Why We Suggest Certain Drugs
When it comes to combatting cancer, Life Extension long ago learned that the initial treatment regimen should be aggressive enough to deprive tumor cells of an opportunity to mutate into forms that are resistant to future therapies. If we know of a relatively side effect-free drug that works via a single or multiple mechanisms to impede tumor survival, were going to include it in our comprehensive surveillance program.
Lets talk first about metformin. It was used in England in 1958 but did not make it into the United States until 199537 years later ! I am familiar with metformin because the FDA tried to have me incarcerated for recommending it as an anti-aging drug long before it was approved to treat type II diabetes.
Whats been happening over the last ten years is an explosion of published studies that consistently show that metformin reduces the risks of certain tumors and may be an effective cancer treatment .
People ask me all the time, how can an anti-diabetic drug work so well against cancer? The encouraging news is that metformin functions via multiple mechanisms to create a less favorable environment for tumor progression . We know that insulin increase the risk of many tumors . This is of particular concern to obese men with prostate tumors. Metformin lowers blood glucose and insulin levels. The sidebar titled Anti-Cancer Actions of Metformin reveals the multiple anti-cancer mechanism of metformin.
Anti-Cancer Actions of Metformin
Evidence For Benefit And Safety Of Finasteride Continues To Grow
Two papers, published in 2018 and 2019, further support the health benefits and safety profile of the 5-alpha reductase inhibitor finasteride.
The first study, which reported on 16 years of follow-up of the PCPT participants, confirmed the study findings: during the 7.5 years after the beginning of the trial, those assigned to the finasteride group had a 29% lower risk of a prostate cancer diagnosis compared with those in the placebo group. And even after the trial endedmeaning the study subjects were no longer taking daily finasteridethere was no significant increase in prostate cancer risk. Over the entire follow-up period, a median of 16 years, those in the finasteride group had a 21% decreased risk of prostate cancer compared with those in the placebo group .
The second paper, which further analyzed the follow-up results from the PCPT, observed that after a median of 18.4 years, men who received finasteride had a 25% lower risk of dying from prostate cancer. Importantly, there was no increased risk for high-grade prostate cancer in the finasteride group .
Overall, the evidence points to a benefit of finasteride in preventing prostate cancer without increasing risk of high-grade disease.
Prostate Biopsies: Size Matters
- Elevated levels of dihydrotestosterone are involved in prostate cancer and contribute to benign prostate enlargement.
- In separate studies evaluating the prostate cancer protective benefit of Proscar® and Avodart®, medications to reduce DHT levels, there was a 22-25% reduction in the risk of prostate cancer, but with an apparent increase in the risk of high-grade disease .
- Avodart® or Proscar® have been shown to reduce prostate gland volume by 17-25% over a relatively brief period of time.
- A review of several published reports attribute the higher Gleason scores observed in the groups taking Avodart® or Proscar® to the fact that it was easier to find high-grade cancers in the shrunken glands of men taking these drugs compared to the much larger glands of men in the placebo group.
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Diagnosis Of Prostate Cancer
Check out this factsheet for a summary of the video.
Diagnosis is the process of finding out the cause of a health problem. Diagnosing prostate cancer usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and do a physical exam. Based on this information, your doctor may refer you to a specialist called a urologist or order tests to check for prostate cancer or other health problems. A urologist is a doctor who specializes in treating conditions of the genital and urinary tracts, including the prostate.
The process of diagnosis may seem long and frustrating. It’s normal to worry, but try to remember that other health conditions can cause similar symptoms as prostate cancer. It’s important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of prostate cancer.
The following tests are usually used to rule out or diagnose prostate cancer. Many of the same tests used to diagnose cancer are used to find out the stage . Your doctor may also order other tests to check your general health and to help plan your treatment.
What If I Am Diagnosed With Prostate Cancer
Many people have been where you are standing. Dont lose hope. More than 2.9 million American men have been diagnosed with prostate cancer and are alive today.
The first thing you should consider doing is to find out about the specifics of your cancer. You should know your stage and grade .
From there you can find out what treatment options you want to pursue, if any. Talk to your doctors. Choose a healthcare team of different specialists, or consult a second opinion. You can also do your own research, or talk to men who have been in your position. Many of our advocates are patients and survivors hear their stories at the video library. Or head to the rest of our website to start some research.
Learn
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Sbus Appraisal Of The Evidence
Many men, on their own initiative, are tested for the concentration of prostate specific antigen in their blood. A high PSA concentration suggests an increased probability of cancer. Men at higher probability often receive further examination by prostate biopsy, an invasive procedure. Since prostate biopsy can lead to complications, unnecessary procedures should be avoided. A result of slightly to moderately raised PSA concentration is difficult to interpret, and uncertainty concerning the necessity of biopsy is common. To avoid unnecessary biopsies, clinicians need new, complementary tests to better determine which men with slightly to moderately raised PSA concentration actually require further investigation.
This report assesses the diagnostic accuracy of three new molecular urine tests when used to supplement previous PSA testing or rectal examination in investigating prostate cancer. The report does not focus on prostate cancer screening or the benefits of treating prostate cancer. Likewise, we have not assessed the potential importance of the new tests in determining the seriousness of the disease, its prognosis, or the choice of treatment.
Procedures Used To Screen For Prostate Cancer And Evaluate Possible Prostate Problems
In addition to regular physical examinations that include blood, urine, and possibly other laboratory tests, many groups, such as the American Cancer Society, suggest talking with your doctor to learn more about the pros and cons of screening for prostate cancer to help you decide if it is right for you. Other expert groups have different recommendations. For example, the U.S. Preventive Services Task Force recommends against routine prostate cancer screening, because the task force believes the benefit does not outweigh the harm. The tests used for screening include:
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DRE . For this test, a doctor places a gloved and lubricated finger into the rectum to examine the rectum and feel the prostate gland. DRE may be conducted annually for men over the age of 50 who choose to be screened. Men in high-risk groups, such as African-Americans, or those with a strong family history of prostate cancer should consult their doctor about being tested at a younger age.
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PSA . PSA is a blood test that measures the level of prostate specific antigen. PSA is a substance produced by the prostate gland, which may be found in higher amounts in men who have prostate cancer. The PSA test may be done annually for men over the age of 50 who choose to be screened. Men in high-risk groups, such as African-Americans, or those with a strong family history of prostate cancer, should consult their doctor about being tested at a younger age or more often.
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Psa Isoforms Psa Density And Velocity
To improve screening and management of PCa, several methods to optimize PSA or PSA derivatives have been used.
3.3.1. PSA aged adjusted
The tPSA value does not account for age-related PSA changes due to prostate volume changes related to the development of BPH. Oesterling et al. were the first to suggest considering age-related reference ranges in order to improve cancer detection rates in young men. They recommended thresholds of 2.5, 3.5, 4.5 and 6.5 ng/mL in men in their 40s, 50s, 60s and 70s, respectively, to improve specificity .
Loeb et al. examined the usefulness of baseline PSA testing in 13 943 men younger than 60 years from a large prospective PCa screening trial in the United States, in which biopsy was performed for a PSA > 2.5 ng/mL or suspicious findings on DRE.
Vickers et al. found that the tPSA value at age 60 years predicts not only a lifetime risk of clinically detected PCa, but also metastases and death from the disease.
Clearly in the discussion with patients about screening, taking into account the results of the Prostate Cancer Intervention versus Observation Trial PIVOT and prostate testing for cancer and treatment trial, the threshold for indicating biopsy should integrate age and life expectancy .
3.3.2. Free PSA
3.3.3. PSA density
PSAd is calculated as tPSA divided by total prostate volume or transitional prostate volume measured on TRUS to avoid unnecessary biopsies.
3.3.4. PSA velocity : PSA doubling time
Carcinoma Of The Prostate
Prostate cancer diagnosis takes one of the following three main routes :
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asymptomatic diagnosis following a screening test .
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urinary obstruction with reduced flow, hesitancy, postmicturition dribbling, or even retention, bleeding, and/or infection. No symptom is helpful in distinguishing prostate cancer from benign prostatic hypertrophy.
Fumihiko Urabe, … Takahiro Ochiya, in, 2020
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After Cancer Is Diagnosed
If the biopsy and other tests show that you have cancer, you may have more tests to help your doctor plan treatment. For instance, your doctor will need to figure out the stage of your cancer. For some cancers, knowing the grade of the tumor or risk group that you fall into are important for deciding on the best treatment. Your tumor may also be tested further for other tumor or genetic.
To learn more about other tests that may be used to plan treatment for your cancer, see the PDQ® cancer treatment summaries for adult and childhood cancers for your type of cancer.
Getting The Results Of The Biopsy
Your biopsy samples will be sent to a lab, where they will be looked at with a microscope to see if they contain cancer cells. Getting the results usually takes at least 1 to 3 days, but it can sometimes take longer. The results might be reported as:
- Positive for cancer: Cancer cells were seen in the biopsy samples.
- Negative for cancer: No cancer cells were seen in the biopsy samples.
- Suspicious: Something abnormal was seen, but it might not be cancer.
If the biopsy is negative
If the prostate biopsy results are negative , and the chance that you have prostate cancer isnt very high based on your PSA level and other tests, you might not need any more tests, other than repeat PSA tests sometime later.
But even if many samples are taken, biopsies can still sometimes miss a cancer if none of the biopsy needles pass through it. This is known as a false-negative result. If your doctor still strongly suspects you have prostate cancer , your doctor might suggest:
- Getting other lab tests to help get a better idea of whether or not you might have prostate cancer. Examples of such tests include the Prostate Health Index , 4Kscore test, PCA3 tests , and ConfirmMDx. These tests are discussed in Whats New in Prostate Cancer Research?
- Getting a repeat prostate biopsy. This might include getting additional samples of parts of the prostate not biopsied the first time, or using imaging tests such as MRI to look more closely for abnormal areas to target.
Prostate cancer grade
Gleason score
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Concern About Eggs And Milk
Large-scale studies associate egg consumption with sharply increased cancer risks .
A 2011 study looked at 27,607 men who developed or died from prostate cancer over a 14-year period . Men who consumed 2.5 or more eggs per week had an 81% increased risk of lethal prostate cancer compared to those who consumed less than half an egg per week . This study showed that consumption of eggs increased the risk of healthy men developing metastatic prostate cancer.
A 2013 evaluation was done using data from the famous Physicians Health Study to identify the impact of consumption of skim or whole milk on incidence and survival after diagnosis of prostate cancer . This analysis involved 21,660 physicians who were followed for 28 years. Skim/low fat milk was associated with increased risk of low grade prostate cancer, whereas whole milk was associated with increased risk of fatal prostate cancers. In these men diagnosed with prostate cancer, consumption of whole milk was associated with a 117% increased risk of progression to fatal disease . This finding further substantiates the important role of diet even after prostate cancer is diagnosed.
The take-home lesson so far is if one has an elevated or rising PSA, it is especially prudent to avoid over cooked red meats, processed meat, eggs, and whole cows milk.
How To Improve Trus Prostate Biopsy Technique
The gold standard to diagnose PCa with an elevated PSA is the 12 core extended sextant TRUS, the TRUS-guided prostate needle biopsy. However, as show in the figure below, the TRUS non-targeted technique carries a risk of sampling error , of missing an aggressive cancer and of overdiagnosing an indolent cancer . As most lesion are now small and sometime located in regions that are not identifiable by DRE and TRUS, different protocols or strategies to improve the detection of clinically significant cancer were evaluated and published.
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Use In Men Already Diagnosed With Prostate Cancer
The PSA test can also be useful if you have already been diagnosed with prostate cancer.
- In men just diagnosed with prostate cancer, the PSA level can be used together with physical exam results and tumor grade to help decide if other tests are needed.
- The PSA level is used to help determine the stage of your cancer. This can affect your treatment options, since some treatments are not likely to be helpful if the cancer has spread to other parts of the body.
- PSA tests are often an important part of determining how well treatment is working, as well as in watching for a possible recurrence of the cancer after treatment .
Disclaimer And Safety Information
This information is not intended to replace the attention or advice of a physician or other qualified health care professional. Anyone who wishes to embark on any dietary, drug, exercise, or other lifestyle change intended to prevent or treat a specific disease or condition should first consult with and seek clearance from a physician or other qualified health care professional. Pregnant women in particular should seek the advice of a physician before using any protocol listed on this website. The protocols described on this website are for adults only, unless otherwise specified. Product labels may contain important safety information and the most recent product information provided by the product manufacturers should be carefully reviewed prior to use to verify the dose, administration, and contraindications. National, state, and local laws may vary regarding the use and application of many of the therapies discussed. The reader assumes the risk of any injuries. The authors and publishers, their affiliates and assigns are not liable for any injury and/or damage to persons arising from this protocol and expressly disclaim responsibility for any adverse effects resulting from the use of the information contained herein.
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What Clinical Trials Are Open
Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:Steven A. Kaplan, M.D., Weill Cornell Medical College Michel A. Pontari, M.D., Temple University School of Medicine
Genetic Testing For Some Men With Prostate Cancer
Some doctors now recommend that some men with prostate cancer be tested to look for certain inherited gene changes. This includes men in whom a family cancer syndrome is suspected, as well as men with prostate cancer that has certain high-risk features or that has spread to other parts of the body. Talk to your doctor about the possible pros, cons, and limitations of such testing.
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How Cancer Is Diagnosed
X-rays use low doses of radiation to create pictures of the inside of your body.
If you have a symptom or a screening test result that suggests cancer, your doctor must find out whether it is due to cancer or some other cause. The doctor may start by asking about your personal and family medical history and do a physical exam. The doctor also may order lab tests, imaging tests , or other tests or procedures. You may also need a biopsy, which is often the only way to tell for sure if you have cancer.
This page covers tests that are often used to help diagnose cancer. Depending on the symptoms you have, you may have other tests, too. To learn more about how specific cancers are diagnosed, see the PDQ® cancer treatment summaries for adult and childhood cancers. These summaries include detailed information about and pictures of diagnostic tests and procedures for each specific type of cancer.
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