May 2015 – God And Prostate

Resting In a Trustworthy God

God always provides! Photo: BJ Gabrielsen

The following was excerpted from a recent Our Daily Bread Ministries devotional.©

If we’re honest, we would probably admit we’ve had moments when we’ve thought the promises in the Bible were written for someone else. It can be tough to lean back into God’s arms in total trust when we’ve just been handed a cancer diagnosis. In moments of pain and suffering, we live in the tension of who we believe God to be and who He appears to be if we use circumstances to define Him. We can learn much from Joseph in the Old Testament. He believed God was good and loving yet circumstances seemed to indicate the opposite. He was jailed innocently, often betrayed, thrown into a pit by his brothers to die and sold into slavery. One after another, the good things of Joseph’s life were stripped away; his freedom, reputation, and his family. He lived for years with no visible evidence that God was working “all things for his good.” Yet Joseph held firmly to faith in a loving God. Why? Joseph’s faith was rooted in his commitment to truth, not in what he could see. He believed in a trustworthy God whose faithfulness was greater than his circumstances suggested. He believed God sovereignly intervened in the course of human history; therefore, he trusted Him. Joseph, like us, lived much of his life in the tension of experiences that didn’t seem to match up with God’s promises. Yet he clung unswervingly to his faith. Trials are a certainty in life, but they don’t have the power to control us when our faith rests in the character of a trustworthy God who promises that through His Son, Jesus Christ, we will triumph in all things.

Two “Must-Read” Prostate Cancer Websites.

I came across two prostate cancer websites which I highly recommend. One is called http://www.HisProstateCancer.com; a site which contains medical and spiritual helps. The second is an inspirational site, http://www.prostateand prayer.com, written by a prostate cancer patient himself. As we and our families and friends experience these medical conditions, it is of great encouragement to know we have a God that lovingly and perfectly cares and others around us who provide invaluable support.

When “No Action” Can Be the “Right Action.”

The following was written by a prostate cancer survivor on the website “Prostatesnatchers” to which I highly suggest you subscribe.

“Back in 1990, when a suspicious lump was discovered on my prostate, my ignorance of the prostate gland and the possibility of prostate cancer was monumental. No one in my family or even among my close friends had ever had prostate cancer, and it never occurred to me that I might one day have the disease.

Now, 25 years later, I am still alive, the average man over 50 is more aware of prostate cancer, and also many less toxic and more effective treatment options are available. And yet one thing has not changed: just hearing the doctor say, “I’m afraid it’s cancer,” can leave even the most pragmatic man planning the music for his funeral.

Truth is there is still a lot of misinformation and misunderstanding out there about this disease. So here are some facts that I hope will alleviate some of your fears, and also clarify why I still contend that if you have to have cancer, prostate cancer is the best deal in town.

Prostate cancer is unique among cancers because the mortality rate is so low. According to the American Cancer Society, more than 2 million men who have been diagnosed at some point are living with the disease in the U.S. It’s difficult to determine actual prostate cancer survival rates because most men are around 70 years old when diagnosed, and many of them will die from medical problems unrelated to the disease. But if you check out the “relative” 5-year survival rate of all stages of prostate cancer, you will find it is almost 100%. And that almost 100% of men with low-risk or intermediate-risk disease live more than 10 years after diagnosis.

Why is it that the statistics for prostate cancer are so much less frightening than for other cancers?

1)    The PSA test is an early warning system that other cancers don’t have.
2)    It can easily be diagnosed at an early stage.
3)    In most cases it has an exceptionally slow growth rate.
4)    Extremely effective monitoring and treatment is now available.
5)    It has a pattern of spread that spares critical organs like the brain, lungs and liver.
6)    There is a safety net like no other called “hormone blockade” that induces remissions lasting more than 10 years in men with relapsed disease after surgery or radiation.

So instead of thinking about your funeral, what you really want to be focusing on is not rushing into some form of radical treatment that will virtually guarantee some degree of impotence or incontinence.

It appears that patients and doctors alike struggle with the idea of “watching” anything called cancer. But unless you have the less common high-risk form of the disease, my advice to you is to consider ‘Active Surveillance’ really carefully, especially if you are over 70. Because bottom line—and it bears repeating—out of over 200,000 men in the U.S. diagnosed annually with prostate cancer, the overwhelming majority will die with the disease, and not from it.”

For Prostate Cancer “Beginners”, These Screening, Diagnosis and Early Treatment Posts May Be of Interest.

Fear not! Help is on the way. Photo by BJ Gabrielsen

Over the years, several specific blogs (listed below) have been written especially applicable for men who are being tested for prostate cancer or who have been recently diagnosed with it. These blogs discuss screening, PSA values, biopsies, initial treatments, patient anxiety and spirituality and can serve as good starting points for your prostate cancer education.

“Prostate Cancer Information from Johns Hopkins Urology”; January 2nd, 2013;

“PSA Screening Recommendations from the American Society of Clinical Oncology”; July 29th, 2012;

“PSA Velocity and Questions to Ask Your Doctor”; August 11th, 2013;

“Prostate Cancer Diagnosis Using PSA Velocity and PSA Density”; June 3rd, 2014;

“Two Blood Tests That Can Determine Your Need of a Biopsy”; July 13th, 2014;

“All You Need to Know About the Gleason Score and its Diagnostic Use”; June 19th, 2014;

“A ‘Calculator’ to Predict Biopsy Outcomes and Understanding the TNM Staging System in Prostate Cancer Diagnosis”; October 19th, 2014;

“Prostate Biopsies”; February 17th, 2014;

“Prostate Cancer ‘Calculator'”; May 4th, 2015;

“So You’ve Been Diagnosed With Prostate Cancer!! Now What??”; June 2nd, 2011;

“Newly Diagnosed Prostate Cancer- What You Need to Know.” October 10th, 2012;

“Unsolicited Advice from Survivors for Newly-Diagnosed Men With Prostate Cancer”; January 23rd, 2015;

“When ‘No Action’ is the ‘Right Action'”; May 22nd, 2015;

“Recent Information on Prostate Cancer Screening and Active Surveillance”; November 28th, 2012;

“Active Surveillance May Be the Preferred Option in Some Men With Prostate Cancer”; August 15th, 2012;

“Update on Active Surveillance for Prostate Cancer”; February 27th, 2013;

“Predicting Outcomes and Characterizing Prostate Tumors”; February 28th, 2013;

“Nerve-Sparing Radical Prostatectomy”; October 22, 2013;

“Are You Contemplating Open Versus Minimally-Invasive Prostate Cancer Surgery?”‘ February 17th, 2011;

“Robotic-Assisted Prostatectomy May Not Reduce Surgical Side Effects”; January 25th, 2012;

“News From Johns Hopkins on Urinary Incontinence, Kegel Exercises and Familial Prostate Cancer”; November 14th, 2014;

“For Those Contemplating Radiation Therapy”; October 9th, 2011;

“Treating Low-Risk, Localized Prostate Cancer Using MRI-Guided Focal Laser Therapy”; July 11th, 2012;

“Four Clinical Trials Involving Focal Therapy for Prostate Cancer Patients Who Are Low-Risk or Under Active Surveillance”; May 9th, 2014;

“Prostate MRI/Ultrasound Fusion-Guided Biopsies for Prostate Cancer Detection”; January 23rd, 2015; also February 17th, 2015;

“A New Urine Test for Prostate Cancer”; December 31st, 2013; and, October 8th, 2013;

“Using Genetic Biomarkers in Prostate Cancer Diagnosis – A Review”; July 16th, 2013;

“New Prostate Cancer Diagnostic Tests”; April 24th, 2014;

“New 17-Gene Test Enhances Ability to Predict Prostate Cancer Aggressiveness”; June 21st, 2013;

“A Longer-Term Study of Treatment Side Effects of Early-Stage Prostate Cancer”; April 25th, 2014;

“Don’t Waste Your Cancer! – God’s Plan For Your Cancer”; January 10th, 2011;

“How to Handle Anxiety”; January 20th, 2012;

“Anxiety-How to Win Our Biggest Battle”; May 7th, 2012;

“Hope When Your World Falls Apart”; January 13th, 2013;

“God Sees the Whole Picture Exceedingly and Abundantly; We Don’t!” November 15th, 2011;

“An Example and a Purpose for Anyone With Prostate Cancer”; November 3rd, 2012;

Metformin Shows Promise for Late-Stage Prostate Cancer.

In the January 23rd, 2015 issue [290(4):2024-33] of the Journal of Biological Chemistry, researchers published the finding of potential benefit for a combination of metformin and the gene inhibitor B12536 in late-stage prostate cancer. Late-stage prostate cancer is commonly treated with androgen (hormone) deprivation therapy (ADT); however, the disease eventually becomes resistant to treatment. Androgen deprivation can disturb the body’s metabolism, leading to insulin resistance that can stimulate unwanted androgen production. Metformin, a drug commonly used to treat diabetes, helps reduce insulin resistance and has been associated with protection against specific cancers. It is known that the gene poly-like kinase 1 (PLK1) can become over-expressed (overactive) during ADT and that its over-expression can also stimulate androgen synthesis, researchers tested the effects of administering the PLK1-inhibitor B12536 with low-dose metformin in prostate cancer cells. The team found that the drugs worked synergistically to inhibit prostate cancer cell proliferation. The findings were confirmed in mice that received human prostate cell grafts. Further animal studies are underway with the eventual goal of initial human trials.

Positive Effects of Metformin, Statins and Diet on Prostate Cancer.

In a May 12th web essay entitled “prostatesnatchers” to which I encourage readers to subscribe, Dr. Mark Scholz, an oncologist, explained his reasons for recommending the use of the anti-diabetes drug metformin and statins to his patients with prostate cancer. One of the things that the last 20 years of his career treating prostate cancer had taught him is that a good diet has a favorable effect on inhibiting prostate cancer progression. As long as his patients with rising PSA levels after surgery stayed on their vegan or macrobiotic diets, their PSA levels would stabilize. “It is known that high animal protein intake increases cancer risk. How can diet make such an impact?” “There are some very logical suppositions. First, cancer cells “hurt” people by the process of cellular multiplication, ultimately spreading throughout the body and causing organ malfunction. It’s logical to assume that “better fed” cancers, the ones that get plenty of protein and energy, will grow faster and better than cancers that are relatively deprived. Animal protein not only provides all the necessary amino acids for the construction of new cells, animal protein is invariably accompanied by substantial amounts of a potent energy source—fat (people forget that the average hamburger is over 50% fats). High protein diets also increase the level of insulin in the blood. And high insulin levels drive sugar and protein uptake into the cancer cells, further promoting growth. And lastly, dietary cholesterol is not only a type of “fat,” but it is also a hormonal precursor, a building block for DHEA and testosterone.”
“Unfortunately, few men have the ability to follow strict vegan diets. It’s a lot of work and requires constant self-denial. Certain medications, however, can achieve some of the same effects. Metformin, a generic medication approved for the treatment of diabetes, suppresses insulin levels in the blood. Studies in diabetic men with prostate cancer who are treated with metformin have shown lower prostate cancer mortality rates compared to diabetic men who are treated with other types of diabetic medications besides metformin. Statin pills, medications such as Lipitor and Crestor, dramatically lower cholesterol levels. Numerous studies have reported higher cure rates in prostate cancer patients receiving radiation who are treated with statins compared to radiation-treated patients who don’t receive a statin. Regular exercise prolongs life in cancer patients. If we had a pill that could accomplish what exercise can do—improved energy levels, sleep, digestion, memory, longevity and less depression—everyone would take it. Many patients are lukewarm about prescription pills like metformin and statins, probably mainly due to concerns about side effects. But side effects can be anticipated with careful monitoring. When a medication side effect occurs it can be detected early and when the medication is stopped the problem is almost always resolved. Following a rigorous macrobiotic diet for the rest of your life is beyond the reach of most of us. Taking an FDA-approved pill, while using careful precautions against potential side effects, is achievable for almost all men.” For information, a macrobiotic diet involves eating grains as a staple food supplemented with other foods such as local vegetables and avoiding the use of highly processed or refined foods and most animal products.

Early Chemotherapy Combining Taxotere (Docetaxel) with Hormone Therapy Recommended for Metastaic Prostate Cancer.

A new large clinical trial suggests that survival can be improved in men with metastatic prostate cancer with the addition of docetaxel® chemotherapy to frontline hormonal therapy. Treatment-naive men with advanced prostate cancer who received both docetaxel and hormonal therapy lived an average of 10 months longer compared with men who were treated with hormonal therapy alone. For details, see the following link. This has also been discussed in a previous website post dated September 20th, 2014.®

Genetic Test Can Determine Whether Expensive Treatments Will Work in Metastatic Cancer

Photo: BJ Gabrielsen — Florida Mum and friend

Enzalutamide and abiraterone are drugs that are used to treat metastatic prostate cancer that is growing despite hormonal therapy. The two drugs work differently. Enzalutamide targets the androgen (e.g. testosterone) receptor on a cell while abiraterone inhibits androgen synthesis. The treatments can cost as much as $100,000 per year and not every man responds to either drug. Resistance to both of these drugs has been observed. Up till now, there was no way to determine whether either drug would work in a given case except to prescribe one and see if it worked, and if it didn’t, then try the other. Recently however, researchers at Johns Hopkins in Baltimore have found that a particular genetic androgen receptor variant on prostate cancer cells, called AR-V7, is associated with resistance to these drugs and they have developed an assay to look for AR-V7 in prostate cancer cells circulating in the blood. Their study was published in September 2014 in the New England Journal of Medicine. In their initial studies, 39% of 31 men taking enzalutamide and 19% of men taking abiraterone had detectable AR-V7 in the prostate cancer cells circulating in their bloodstream. Of the men on enzalutamide, those who were AR-V7 positive had poorer PSA response rates and shorter progression-free survival compared to men with no detectable AR-V7. A similar situation was observed for men taking abiraterone. After adjusting for other factors, the researchers concluded that men who were AR-V7 positive had “independently inferior responses to the two drugs” than men whose blood showed no AR-V7. During the study, it was also observed that some men who had been AR-V7 negative before treatment changed during the course of therapy and became AR-V7 positive. These men had intermediate clinical outcomes. The AR-V7 variant was found to be relatively common among men with hormone-resistant prostate cancer. It was present in 12% of the men who had received neither drug but it appeared in 67% of the men after exposure to both enzalutamide and abiraterone. Larger studies are underway to determine if AR-V7 can eventually be used as a biomarker to predict primary or acquired resistance to androgen pathway-targeted therapies. The turn-around time for an AR-V7 assay is only three days, hence the test could be used in the near future for men contemplating treatment with either of the two drugs. If they test positive for AR-V7, these men could potentially be steered to alternative treatments such as immunotherapy, chemotherapy or radiotherapy.

Prostate Cancer “Calculator”

I recently came across an interesting article about a 72 year old man seeking advice on his prostate cancer diagnosis from his urologist at the University of Texas Health Center. His urologist showed him a unique way for men to evaluate their risk of developing prostate cancer by using a simple tool called the Prostate Cancer Risk Calculator. It involves entering data regarding age, race, PSA level, family history, digital rectal examination and prior prostate biopsy into a “calculator” which then gives a general risk percentage of high-grade or low-grade prostate cancer, and the chances that a biopsy would be negative. The web address for this calculator is deb.uthscsa.edu and can be accessed from the linked article. Please be advised that this is for information purposes only and should always be used in consultation with one’s personal physician.