Prostate Cancer: An Owner's Manual to Prevention and TreatmentProstate Cancer: An Owner's Manual to Prevention and Treatment

By Dr. Mao, L.Ac., D.O.M., Ph.D, Dipl. C.H., ABAAP

One in six men will develop prostate cancer in their lifetime. Each year in the U.S., about a quarter of a million men are diagnosed with prostate cancer, and about 35,000 people die of the disease. The highest risk groups for prostate cancer include men who are 65 and older and non-Hispanic Black men. It's incredible how little men know about their prostate and the women who love and care for them. Most men can avoid getting prostate cancer. This article will provide an integrative East-West perspective on the prevention and treatment of prostate cancer.

What is the Prostate, and What does it Do?

The male body is equipped with a chestnut-size gland that sits below the bladder and wraps around the urethra called the prostate. The prostate gland's primary function is to produce the seminal fluid that nourishes, carries, and then forcefully expels sperm out of the penis during sexual ejaculation for reproductive purposes. The prostate also acts as a gatekeeper to close the urethra during sperm ejaculation and the seminal ducts during urination. It also converts testosterone to biologically active dihydrotestosterone or DHT.

There are three layers to the prostate gland that encircles the urethra: the transition zone, the central zone, and the peripheral zone. The transition zone is the innermost and smallest. It compromises about 10% of prostate tissue. The central area is where the seminal and ejaculatory ducts are located and consists of about 25% of the gland. The peripheral zone is the outermost layer which comprises about 70% of the prostate.

Why Does the Prostate Become Cancerous?

The prostate gland changes with age, just like the rest of your body. In my book on cancer care and prevention, Live Long, Live Strong, I explained that the most significant cause of cancer is AGING! With exposure to carcinogens, cell mutations, time for the accumulation of various mutations to become cancerous, and the decline of immune function, it's no wonder aging is the biggest cause of cancer.

This is certainly true for prostate cancer. The innermost transition zone often becomes enlarged with age. Although it is mostly benign (called prostatic hyperplasia or BPH), it can still cause pressure on the urethra and bladder, leading to difficulty urinating - common problem for older men. On the other hand, prostate cancer primarily develops in the peripheral zone.

What are The Risk Factors for Prostate Cancer?

The following are ten factors that raise risks for prostate cancer:

  • Age - the older you are, the higher risk
  • Race - non-Hispanic Black men
  • Urban environments - watch out for pollution
  • Genetic history - family history accounts for 10-20% of all cases
  • Toxin exposure - agent orange, nitrites, pesticides, etc.
  • Obesity - high blood sugar, insulin growth factor IGF-1
  • Sedentary lifestyle - couch potatoes, consider yourself forewarned
  • Lack of sexual activity - use it or lose it!
  • Smoking - quit while you are ahead
  • Excess alcohol - moderation, one drink per day is key

How Can Chinese Medicine Help with Prostate Cancer?

Chinese medicine emphasizes prevention. For those diagnosed with prostate cancer and undergoing treatment, Chinese medicine can also support your immune system, manage symptoms, side effects from surgery, radiation, and chemotherapy, improve urinary and sexual function, and prevent cancer recurrence.

Studies have found the following modalities to be useful integrative adjuncts to Western medical oncology:

  • Anti-cancer diet and nutrition such as the inclusion of cruciferous vegetables, i.e., broccoli, cauliflower, cabbage, Brussels sprouts, kale, etc., and exclusion of red meat, dairy, sugar, deep-fried, fatty foods, and processed and refined foods
  • Herbal and nutritional supplement programs such as saw palmetto, nettle, and maitake; trace minerals like selenium and zinc; and flavonoid compounds like quercetin are helpful both as preventive, during, and after cancer treatments. These and other ingredients are found in Prostate Support, which I take daily because I too, am the owner of a prostate.
  • There is solid evidence that mind-body practices like qi gong and meditation can lower the inflammatory stress hormone cortisol and increase immune function. You can learn from Qi Gong for Cancer Support DVD or download.
  • Acupuncture with microcurrent stimulation is used to ease urinary flow, incontinence, and sexual dysfunction, as well as pain management.

How is Prostate Cancer Diagnosed?

Prostate cancer is usually discovered by a routine digital exam performed during an annual physical with one's physician, during which the prostate gland is palpated rectally. A structural change in the prostate gland is noted, and a follow-up blood test for the prostate - specific antigen or PSA reveals elevated levels above 4. In addition, a urologist may perform prostate imaging with an MRI to assess the size and location of the tumor if one is felt.

If a tumor is confirmed, there is normally a biopsy follow-up to determine the pathology of the tissue. Once tissue samples are determined to be malignant, they undergo further grading based on a Gleason score. A Gleason score is a numerical grading that compares cancer cells to healthy cells. If the total Gleason score is 7, it usually means there is a medium grade cancer, whereas 6 is low grade and 8 and above is a high grade which also means the cancer cells look very different from healthy cells and have a higher likelihood of spreading.

Staging the Cancer

In addition to grading, the oncologist will stage the disease based on the TNM system, which stands for Tumor (T) size, Node (N) of the lymph system, and Metastasis (M) spread. Staging also includes PSA level and Gleason score.

  • Stage I: Slow growing, PSA is low, tumor contained to one half of the prostate, and the cancer cells look like healthy cells - meaning the Gleason Score is 6.
  • Stage II: The tumor is still confined to the prostate, PSA is medium, and the Gleason score is 7 or 8.
  • Stage III: PSA is high, and the tumor has spread beyond the prostate into the surrounding tissue. The Gleason's score is 8 or higher.
  • Stage IV: Cancer has spread beyond the prostate into the lymph nodes and other parts of the body.

Treatment of Prostate Cancer

A urological oncologist will consider all the diagnostic information above and current urinary and sexual function, quality of life, and health history to arrive at a treatment recommendation for each patient. Treatment may include modalities such as active surveillance, surgery, radiation, chemo, hormone-blocking, or a combination thereof.

Active Surveillance

For patients with slow-growing prostate cancer, such as in stage I, a low PSA and a low Gleason score of 6 or 7 may be eligible for "active surveillance," sometimes called "watchful waiting." Some patients have called this stage "sitting duck." In many cases, these cancers grow so slowly that they do not threaten one's lifespan. Regular PSA measurements taken every 4-6 months are prescribed, and generally, there is no need for further treatment. However, it is not known whether the disease process could accelerate and eventually become aggressive. Therefore, taking preventive steps at the time of diagnosis would be wise to ensure that the disease does not progress beyond this stage.

Surgery

Any cancer treatment can be frightening, especially when considering surgery to remove the entire prostate. Depending on the tumor type and location and whether it has penetrated surrounding tissue, the surgeon can choose to do a radical open prostatectomy where the entire prostate, tumor, and testicles are removed while taking care to spare the nerves for normal urinary and sexual function. Laparoscopic or robotic surgery may be chosen for less invasive cancers, which causes less collateral damage, although it could cause urinary incontinence and erectile dysfunction as well.

A subset of surgery may include cryotherapy or cryoablation, whereby the doctor inserts a metal rod into the prostate to "freeze and destroy" cancer cells. Cryotherapy for prostate cancer is not considered a standard of care. The FDA has not approved it for the treatment of prostate cancer. However, proponents argue that it is less invasive and produces little to no side effects for patients with low-grade and slow-growing prostate cancer.

Radiation Therapy

Radiation oncologists use high-intensity X-ray, proton beams, or ultrasound (HIFU) to destroy cancer cells. This energy medicine harnesses short electromagnetic waves, energy waves, or sound waves to treat disease. Radiation therapy can also take the form of intravenous infusion with radioactive radium and lutetium. The side effects of radiation therapy are similar to those of surgical intervention in which patients may be left with urinary incontinence and/or erectile dysfunction. There are two types of radiation, external beam and internal radiation or brachytherapy.

External beam radiation can be high intensity but short in duration (hypofractionated radiation) or low intensity with a longer treatment course duration (stereotactic body radiation). Sometimes the two are combined to produce a better outcome. Proton therapy uses a proton beam rather than an X-ray beam to destroy cancer. The difference may be that the proton beam is more precise and thus causes less collateral damage than the X-ray beam.

Internal radiation or brachytherapy involves implanting a radioactive seed that gives off radioactive energy to destroy cancer cells which may last from 30 minutes to one year. Sometimes both external and internal radiation therapies are combined depending on the severity of the prostate cancer and the patient's tolerance of side effects. Moreover, radiation therapy may be combined with hormone therapy to better prevent a recurrence.

High-intensity focused ultrasound (HIFU) utilizes high-frequency sound waves to generate heat to "burn and destroy" the cancerous prostate tissue. It was approved by the FDA in 2015 and is gaining traction for low-grade, slow-growing prostate cancers. Since it's a relatively new procedure, not every radiation oncologist has the experience or the equipment to perform HIFU treatments. The virtue of HIFU is that it minimizes collateral damage and side effects compared to conventional radiation therapy, but its efficacy requires long-term analysis.

Intravenous radiation is used for patients with metastatic prostate cancer that did not respond to hormone therapy and involves radioactive radium 223, which is reserved for bone metastasis as the radium targets calcium changes in the bone tissue. Lutetium 177 is another radioactive element used to target a specific molecule called PSMA (prostate-specific membrane antigen), highly expressed in prostate cancer cells. Side effects vary from patient to patient but mostly involve fatigue, anemia, and immune suppression.

Hormonal Therapy

Sometimes also called testosterone-blocking or medical castration, hormone therapy aims to shut down either the signal to the testicles to produce, the actual production of testosterone from the testicles, and/or the testosterone receptors on the cancer cells. These have similar effects of removing the testicles - thus the term medical castration. However, the effects of medical castration are reversible once the blockers are stopped, whereas orchiectomy - surgical removal of testicles - is not. Hormone therapy is often combined with other therapies mentioned above to lower the risks of disease recurrence.

Testosterone - blockings side effects can cause severe quality of life concerns for many patients, including depression, cognitive decline, osteoporosis, heart disease, low libido, sexual dysfunction, and fatigue. The good news is that I've been helping patients reduce and manage these side effects with natural and complementary therapies to ensure the patients' quality of life while keeping their prostate cancer at bay.

Chemotherapy and Targeted Therapy

For patients with metastatic prostate cancer that has spread beyond the prostate and did not respond to surgery, radiation or hormone therapy may be given intravenous chemotherapy such as docetaxel (Taxotere) and other chemo drugs. Side effects from chemotherapy may include fatigue, digestive upsets, cognitive decline, nerve damage, and hair loss which may be managed with complementary therapies.

Targeted therapies for patients with specific genetic mutations such as BRCA1 and BRCA2 mutations may be given PARP-inhibitor drugs that help with DNA repair. There is also immunotherapy involving vaccine therapy whereby a patient's blood is drawn, and T-lymphocytes, the body's troops, are isolated, modified, and infused back into the patient's body to target the prostate cancer cells. As with every treatment, side effects may include allergic reactions, flu-like symptoms, or joint pains, which can be managed effectively with complementary therapies.

Preventing Prostate Aging and Cancerous Changes

As cancer is a function of organ or tissue decline due to aging, one may be resigned to its inevitability. However, the good news is that while death is inevitable, getting prostate cancer is not. Studies show that efforts to slow down prostate aging and prevent cancer may pay off in the form of delayed onset or entirely avoiding prostate cancer altogether. Researchers have discovered that certain foods, herbs, and nutrients can improve prostate health and function as well as prevent and inhibit cancerous changes.

Anti-Aging Diet and Nutrition for the Prostate

Prostate aging causes enlargement or benign prostatic hypertrophy (BPH). To prevent or reverse BPH, your diet should be rich in isoflavones and flavonoid compounds such as soybeans and other soy products like tofu, soy milk, edamame, tempeh, and natto. Eat a large variety of beans and legumes, including black beans, adzuki beans, and lentils. Green tea, apples, and onions contain rich flavonoids like polyphenols and quercetin.

Regularly consume pumpkin seeds and Brazil nuts, both rich zinc and selenium sources that keep the prostate healthy and prevent cancerous changes. Increase your intake of cruciferous vegetables like broccoli, cauliflower, cabbage, Brussels sprouts, and kale that contain a sulfur compound sulforaphane that helps fight and prevent cancer. Finally, tomato, papaya, and watermelon are rich in lycopene which is beneficial for prostate health.

Avoid drinking excessive amounts of alcohol, which is a known carcinogen, cow's milk products with their inflammation-inducing A-1 casein protein and an abundance of lactose sugar, processed and refined foods containing preservatives that are known prostate irritants, and sugary foods that spike your insulin growth factor (IGF-1) which supports cancer cell growth, along with heavy consumption of red meat that studies show correlates to an increased incidence of prostate cancer.

Natural Prostate Support from Mother Nature

Herbs have a long history of use for prostate health, especially in Chinese medicine, in which volumes of books were written by renowned physicians over the centuries to record their use to help improve symptoms of BPH, urinary symptoms, and cancerous tumors. Specific herbs include:

  • Saw palmetto, stinging nettle, and pygeum have all been found to maintain prostate health and reduce BPH.
  • Pumpkin seed oil and red cloves have also shown favorable results in clinical research.
  • Astragulus has been used to support immune function and treat prostate inflammation and BPH in Chinese medicine.
  • Medicinal mushrooms such as maitake and reishi have been studied and used for their anti-cancer, anti-viral, and immune-boosting properties.
  • Check out our Prostate Support PLUS formula that contains all of the herbs listed above and more.

Note: Herbs should be blended according to individual needs; consult with a licensed practitioner for a personalized formulation.

Mind-Body Practices: Qi Gong & Meditation for Cancer

Qi gong practice, sometimes called moving meditation, is widely practiced in cancer centers throughout China and has repeatedly demonstrated its effectiveness in strengthening the immune system, fighting fatigue, depression, and side effects of cancer treatments, and inducing a sense of well-being. Cancer patients undergoing oncological intervention should participate in qi gong exercises and meditation, particularly in group practice sessions, to provide a gentle exercise program to reduce stress and fatigue. Check out my Qi Gong for Cancer Support DVD.

In conclusion, following the time-tested, well-researched protocols in this article can help you work toward avoiding prostate cancer. If you or a loved one are currently undergoing an evaluation or treatment for prostate cancer, I would be happy to advise through telemedicine on a personalized integrative health protocol to help optimize recovery while managing side effects from cancer treatments to maximize the quality of life.



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