Prostate Cancer

[Guest guest]

Hi All, & Hi Sammy,

 

Sammy, Many thanks for the fine summary of BPH throught to PC.

 

Could I have your permission to cross-post to the Chinese Herb

Academy List? CHA has >800 herbalists on board.

 

IMO, a discussion of current attempts to treat BPH and PC with

herbal medicine and/or acupuncture would be very useful.

 

Best regards,

Phil

 

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<ga.bates

Date sent: Tue, 30 Sep 2003 23:38:28 +0100

 

Ken and All, The prostate is a primary male sexual characteristic

having its embryological origins as described previously by

Emmanuel " It is the male organ which is homologous with

(embryologically from the same tissue as) the female uterus " .

 

During growth the male prostate differentiates itself from the female

uterus by morphological changes which position it at the base of

the bladder and through which the urethra passes. Manual

examination or digital rectal examination (DRE): When fully

developed the prostate is a small walnut shaped muscular gland

which may be digitally palpated via the colonic mucosa. A normal

prostate should feel solid, smooth and round without asymmetry.

Observing standard clinical practice (surgical glove and anti-friction

gel), a normal palpation of the prostate with the fingertip should not

be painful.

 

After maturation the prostate consists of both muscle and glandular

tissue (similar to the breast) and provides a thick milky fluid

(semen) to help express sperm cells into the vagina. The prostate

sits upon the urethra and it is from the prostate and seminal

vesicles that prostatic fluid is pumped during orgasm.

 

Because of variations in sexual activity during the life time of the

male the prostate is capable of undergoing changes in size to

maximise reproductive capacity at crucial times and minimise

energy loss and wasteful sexual activity during less critical periods

(e.g. during times of seasonal hardship). These changes in

prostate size do not normally affect urinary function. Hormone

receptors in prostatic tissue respond to growth triggers during

puberty and thereafter. Secondary sexual growth inhibition factors

impose limits on the size of the prostate despite high levels of

androgen in the young sexually active male.

 

From the thirties onward in many men the prostate undergoes

changes that reflect ageing. Various processes including capillary

atherosclerosis, urinary reflux and virus infection contribute to a

benign prostatic hyperplasy (BPH - or prostatic enlargement) that

may impact on free passage of urine through the organ. Prostatic

interepithelial neoplasia (PIN) is believed to occur after BPH

induced cellular breakdown facilitates leakage of prostatic cell-

fragments into the rich growth supporting environment of prostatic

fluid stored in the organ and the seminal vesicles. A final stage to

prostatic carcinoma (PC) may be facilitated by changes in the

male sex-steroid hormone mileau which interfere with the normal

homeostatic processes controlling prostate size and cellular

response to growth triggers.

 

Despite occult PC being age-dependent with a consistent

distribution across cultures worldwide, there is a strong tendency

in western society for the disease to become manifest and often

fatal. Men of African descent living in the west have a higher

incidence of PC. This probably reflects socio-economic, cultural

and life-chance patterns, rather than a racial connection. Indeed,

there is no evidence that Africans, or any other rural group from the

Eskimo to the Bushman are more (or less) prone to PC regardless

of ethnic dietary preferences for meat or fat or carbohydrates in

the context of daily subsistence living. By contrast second and

third generation diaspora acquire the same (or worse) tendency to

PC in the context of a western diet and lifestyle. Many contributing

factors to carcinogenesis have been postulated from

xenoestrogenic pesticides and packaging plastics to the 'male

menopause' and the disruption of male hormones in the workplace.

 

 

Symptoms of BPH may often go unnoticed until an incident

(perhaps through stress or infection) precipitates subjective

awareness of dysuria: for example nocturia, latency; or inability to

'pee' with a full sensation, dribbling and pain in the urethra. PC

itself may be associated with pain on ejaculation and blood in the

urine. However, many cases of fully blown metastatic PC occur

without prior warning. PC metastasises to the bone generally in the

lower back and to the lymph nodes. Some western texts now

associate PC with low back pain and weakness in the legs - text

book Kidney Yin deficiency - a TCM influence that has not had its

full potential realised.

 

In the 1950's it was discovered that death due to metastatic PC

could be averted by five years or more by bilateral orchietomy.

Since then the procedure has become commonplace, and in some

countries mandatory NHS treatment for advanced PC. Albeit

castration removes the hormonal impulse of prostatic tissue to

grow this is only a temporary palliation since the condition returns

in an androgen independent form (AIPC).

 

Because of its unpleasantness alternatives treatments to

castration have always been sought. Modern gene manipulation

techniques hold some hope in the distant future, but the mainstays

are still surgery and radiation which may remove local disease.

Once the PC is said to have 'breached the prostatic capsule' and

become systemic, local therapy is useless and hence the

continued need for castration to palliate the condition. Sadly, many

men with PC end their days being castrated either physically or

chemically.

 

Chemical castration agents block the production of testosterone

(e.g. estrogens which lead to feminisation) or anti-androgens (AA)

which block sex-steroid cell receptors. A class of drug known as

luteinising hormone releasing hormone agonist analogs (LHRH-a) is

used to inhibit testosterone production by a 'crowbar effect' on the

hypothalamus-pituitary. All forms of androgen suppression lead to

serious side effects in men including bone demineralisation,

muscle loss, affective and cognitive disorders including Alzheimer's

disease.

 

Detection: The 'PSA' or prostate specific antigen is a protein

detected in blood which normally resides within the healthy

prostatic cell. Once PSA is detectable in significant amount in the

blood it is generally accepted that PC is present although small

amounts may indicate BPH [ range 0 - 4 ng/ml normal to 40 years

of age and then add 2 ng/ml per decade until 80 years.] A PSA >

20 ng/ml is generally regarded as indicative of PC at any age. The

'free PSA' is a measure of bound and unbound PSA proteins and is

held to be more reliable than the 20 ng/ml ceiling.

 

Staging: PC itself may be described by the TNM staging method

as well as what is known as Gleason Score (GS) which is

histologically determined based on cellular architecture - the higher

the Gleason Number [ range 0 - 5 ] the less differentiated the cell.

A Score is obtained by determining the two most frequent cellular

architectures and adding. Gleason Scores between 0 - 10 are then

possible. A GS is believed to predict fairly accurately patient

survival: a GS 10 being the least prognostically hopeful.

Prognostic distinctions for a particular GS are commutative: so for

example a GS [ 3 + 4] = 7 is different from a GS [ 4 + 3] also = 7

[ In this case the 3+4 is prognostically better than the 4+3].

 

Most western cancer agencies are now recommending that all men

over the age of 50 undergo a DRE and PSA test. Individuals with a

family history or members of certain racial populations (Africans)

are advised to start testing at age 40. PC can be treated

successfully if detected early and given appropriate timely

treatment. Some men however prefer not to know what their PSA is

due to a possible false positive indication, and in order to avoid

potentially destructive side effects of treatment. This position is

also taken by some governments as a cheap alternative to national

screening programmes that will appeal to the ignorant and

uninformed. Failure to treat PC may lead to premature death. In the

UK 1000 men under the age of retirement die of PC every year. In

the USA the figure is about 5000. About 50,000 men in all die of

prostate cancer every year in the USA, 10,000 in the UK.

 

I hope this has helped TCM students appreciate the importance of

this disease in the west. There are many informational pages on

prostate cancer available on the internet. They all have an agenda

of one sort or another from the persuasive pieces written by the

doctor trying to recruit another patient for his clinic to the

pharmaceutical company eager to demonstrate how effective their

brand of treatment can be. This piece has been written with the

inside knowledge of one who has survived the condition for seven

years as a non-castrate.

 

I am trying to translate my survival perience into something that will

make sense on both sides of the east-west conventional-traditional

divide.

 

Unfortunately modern medicine knows as much about natural

hormone control as traditional medicine knows about sex-steroid

synthesis. Just as modern physics needed a Heisenberg to

crystallise the uncertainties of quantum mechanics, so we need a

master alchemist who will fuse ancient and modern into a brand

new paradigm.

 

A successful treatment that did not impact on male quality of life

would certainly put TCM on the map and it is something I advise

any ambitious student to put his or her mind to. It is getting late

now and I have spent most of the evening putting this together. At

some time in the future I'll take a look at the existing TCM

treatments for PC. In the meantime you might like to take a look

yourself at PC-SPES a very famous TCM/WM recipe that really

clobbered PSA and then got clobbered itself by the FDA for its

pains; or, Equiguard the big promise that never seemed to

materialise. Or perhaps some of the more recent treatments

Vervain for instance (is it just another estrogen analogue ?) or

Sarcandra - does it really reduce prostatic inflammation ? What

about DIM the Great White Hope ? [ No I am not being an inverted

racialist, DIM is made from extract of white cabbage ;-] Cheers,

Sammy.

 

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Best regards,

 

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