CaPLESS & Prostate Cancer

Will the Prostate Cancer 4Kscore Test Help You?

blood testWill the Prostate Cancer 4Kscore Test Help You?

The Takeaway First

The newest available blood test, 4Kscore® Test (OPKO Lab, Nashville, TN) is better at detecting potential deadly prostate cancer than a PSA test.

The Details

Since the prostate-specific antigen (PSA) test first became available in the early ‘90s, there have been significantly fewer deaths from prostate cancer. However, it also has led to overdiagnosis and overtreatment. As a result, about one million prostate biopsies are done yearly in the U.S. alone, and most of it has been from unnecessary overtreatment of indolent cancer in order to rule out the possibility of death.

Numerous studies from Europe and the U.S. indicate that the 4Kscore could be used to distinguish between the less deadly form of prostate cancer (pathologically indolent, as a doctor calls it) and the more dangerous form of the disease — all while reducing excess biopsies.

If that’s true, I’m a fan.

How does the 4Kscore test work? 

The 4Kscore test is a blood test and incorporates a panel of four — buckle your seatbelts — kallikrein protein biomarkers: total PSA, free PSA, intact PSA, and human kallikrein-related peptidase. It looks at these biomarkers as well as other clinical information and provides a percentage risk for high-grade (Gleason score 7 or higher) cancer on biopsy.

In 10 peer-reviewed studies, the four kallikrein biomarkers of the 4Kscore Test have been shown to improve the prediction not only of biopsy accuracy, but also surgical pathology and occurrence of aggressive, metastatic disease.

Instead of a PSA-style range value of normalcy, the 4Kscore result is a percentage with personalized positive predictive value of finding Gleason score ≥ 7 cancer on a subsequent biopsy. This is key because the PSA “normal range” value of 0 to 4.0 ng/ml is extremely inaccurate. I see many patients with a PSA higher than 4.0 without prostate cancer and undergoing excessive prostate biopsies.

How does the 4Kscore compare to the urine PCA3 test?

The PCA3 test looks at a urine sample produced immediately after a vigorous prostatic massage. PCA3 is a gene that expresses genetic material in urine. This material is found only in prostate tumor tissue, not normal prostate tissue.

The problem with the PCA3 test is that the results can be difficult to interpret, partly due to lack of an optimal cutoff for a positive test result. The other issue is that the PCA3 is that there’s not a lot of evidence that it actually helps to detect disease. So, while a reading higher than 35 on a PCA3 test may mean prostate cancer is present, a reading of 100 does not necessarily mean that the cancer is aggressive or deadly. In other words, a higher number does not necessarily mean bad cancer.

Remember: a man is only interested on knowing if he has bad cancer that may eventually kill him – not cancer that’s indolent and non-threatening.

Should I get a 4Kscore test?

No, if you:

  • have been diagnosed with prostate cancer
  • are taking 5-alpha reductase inhibitors like Finesteride (Proscar) or Dutesteride (Avodart)
  • have undergone a prostate procedure within 6 months, e.g., TURP for prostate enlargement

Yes, if you are an otherwise healthy, risk-averse man. The 4Kscore test allows you to gauge your risk and decide, based on reliable, personalized results, whether or not to pursue a biopsy. The level of individualized risk prediction afforded by the 4Kscore test is not only helpful to the patient but also to the urologist (me!), who shares in the patient’s decision making.

My take on the 4Kscore Test for Prostate Cancer

Thumbs up. (Where’s my emoji thumbs-up button?)

Anything that helps to prevent unnecessary procedure and helps the patient make an informed decision is fine by me.

Not only do we now have a test superior to the PSA and even PCA3, but when a biopsy is necessary, we can do a targeted biopsy, which is available in many institutions. This helps to detect only bad cancer cells.

References

Ankerst DP, Hoefler J, Bock S, et al. Prostate Cancer Prevention Trial risk calculator 2.0 for the prediction of low- vs high-grade prostate cancer. Urology. 2014;83:1362–1367.

Vickers AJ, Gupta A, Savage CJ, et al. A panel of kallikrein marker predicts prostate cancer in a large, population-based cohort followed for 15 years without screening. Cancer Epidemiol Biomarkers Prev. 2011;20:255–261

Useful Links:

OPKO Labs

Reviews In Urology

What science still hasn’t told us about red meat

red meat

The Takeaway First

Despite the huge conversation that health professionals and consumers alike are having about the effects of consuming red meat on human health, scientific research hasn’t quite settled the score. A new paper (Klurfeld, 2015) published this past May highlights the many limitations of the studies we have done. So what do we have left…?

Study Details

  • David Klurfeld highlights some flaws in the current literature surrounding red meat. In order to know for sure whether red meat causes diseases long-term, for example, we would need a longitudinal study (where subjects are tracked for several decades) with an extremely large sample size. Not only have we not done this, but we can’t; it’s too expensive.
  • Besides, says Klurfeld, supposing we had the money, scientists can’t feed red meat to humans on the premise that it might cause them to become diseased. It’s unethical.
  • The nature of observational studies and the immense amount of data that researchers collect enables such studies to find (potentially) thousands of statistically significant correlations, many of which may simply be false positives.
  • Some influential studies that have found significant associations between meat consumption and colorectal cancer are clouded by confounding variables such as daily caloric intake and smoking.
  • While known toxins such as tobacco and alcohol increase risks of lung cancer and liver cirrhosis ten- to thirty-fold, eating meat does not increase the risk of any disease by more than 50 percent.

My Take on Meat

It seems from this paper that we should be cautious when we say that eating or not eating red meat poses a danger to our health. Not only are the data limited and easy to skew, but the data on the increased risk of disease forces us to ask, “How much of a difference does this really make?”

In my opinion, we should not be worried about meat so much as wheat and simple carbs like pasta, bread, cookies, and flour. Meat should only worry us when it’s in excess or excessively cooked, as one study has shown that charred meats contain carcinogens (Zheng et al. 2009).

Of course, I have long believed, and still believe, that individual differences can make or break a diet for anyone. This is why I design an individualized anti-cancer lifestyle plan for each of my patients. For patients whose baseline risk for disease is elevated due to heredity or past behavior, I adjust their plans accordingly.

What You Should Do

When our modern methods fail to provide satisfying answers to these questions, we can be sure of one thing: uncertainty about how much does not equal a license to let ourselves go. In other words, it would be detrimental to your health if you used uncertainty as an excuse for irresolution and made a habit of saying, “Well, since we don’t really know, I guess I’ll just stick to my usual breakfast of three fried eggs and half a pig.”

While we may have reasons to be skeptical about the “statistically significant correlations” that bring smiles to every researcher’s face, we cannot afford to be wishy-washy about our commitment to a balanced diet of whole foods. Balance, unlike meat, has well-known effects. Moderation in all things—that’s the key.

References

Klurfeld, D. M. Research gaps in evaluating the relationship of meat and health. Meat Science(0). doi: http://dx.doi.org/10.1016/j.meatsci.2015.05.022

Zheng, W., & Lee, S.-A. (2009). Well-done Meat Intake, Heterocyclic Amine Exposure, and Cancer Risk. Nutrition and Cancer61(4), 437–446. doi:10.1080/01635580802710741

Selenized Yeast better than Selenomethonine for Prostate Cancer – new study

Selenized Yeast (SY) Better than Selenomethionine (SeMet) for Prostate Cancer – new study shows

 

Doggy Bag Message First

First of, don’t believe much of what you hear from the media or “experts” untrained in nutritional science. Therapeutic  nutrition is a complex subject and a discipline of its own. Why am I saying that? Outcomes from the SELECT study has shown that by using unnatural, isolated ‘natural’ compounds ( SeMet) can increase the formation of prostate cancer.

The overall evidence with selenium suggest’ that this trace mineral , ONLY in the form of selenized yeast (SY),  has potential of being protective against prostate cancer.  Furthermore, SY does not cause or promote diabetes and it has no adverse side effects at dosages of up to 800 mcg/day. The RDI upper tolerated dose is 400 mcg/day.

Today’s highlighted study and most others use approximately 200mcg/day of a specialized selenium yeast, SelenoExcell. Most men, by the way, consume about 134mcg/day from their diet –  but of course, that varies.

 

Details of the study

  • The effects of Selenomethionine (SeMet) and Selenized Yeast (SY) were compared for the first time on prostate cancer relevant biomarkers in men.
  • A randomized double blind, placebo-controlled trial of SY (200 or 285 mcg/day) and SeMet (200 mcg/day) administered for 9 months in 69 healthy men.
  • Researcher looked blood levels of selenium-containing compounds and oxidative stress (free radicals) biomarkers
  • (In case you feel geeky today and are interested in the biomarkers tested; here they are: urine 8-hydroxy-2′-deoxyguanosine [8-OHdG] and 8-iso-prostaglandin-F2α [8-iso-PGF2α] and blood glutathione [GSH]).
  • Secondary endpoint researchers looked for was blood glucose and PSA levels.
  • Conclusion: Reduction in biomarkers of oxidative stress following supplementation with SelenoExcell SY but not SeMet in healthy men. This study suggests that selenium-containing compounds other than SeMet may account for the decrease in oxidative stress. There was no difference on PSA or blood sugar levels between the SY,  SeMet and placebo group (Richie et al. 2014)

Other studies on SY and SeMet

Although the Richie study is the first head-to-head study comparing SY to  SeMet, others have independently shown to favor SY over SeMet for its protective qualities.

High-SY has been found to be more effective than selenomethionine in the reducing DNA damage and an increase in epithelial cell apoptosis (natural cell death) within  aging canine prostate cells. (Waters et al. 2003)
In contrast, Dr. David McCormick at the Experimental Toxicology and Carcinogenesis Division, IIT Research Institute in Chicago found no effects with SeMet supplementation on the prevention of prostate cancer in rats (McCormick & Rao. 1999).
A small trial of selenium (SeMet) supplementation among men with a lesion widely regarded as a premalignant precursor of prostate cancer showed no benefit. (Marshall et al. 2011)

A recent report, in the SELECT study showed a significant increase of advanced prostate cancer in men consuming 200mcg/day of only SeMet.

Note: The SELECT was a 300 million dollar study looking at vitamin E (in the form alpha-tocopherol) and selenium (in the form of L-selenomethionine) and prevent prostate cancer. The trial was simply called the SELECT trial (SELenium and vitamin E Cancer prevention Trial). More on SELECT HERE.

In the Nutritional Prevention of Cancer (NPC) study published in JAMA  by Clark et al, men receiving supplemental selenium in the form of  200mcg/day of SelenoExcell (SY), had a reduced incidence of prostate cancer of up to 63% over a period of about 4.5 years.. (Clark et al. 1996)

Lastly, a 2011 meta-analysis of nine randomized controlled clinical trials including 152,538 participants established that selenium supplementation cut risk for all cancers by 24%. The cancer-preventive effect rose to 36% in people with low baseline selenium levels. (Lee et al. 2011)

Selenium rids the body of unwanted metals – a really good thing.

100 Chinese were randomized to receive 100 micrograms of SY for 90 days. Urinary excretion of mercury increased by 74% in 30 days and by 175% by 90 days in the Selenium group. (Li YF et al. Enviorn Sci Technol. 2012)

Selenium appears to rid the body of cadmium (a major prostate cancer causing metal), especially in acute exposures. In a mouse study, after acute cadmium exposure a significant decrease in cadmium levels was observed in the kidneys and liver following an eight-week daily selenium supplementation. (Jamba et al. 1997)

 

My Take On This


The research by Richie et al. is exciting. This is the first head-to-head study comparing SeMet to SY that I know of. There is a  difference between the two so when claims are made on “Selenium” promoting cancer the question that needs to be asked is; what kind of selenium was used?
 Scientists, practitioners and the media who are not trained in nutritional science are guilty of making incorrect, unreliable and potentially harmful conclusions.
In nature, vitamins and minerals work in concert, not independently.  Besides, super isolation of  any one compound would then make that compound a drug. And that’s what we’re trying to avoid, right?

Anytime a  substance is super concentrated as is the case with pure SeMet, that causes havoc with the interplay amongst all components of a natural substance. For example, the use of alpha-tocopherol vitamin E at 400 mcg/day seems to promote prostate cancer. Alpha – tocopherol vitamin E is an isolated and super concentrated form of vitamin E  versus mixed tocopherol which include beta, delta and  the very important gamma-tocopherol. More on that HERE.

SelenoExcell SY, on-the-other-hand consist of 200mcg of THREE types of selenium; selenomethionine , selenocysteine and  methylselenocysteine which very likely could have greater anti-carcinogenic activity than SeMet alone.

And that’s all for today.

 

Reference:
Clark LC, et al. Effects of selenium supplementation for cancer prevention in patients with carcinoma of the skin. A randomized controlled trial. Nutritional Prevention of Cancer Study Group. JAMA. 1996;276(24):1957–63.

Jamba L, Nehru B, Bansal MP. Selenium supplementation during cadmium exposure: changes in antioxidant enzymes and the ultrastructure of the kidney. J Trace Elem Exp Med 1997;10:233-242.

Waters DJ, Shen S, Cooley DM, Bostwick DG, Qian J, Combs, Jr. GF,  Glickman LT, Oteham C, Schlittler D, and Morris JS. Effects of dietary selenium supplementation on DNA damage and apoptosis in canine prostate.   J. Natl Cancer Inst 2003; 95:237-240.

Selenium Yeast superior to Selenomethionine for Prostate Cancer – new study

Selenium from Yeast (SY) shows more protection than selenonethionine (SeMet) in men with prostate cancer

Se

Doggy Bag Message First
The overall evidence suggest’ that selenium ONLY in the form of selenized yeast has potential in being protective against prostate cancer.  Selenized Yeast does not cause or promote diabetes and it has no adverse side effects at dosages of up to 800 mcg/day. The RDI upper tolerated dose is 400 mcg/day.
This study and most others use approximately 200mcg/day and that’s what I would recommend. Most men, by the way, consume about 134mcg/day in their diet –  but of course that varies.

Details of the study

  • The effects of Selenomethionine (SeMet) and Selenized Yeast (SY) were compared for the first time on prostate cancer relevant biomarkers in men.
  • A randomized double blind, placebo-controlled trial of SY (200 or 285 mcg/day) and SeMet (200 mcg/day) administered for 9 months in 69 healthy men.
  • Researcher looked blood levels of selenium-containing compounds and oxidative stress (free radicals) biomarkers
  • (In case you feel geeky today are interested in the biomarkers tested, here they are: urine 8-hydroxy-2′-deoxyguanosine [8-OHdG] and 8-iso-prostaglandin-F2α [8-iso-PGF2α] and blood glutathione [GSH]).
  • Secondary endpoint researchers looked for was blood glucose and PSA levels.
  • Conclusion: Reduction in biomarkers of oxidative stress following supplementation with SY but not SeMet in healthy men. This study suggests that selenium-containing compounds other than SeMet may account for the decrease in oxidative stress. (Richie et al. 2014)

Other studies on SY and SeMet
Although the Ritche study is the first head-to-head study looking at SY and SeMet, others have independently shown to favor SY over SeMet for its protective qualities.

High-Selenium Yeast, on the other hand, has been found to be more effective than selenomethionine in the reducing DNA damage and an increase in epithelial cell apoptosis (natural cell death) within  aging canine prostate cells. (Waters et al. 2003)
In contrast, Dr. David McCormick at the Experimental Toxicology and Carcinogenesis Division, IIT Research Institute in Chicago found no effects with SeMet supplementation on the prevention of prostate cancer in rats (McCormick & Rao. 1999).
A small trial of selenium (SeMet) supplementation among men with a lesion widely regarded as a premalignant precursor of prostate cancer showed no benefit. (Marshall et al. 2011)

A recent report, in the SELECT study showed a significant increase of advanced prostate cancer in men consuming 200mcg/day of SeMet.

Note: The SELECT was a 300 million dollar study looking at vitamin E (in the form alpha-tocopherol) and selenium (in the form of L-selenomethionine) and prevent prostate cancer. The trial was simply called the SELECT trial (SELenium and vitamin E Cancer prevention Trial). More on SELECT HERE.

In the Nutritional Prevention of Cancer (NPC) Study by Clark et al, men receiving supplemental selenium in the form of  200mcg/day of high-selenium yeast (SY), had a reduced incidence of prostate cancer of up to 63% over a period of about 4.5 years.. (Clark et al. 1996)

Lastly, a 2011 meta-analysis of nine randomized controlled clinical trials including 152,538 participants established that selenium supplementation cut risk for all cancers by 24%. The cancer-preventive effect rose to 36% in people with low baseline selenium levels. (Lee et al. 2011)

Selenium also rids the body of unwanted metals – a really good thing.

100 Chinese were randomized to receive 100 micrograms of selenized yeast for 90 days. Urinary excretion of mercury increased by 74% in 30 days and by 175% by 90 days in the Selenium group. (Li YF et al. Enviorn Sci Technol. 2012)

Selenium appears to rid the body of cadmium (a major prostate cancer causing metal), especially in acute exposures. In a mouse study, after acute cadmium exposure a significant decrease in cadmium levels was observed in the kidneys and liver following an eight-week daily selenium supplementation. (Jamba et al. 1997)

My Take On This

The research by Ritchie et al. is exciting. This is the first head-to-head study comparing SeMet to SY. There is a big difference between the two so when claims are made on “Selenium” promoting cancer the question that needs to be asked is; what kind of selenium was used?
Scientists, practitioners and the media who are not trained in nutritional science are guilty of making unspecific, unreliable and potential harmful claims.
In nature, vitamins and minerals work in concert not independently. So when you super concentrate a natural substance as in SeMet the biological effect is often detrimental at high dosages. Besides, super isolation of   natural agents would then becomes a drug. And that is what we trying to use less off, right?
Anytime a  substance is super concentrated as is the case with pure SeMet, that causes havoc with the interplay that  occurs with other essential components of a natural substance. The use of alpha-tocopherol vitamin E alone versus mixed tocopherol vitamin E is another example of this. More on that HERE.
SY, on-the-other-hand consist of 200mcg of THREE types of selenium; selenomethionine selenocysteine and methylselenocysteine of which about 70% is SeMet.

I hope this helps.

Reference:
Clark LC, et al. Effects of selenium supplementation for cancer prevention in patients with carcinoma of the skin. A randomized controlled trial. Nutritional Prevention of Cancer Study Group. JAMA. 1996;276(24):1957–63.

Jamba L, Nehru B, Bansal MP. Selenium supplementation during cadmium exposure: changes in antioxidant enzymes and the ultrastructure of the kidney. J Trace Elem Exp Med 1997;10:233-242.

Waters DJ, Shen S, Cooley DM, Bostwick DG, Qian J, Combs, Jr. GF,  Glickman LT, Oteham C, Schlittler D, and Morris JS. Effects of dietary selenium supplementation on DNA damage and apoptosis in canine prostate.   J. Natl Cancer Inst 2003; 95:237-240.

Dogs Good at Diagnosing Prostate Cancer – I’m not kidding – AUA

Dogs to Diagnose for Prostate Cancer

Dogs2
Early Sunday morning an Italian physician presented at the American Urological Association meeting about a unique tool for diagnosing prostate cancer: dogs. I’m not kidding.
Dr. Gianluigi Taverna presented a study that included a total of 677 people, of whom 320 were prostate cancer patients. The test involved training two dogs to identify the presence of volatile organic compounds (VOCs) unique to prostate tumors.
VOCs, if present in the urine, produce an odor that is easily detected by the highly sensitive canine nose.
During the study, the dogs were trained to sniff urine samples looking for VOCs. An accurate identification resulted in a reward.
After repeated testing, one dog detected cancer at 98.9 percent of accuracy and the other one at 97.3 percent.

My Take On This

Well, I don’t have much to say about this, do I? I presume if reducing healthcare costs is really a top priority on the healthcare agenda, then we should forget about PSA and biopsies (even the better methods of prostate biopsy) and just use dogs to diagnose for prostate cancer.

I can’t way to see how all this evolves.
Stay tuned.
Source:
AUA 2014, Orlando, Florida – Dr. Taverna’s Abstract presentation

Dosage of Exercise for Men on Androgen Deprivation Therapy (ADT) – AUA

High impact exercise is most important for men on Androgen Deprivation Therapy (Hormone Therapy) for prostate cancer

 

ADT Exer

Men with prostate cancer (CaP) undergoing androgen-deprivation therapy (ADT) are recognized to gain fat mass, lose muscle, and be subject to a series of adverse effects from the therapy.

Dr. Robert Newton, an exercise scientist from Australia gave a brilliant presentation at the AUA conference on the benefits of properly done exercise in reducing side effects from ADT (hormone treatment) for prostate cancer.

In the research Dr. Newton and his team,  two important findings were observed:

1. Six month of supervised exercise resulted in improved cardio vascular and repiratory fitness, lower-body physical function, self-reported physical functioning and mental health, and muscle strength compared with standard public health recommendations on physical activity

2. These benefits were largely sustained in the following 6 mo with a home-based maintenance program.

The exercise routine included the following:

Approximately 60 minutes in duration, involving moderate to high intensity aerobic and resistance exercises as well as standard warm-up and 8 cool-down periods.

The aerobic exercise component included 20– 30 minutes of cardiovascular exercise using a variety of modes such as walking or jogging on a treadmill, cycling or rowing on a stationary ergometer or exercising on a cross trainer machine.

Target intensity was set at approximately 70-85% of estimated maximum heart rate. The resistance exercise component involved 8 exercises that targeted the major upper and lower body muscle groups (leg press, leg extension, leg curl, calf raise, chest press, lat pulldown, biceps curl and triceps extension). Cormie et al. 2014

Dr. Newton made an important point that stuck in my head. He said, “Exercise is not a single medicine and how it’s prescribed make all the difference.”

My Take On This

Wow! You can imagine how excited I was listening to Dr. Newton’s presentation. I have clinically found that men on ADT for prostate cancer still experience suboptimal quality of life when only doing aerobic exercises and no weight resistance.

And not only is weight resistance important, the proper amount is also critical. The prostate cancer book I am currently writing , the CaPLESS Wellness Method,   emphasies the dosage on everything from broccoli consumption to exercise to supplements.

Another words, it’d be useful to know what is the minimal effective dose of every aspect of a targeted lifestyle program to get maximal results.

 

Doggy Bag Message

Well, now we know that men on ADT (hormone therapy) for prostate cancer should practice weight resistance, 3 to 4 times a week, 30 minutes at a time,  while including aerobic exercises the rest of the time. The amount of total time of exercise per week should be 3 to 4 hours. Nothing less.

 

Reference:

AUA 2014, Orlando, Florida

Cormie P1, Galvão DA, Spry N, Joseph D, Chee R, Taaffe DR, Chambers SK, Newton RU.Can Supervised Exercise Prevent Treatment Toxicity in Prostate Cancer Patients Initiating Androgen Deprivation Therapy: A Randomised Controlled Trial. BJU Int. 2014 Jan 27.

Best Prostate Biopsy – Live at the AUA

The Best Prostate Biopsy – Live at the AUA 2014

MRUS

A Transrectal Ultrasound prostate biopsy (TRUS Bx) is performed using a probe inserted into the rectum.  The probe transmits sound waves through the rectal wall toward the prostate gland. The waves bounce off of different kinds of tissue, and register as black-and-white images on a computer monitor. Although abnormal prostate tissue may show up differently than normal tissue, information about the true nature of the abnormality is limited.
According to Dr. Peter Pinto (NCI), speaking here at the American Urology Association meeting, up to 60% of “suspicious lesions,” meaning areas that look like cancer in an ultrasound, are negative and not cancerous.
Thus, a TRUS Bx is considered a “blind” biopsy – meaning physicians must randomly sample the prostate. This is an approach that has been in use since the 1980s and is still the standard form of performing this procedure.
TRUS Bx lacks precision and often misses ‘bad cancers,’ leading to under-diagnosis. In the newer Magnetic Resonance Imaging-Ultrasound Fusion method (MR/US) the patient undergoes an MRI exam before undergoing a biopsy. The MRI is much better at detecting cancerous lesions than an ultrasound. During the biopsy, the MR image is fused with ultrasound (US) imaging.
The MR/US combination guides the biopsy needle to the lesions that detected by the MRI – leading to significantly higher accuracy in finding bad cancer of the prostate.
In their presentations at the American Urology Association (AUA) meeting, Dr. Pinto and Dr Samir Taneja (NYU) presented compelling evidence suggesting significant improvement in cancer detection rates with targeted MR/US fusion prostate biopsies compared to blind biopsies.
They highlighted a study published in the European Journal of Urology, which showed that among 172 prostate biopsies, targeted biopsy detected 75.0% of all clinically significant cancers and 86.4% of Gleason sum ≥7 cancers compared to the standard (blind) biopsy.  (Wysock et al 2013).

 

Challenges with MR/US fusion prostate biopies

It may be a challenge to find physician’s performing targeted biopsies across the U.S and the world at large. Community physicians are particularly unlikely to use this newer technique for collecting prostate tissue since there is a relatively steep learning curve and higher cost associated with MR/US fusion biopsies. Lastly, targeted biopsies require a team effort among urologist, radiologist and pathologist.

In order to perform these MRIs and interpret the resulting images correctly, radiologists need a specialized skill set specific to the prostate. In other words, a radiologist who typically looks for cancerous lesions on the breast may be under-qualified to adequately find lesions of the prostate.

My Take On This

I attract many patients who are (understandably) reluctant to undergo biopsies despite their high PSA score. Prostate biopsies are no fun, to put it lightly.

However, at this time, the gold standard way of diagnosing a man with prostate cancer is by obtaining prostate tissue. And that’s it. So when there is suspicion of prostate cancer and a biopsy is required, it makes sense to undergo the best biopsy possible. As of now, the best type of prostate biopsy is the MR /US fusion method.

Current medical institutions performing targeted MR/US fusion biopsies include:

NYU Smilow Comprehensive Prostate Cancer Center – main urologist performing this technique, Dr. Samir Taneja

National Cancer Institute department of Urology – main urologist performing this technique, Dr. Peter Pinto

UCLA Urology – main urologist performing this technique, Dr. Leonard Marks

This list is incomplete as I am still learning about groups performing MR/US fusion prostate biopsies.

Stay tuned for more Prostate Cancer AUA updates.

 

Reference:

AUA convention 2014, Orlando, Florida

Wysock JS1, Rosenkrantz AB2, Huang WC1, Stifelman MD1, Lepor H1, Deng FM3, Melamed J3, Taneja SS4. A Prospective, Blinded Comparison of Magnetic Resonance (MR) Imaging-Ultrasound Fusion and Visual Estimation in the Performance of MR-targeted Prostate Biopsy: The PROFUS Trial. Eur Urol. 2013 Nov 8.

Is Organic Food a Waste of Your Hard Earned Money?

Is Organic Food a Waste of your Hard Earned Money?

organic

Currently, the European Union, the United States, Canada, Mexico, Japan and many other countries require a special certification from producers in order to sell food as organic. In the context of these regulations, organic food is food produced in a way that complies with organic standards set by national governments and international organizations.

Very Brief History

•    Historically, organic farms have been relatively small family-run farms, which is why organic food was once only available in small stores or farmers’ markets.

•    In 1939, Lord Northbourne coined the term organic farming in his book Look to the Land (1940), out of his conception of “the farm as organism,” to describe a holistic, ecologically balanced approach to farming.

•    J.I. Rodale, a New Yorker, had an interest in promoting a healthy and active lifestyle that emphasized organically grown foods, inspired by his encounter with the ideas of Sir Albert Howard (British agronomist)

•    He was the founder of Rodale Press and publisher of Organic Farming and Gardening magazine starting in 1942 (Rodale Press later published the popular Men’s Health magazine)

•    Organic Farming and Gardening promoted organic foods; later re-titled Organic Gardening – this publication was the birth of organic foods in the U.S.

•    In 1990 Congress in the US passed the Organic Foods Production Act, which led to the National Standards on Organic Agricultural Production and Handling rule in 2000.

•    In the US the USDA carries out routine inspections of farms that produce USDA Organic labeled foods.

•    On April 20, 2010, the Department of Agriculture said that it would begin enforcing rules requiring the spot testing of organically grown foods for traces of pesticides, after an auditor exposed major gaps in federal oversight of the organic food industry according to the New York Times.

What’s the deal with Organic foods?

During the past few decades the organic food industry has grown immensely. In 2012 the total size of the organic food market in the United States was about $30 billion from $3.6 billion in 1997. So economic growth of this food sector begs the question:

Is organic food really organic and is it worth it?

Answer: Yes and Maybe.

Are Organic foods really “Organic”?

When a food is labeled organic, it actually has been deemed so through a federally approval process that regulates the food so that it has no genetic engineering (No GMO), no synthetic pesticides or fertilizer, no antibiotics or growth hormone and has not been irradiated.

With organic livestock animals eat organically produced feed that is pesticide and animal byproduct free with the freedom to move around, have access to fresh air and sunlight.

Is eating organically healthier for you?

Most of it is. Some is not.

Allow me to explain.

Although there is no clear evidence of health benefits or harm from consuming organic foods (Dangour 2010), we know that conventional (non-organic) foods are 30% higher in pesticides and conventional chicken and pork have a higher risk for contamination with bacteria resistant to antibiotics. (Smith-Spangler et al. 2012)

While I promote organic food, especially those most contaminated with pesticides and herbicides (See dirty dozen – actually dirty 15 foods) I realize not all organic food is good for us.

For example, organic packaged dry products such as cookies, breads, etc. are still poor nourishing foods – the organic versions are just “poor” organic foods. Also, packaged foods are not required to be 100% organic. In fact, products “made with organic ingredients” up to 30 percent of the content need not be.

Lastly, foods made from organic livestock, like organic milk for example, only means the cows eat organic corn. Cows are meant to eat grass, not corn. While cows fed organic corn might be marginally better, only foods from organic, grass-fed cattle are highest in nutritional value.

The flip side of the story is that I want less ‘crap’ in my body with less GMO products (more on this later), pesticides, herbicides, hormone and anti-biotic byproducts that are harmful for prostate cancer and overall health. In other words, the poison may be in the dose, but I don’t know what that dose is, so minimizing the consumption of these harmful chemicals  makes sense.

Studies showing no major benefit (Dangour et al. 2010) looked at other studies (meta-analysis) with a small number of studied subjects and for a short length of time.

Therefore,  proving non-organic foods to be harmful is a difficult task.
Such a study would require more than 500 people consuming organic food compared to another 500 people consuming conventionally grown, non-organic food. These two groups would be followed for over 10 years to assess whether or not organic food protects against cancer and other maladies.

This type of research would be exorbitantly expensive and difficult to manage since it would be challenging to control what each group eats.

 

Organic2

So what should you do?

•    Eat mostly fruits and vegetables from nearby farms or farmers markets even if the food is not organic.

•    Don’t be fooled. Just because something is organic doesn’t necessarily make it better for you. Packaged organic products are NOT healthier.

•    Real organic foods – are natural foods (right from nature), with organic farming practices and if possible. This is what Sir Albert Howard and J.I. Rodale promoted.

•    Organic Milk is 2 notches better than regular milk. The best type to consume however, is milk from organic, grass-fed cattle. Still consume moderately as some studies have suggested dairy to increase prostate cancer risk. Consumption of organic, grass-fed milk has never been studied in relation to any disease – but it’s much higher in Omega-3 fatty acids (really good fat) and other nutrients.

•    Organic meats are 2 notches better as well. Again, grass-fed, organic beef is much superior in nutritional content.

•    With fruits and vegetables, organic is certainly better. But, don’t use this as an excuse to avoid non-organic vegetables. If for whatever reason you don’t have access to organic vegetables, non-organic vegetables are always better than no vegetables

•    Eat the  ”dirty” 15 foods organically, don’t worry much about the others.

Lastly, I realize organic foods cost 10 to 40% more than non-organic foods. For packaged, processed food with the organic label stuck on the front of the box, the extra money may not be worth it. For fruits and vegetables, especially those 15 foods most sprayed with potentially harmful chemicals, the organic variety is money well spent.

What’s your opinion on organic foods? Is it worth the extra expense?

References:

Dangour AD1, Lock K, Hayter A, Aikenhead A, Allen E, Uauy R.Nutrition-related health effects of organic foods: a systematic review. Am J Clin Nutr. 2010 Jul;92(1):203-10.

Smith-Spangler C1, Brandeau ML, Hunter GE, Bavinger JC, Pearson M, Eschbach PJ, Sundaram V, Liu H, Schirmer P, Stave C, Olkin I, Bravata DM. Are organic foods safer or healthier than conventional alternatives?: a systematic review. Ann Intern Med. 2012 Sep 4;157(5):348-66.

Crucifers: Why We Should Eat a lot of them – new study

 We Should Eat A lot of Cruciferous Vegetables

Crucifers

 

Doggy Bag Message First

Cruciferous vegetable deliver significant anti-inflammatory benefits in this latest study. The consumption of about 6 servings a week of these powerful plants show maximum protection against most cancer’s and heart disease.

Study Details

  • Over 1000 Chinese women were studied
  • Higher intake of cruciferous vegetables was connected with significantly lower of pro-inflammatory markers (for the curious minded, those markers include: tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and IL-6)
  • Less anti-inflammatory benefits were observed with consumption of all vegetables combined but not with non-cruciferous vegetables.

My Take On This

If there were a vegetable that deserves most praise for it’s health benefits it would be cruciferous vegetables. These family of vegetables includes: broccoli, cauliflower, Brussels sprouts, cabbage, bok choy, collard greens, horseradish, wasabi and kale.

There are two main phytochemicals found to have the most benefit; sulforaphane and indole-3-carbinol. These powerful plant chemicals seem to possess anti-carcinogenic, detoxification  and anti-inflammatory value.

Cruciferous and Prostate Cancer

For the past decade, there has been a plethora of research on the benefits of these vegetables and prostate cancer.

The stimulation of a specific detoxification group of enzymes (called phase II enzymes) could be partly responsible for the association of intake of broccoli and other cruciferous vegetables with decreased prostate cancer risk (Brooks et al. 2001)

In the one big study on men and prostate cancer, high consumption of cruciferous was associated with a 32% decreased risk of incident prostate cancer. (Steinbrecher et al. 2009)

In 1,560 men,  cruciferous vegetables consumption after diagnosis was strongly associated with reduced risk of prostate cancer progression among men initially diagnosed with non-metastatic prostate cancer. (Richman et al. 2011)

Cruciferous and Breast Cancer

4,886 Chinese breast cancer survivors who were diagnosed with stage 1 to stage 4 breast cancer from 2002 to 2006. Breast cancer survivors who eat more cruciferous vegetables may have improved survival. Women who consumed the highest intake of vegetables per day had a 62 percent reduced risk of breast cancer mortality, and 35 percent reduced risk of breast cancer recurrence, compared to women with the low intake. Study LINK HERE.

The benefits of broccoli and its “cousins” are not only in cancer. One group of researchers saw a 31% lower cardiovascular mortality in individuals with the highest intake of cruciferous vegetables. (Zhang et al. 2011)

So, there you have it. The more cruciferous you consume, the longer you live. Here are some tips though:
Make sure the vegetable is not brown or overly cooked – that would reduce the amounts of protective phytochemicals. Also, steam them just a little and avoid eating them raw since raw vegetables may be indigestible in many who eat them.

 

Crucifer Soup Recipe

Here’s a scrumptious and protective crucifer soup recipe from our Natural gourmet chef Marti Wolfson.

Creamy Emerald Soup

Created by Marti Wolfson, CHC

Serves 4-5

Ingredients:
1 T. olive oil
1 medium onion, diced
1 tsp. ginger, minced
2 cloves garlic, minced
2 large celery stalks, chopped
1 bunch kale, stems removed and discarded
3 cups water or homemade vegetable stock
1 tsp salt
1/8 tsp. ground black pepper
Squeeze of lemon

Directions:
Heat the oil in a medium pot on medium high heat. Add the onion and cook until the onions soften and become translucent. Add the garlic, ginger, celery, broccoli, kale and ½ tsp. sea salt and sauté for 3 minutes. Add the water or stock and remaining salt and pepper. Bring to a boil, cover and reduce the heat, simmering for 20 minutes.   Place the soup in a blender and blend until smooth and creamy. If a thinner consistency is desired add water ¼ cup at a time. Taste for salt and finish with a squeeze of lemon.

 

References:

Jiang Y, Wu SH, Shu XO, Xiang YB, Ji BT, Milne GL, Cai Q, Zhang X, Gao YT, Zheng W, Yang G. Cruciferous Vegetable Intake Is Inversely Correlated with Circulating Levels of Proinflammatory Markers in Women. J Acad Nutr Diet. 2014 May;114(5):700-708.e2.

Brooks JD, Paton VG, Vidanes G (2001) Potent induction of phase II enzymes in human prostate cells by sulforaphane. CEBP 10:949–954

Steinbrecher A, Nimptsch K, Husing A, Rohrmann S, Linseisen J. Dietary glucosinolate intake and risk of prostate cancer in the EPIC-Heidelberg cohort study. Int J Cancer 2009; 125: 2179–86.

Richman EL, Carroll PR, Chan JM.Vegetable and fruit intake after diagnosis and risk of prostate cancer progression. Int J Cancer. 2011 Aug 5.

X. Zhang, X.O. Shu, Y.B. Xiang et al. Cruciferous vegetable consumption is associated with a reduced risk of total and cardiovascular disease mortality Am J Clin Nutr, 94 (1) (2011), pp. 240–246

Fish Oils Reduce Blood Pressure – new study

Fish oil helps with High Blood Pressure

 

 

Doggy Bag Message First

 

fishoils2

•    Eicosapentaenoic (EPA) and Docosahexaenoic (DHA) are essential Omega – 3 fatty acids typically found in cold-water fish.  Essential fatty acids are essential because your body cannot make them and you need to get them from food to stay healthy and to avoid premature mortality.
•    Recently there have been unwarranted concerns about consumption of Omega 3 fats and its potential increase in prostate cancer risk
•    This meta-analysis demonstrates that consumption of 2 grams or more of EPA and DHA can significantly reduce blood pressure.

Study Details:

•    This study of studies (meta-analysis) looked at 70 studies

•    EPA+DHA–rich or –fortified foods were LESS effective than supplements with regards to lowering BP.

•    Collectively, the evidence from RCTs indicates that provision of over 2 grams of EPA+DHA may reduce blood pressure.

•    Hypertensive individuals who are not on anti-hypertensive medication showed the most improvement.

•    Lower dose EPA + DHA (between 1 and 2g/d) may reduce only moderately reduce blood pressure

•    Quote from the study authors: “The reductions in BP observed in this analysis are not only statistically significant but also are clinically meaningful”

– Miller et al. 2014

My Take On This

This study was published in the reputable American Journal for Hypertension about 3 weeks ago. Did you read any headlines on the results of this study? Where were the sound bytes on the health benefits of  fish oils?

If we make health decisions based on what we hear or read from the media you are in trouble. Attracting “eyes and ears” through sensational reporting takes priority these days with most media outlets.

Headlines like  – “Fish oils may raise prostate cancer risks, study confirms”  are incorrect, misleading and irresponsible.

Fish oils from food or supplements do not cause prostate cancer  – or any other cancer. And that’s the what  many in the scientific community carefully concluded – MORE ON THIS HERE

A Smart Supplement consumption regimen should have multiple systemic benefits and not only help one part of the body or prevent just one disease.

Lowering blood pressure can reduce the risk of coronary plaque rupture, stroke, and complications of stroke, including related cognitive decline, thus improving clinical outcomes for higher-risk populations.

EPA+DHA are as effective, and in some cases more effective, than other lifestyle-related interventions, including increasing physical activity and restricting alcohol and sodium (Dickinson et al; 2006)

The other key point to this study is what nutritionally oriented practitioners have learned for decades –   consumption of Omega 3 fatty acids work best in dosages higher than 2 grams a day. Miller and his research team point out that most benefit was experienced when dosages were 2 grams or higher in hypertensive people who were not on any medications for hypertension.

Clinically, I start patients at about 2400mg a day and adjust accordingly thereafter depending on how patients respond.

 

Do NOT take fish oils if…

Important to know that patients on blood thinners like Heparin or Plavix should consult with their physician before consuming fish oils as they too have blood thinning properties. Also, those undergoing surgery should stop taking fish oils one week prior to their procedure.

 

Reference:

Miller PE1, Van Elswyk M, Alexander DD.Long-Chain Omega-3 Fatty Acids Eicosapentaenoic Acid and Docosahexaenoic Acid and Blood Pressure: A Meta-Analysis of Randomized Controlled Trials. Am J Hypertens. 2014 Mar 6.

Dickinson HO, Mason JM, Nicolson DJ, Campbell F, Beyer FR, Cook JV, Williams B, Ford GA. Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials. J Hypertens 2006; 24:215–233.