Cancer of the Prostate - A Naturopathic Perspective
by Tom Kruzel, ND, email:takruz@compuserve.com


The prostate gland acts as the male genitourinary systems first line of defense against infection as well as in the packaging and delivery of sperm. The gland is composed of fibromuscular and glandular tissue, is approximately the size of a chestnut and lies between the bladder and external urethra, anterior to the rectum. The urethra, the conduit through which the urine flows, passes through the prostate gland at the portion closest to the bladder outlet. It is at this point where the ejaculatory ducts enter the urethra for the packaging of sperm prior to ejaculation. The prostate gland is composed of four parts. The peripheral zone, the central zone, a transitional zone which is near the opening for the ejaculatory ducts and the periurethral zone or that portion which lies adjacent to the urethra.

The prostate secretes a thin, milky white fluid both prior to and following ejaculation. This fluid is high in citric acid, calcium, acid phosphatase and zinc and acts to sterilize the urethra as well as provide nutrients for the spermatozoa. The ejaculate also contains fructose which acts as a nutrient for sperm, prostaglandin's, phosphorylcholine, fibrinogen and coagulating substances.
Enlargement of the prostate gland is caused by an abnormal over-growth or swelling of tissue, termed hyperplasia. When this occurs a blocking of the urethra or opening from the bladder takes place. This will happen regardless of whether the growth is associated with benign prostatic hypertrophy (BPH), prostatitis or cancer. Additionally, because of the close proximity of the bladder sphincter to the prostate, symptoms of frequency and urgency to urinate will occur due to prostatic irritation. Because nodular hyperplasia associated with BPH or prostatitis takes place primarily in the region surrounding the urethra, urinary obstruction can occur with little overall glandular enlargement. On the other hand, if the urethral obstruction occurs due to enlargement of the peripheral regions, a significant amount of abnormal tissue must be present in order for the symptoms of urinary obstruction to occur. Most prostate cancers arise in the peripheral zone away from the urethra and therefore symptoms of urinary obstruction develop later on. If the symptoms of obstruction are due to cancer of the prostate (CAP) it generally means that there is a significant amount present. Symptoms most often encountered will be a painless hematuria or irregular urination (dysuria) due to obstruction. Pyuria, or white blood cells in the urine, may also be present if there is an infection.

Cancer of the prostate is responsible for upwards of 30,000 deaths every year in the United States. It is the most commonly found cancer in males over 50 years of age and is the most common cancer afflicting men, accounting for 21% of all cancers diagnosed. The incidence of cancer of the prostate increases until greater than 50 % of men over age 70 years will have some histologic evidence of prostate cancer. Only about a third of these cancers become clinically manifest in this age group. In 1983 there were 73,000 new cases of CAP and 23,300 deaths reported from this disease. The number of new cases jumped to 106,000 in 1991 with a reported 30,000 deaths for this period. While the total number of CAP cases increased by 33,000, the percentage of those dying from CAP decreased from 31.9% in 1983 to 28.3% by 1991. The continued decrease in the percentage of deaths due to CAP probably reflects the results of careful screening and early intervention.
Prostate cancer is extremely rare in Orientals and very prevalent in blacks, especially those who live in the United States. A correlation with environment has been noted in that men from cultures with low incidences of CAP show higher incidences of prostate cancer if they move to the United States.
Approximately 20% of all prostate enlargements are the result of cancer. About 80% of these cancers are of the slow growing variety, do not metastasize readily and often cause little if any problem. A smaller percentage of these cancers may spread quickly depending upon the type and location of the lesion. Prostatic cancer arises primarily in the peripheral zone, that area which is most affected by the male hormone testosterone. In conventional medicine it is felt that most prostate cancers will metastasize given enough time and no treatment, with dissemination occurring through the lymphatics and bloodstream. The primary area of metastases is to the bones, especially those of the lumbar vertebrae and lymph nodes of the pelvis. Spread to the abdominal viscera is rare.

Pre-cancerous lesions
A study reported to the American Urological Association showed the incidence of pre cancerous prostate gland lesions range from 22% to 41% in males between the ages of 30 and 49 years with the percentages increasing with age. Another study conducted in England supports these findings. These statistics suggest that pre-cancerous lesions of the prostate are more prevalent than previously thought.

Until recently it has been assumed that pre-cancerous lesions would become clinically significant with time, leading to the development of CAP and higher morbidity and mortality. There is still some uncertainty however, as to the natural history of the development of cancer of the prostate from the atypical hyperplasia commonly found in a significant percentage of men. Some of the difficulties in establishing the diagnosis of prostatic cancer are encountered with lesions such as prostatic intraepithelial neoplasia (PIN) and small acinar lesions or atypical adenomatous hyperplasia (AAH). While these particular lesions are more often found with CAP, finding them does not always mean that CAP will develop. Atrophy associated with an aging prostate gland is commonly encountered and often mistaken for CAP. This is especially true following needle biopsy used to establish the diagnosis, as this form of sampling may not provide enough material for full evaluation. Variants of prostatic hyperplasia such as acinar hyperplasia, basal cell hyperplasia, and cribiform hyperplasia occur frequently, and may be misinterpreted as CAP. Additionally, nonspecific granulomatous prostatitis, the most common form of prostatitis, can mimic CAP in a large percentage of cases.

In part due to these findings some discussion as to the significance of pre-malignant lesions has ensued. Elevated serum Prostatic Specific Antigen (PSA) levels have been associated with prostatic intraepithelial neoplasia (PIN) as well as prostatitis and BPH. As the natural history of PIN has not been fully determined, it is not known if this lesion is a precursor to CAP or if it will regress with proper treatment. PIN satisfies several criteria for classification as a pre malignant lesion and is more often than not seen along with or just prior to development of carcinoma of the prostate. These lesions are also found to be more prevalent in the peripheral zone, the area where CAP usually arises.

Another view can be taken that the prostate gland is a dynamically functioning organ which is responsive to the environment in which it exists. An example would be its response to infection during which there is an intense tissue inflammatory reaction resulting in hyperplasia and destruction as well as a proliferation of white blood cells, often appearing similar to CAP. Upon resolution of the infection a normalization of tissue and function usually occurs. Secondly, while it has been supposed that pre-malignant lesions would turn cancerous, the larger number of these lesions found in younger age groups suggests that this is either a normal variation or part of the dynamic of tissue growth and proliferation and cellular death. In other words, the prostate gland goes through changes similar to any other organ system and has the ability to repair and normalize function.
Pre-cancerous lesions may therefore present a problem diagnostically. They may predispose the patient to the development of CAP, but also may represent a stage in the natural history of the gland, and with proper treatment, revert to a more normal tissue. Second opinions therefore are recommended for someone presented with a diagnosis of CAP or a pre-cancerous finding on biopsy.

While the number of cases of prostate cancer has risen dramatically over the past 10 years the percentage of deaths compared to new cases has dropped. In part, the increase in the number of new cases is explained by the advent of newer diagnostic techniques such as serum Prostatic Specific Antigen, transrectal ultrasound and needle biopsy. Additionally, an increased physician and public awareness has also lead to earlier screening and detection of cancerous lesions which would otherwise have gone undetected until later in the course of the disease.

CAP Staging
There are generally 4 stages of classification of prostate cancer, each with sub grading. These are used to differentiate the lesion further and to aid in determining the prognosis and potential for metastasis. A further system of grading tumors frequently used is the Gleason system. A Gleason score of 2 to 10 is employed in order to aid in predicting the tumors metastatic potential. The higher the score, the greater liklihood of metastasis.
Stage A tumors are confined to the prostate gland. These are often not palpable on rectal exam and are usually an incidental finding on biopsy or surgery for BPH. They can be further classified into lesions which are localized or diffuse throughout the gland. Tumors of at least stage A2 must be present in order for the serum PSA to be elevated.
Stage B tumors are also confined to the prostate gland but are palpable on rectal exam. Often these lesions are visible with ultrasound examination. Tumors which lie near the apex or base of the gland have a greater likelihood of metastases. This is due to their close proximity to the prostate capsule and the weakness in these regions.
Stage C tumors have left the confines of the prostate gland and have invaded the soft tissues which surround it. Tumor spread involves the seminal vesicles, bladder neck, urethral muscle or surrounding fatty tissue in the absence of treatment. Spread to these regions is often followed by a more distant metastases within 5 years.
Stage D tumors have invaded the pelvic lymph nodes which are abundant around the prostate gland, as well as the bones in the lumbosacral region. This means that distant metastases has occurred and eventually the cancer will show up in other areas of the body. This form of metastases is the most common.

Causes of CAP
As with other cancers, the precise cause of carcinoma of the prostate is unknown. A number of epidemiological factors have been noted which are thought to contribute to a higher incidence of prostatic cancer. The persons age, race, endocrine system, diet and environment all play a role in development of cancer of the prostate, but it is usually a combination of several or all of these which contribute to its development. The predisposing factors, as well as the course of the disease, will vary from person to person.

Age
The risk of prostate cancer increases steadily after age 40 until a peak incidence is reached about age 80. Pre-malignant changes seen in younger men often do not become apparent until much later in life, thus contributing to the increasing incidence seen with aging. As there are a number of factors involved with the development of CAP, aging alone does not necessarily mean that one will develop the disease.

Hormones
Hormone levels certainly influence the course of cancer once it has become established, and is also thought to be involved in its origin. The higher incidences of cancer found as the male population ages is related to the changes in the levels of testosterone, dihydrotestosterone and estrogen that normally accompany aging. In eunuchs a very low incidence of prostate cancer is found, due to the almost total absence of testosterone.

While serum testosterone levels decline with age, they remain high within the prostate gland, suggesting an intracellularly controlled mechanism. Because of this a shift in the testosterone/dihydrotestosterone ratio occurs leading to an androgen imbalance. Under the action of the enzyme 5-alpha reductase, testosterone is converted to its more potent form dihydrotestosterone, which results in a higher rate of tissue proliferation. In patients with CAP, a reduction in androgen levels results in a decrease of tumor size which suggests a direct relationship between testosterone and tumor growth. However, a direct correlation between serum testosterone levels and tumor reduction is not always seen due to intracellular factors. Secondly, as testosterone levels decrease, the ratio of testosterone to estrogen increases which can contribute to the prostatic enlargement found with benign prostatic hypertrophy. Estrogen seems to have a more profound effect on the cells which line the prostatic urethra causing more growth. Estrogen also affects the prostate gland by suppressing the release of pituitary gonadotrophin releasing hormone (GRH), the hormone which stimulates the production of testosterone by the testicles and adrenal glands. Estrogens are used in treatment of prostatic cancer to lower testosterone levels with some success.

It has been suggested that hormonal factors may be affecting the prostate as early as puberty. Males who enter puberty later seem to have higher incidences of prostatic cancer. Further, prostatic cancer patients generally report greater levels of sexual activity than counterparts who do not have cancer.

Genetics
Genetic factors seem to play a role as there are higher incidences of CAP in some families than others, especially if there is a father or brother with the disease. An early onset of the disease, in males less than 55 years old, suggests that a familial predisposition is more likely. Black American males show a 50% higher incidence than whites. As of yet, a specific gene for predisposition to CAP has not been identified.

Diet
Populations with diets high in animal fats and refined sugar and lower in fiber and vegetable intake have much higher incidences of cancer of the prostate. High animal fat intakes, as well as with the development of obesity, has been shown to have one of the strongest associations with prostate cancer. Men from cultures traditionally with low incidences of CAP, who migrate to the United States, develop the cancer at rates comparable to those of their American counterparts. If however, they retain their native diets, the incidence does not increase as much. A number of epidemiological studies have shown, with all other contributing factors being equal, that diets high in fiber, fruits and vegetables result in a lower incidence of prostate as well as other cancers.

Environment
Environmental factors play a variety of roles in the development of CAP. Often it is several factors which contribute over a period of time, but some seem to play a greater role than others. It has been noted that there are higher rates of prostatic cancer in males who are exposed to chemical toxins. Occupations in industries such as petrochemical, rubber and textile are among the highest in number of CAP cases. Urban, as opposed to rural areas, have higher incidences of CAP which is felt to be due to air and other pollutants.

Cadmium has also been implicated in cancer of the prostate as a much higher incidence is found in men who work with batteries. Zinc is normally found in high concentrations in the prostate gland and will be displaced by cadmium.

Viruses
While viruses are implicated in other types of cancers, a direct relationship with prostatic carcinoma has not been found. Viral particles have been found, however, in electron microscopic examination of cancerous prostatic tissue. A relationship between previous gonorrhea and Chlamydial infections and higher incidence of cancer have also been suggested. Usually these infections are frequent in occurrence, cause persistent symptomology or have been poorly treated resulting in chronic prostate problems.

Vasectomy
Several studies have suggested that men who have undergone vasectomy have increased risks of developing prostate as well as testicular cancer. The production of allosperm antibodies, which are formed following the procedure, has been proposed as a mechanism for lowered immune response and the body's subsequent inability to destroy cancerous cells.
Other studies have not shown the same correlation and the matter remains unresolved.

Monitoring the Patient With CAP
The laboratory evaluation of CAP relies primarily on 2 tests, the Prostatic Specific Antigen [PSA} and the Prostatic Acid Phosphatase [PAP]. Ultrasound examination provides some information as to the location of the tumor and is sometimes helpful to evaluate its size following therapy. Neuroendocrine parameters found to be associated with other cancers are also being looked at in relation to CAP. Plasma chromogranin A, neurone-specific enolase, substance P, calcitonin, somatostatin, neurotensin and bombesin levels are being studied to determine if their levels may aid in early detection, evaluation and staging of CAP. To date they have shown little promise.
A review of cases where digital rectal exam and ultrasound screening were done concluded that they alone have not produced any significant decrease in CAP deaths in men over 70 years of age. Therefore a combination of different tests is used by physicians in order to evaluate the disease.
Prostatic specific antigen (PSA) is a glycoprotein which is particular to prostatic epithelial cells. Increases are found with prostate cancer, benign prostatic hypertrophy (BPH), prostatitis and prostatic interepithelial neoplasia. With BPH and prostatitis, levels will vary from one blood draw to the next, depending on the degree of involvement or level of inflammation. Additionally, age related changes in PSA values have been noted suggesting that different reference ranges be adopted depending upon the persons age.

A correlation between prostate tumor size (volume) and increase in serum PSA levels have been demonstrated in a number of studies. Tumor size greater than stage A1 in CAP is necessary to elevate PSA in most cases. In general, patients with increased PSA levels, without evidence of an enlarged prostate gland, should be suspected to have at least a grade A2 CAP. Prostatic specific antigen levels drop after prostatectomy or successful treatment of the cancer, prostatic hypertrophy or inflammation.

Prostatic specific antigen levels are not specific for CAP but are much more sensitive for prostate enlargement than acid phosphatase. Serum levels greater than 15 suggest a large tumor while those greater than 50 suggest an advanced cancer or metastases. Because of this the PSA has become a good screening test, along with digital rectal examination, for prostate gland abnormalities, as well as for following the course of therapy.

Acid phosphatase is found primarily in the prostate gland, as well in smaller amounts in other tissues. Prostatic acid phosphatase (PAP) is produced by the epithelial cells and secreted into the glandular lumen. High amounts of PAP are found in seminal fluid.

A major limitation in the evaluation of prostate cancer is the ability to quantitate the extent and progression of the disease. Prostatic acid phosphatase, while more specific than prostatic specific antigen (PSA) for cancer of the prostate, isn't as sensitive and is only increased if the tumor is a stage C or greater with metastases. Therefore, PAP is not utilized as often by clinicians and not recommended as a screening test.

The value of PAP lies in its ability to help determine tumor staging, monitoring of therapy and prognosis. While the majority of CAP are slow growing, those that aren't tend to metastasize quickly, especially once outside the prostate capsule. In general, a persistent decrease by 50% from the mean PAP value is suggestive of a favorable response to treatment. A return to the reference range of the PAP also indicates a favorable response to treatment and a better prognosis. Patients who had a normalization of PAP after therapy had a significantly longer survival rate than those who did not.

Ultrasound examination is most often done to determine the location of the prostatic mass in order to obtain a more accurate biopsy. Occasionally it is useful in assessing treatment. It does not differentiate the type of tumor which is something only a biopsy can do.

Generally, I obtain a baseline PSA, Acid Phosphatase and serum testosterone level at the first visit in order to establish a base line. I may also obtain an Anti Malignin Antibody [AMA] if the patient has not had a biopsy of the prostate to obtain the diagnosis. The AMA helps to determine if the tumor is malignant and the patients level of immune response. The AMA can be monitored throughout the therapy to assess its efficacy. The PSA should be repeated at frequent intervals initially [every 2 to 3 months], then less so as the cancer is controlled. An initial increase in the PSA is not unusual before it starts to stabilize and decrease. The patient should be warned about this as an increasing PSA can cause much anxiety.

Treatments


Watchful Waiting
Depending upon which physician you consult, a variety of opinions and philosophies as to whether or not to treat the cancer aggressively will be found. Some physicians express the view that watchful waiting is the wrong approach in men younger than 65 because of the potential to metastases, while others do not share this view based on statistical evidence and a lack of knowledge of the natural progression of CAP. Some physicians however, citing the decrease in mortality from CAP, and studies which suggest that no treatment is as effective as surgery, take the view that frequent screening is not needed and may in fact lead to needless diagnostic procedures and patient anxiety.
In older men it is felt that since a large percentage of them do not manifest symptoms of the disease, and the treatment causes higher morbidity and mortality, that CAP should be left untreated because they are more likely to die of other diseases long before the cancer manifests. In a number of studies there have been no significant differences in survival rates between patients treated with orchiectomy or estrogen therapy alone, or in combination with one another as compared to no treatment at all. In one study, 223 patients diagnosed with early stage CAP were followed for 10 years and examined by PSA and bone scan every 6 months for the first 2 years and yearly afterward. The patients were treated only if they developed symptoms of CAP or if evidence of aggressive tumor growth. After 10 years only 19 of the 223 patients (8.5%) died from CAP with 105 dying of other causes (47%). Those with localized tumors had a much better prognosis than those with poorly differentiated tumors or with metastases. The survival rate was 86.8% with no treatment compared to 65% to 83% for those who underwent irradiation or prostatectomy. This suggests that treatment may even have a negative effect on survival.

In several other studies done on men with well and moderately differentiated prostate cancers a mean survival time of 10 years was found in 85% to 90% . These statistics are common and are derived from populations which are receiving no therapy whatsoever, not even natural therapies.
A watchful waiting program, monitored by your physician, offers the opportunity to persue a natural medication program before having to resort to surgical or radiation therapy. If this is coupled with the use of diet and nutritional changes, the chances of having to undergo surgery diminish.

Herbal medicines:
Herbal medicines have long been a main stay in the treatment of cancer in general and in particular for prostate cancer. As a general rule, herbal medicines are not specific for the different types of tumors encountered but rather act as an overall immune system stimulant. (In contrast, chemotherapy, the "big gun" of conventional medicine has shown dismal results.) Certain herbal medications tend to have an affinity for particular tumor types and can also be selected based upon their specific indications.

Herbal medications perform a variety of functions when attacking cancerous tissue. They act to stimulate production and activation of both T & B cell systems of the lymphocytic variety of white blood cells. Additionally, the different components contained in herbal preparations will adhere to the tumor cell surface making it easier for the lymphocytes to attach and destroy the cell. Certain components of herbal medicines will enter the tumor cell and disrupt its function making it more vulnerable to destruction by the immune system. Many chemotherapeutic agents such as vincristine and taxol are derivatives of botanical medicines. Lastly, botanical medicines have built in check and balance systems which make it less likely for them to become toxic and thus harmful to healthy tissues.

Specifically for cancer of the prostate, the components of the herb Serenoa serulatta/repens [Saw Palmetto] and Pygeum africanus are the mainstay of any herbal medicine program for cancer. Serenoa blocks the conversion of testosterone to its more potent form dihydrotestosterone by inhibiting the enzymes 5-alpha reductase and 3-ketosteroid reductase. This results in decreased swelling and thus increased blood flow to the prostate.

Additionally, Serenoa extract has been shown to reduce cholesterol levels within the prostate gland. This is of significance since higher levels of cholesterol are found in cancerous prostate glands than non-cancerous ones.

Serenoa (Saw Palmetto) has also been found to have antiestrogenic effects upon the prostate gland. Serenoa was found to lower the number of cytosol and nuclear receptors for both estrogen and progesterone. While there was no effect on the number of cytosol androgen receptor sites, following the use of Serenoa, a lower number were found on the nuclear membrane. Therefore it is concluded that Serenoa blocks estrogen and progesterone as well as competitively blocking androgen binding to the nuclear envelope.

Lithospermum, or stone seed, has been found to block gonadotrophic hormone and its effect on the anterior pituitary. It decreases follicle stimulating hormone [FSH] which is needed to increase estrogen and testosterone levels. Because these hormones are involved with tumor proliferation and prostatic enlargement, a reduction in PSA values are seen following administration of Lithospermum. Another commonly found herb, Fenugreek, also decreases FSH and estrogen levels. Vitex Agnus Castus, an herbal medication often used for women during menopause, decreases FSH and estrogen levels as well.

Urtica dioca has been used in the treatment of BPH with some success, especially in the early stages. It has now been shown that its' action on the prostate gland is by lectin binding, suggesting that Urtica may also be effective against prostate cancer, especially those confined to the periurethral and transitional zones.

Less specifically but equally important are the use of medicines such as Phytolacca decandra [Polk weed], Vinca rosa [Periwinkle], Viscum album [Mistle toe], Colchicum autumnale, Conium maculatum, Berberis aquifolium [Oregon Grape], Echinacea angustifolia, Digitalis purpuria and Arctium lappa [Burdock]. These, along with others, have been found to effectively treat cancer of the prostate and when used along with a holistically oriented program, have equal or improved survival rates over conventional therapy.

I will often use the Hoxsey formula as a base prescription to be taken 2 to 4 times daily in addition to the other botanical medicines I prescribe. Besides being an overall immune stimulator, it enhances lymph flow and helps with an overall detoxification of the body. Additionally, I put the person on an herbal anticoagulant formula if they are not taking modified citrus pectin as there is less likelihood of metastases in patients on anticoagulant therapy. If I am doing electrotherapy, I will use an additional formula containing Red Clover along with some Digitalis.

Nutritional:
Along with any treatment program for cancer, including conventional medical therapies, the nutritional aspects are important to address. This is especially true if the person is undergoing therapy which acts to destroy the tumor by exogenous means such as chemotherapy or radiation.
An overall balanced diet which is high in protein and vegetables, lower in calories and very low in fat (less than 25 grams per day) and cholesterol is needed to maintain a healthy internal environment. Additionally, we have found that a specific diet based upon the persons Serotype, can enhance the immune response to the tumor. A Serotype diet, as per D'Adamo, can also be used by the physician to recommend specific foods which have a propensity to attacking certain cancer cells.
Garlic (Allium sativum), in its natural clove form, helps supply the body with vitamins and minerals but most importantly helps to prevent infection as well as enhance t-cell binding to cancerous cells. Allium sativum also disrupts the metabolism of the cancerous cell by disrupting its ability to produce lactic acid. Garlic in capsule form is often found clinically to be less potent than fresh garlic, requiring ten times the amount to achieve the same effect. Some studies suggest that some, but not all, immune enhancing activities of garlic may be preserved by the deodorizing process.
Fish oils, olive oil and high amounts of Evening Primrose oil (EPO) or Eicosapentanoic acid (EPA) act to reduce thrombus formation thus lowering the potential for tumor and thrombus spread. Decreased thrombus formation has been linked with better survival rates in cancer patients due to the inability of the cancer to spread by this route. This may be the reason that shark cartilage/oil therapy has been shown to prevent tumor metastasis. Research suggests that shark cartilage/oil prevents thrombus formation, thus making it difficult for the tumor to spread. This also has the effect of isolating the tumor, making it easier for the immune system to destroy it.

More recently, modified citrus pectin (MCP), but not citrus pectin (CP), has been shown to combine with a variety of galactose-specific proteins on cancer cell surfaces. MCP inhibits metastases in rat CAP by adhering to the cancer cell surface thus making it unavailable for aggregation and adhesion needed for metastases. The studies show that MCP does not inhibit the cancer growth but makes it difficult to spread. MCP has been shown to affect not only the metastases of human prostate adenocarcinoma, but human breast cancer, malignant melanoma, and laryngeal epidermoid carcinoma as well.

Antioxidants such as Vitamin C, E, and beta carotene should be taken in large doses as they eliminate free radical formation and enhance cellular oxidation. Intravenous administration of them may be needed initially, especially if the person has undergone chemotherapy or radiation. It has been my experience that the person who has opted for radiation or chemotherapy does not suffer their effects as severely if they are receiving antioxidant therapy.

Other Naturopathic Therapies
Certainly with any treatment of cancer the overall needs of the individual must be addressed. These include physical, mental/emotional and even spiritual needs. Simply treating the disease without addressing the whole person makes any therapy less effective.

Patients with cancer are often found to possess what is termed a "cancer personality". They are often encumbered with excesses of guilt, worry, frustrations and suppressed anger. It is not unusual to find a person with cancer who is trapped in a living situation which is unbearable for them, or to find they have never learned to "loosen up" and relax or is a "type A" or high achiever personality. There are a variety of factors which contribute and must be addressed through self help groups, counseling or psychotherapy. Statistically, those patients with the best outlooks concerning their cancers have the longest survival rates, regardless of the therapy that they are undergoing.
Hydrotherapy, or the use of hot and cold water, is also useful in the treatment of cancer of the prostate. Specifically, many naturopathic physicians use the constitutional hydrotherapy technique developed by Henry Lindlahr M.D. and refined by O.G. Carrol N.D. and others. Constitutional hydrotherapy uses a combination of hot and cold applications coupled with a mild electrical current to induce a healing reaction by the patients' immune system. Hydrotherapy has been shown to increase the circulating white blood cell count for up to 36 hours following treatment. Further, it improves oxygenation to the affected tissues, higher oxygen levels making it difficult for cancer cells to survive. In addition, the increase in body temperature accelerates immune system function.
Homeopathic medicine is an integral part of any treatment plan for CAP as it helps the body adjust to the ravages of the disease and stimulates the immune system. My own personal preference is for using homeopathic medicines, but acupuncture also provides the energetic boost needed for balancing of the body and stimulation of the immune system.

An immune therapy which shows promise utilizes BCG (bacillus Calmette-Gue_rin) or Staphysage lysate. Injected intradermally, these vaccines act to stimulate lymphocyte production and thus enhancing the immune response. Along with this therapy I will also give the patient thymus extract and Eleuthrococcus senticosus to help boost production.

Electrical current in the form of positive galvanism, applied transrectally, has been used in the treatment of CAP as well as BPH. A steady current of 1 to 5 milliamps for 10 to 15 minutes creates an acidic environment within the prostate gland, oxygenating the tissues and increasing the white blood cell count. This treatment must be coupled with anticoagulant and antioxidant therapy. During and following a series of treatments, protomorphogen therapy helps the growth of healthy prostate tissue.

With natural treatment for CAP it is important to remember that the therapy will have its ups and downs. Because tumor response to treatment is usually measured by the PSA, it is important to remember that this test reflects changes in tissue inflammation as well as in new and cancerous tissue growth. Therefore, a slight rise initially in the PSA may not necessarily be a bad sign but a reflection of the healing process. Also, during the course of treatment a leaveling out of, or slight rise in the PSA, may be seen. In my experience, a slight rise in the PSA soon after initiation of natural therapies is usually followed by a decrease. Continued elevations should alert the clinician to make medication changes in order to reverse the trend.

Treatment of cancer of the prostate is one of the diseases in which naturopathic medicine can have a high rate of success. What is required is commitment on the part of the patient and physician to follow through with the therapeutic program. The physician must be aware of the aspects of the pathophysiology of the disease as well as the psychological aspects of the patient. A diagnosis of cancer has a tremendous psychological impact and the physician must be sensitive to the patient's needs while maintaining objectivity. Educating the patient as well as informing them at every junction of the therapeutic process will help allay fears and make for better patient compliance. Additionally, the patient must be helped to understand that they must make a total commitment to their health and well being in order for the treatment to ultimately be successful. There are no "quick fixes" but the rewards are great.



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