regardless of age actually have prostatitis when properly tested. In a trial of 121 consecutive men who exhibited voiding symptoms, 80% were found to have chronic prostatitis regardless of their age. B. THE DIAGNOSIS Prostatitis has been termed “the waste basket of clinical ignorance” by prominent Stanford University Urologist Dr. Thomas Stamey because of the difﬁculty it presents in diagnosis and treatment. Prostatitis is usually indicated or suggested by the symptoms it produced and the ﬁndings of a sore or tender prostate when a digital rectal examination is performed. Prostate Speciﬁc Antigen (PSA), a blood test designed to identify patients at risk for prostate cancer, will also be elevated in cases of prostatitis. The presence of a speciﬁc urinary infection together with pelvic pain, voiding symptoms and a sore or tender prostate on rectal examination will identify those 5% of patients with bacterial prostatitis, a true infection. But the only truly accurate and reliable way to diagnose prostatitis is from a microscopic examination of the prostatic ﬂuid or expressed prostatic secretion (EPS). The prostatic ﬂuid is obtained by gentle massage of the prostate during the digital rectal examination. When the ﬂuid is examined under the microscope, a ﬁnding of more than 10 white blood cells per microscopic ﬁeld is considered deﬁnitive proof of inﬂammation and prostatitis. Histological examination of a prostatic biopsy can also show deﬁnitive signs of inﬂammation and diagnose prostatitis. Despite the fact that examination of the prostatic ﬂuid or EPS makes the deﬁnitive diagnosis, few family physicians and only about 33% of all urologists perform it because of difﬁculty in obtaining Page 2 May, 2004 a proper sample, inadequate testing equipment or just lack of knowledge. In prostatitis, any combination of pelvic and urinary symptoms are possible, as well as the rare individual who is without pain, discomfort or urinary problems yet still has prostatitis based on an abnormal examination of the prostatic ﬂuid or EPS. THE ETIOLOGY (POSSIBLE CAUSES) Virus Idiopathic (Unknown) • Bacteria Stress and Psychological Factors • Yeast Immune System Based • Dietary, and a Combination of Above • Crystal Deposition Social, Genetic or Environmental • C. TREATMENT OPTIONS Treatment of prostatitis has been anything but a sure proposition. According to noted prostatitis expert Dr. Curtis Nickel of Kingston, Ontario, “there is widespread frustration, discomfort, and lack of knowledge in both primary cases. Those patients who truly have an identiﬁable infection of the prostate will certainly beneﬁt from antibiotics. These need to be continued for at least 6-12 weeks and in some cases long-term or indeﬁnite antibiotic suppression therapy is necessary. We don’t have any data that looks at recurrent disease over many years. Campbell’s Urology, the urologist’s most authoritative reference text, identiﬁes only about 5% of all patients with prostatitis as having bacterial prostatitis which can be ‘cured’ at least in the short term by antibiotics. In other words, 95% of men with prostatitis have little hope for a cure with antibiotics alone since they don’t actually have any identiﬁable bacterial infection.” In the treatment of prostatitis, physicians have traditionally recommended everything from doing nothing to multiple and extended courses of antibiotics, other drugs and lifestyle changes. Alpha-blockers (Hytrin, Cardura and Flomax) are designed to relax the muscle tension in the prostate and improve urinary ﬂow. They do tend to improve voiding difﬁculties and relax tension in the prostate but they are expensive, need to be taken indeﬁnitely in high doses, may often have signiﬁcant side effects and don’t cure the underlying problem or prevent recurrences. Finasteride (Proscar) can shrink prostate tissue but there is no proof it helps in the treatment of prostatitis. Allopurinol, a drug which reduces uric acid levels in the body, has been used to treat prostatitis based on the theory that uric acid crystals may form in the prostate and cause inﬂammation. Most clinicians who have tried Allopurinol for prostatitis report disappointing results from this therapy. [This medication also has a serious side effect proﬁle -Ed]. Anti-inﬂammatory agents (Motrin or Advil) and hot sitz baths have been helpful in treating the discomfort caused by prostatitis in many patients, but neither of these treatments actually cures the disease and the beneﬁts wear off rapidly. Irritative voiding symptoms may be relieved by bladder relaxing agents such as oxybutynin (Ditropan) while antidepressants such as amitriptyline (Elavil) have been helpful in various chronic pain conditions such as prostatitis associated with depression. Biofeedback, behavioral therapy, referral to a pain clinic, and psychological treatment, have all been recommended for patients with prostatitis and occasionally offer some relief to selected individuals. For the most part, current treatment methods for prostatitis are generally rather disappointing. Prostatic massage plus antibiotics deserves further review. Proponents of prostatic massage (championed in the Philippines) have little reproducible data to support their methods. Other drawbacks include intense discomfort/pain at the time of massage, the need for accurate cultures of the prostatic ﬂuid and a dependence on antibiotics to ultimately affect the cure. Dr. John Krieger appropriately points out that the following multiple factors preclude accuracy of the culture technique involving urine, semen or prostatic secretion for diagnosing or treating prostatitis: 1. The presence of inhibitory substances. 2. The unknown effects of many previous courses of antibiotics. 3. The fact that most bacteria from the prostate do not readily grow on conventional culture media. 4. The high number of uncharacterized bacteria that infect human prostate tissue. 5. The difﬁculty in obtaining a pure specimen from the prostate, which has not been contaminated by possible infectious organisms of the urethra or urinary passage. 6. The fact that most cases of prostatitis are not infections in the ﬁrst place. II. PROSTATE SPECIFIC ANTIGEN (PSA) AND PROSTATITIS PSA is a Surrogate Marker for Prostatitis and the ‘Barometer’ for Prostate Health. Through research that Dr. Wheeler presented at the National Institute of Health (NIH), it was demonstrated that Prostate Speciﬁc Antigen (PSA) is a surrogate marker for the diagnosis of prostatitis. In a study of 177 men, if the PSA was greater than or equal to 1. 0 ng/ml, 100% of the participants had Page 3 Fact, Fiction & Fraud in Modern Medicine prostatitis as deﬁned by the expressed prostatic secretion (EPS). [This is frequently performed at the Paracelsus Clinic and evaluated with dark ﬁeld microscopy by Dr. Dorman -Ed]. Most men understand that EPS is the diagnostic marker for prostatitis. Despite this fact, fewer than 30% of Urologists and the rare Primary Care Physician perform this critical evaluation of the prostate secretion. Once again, the relevance is based on making the correct diagnosis, as it will encourage an improved treatment plan with a predictable outcome. That said, most physicians choose to ignore the facts, while following the dictum they learned in medical school ten or more years prior. My data was corroborated by research from Johns Hopkins and Ballentine Carter, M.D. that showed men aged 40-60 with a PSA greater than 0. 7 ng/ml had a 3-4 fold increased incidence of prostate cancer within their subsequent 20 years (reference – The Baltimore Longitudinal Study). This is cutting edge data that supports the concept of normalcy for a PSA to be less than one. Therefore, living with a PSA of greater than one provides an individual with an increased risk for prostate cancer. In this manner, PSA represents disease activity and serves (for many) as the “Barometer of Prostate Health. ”It is common for men as they age to note PSA elevation secondary to components of prostatitis, BPH, and/or prostate cancer. Notwithstanding that statement, the number one reason that PSA rises is secondary to prostatitis, not benign prostatic hyperplasia (BPH) or prostate cancer. As mentioned earlier, Prostate Speciﬁc Antigen or PSA was originally designed as a blood test for prostate cancer screening. PSA blood levels of 0-4 were designated as “normal,” but this range was arbitrarily selected as a guide for possible prostate cancer screening and does not necessarily indicate a healthy prostate. We now know that up to 30% of all prostate cancers occur in patients with PSA levels less than 4.0. Since prostate cancer obviously cannot be considered normal, this suggests that the original “normal” PSA range of 0-4 is much too high. It’s been suggested that any PSA level greater than 1.0 indicates an unhealthy prostate with active prostatitis. It’s well known that prostatitis increases the PSA level. In fact, it is much more likely that any unexplained increase in PSA level is due to prostatitis than to prostate cancer. Many urologists will currently treat their high PSA patients with one month of antibiotics and repeat the PSA level before recommending a biopsy. Only if the second PSA level remains elevated will a biopsy be ordered. We believe that a signiﬁcant percentage of any el- evation of PSA level in the blood should be considered prostatitis until proven otherwise. While prostate cancer is certainly a concern and should be considered carefully and appropriately, prostatitis is much more likely. PSA can serve as a very useful marker or indicator of the degree of prostatic inﬂammation present and help determine the effectiveness of prostatitis therapy. III. THE LINK BETWEEN CHRONIC PROSTATITIS AND PROSTATE CANCER All men develop prostatitis. This has been shown in several studies including one done in 1979 by Drs. Kohnen and Drach who found 98.1% of 162 prostates removed surgically had evidence of inflammation. Dr. Timothy Moon, urologist at the University of Wisconsin, and many others report that virtually 100% of the biopsy and surgical prostate specimens they examine show evidence of prostatitis. We also know that all men eventually get prostate cancer if they live long enough. Annually, 40,000 men die from prostate cancer while over 300,000 new cases are diagnosed. Prostate cancer is the most common cancer to affect men and the second leading cause of cancer death in men (lung cancer is ﬁrst). In the United States, one in four men who undergo prostate biopsy will be found to have prostate cancer, but all of them will have prostatitis. These ﬁndings have led Dr. Timothy Moon and others to suggest that prostate cancer is always associated with prostatitis. Prostatitis leads to Prostate Cancer At the 2002 Naples, Florida meeting of the American Association of Cancer Research (AACR), national experts in microbiology and genetics, representing our ﬁnest institutions of higher learning, demonstrated that prostatitis (an inﬂammatory, non-bacterial event common to the prostate) evolves to prostate cancer. Despite this very important ﬁnding, the majority of physicians treat prostatitis as a disease of exclusion and continue to offer antibiotics as their only form of therapy. Notwithstanding the above, antibiotics suppress the immune system and provide added risk for the evolution of “super resistant organisms. ” In the AACR paradigm, the pathway from prostatitis (the non-bacterial, inﬂammatory process in 95% of all cases) leads to cellular dysplasia. Early cellular atypical change, consistent with dysplasia and oxidative change, results in Proliferative Inﬂammatory Atrophy (PIA) that induces the mutagenic process to Prostatic Intraepithelial Neoplasia (PIN). This entire process Page 4 May, 2004 involves cellular instability through the promotion of “free radicals.” As we know, PIN frequently evolves to prostate cancer. Whether men have prostate cancer or the diseases of BPH or prostatitis, the PEENUTS formula makes sense for all men as it works versus the cellular oxidative process that enhances the risk of or the growth of prostate cancer. Young men in their 30s typically are quite prone to prostatitis and are not generally thought to be at risk for prostate cancer. But a study from Memorial Sloan Kettering Cancer Center in New York found that 30% of 525 American men aged 30-39 actually had microscopic prostate cancer. Is it possible that chronic prostatitis may increase the risk or promote the growth of prostate cancer? There is evidence that suggests this may be so. It’s well known that chronic inﬂation of several other organs is associated with various cancers. Examples include the inﬂammation of the lower esophagus (Barrett’s esophagitis), which leads to esophageal cancer, hepatitis that eventually becomes hepatic cancer and ulcerative colitis, which develops into colon cancer. Since chronic inﬂammation causes cancer in other organs, it is reasonable to suggest that chronic prostate inﬂammation (prostatitis) if left unattended may ultimately lead to prostate cancer. Prostate cancer is always found together with prostatitis and all men will probably get both diseases if they live long enough. Both prostate cancer and prostatitis raise Prostate Speciﬁc Antigen (PSA) levels and occur most often in older men. Both conditions are currently at epidemic levels. Zinc levels are low or absent in both prostate cancer and chronic prostatitis. While prostate cancer and chronic prostatitis are clearly associated in some way, further research and epidemiological studies are required to determine the exact nature of the relationship as well as the cause and effect mechanism. IV. THE RESEARCH Present research dollars in prostatitis are so few that at our present pace a millennium will pass with countless innocent men suffering and possibly dying needlessly before the true answers are known. At the 1998 National Convention of the American Urological Association (attended by American and International urology experts), 51% of all the papers and studies presented involved prostate cancer while only 3% addressed prostatitis. While a few studies of various antibiotics for the treatment of prostatitis are underway (funded largely by the pharmaceutical industry that makes the antibiotics), there is virtually no other signiﬁcant research currently being done in the United States on this disease. Practically every man alive has prostatitis, making it one of the world’s most common diseases. Diagnosis is difﬁcult and current treatments are frequently inadequate. The association between prostatitis and prostate cancer is irrefutable. With all this in mind, it is particularly disturbing that prostatitis research has been so seriously underfunded for years. Leroy Nyberg, M.D., Head of Urology Research for the National Institute of Health (NIH) has stated: “It’s amazing to me that we can’t reliably treat the majority of men with prostatitis.” The NIH has organized a research arm that expects to bring a fresh look to chronic prostatitis, but the results of this research are not expected for several years. Today, chronic prostatitis remains the single most under-diagnosed, misunderstood and under-treated medical disease in the world. The Prostate Merry-Go-Round A classic example of a typical patient’s experience involved a 65-year old man from Lubbock, Texas who had noted a PSA of 18. His urologist appropriately performed an ultrasound examination and prostate biopsy. The result was chronic prostatitis with no evidence of cancer. Antibiotics were given, but no other therapy was offered. (Remember that only 5% of cases of prostatitis are actually caused by bacteria, which are potentially curable with antibiotics.) His PSA was repeated after six months and found to be unchanged. The patient underwent a second prostate biopsy, which again showed only chronic prostatitis. When the patient asked the doctor what he could do, the urologist offered to repeat the PSA in another six months and consider an additional biopsy then. The patient got onto the Internet and researched prostatitis. Eventually, he discovered a nutritional product that improved his voiding problems substantially and reduced his PSA by almost half in only three months. V. NUTRITIONAL THERAPIES Natural herbal remedies, although not highly regarded by most physicians in the United States, are among the most promising new treatments available for prostatitis at this time. They have been used extensively in Asia and Europe but are only now becoming popular in America. While usually recommended for prostate enlargement, there is growing evidence that they may be quite effective for prostatitis when used in the right combinations. These products appear to be quite safe and have no known side effects or drug interactions. Page 5 Fact, Fiction & Fraud in Modern Medicine Saw Palmetto is the most popular plant product used for prostate problems in the world. It seems that an extract from this plant is somehow able to reduce prostatic inﬂammation and swelling as well as improve many bothersome urinary symptoms. Pygeum africanum is made from the bark of African evergreen tree. It appears to work as an anti-inﬂammatory agent. It improved urinary symptoms in 66% of patients tested in several European studies. Selenium has been shown to reduce the incidence of prostate cancer by up to 66% in various studies. This theoretically occurs because of an improvement in the general health and immunity of the prostate. A Finnish study showed that Vitamin E reduced prostate cancer by 32%. Zinc has also been linked to the prevention of prostate cancer and an improved prostatic immune system. It also exerts an anti-inﬂammatory effect on the prostate. Combining these remedies along with other herbal products, vitamins, antioxidants and amino acids seems to improve the overall beneﬁt and effect. For example, Vitamin E and Selenium together are able to stimulate T cells, which help the immune system work to better protect and heal the prostate. Zinc may need substantial amounts of Vitamin E and Selenium as well as other nutrients to be able to effectively enter and treat the prostate. My patented and promising all natural combination product developed recently is called “PEENUTS.” PEENUTS is an acronym for Power to Empty Every Time while Never Urinating Too Soon and stands for normal urinary function and prostatic health. This particular combination product contains all the natural remedies known to improve prostate health in a unique formula, which seems to be particularly effective in treating both male urinary symptoms and especially prostatitis. In an effort to qualify the effectiveness of “PEENUTS,” Dr. Wheeler’s group has conducted a prospective, randomized, double blind, placebo controlled study. “PEENUTS” was shown to be statistically and clinically signiﬁcant. All men in the study improved 3 out of 7 voiding symptom categories. Sixty-nine percent of the men improved 6 or 7 out of 7 categories. In a follow-up to the study, more than 300 men have been evaluated in the clinical ofﬁce setting. The average improvement in voiding symptom score was approximately 13 points (50%). The PSA, a barometer of prostate health, improved in all patients by an average of 41. 3%, while the EPS, our most sensitive marker for prostatitis, noted a 65% reduction in white blood cells. There were no side effects or drug interactions noted during testing or clinical follow-up. As these ﬁndings can be conﬁrmed by other researchers, it would mean that “PEENUTS” could be the medical breakthrough we’ve been looking for in the treatment of prostate disorders, male urinary problems and especially chronic prostatitis. Through our research, the inability of the PSA to fall while on PEENUTS is likely associated with the diagnosis of prostate cancer. This is important, as this is the group that should consider a prostate biopsy with the “Color Flow Doppler” ultrasound technique. In Dr. Wheeler’s practice, men need to qualify for prostate biopsy through the failure of PEENUTS to lower the PSA, as 70-80% of all biopsies are negative. Therefore, the failure to decrease the PSA on the PEENUTS formula would suggest the likelihood of bigger problems. This ultrasound technique is similar to Doppler radar applied to our local weather forecasts. The application of Doppler ultrasound to the prostate identiﬁes areas of movement associated with blood ﬂow. Blood ﬂow is a well-recognized component of prostate cancer evolution and growth. I have had many patients who had a negative biopsy using the traditional “gray scale technique,” who were diagnosed with cancer using the “Color Flow Doppler” methodology. Our experience with the “Color Flow Doppler” ultrasound evaluation has made the gray scale technique obsolete. I frequently remind patients that stability of the PSA blood test is not a favorable factor when the number is between 4. 1 ng/ml and 10. 0 ng/ml or even higher as this indicates signiﬁcant oxidative disease or prostatitis. Prostate cancer, therefore, is often a result of years of oxidative cellular stress associated with prostatitis. SLOPE OF DISEASE The slope of disease reﬂects whether the prostate is getting healthier or less healthy. Statistically speaking, as men age the PSA generally rises. The reason for this is associated with an increase in prostate disease. While I understand the thinking process, it does not have to happen. That said, the PSA blood test result is a “dot” on a speciﬁc disease or health curve. In an effort to understand this, a good analogy would be a thermometer measuring your body temperature at 100 degrees (the dot on the disease curve), only to realize that 4 hours later it is 102 degrees. The slope of this disease is upward indicating a worsening of the temperature marker which probably also reﬂects a worsening of disease. In the case of PSA, the number represents a similar point on the clinical reference curve and in fact may be associated with an intensifying problem. This is mentioned, as Page 6 May, 2004 men may need to take the PEENUTS product for 6-12 months to change the slope of disease. In this manner, it may take 6-12 months before the PSA stabilizes and then starts to go down. Some men have a more rapid response than others but the most appropriate time to evaluate may be 12 months. I have found that 4 factors play a major role in this in the timeline to PSA reduction. The four factors are: prostate size, severity of disease, duration of disease and the possibility that cellular mutation may be taking place through the PIN mechanism (a precursor process to prostate cancer), as example, or that prostate cancer is also present. In this regard, men need to be patient and take either two or three PEENUTS per day in divided dose with meals. “NIGHTTIME VOIDING” My ﬁnal comments involve the possible need for alpha blockade in addition to the PEENUTS formula for optimal bladder/prostate function. While PEENUTS works on the overall integrity of the prostate at the cellular level (ﬁghting oxidative reaction), alpha blockade such as Flomax, works primarily at the bladder neck effectively relaxing this area in a hammock-like manner. My clinical acumen suggests that 20-25% of all men have this bladder neck anomaly. In this regard, it is not uncommon for many men to beneﬁt from PEENUTS and Flomax. My preference for treatment of voiding symptoms would always be to try the natural product ﬁrst and add the synthetic (Flomax) secondarily. On the topic of nighttime voiding, men need to understand the inability to sleep well is the primary reason men still get up while using the PEENUTS product. In other words, men who are easily aroused during their sleep cycle will generally get up to use the bathroom out of habit, more so, than the need to empty. Despite this common ﬁnding among men, most men continue to improve the nighttime voiding process on PEENUTS. Please remember that regardless of the disease we encounter, I would be happy to guide you to the least invasive, least traumatic, yet equally effective form of therapy that highlights your quality of life. In our next prostate disease update, I will talk about the best treatment options when prostate cancer is discovered. You will learn why it may be preferable to treat your prostate cancer as a chronic disease and avoid radical prostatectomy and radiation therapy. In this manner, men may avoid the predictable loss of Quality of Life issues associated with incontinence and impotency as well as avoid the potential for disappointment given the possibility the disease may return. Until then, I remain your consultant and advisor to a healthier prostate. SUMMARY A PSA of over 1 may indicate an unhealthy prostate. It’s obvious that the lower the PSA the lower the risk of prostate cancer. Anything you can do to lower your PSA level will probably reduce your risk of eventually getting prostate cancer. Keep track of your PSA level yourself. If the level is rising, even if it remains below “4,” make sure your physician is aware of it. Have your PSA and rectal examination performed regularly, usually at least every year for men 50 or over. Men at higher than average risk for prostate cancer, such as Blacks and men with a positive family history of prostate cancer, should be checked starting at age 40. Men with known elevations in their PSA levels and those with inconclusive or “suspicious” previous biopsies may need to be checked more often. Don’t be afraid to ask questions of your physician or get a second opinion about your health. A true professional will take the time to answer your questions and be open to suggestions about alternative therapies. There may be a link between prostatitis and prostate cancer. Practically all men eventually are expected to get both and they are often found together. Find out all you can about prostatitis and treat it as aggressively and effectively as you can. It may delay or even prevent the development of prostate cancer. Be aware that your physician may not be an expert on the treatment of prostatitis. Ask him about the various diagnostic tests and therapies available and which ones are appropriate for you. Page 7 Thomas A. Dorman, MD is now practicing at The Paracelsus Clinic 2505 S. 320th Street, Suite 100 Federal Way, WA 98003 253-529-3050 Fax 253-529-3104 Fact, Fiction & Fraud in Modern Medicine Exploring issues of Philosophy, Principle and Conscience in Contemporary Health Care May, 2004 The Prostate 216 Railroad Ave. N. Kent, WA 98032 ADDRESS CORRECTION REQUESTED Fact, Fiction & Fraud in Modern Medicine is published monthly by DORMAN PUBLISHING. MAILING ADDRESS for subscription matters and renewals: 216 Railroad Ave. N., Kent, WA 98032 USA. Editorial correspondence to: Dr. Thomas Dorman, 929 S. 291st Street, Federal Way, WA 98003-7300. Fax: 253-529-9782. E Mail: [email protected] Yearly Subscription Price: $69.95. Single copies $5.95. Please Note: The information in this Newsletter is not intended for individual use and should not be construed as speciﬁc advice for any individual. Every effort is made to Page should 8 report accurately, however, no guarantee for the veracity of any information be assumed. Web Page: http://www.dormanpub.com.
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