The good news according to Johns Hopkins urologists, including Drs. Patrick Walsh, Mario Eisenberger and Alan Partin among others, is that there is no need to panic if your PSA levels begin to rise after surgical prostate removal. You may not have to do anything for years. Hopkins doctors have developed guidelines to help doctors and patients know what to do if your PSA comes back. On the average it took eight years from the time a man’s PSA first went up until he developed metastatic disease as detected by bone scans or other imaging techniques. Hopkins researchers found that this interval can be predicted using three pieces of information. These parameters include the Gleason score of the pathologic specimen of the removed prostate, the time it takes for PSA to come back and thirdly, how rapidly the PSA is doubling. The guidelines are excellently summarized in the linked article published in the Journal of the American Medical Association and summarized in the Johns Hopkins Prostate Cancer Update.
The word “prostate cancer” evokes anxiety and often fear in every man with whom I have ever spoken. “Is my PSA value normal?” “Do I need a prostate biopsy?” If cancer is detected, what can be done to rid me of it?” “If I have metastatic cancer, what is my life expectancy?” All these questions are understandable. Life is filled with uncertainties. In addition, there are the “what if” questions. “What if I undergo a specific treatment, will it cure me or will there be undesirable side effects?” Sometimes we don’t even need a current stressful situation in order to worry. We can borrow from the future and carry anxiety for what may or may never happen. Personally, I have often found myself conceiving the worst possible scenario figuring any actual result could only be better. Prostate cancer can evolve into a lifestyle of anxiety. It can become a constant companion, hovering over us like a cloud, stealing any peace, contentment or joy of life.As Christians, this is not what God desires for His children and He has made every provision for us to live in contentment and peace. The apostle Paul said in Philippians 4:11 that he learned to be content in whatever circumstance he was facing even death and that the power to do so came through Christ who strengthened him. If we have a personal relationship with God through Christ, our confidence is also found in Him and we will not be swayed by our circumstances. True contentment is based on a Person, and not what’s going on around us.
Many people feel that prayer is the solution because Paul tells us to pray about everything and not be anxious about anything. While such prayers are good, we may simply want God to solve the problem without digging up its root. However, if we know the source of our anxiety, we can actually discover the key to overcoming it.
Dr. Charles Stanley, a well-known pastor and author, identifies three roots of anxiety that feed into our worry. The first root is fear and the key to overcoming it is faith in God’s Word. Fear might be the dread of our current situation or what could happen in the future. “Will my cancer be cured or what happens if it comes back?” The problem is our focus and God’s Word has been written that we may have hope. On more than one occasion, Christ’s disciples were faced with an impossible situation such as feeding 5,000 men not counting women and children with a five loaves of bread and two fish. Jesus’ answer to them and to us is the same; “with people this is impossible, but with God all things are possible” (Matt. 19:26). The Word of God is filled with examples, promises, commandments, and principles that reveal our Lord is bigger than any problem we may encounter.
The second root of anxiety is doubt and the key to contentment is trust in God’s ways. We may know in our mind that God is capable of dealing with our need but we are not sure if He will do it. We may acknowledge His limitless power, yet He doesn’t seem to be doing anything to change our current situation. We would readily trust Him if He’d jump the first time we called and did exactly as we asked or hoped. But He’s the one in control, not us. True contentment comes when we are willing and able to lay our burden at His feet, trusting in His plans and perfect timing. Proverbs 3:5-6 states we are to “trust in the Lord with all our heart and lean not to our own understanding. In all our ways, we are to acknowledge Him and He will direct our paths.” After all, God loves us more than we know.
The third root of anxiety is control, and the key to overcoming it is surrender to God’s will and plan. When circumstances are going well, there is a calm sense of security. A surgeon may tell you, “we got all the cancer and you can consider yourself cured”. In fact, my cancer was found so early that I was told “if we can’t cure you, we can’t cure anyone”. I felt secure and confident till it came back eight years later. In cases like this, the balance is upset and we feel out of control. In reality, we were never in charge of our body. Psalm 103:9 says “the Lord has established His throne in the heavens and His sovereignty rules over all.” That includes all the details of our lives. When we know the Lord and trust in His goodness and love, surrendering to His will and letting go of our desire to control, then we will experience the contentment that comes with knowing we are safely held in His hands, no matter what conditions rage around us. Like a child being led by a loving parent crossing a dangerous street, our security is not simply dependent on our holding God’s hands, it rests in the fact that He is holding ours.
Peace and contentment can become a reality in your life even as you face prostate cancer. It has nothing to do with circumstances and everything to do with God Himself. In the midst of storms, His peace is like a shelter around you, guarding your heart and mind in Christ Jesus (Philippians 4:7). Nothing comes your way without His permission, and if He’s allowed something difficult, you can be sure that He will use it to strengthen your faith and build your character. God desires to give you peace in every circumstance.
The message above is applicable to anyone whose life is based on experiencing a personal relationship with God through faith in Jesus Christ. If you are not sure of your own personal relationship with Him, consider making such a decision. God truly loves each one of us and has a unique plan for our lives. But we are all sinful beings and none of us match up to God’s character and requirements of true holiness. We have all violated His laws at one time or another. Therefore a penalty has to be paid to satisfy God’s character as a just and impartial judge. God’s Son, Jesus came to this earth to do just that, namely give His life as an payment for the sins of each one of us. By placing our faith in Christ’s sacrifice alone and not our own works, God’s requirement is fulfilled and He then sees us as righteous, forgiven and justified through the filter of Christ’s death on a cross. God’s spirit then comes to live within each of us as our divine guide and “helper”. Through Christ’s resurrection from the dead, we are also given the gift of eternal life in a new heaven and a new earth with a new perfect cancer-free body. So if you have never done so, please consider placing your faith in Christ alone and submitting your life to the plans the Creator Himself has formulated. Then the promises in God’s Word as described above become your very own.
A Northwestern University study of 190 men of median age 64 having their prostate removed found those with low vitamin D levels were more likely to have rapidly growing tumors than those with normal levels of the “sunshine” vitamin. The study was published on-line in the Journal of Clinical Oncology. The researchers found that nearly 46 percent of the men had aggressive cancer, and these men had vitamin D levels about 16 percent lower than men with slower-growing tumors. Racial distinctions were also noted in this study with black men having more aggressive tumors and lower vitamin D levels than white men. After accounting for age, PSA levels and abnormal rectal exams, researchers found that blood vitamin D levels below 30 nanograms per milliliter (ng/mL) were linked to higher odds of aggressive prostate cancer. The study however does not necessarily prove that vitamin D deficiency causes aggressive prostate cancer, only that the two are associated. Experts quoted herein state that while these results are important enough to spur further study into the vitamin D – prostate cancer potential biomarker connection, there is not sufficient evidence at this time to recommend vitamin D supplements to prevent prostate cancer or to make it less aggressive. It should be noted however that most Americans in general have lower than normal vitamin D levels which seem to be implicated in several medical conditions. It is recommended that men and women be blood-tested routinely for vitamin D levels using the 25-hydroxy vitamin D assay. Optimum levels should be at least 30 ng/mL. (One can get too much vitamin D so consult your physician to discuss test results and supplement recommendations if needed.) It was also suggested that perhaps men should be tested for Vitamin D when they are diagnosed with prostate cancer and subsequently supplemented with vitamin D if they are deficient. For further information, see the link to this study published in the National Institutes of Health Medline. For an additional summary of this study see the following link from Cancer Therapy Advisor.
Prostate Cancer News Today recently sent an e mail summarizing the twelve currently-approved drug treatments for prostate cancer. Rather than reproducing the list here, I am providing a link to the article.
After writing the somewhat depressing April 13th blog, I had to add some personal words of encouragement which appear in bold type at the end of the linked revised post. If you have already read the un-edited April 13th blog, please go back and read the revised personal notes at the end of this link.
A large study (see the Cancer Network Oncology link) from Harvard Medical School and Brigham and Women’s Hospital in Boston suggests that men receiving testosterone-suppressing (hormone) therapy (ADT) for prostate cancer may be at increased risk of developing depression. The findings, published online April 11th in the Journal of Clinical Oncology, are based on Medicare records for over 78,000 U.S. men treated for prostate cancer between 1992 and 2006. Overall, 43 percent underwent hormone therapy. Once other factors were taken into account, the study found a 23% increased risk of depression compared to men receiving other cancer treatments and a 29% increased risk of inpatient psychiatric treatment. The investigators also concluded that the longer men were on hormone therapy, the greater the risk of depression. Longer exposure to hormone therapy (ADT) resulted in an increased risk of depression from 12% with less than 6 months of therapy to 26% with 7-11 months of therapy and up to 37% among patients treated for 12 months or longer. While the increased risk of depression may be a direct result of reduced testosterone levels, there could also be indirect effects such as sexual dysfunction, hot flashes and weight gain. Hormone therapy (ADT) can also be accompanied by metabolic, cardiovascular, bone and cognitive adverse events. Several prior studies have found a similar significant association between depression and ADT yet smaller studies have also shown no link. There is currently no consensus on whether ADT is associated with depression noted the authors. The study authors also stated that while hormone therapy may not be a good choice for men with “low-risk” cancers, but for “higher-risk” cancers treated by surgery or radiation, adding hormone therapy might be a good choice. For men with “intermediate-risk” prostate cancer, the benefits of hormone therapy are less clear, and would have to be weighed against the risks. Pertinent commentary from Dr. Mayer Fishman of the Moffitt Cancer Center in Tampa, FL (not Miami) was also provided in the following linked Medline article.
On a personal level, I have been on intermittent ADT for over nine years and thankfully I am asymptomatic. In light of the above, I have at times experienced very short periods of mild depression which could be due to any one of a number of causes not just ADT. More importantly however, as I approach 75 years of age, my personal relationship with God through His Son Jesus Christ and the in-dwelling Holy Spirit, allows me to retain my joy of this earthly life and the anticipation of my eternal life to come in a new heaven and a new earth with a new disease-free body. Over the years, I may have asked God the same questions as did the authors of Psalm 42. They wrote in verse 11, “Why my soul are you downcast? Why so disturbed within me? Put your hope in God, for I will yet praise Him, my Savior and my God.” I can echo the words of the Old Testament prophet Nehemiah 8:10 who states “do not be grieved, for the joy of the Lord is your strength.” Hopefully, these brief thoughts could serve as an antidote for any disease-induced depression.
While the average age of prostate cancer diagnosis is 66, rates are rising in men age 55 and younger. In my own case, I was initially diagnosed with prostate cancer at the age of 54, which is now over twenty years ago. Here are a few things to consider about screening, treatment and prevention.
1) It can be more aggressive. Most men with early-onset prostate cancer are diagnosed with low-risk disease, a University of Michigan study found. But among certain types that strike at a younger age, tumors appear to grow more quickly and be more lethal.
2) Early detection is recommended. Prostate cancer diagnosed in younger men has a strong genetic component e.g. variants in genes such as BRCA2 or BRCA1. Men with a family history of the disease are known to be at higher risk. Certain ethnic groups such as Scandinavians and African-American men among others have a somewhat higher overall risk of prostate cancer. For men with average risk, discussions with doctors about prostate cancer screening should take place at age 50, according to the American Cancer Society. But men at higher risk should consider screening at age 45.
3) Screening tests such as a PSA blood test and a digital rectal examination are simple and should be carried out in consultation with one’s personal physician.
4) Early prostate cancer doesn’t usually cause any symptoms but remember we are our own best physicians. Therefore we should always notice any unusual symptoms as they arise and discuss them with our physician.
5) Men with male-pattern baldness may have a slightly higher risk of developing fatal prostate cancer compared to men with a full head of hair, according to a recent study in the American Journal of Epidemiology. However, the study author concludes that much more follow-up research is needed to better understand the possible overlap between hair loss, male-hormone levels and disease risk. “Men of any age and any balding status need not be additionally concerned about their individual risk of prostate cancer.”
6) In some cases, early treatment may help later in life.
7) Watchful waiting (active surveillance) can work. For many men, active surveillance – close monitoring with new visualization technologies like multi-parametric MRI that make it more accurate to know whether a tumor is progressing – is a very good choice for many men with early prostate cancer.
8) Lifestyle factors such as being physically active, trying to maintain a healthy weight and choosing healthy foods, is a key.
The following comes from the Prostate Cancer Foundation (PCF). Tomatoes are rich in lycopene, which is one of the most well-studied antioxidants in the fight against prostate cancer. Recent research suggests that lycopene may inhibit prostate cancer growth and development of metastases. Cooking tomatoes and consuming them with healthy fats (such as olive oil) increases the body’s ability to absorb lycopene. PCF recommends that men -with or without prostate cancer- consume a healthy diet rich in a variety of vegetables, including cooked tomatoes. It is NOT recommended that men take a separate lycopene supplement. To find out more about the latest research into healthy eating with a prostate cancer diagnosis, download or order the Prostate Cancer Foundation’s new guide, Health & Wellness: Living with Prostate Cancer, at www.pcf.org/guides. Their phone number is 1-800-757-CURE (2873).
Since I personally have recurrent but asymptomatic prostate cancer, I have my PSA checked every four months. Thinking back to similar experiences over the past twenty years, this regular PSA testing usually was accompanied by some degree of anxiety, fear and pleas to God that the results would be positive. While some degree of apprehension or anticipation could be considered as normal, I have been steadily progressing in my faith journey leaving my condition in God’s hand and getting to the point where I can truly say “not my will by Thine be done.” Last week was a day of testing. Over the years, God has given me the ministry opportunity and I believe an assignment to write this website and share my journey with others. Remembering what He specifically promised me as recorded in the April 30th, 2015 video blog, He said “You (me) keep sharing your ministry and I’ll (Jesus) take care of your body.” So last week as I am driving to my doctor’s office to get my blood drawn for my PSA test, I passed a local Methodist church whose pastor had written his upcoming sermon topic for the upcoming Sunday on the church signpost. In big, unmistakable letters, it read “God Keeps His Promises.” I praised and thanked the Lord for this unexpected reinforcing message and took my test with a calm, submissive spirit. By the way, the PSA result was very positive when it could have been otherwise. As James 1:2-4 states, “Consider it all joy, my brethren, when you encounter various trials, knowing that the testing of your faith produces endurance, and let endurance have its perfect result, that you may be perfect and complete lacking in nothing.” My medical journey with “the Great Physician” continues.