Jun
17
2017

Prostate Cancer Treatment Is Often Inadequate

Prostate cancer treatment is often inadequate when you follow the advice of conventional physicians. The gold standard for prostate cancer treatment is considered to be a radical prostatectomy. Below I am explaining that this often leads to recurrences of prostate cancer in the order of 25 to 35% when patients are followed up for 10-years. There is, however, another method of diagnosing and treating prostate cancer, which reduces the recurrence rate to only 6% at 10 years of follow-up. I will first explain the process of the initial assessment of prostate cancer, and then describe different treatment modalities.

Which prostate cancer biopsy method is superior?

  1. The standard biopsy method consists of 6 to 16 random biopsies via the transrectal approach. However, this approach has two downfalls. One is the danger of infection. The rectum is full of E. coli bacteria, which can be spread into the bloodstream. This can cause septicemia in 1 out of 200 biopsies, which is a medical emergency. It is treated with high doses of antibiotics. The second problem with the standard biopsy method is that 25 to 35% of prostate cancers are missed, which may take 10 years to show up as a prostate cancer recurrence. A careful study by the John Hopkins University, Cleveland, OH still showed a 23% recurrence after 10 years. Conventional specialists tend to downplay this long-term risk, but all of the publications that I have reviewed in my book show similar poor long-term results.
  2. The interventional radiologist, Dr. Gary Onik from Ft. Lauderdale, invented the 3-dimensional mapping biopsy. In this case the needles are inserted through a brachytherapy grid over the perineum, the skin between the scrotum and the anus. The area can be thoroughly disinfected, which eliminates the risk of infection as the needles are placed. The patient is under a general anesthetic, and the specialist inserts between 60 and 90 biopsy needles through the perineum into the prostate gland depending on the prostate gland size. This way the entire prostate gland is probed using biopsy needles, and no area of cancer is missed. The procedure is observed through a transrectal ultrasound (TRUS) probe. Each of the biopsies is carefully labeled and kept track of, so the results from the pathologist can be entered on a map, (hence the name mapping biopsy). This is like a geographical image of the areas where prostate cancer was found. It is not a paper map, but a computer generated ultrasound image of the patient’s prostate gland with overlaying histology results. Because of the higher number of biopsy needles used with mapping biopsies the resolution is much better compared to the TRUS guided rectal biopsies. It also tells the treating physician exactly where the cancer is located, if this is going to be treated with ablative cryotherapy. Dr. Onik has published a 10-year follow-up of 70 prostate cancer patients treated in this way. There was a 100% survival of the prostate cancer patients treated with cryotherapy. 94% were completely free from any recurring prostate cancer. 6% had recurrent disease. These kinds of statistics are unheard of with other treatment modalities. The patients’ ages were between 45 and 77 years at the time of surgery.

My own personal experience with prostate cancer

As I have explained in my book entitled “Prostate Cancer Unmasked”, I was diagnosed with prostate cancer in early 2016. Tests were initiated because my blood PSA (prostate specific antigen) test was elevated. I started reviewing the medical literature to see what was the most optimal survival with the least possible side effects. This is how I came across the name of Dr. Gary Onik who has been a pioneer of prostate cancer research for decades. I was impressed by his extremely low prostate cancer relapse data after 10 years of follow-up. I decided to be treated by him in Ft. Lauderdale, FLA. I had the 3-D prostate biopsy involving 96 biopsy needles (due to an enlarged prostate gland, called prostate hypertrophy). One month later I was treated with ablation cryotherapy, which is the equivalent of a lumpectomy for breast cancer in women. Since then (Aug. 17, 2016) my 3 monthly PSA levels have stayed extremely low meaning that there is no recurrence of prostate cancer. I also have tested negative using the Oncoblot test, an extremely sensitive cancer test that had been positive prior to the prostate cancer surgery.

Combination treatment with ablation cryotherapy and IRE surgery

Dr. Onik told me that he wanted to use two procedures simultaneously in my case to treat my lesions optimally. His concern was the neurovascular bundles that cross through the outer aspect of each lobe of the prostate to the penis. The ablation cryotherapy could destroy them, if he came too close to them, which would result in sexual problems. On the other hand he needed to treat the prostate cancer until all of the cancer cells were dead. The surface antigens would still be intact and would stimulate my immune system to destroy any remaining prostate tumor cells. Dr. Onik has done extensive research regarding the immune response in prostate cancer patients and he was working on a publication in end-stage cancer patients.

The other procedure that was patented in the past and was FDA approved 4 years ago was IRE surgery.

IRE surgery

Another technique pioneered by Dr. Onik is the NanoKnife or irreversible electroporation (IRE surgery).

This is another tumor ablation method using high voltage electrical impulses that put nano-sized holes into cancer cells, but not into surrounding healthy tissue.

Dr. Onik has been pioneering this procedure on prostate cancer patients, but he has also shown in liver cancer that these methods can double the survival rates, compared to conventional treatment methods. Cancer cells are killed by this method, and the released surface antigens of cancer cells stimulate the immune system to further the healing. The interesting finding in Dr. Onik’s past research regarding the IRE surgery is that the neurovascular bundle is not damaged by the IRE surgery within the prostate. With the two lesions in my right prostate lobe Dr. Onik wanted to use mainly IRE surgery, because they were in closer proximity to the neurovascular bundle.

Summary regarding mapping biopsy and prostate surgery

There are several points that impressed me with ablation cryotherapy.

  1. It starts with the mapping biopsy, which gives an exact histological picture of any prostate cancer in your prostate. This provides the roadmap for the surgeon to treat any lesions that are found in the biopsy with ablation cryotherapy. While the biopsies are taken there is transrectal ultrasound guidance (TRUS) using a rectal probe. This helps in locating the cancer 3- dimensionally.
  2. Like the mapping biopsy ablation cryotherapy is done under general anesthetic. The same lesions found with the mapping biopsy are treated now with special Argon sounds, and temperature probes measure the temperature to make sure the cancer was frozen long enough to be destroyed. This is repeated one more time to be certain that all cancer cells are killed.
  3. For cancer lesions too close to the neurovascular bundle to be removed with cryotherapy, the surgeon can use the alternative, IRE or also called NanoKnife. It had been researched in dogs and later in humans that it will  eradicate cancer cells, but not normal cells. It also does not attack the neurovascular bundle. Between the two procedures the entire cancer within the prostate can be removed safely.
  4. This means that the side effects are much less than with conventional prostate surgery. The erectile dysfunction is only temporary for 3 to 5 months, but Cialis and/or Viagra can be titrated to achieve normal sex until your own erections come back. There is no effect on the rectum and no sign of bladder leakage. Problems urinating are only temporary in the beginning and can be overcome with self-catheterization or with an indwelling catheter for a period of time. The end result is that the patient is back to normal, and the prostate cancer is removed.
Prostate Cancer Treatment Is Often Inadequate

Prostate Cancer Treatment Is Often Inadequate

Conclusion

When I compared all of the other prostate cancer procedures to ablation cryotherapy, I came to the conclusion that ablation cryotherapy was the best solution for me. It is straightforward, cancer specific and works with the least amount of damage to the normal surrounding tissue. The 10-year survival was 100% with a tumor free rate of 94%. Another advantage of this method is that anytime the PSA would be elevated in the follow-up blood tests, the mapping biopsy could be repeated, and if a recurrent cancer should be found, the ablation cryotherapy can be done again.

Reference: https://www.amazon.com/Prostate-Cancer-Unmasked-Ray-Schilling/dp/1542880661

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Apr
29
2017

Cancer By Chance

A new theory talks about cancer by chance. In other words, it likely is mostly bad luck when cancer develops. Mathematician Cristian Tomasetti and cancer geneticist Bert Vogelstein of Johns Hopkins University in Baltimore, Maryland developed a new model of cancer development. They found that stem cells in different organ systems divide at different rates. The faster they go through cycles of cell divisions, the higher the chances of a mutation. The mutations happen in the genetic material and can lead to cancer. Dr. Vogelstein applied this model to 32 different cancer types and found the following.

  • 66% of cancers: cancer-promoting mutations develop by chance during cell division in various organs
  • 29% of cancers are due to environmental causes
  • 5% of cancers are inherited

Stem cells in organs can turn into cancer by chance

Key to the new theory of “cancer by chance” is that cancer likely is developing from stem cells in different organs. Different stem cells have different rates of stem cell divisions.

In pancreatic cancer they found that 5% were inherited, 18% were from environmental factors (smoking) and 77% came from chance mutations. This data was derived from the Cancer Research UK database.

For prostate cancer the rate of spontaneous mutations is 95%. When all of the cancers are looked at about 1/3 of cancers are due to either environmental or inherited factors, but 2/3 of all cancers are due to random mutations (“bad luck mutations”). They pointed out this fact in their first publication.

With the second publication, as mentioned in the beginning, Vogelstein and Tomasetti concentrated on 17 common cancers in 69 countries. They searched 423 international cancer databases. Again they found that the more stem cells divided in an organ, the more random mutations occurred. This caused cancers in that organ.

Here are a few examples for lifetime stem cell divisions:

  • Colon: 6,000 cell divisions in stem cells of the colon
  • Breast: 300 cell divisions in breast stem cells
  • Lung: only 6 cell divisions in lung stem cells

Colon cancer is very common because of the high stem cell division rate. But they also looked at environmental factors. For instance, lung cancer is rare in non-smokers because stem cells in lungs divide slowly. However, the carcinogens from cigarette smoke add a huge environmental risk. The end result: there is more lung cancer in smokers. Vogelstein said that with every stem cell division there is the creation of three new cell mutations because the body has a “poor copying machine”. During meiosis DNA breaks can occur that lead to mutations. Once they occurred, they continue to get copied.

Environmental factors versus cancer by chance

In the first paper the medical community was critical about how the authors had overemphasized that two third of cancer is caused randomly. So in the second paper Vogelstein and Tomasetti mentioned quite a bit how a change of the environment can change the final outcome of developing cancer.

This is also reflected in this summary from the CNN.

They mentioned that one mutation is not enough to cause cancer. You need three or four such mutations. As we get older there is a higher likelihood that we accumulate this number of mutations, and cancer can develop. But if we exercise, stop smoking and avoid red meat, this can contribute to a much healthier environment in the dividing stem cells. In this case we may not accumulate enough stem cell mutations in our lifetime to come down with cancer.

There is a problem with prostate cancer as indicated in this German summary of Vogelstein and Tomasetti’s work.

Japanese men have an extremely low rate of prostate cancer, namely 1/25th of the rate in the US. When Japanese men immigrate to the US, it does not take long before their risk is the same as that of US men. This is a classical case of the importance of environmental factors in cancer causation. Song Wu has pointed out in a publication in Nature that in his opinion Vogelstein and Tomasetti did not pay enough attention to extrinsic (environmental) factors in the causation of cancers.

This could explain the prostate cancer conundrum just mentioned. There may be more xenoestrogens in the environment in the US when compared to Japan, and this may have caused the additional prostate cancers when Japanese men moved to the US. Xenoestrogens are estrogen-like hormones in the environment, which can cause prostate cancer.

Prevention undermines “cancer by chance”

The role of prevention is likely larger than previously estimated. Now that we know that on average 2/3 of all cancers are due to chance mutations, it is important to realize that prevention and early detection play an enormous role.

  1. Most cancers can only be cured in stage 1 and stage 2 out of 4 stages. And this is only the case when the mutated stem cells are removed along with the clone of cancer cells.
  2. In terms of reducing the risk for lung cancer this means to stop smoking.
  3. With colon cancer it means having regular colonoscopies where the suspicious polyps are removed.
  4. For prostate cancer it means to do a mapping biopsy and to do cryoablation therapy, which has a prostate cancer vaccination effect as well.
  5. Not all cancers can be diagnosed early. Pancreatic cancer is such a difficult to diagnose cancer. But screening methods have been developed that are more sensitive and very specific such as the Oncoblot test.  With this test even cancer of the pancreas can be diagnosed years before it would be clinically detectable.
  1. We do know that chronic inflammation can lead to cancer. It makes sense therefore to start with an anti-inflammatory diet like the Mediterranean diet. Fish oil is also anti-inflammatory.
  2. Add to this regular exercise, as we know it reduces the risk for cancer development and strengthens your heart and lungs.
  3. Vitamin D3 can reduce cancer risks in both males and females. When vitamin D3 was given and blood 25-hydroxyvitamin D levels were above 40 ng/ml, the breast cancer rate was reduced by 71% compared to a low vitamin D3 group. Similarly in men the prostate cancer rate dropped by 71% with vitamin D3 supplementation.  There is more good news with vitamin D3. You can read about it in the link.
Cancer By Chance

Cancer By Chance

Conclusion

The causes of cancer have always been by chance, by environmental exposure and by inheritance. In recent years more detail about this has come to the forefront. Now we know that the majority of cancers develop by chance, but this does not mean we should sit back and do nothing. The PAP test with early diagnosis of cancer of the cervix and early treatment has almost eradicated this cancer. HPV vaccinations have added to the armamentarium. Colonoscopies have reduced the incidence of colon cancer, but only through screening at regular intervals. The PSA test has enabled men to check for prostate cancer, and early treatment for this is quite successful. More is known about cancer prevention through supplements and lifestyle.

Nature is cruel and wants to knock us off, as we get older. The only alternative we have is to fight back as follows: reducing environmental causes, increasing preventative steps and going for early treatment, when cancer is diagnosed.

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Mar
11
2017

Obesity And Diabetes Can Cause Cancer

Dr. Nalini Chilkov gave a talk about how obesity and diabetes can cause cancer. The original title was “Integrative Cancer Care, Increased Rates of Cancer and Cancer Mortality Associated with Obesity and Insulin Resistance, Nutraceutical and Botanical Interventions”. Her talk was presented at the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas that I attended.

In the following I will present a brief summary of her lecture.

Obesity is a major risk factor for cancer

Obesity causes 14% of all cancer deaths in men and 20% of cancer deaths in women.  This link explains this in more detail. The following 15 cancers were linked to obesity in terms of causation. They are: colon cancer, gastric cancer, gallbladder cancer, ovarian cancer, breast cancer, liver cancer, uterine cancer, endometrial cancer, rectal cancer, pancreatic cancer, cervical cancer, non-Hodgkin’s lymphoma, renal cancer, multiple myeloma and esophageal cancer.

The American Society of Clinical Oncology reported about a meta-analysis involving 82 studies. This involved more than 200,000 women with breast cancer. Premenopausal and postmenopausal women were compared who were obese or normal weight. Premenopausal, obese breast cancer women had a 75% increase in mortality compared to the normal weight breast cancer group. With postmenopausal, obese breast cancer women there was a 34% increase of mortality compared to the normal weight group.

With obese prostate cancer patients there is a similar observation. Obese patients have a more aggressive prostate cancer on the Gleason score and the cancer is in a more advanced stage at the time of diagnosis.

Diabetes increases mortality from cancer

Obesity is a common risk factor for both cancer and diabetes. But diabetes by itself is also increasing mortality of several cancers. In a consensus report details of the relationship between cancer and diabetes have been discussed in detail. The following cancers have been identified to have an increased risk of diabetes: pancreatic, gastric, esophageal, colorectal, liver, gallbladder, breast, ovarian, endometrial, cervical, urinary bladder, renal, multiple myeloma and non-Hodgkin’s lymphoma.

A meta-analysis suggests that cancer patients who are diabetic have a 1.41-fold increased risk of dying compared to those cancer patients who have normal blood sugars. Dr. Chilkov explained in detail what the various mechanism are that account for the faster cancer growth in obese and diabetic patients. High insulin levels is one of the risk factors, so is IGF-1, an insulin-like growth factor. The aromatase enzyme in fatty tissue turns male type hormones into estrogen, which also can stimulate cancer growth.

Carbohydrate restriction diet to prevent obesity

Low carb diets like the Mediterranean diet, the ketogenic diet and the Atkins diet will drop blood insulin and lactate levels. Cancer size and cancer growth are related to insulin and lactate levels. A low carb diet can reduce insulin-mediated uptake of sugar into cancer cells.

Research has shown that cancer metabolism slows down when a 10%-20% carb/high protein diet is consumed by the patient. This reduces the amount of sugar that is taken up by cancer cells. It also reduces insulin, so there is less cancer growth. A ketogenic diet is a more strict way to restrict carbohydrates. Intermittent fasting is also a useful method to reduce carbohydrate intake.

Here is an interesting study that illustrates the power of intermittent fasting. The study involved 2413 patients with early breast cancer who were followed for 7 years. Those breast cancer patients, who consistently did not eat anything between dinner and breakfast for 13 hours or more, had a 36% lower risk of having a cancer recurrence. There was also a 21% lower risk of dying from breast cancer when fasting was done for 13 hours or more overnight.

Supplements to prevent obesity, diabetes and cancer

A low carb diet and in some cases even a ketogenic diet is beneficial as a baseline. A regular exercise program is also useful for general fitness building and cardiovascular strengthening. In addition Dr. Chilkov recommended the following supplements.

  1. To reduce inflammation in the body, Dr. Chilkov recommended taking 2000 to 6000 mg of omega-3 fatty acids per day (molecularly distilled fish oil).
  2. Berberine 500 to 1000 mg three times daily. Dr. Chilkov said that Berberine has anti-cancer properties, improves insulin sensitivity and reduces absorption of sugars in the intestinal tract.
  3. Curcumin inhibits cancer cell division, invasion and metastatic spread through interaction with multiple cell signaling proteins. Several researchers showed that curcumin could lower blood sugar levels by stimulating insulin production from beta cells in the pancreas. Triglycerides, leptins and inflammation in fat cells are also lowered by curcumin. Insulin sensitivity increases through the action of curcumin. Dr. Chilkov recommended 300 mg/day of curcumin for 3 months.
  4. Resveratrol, the bioflavonoid from red wine is a powerful anti-inflammatory. This antioxidant has several other effects, which make it challenging to measure each effect by itself. This group of investigators managed to simultaneously measure these effects. They found that resveratrol lowered the C-reactive protein by 26% and tumor necrosis factor-alpha by 19.8%. Resveratrol also decreased fasting blood sugar and insulin; in addition it reduced hemoglobin A1C and insulin resistance. The recommended daily dose of resveratrol is 1000 to 5000 mg.
  5. Green tea catechins (EGCG) help to normalize the glucose and insulin metabolism. The dosage recommended was 1-3 grams per day.
  6. Reishi mushroom (Ganoderma lucidum) contain polysaccharides with antidiabetic and antiobesity effects. They make gut bacteria produce three types of short-chain fatty acids that control body weight and insulin sensitivity.
Obesity And Diabetes Can Cause Cancer

Obesity And Diabetes Can Cause Cancer

Conclusion

Obesity is a risk factor not only for diabetes, but also for cancer. Chronically elevated blood sugars, increased fasting insulin levels and increased IGF1 levels can cause cancer. In addition they can stimulate tumor growth and increase cancer mortality. It is for this reason that the health care provider should screen all diabetics for cancer. In her talk Dr. Nalini Chilkov gave clear guidelines what supplements will be beneficial to reduce the risk of obesity and diabetes as well as cancer. Start with a healthy, balanced diet. Add an exercise program. Then consider some of the above-mentioned supplements to reduce your risk for cancer, diabetes and obesity.

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Feb
25
2017

Heart Health Improves With Hormone Replacement

Dr. Pamela Smith gave a lecture in December 2016 showing that heart health improves with hormone replacement. Her talk was part of the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9 to Dec. 11, 2016) in Las Vegas, which I attended. The title of the talk was: “Heart health: The Importance of Hormonal Balance for Men and Women”. Her keynote lecture contained 255 slides. I am only presenting a factual summary of the pertinent points here.

1. Estrogen

Observations regarding risk of heart attacks

  1. Women have a lower risk of heart attacks before menopause compared to men of the same age.
  2. Heart attack rates go up significantly after menopause.
  3. Estrogen replacement therapy may reduce the risk of heart attacks by 50% for postmenopausal women.

Lipid profile after menopause

There is an elevation of LDL cholesterol, total cholesterol and triglycerides as well as lower HDL cholesterol levels. All of this causes a higher risk of heart attacks for postmenopausal women. Estrogen replacement therapy increases the large VLDL particles, decreases LDL levels and raises HDL-2. These changes are thought to be responsible for helping reduce heart attack rates in postmenopausal women who do estrogen replacement therapy (ERT).

Difference between oral and transdermal estrogen replacement

When estrogen is taken by mouth, it is metabolically changed in the liver. This reduces the protective effect on the cardiovascular system. In contrast, transdermal estrogen (from commercial estrogen patches or from bioidentical estrogen creams) has a higher cardioprotective effect. The liver does not metabolize transdermal estrogen. Dr. Smith explained in great detail using many slides how estrogen prevents heart attacks. Details about this would be too technical for this review. Apart from lipid lowering effects there are protective effects to the lining of the arteries. In addition there are metabolic processes in heart cells and mitochondria that benefit from estrogens. The end result is that postmenopausal women who replace estrogen will outlive men by about 10 years. Stay away from Premarin, which is not human estrogen, but is derived from pregnant mares. Also the tablet form is metabolized by the liver, which loses a lot of the beneficial effects that you get from transdermal estrogen. 

How can you document the beneficial effects of estrogen replacement?

  1. Carotid intima measurements in postmenopausal women on ERT show a consistent reduction in thickness compared to controls.
  2. The physical and emotional stress response is reduced compared to postmenopausal women without ERT.
  3. Hormone replacement therapy in postmenopausal women reduces blood pressure. Measurements showed this effect to be due to a reduction of angiotensin converting enzyme (ACE) by 20%. This is the equivalent of treating a woman with an ACE inhibitor without the side effects of these pills.
  4. Coronary calcification scores were lower in postmenopausal women on ERT than a control group without ERT. These calcification scores correlate with the risk for heart attacks.
  5. Oral estrogen replacement leads to proinflammatory metabolites from the liver metabolism of estrogen. This is not found in the blood of women using transdermal estrogen. The anti-inflammatory effect of transdermal estrogen is another mechanism that prevents heart attacks.
  6. Postmenopausal women on ERT had no increased risk of heart attacks or venous thromboembolism (clots in veins). Menopausal women without ERT have a risk of 40% of dying from a heart attack. Their risk of developing breast cancer is 5.5%, the risk of dying from breast cancer is about 1%. Oral estrogen use was associated with venous thromboembolism.
  7. Estrogen has antiarrhythmic effects stabilizing the heart rhythm. Dr. Smith said that in the future intravenous estrogen might be used to prevent serious arrhythmias following heart attacks.

Estrogen levels in males

Males require a small amount of estrogens to maintain their memory, for bone maturation and regulation of bone resorption. But they also need small amounts of estrogen for their normal lipid metabolism.

However, if the estrogen levels are too high as is the case in an obese, elderly man, there is an increased risk of heart disease. Factors that lead to increased estrogen levels in an older man are: increased aromatase activity in fatty tissue, overuse of alcohol and a change in liver metabolism, zinc deficiency, ingestion of estrogen-containing foods and environmental estrogens (also called xenoestrogens).

2. Progesterone

Progesterone is significantly different from the progestin medroxyprogesterone (MPA). MPA was the oral progestin that was responsible for heart attacks and blood clots in the Women’s Health Initiative. MPA increases smooth muscle cell proliferation. This in turn causes hardening of the coronary arteries. In contrast, progesterone inhibits smooth muscle cell proliferation, which prevents heart attacks. Progesterone also lowers blood pressure and elevates HDL cholesterol, but MPA does not.

Progesterone in males

In a small study Depo-Provera was given to males for 17 days. Blood tests showed a lowering of triglycerides, LDL cholesterol and Apo A-1.

3. Testosterone

Testosterone replacement in women

Testosterone in women does not only increase their sex drive, but also relaxes the coronary arteries in women who were testosterone deficient. This allows more blood flow to the heart. In postmenopausal women testosterone replacement lowered lipoprotein (a) levels up to 65%. The physician will only replace testosterone in women who have either enough of their own estrogen production or else have been replaced first with bioidentical estrogen. Otherwise testosterone alone can cause heart attacks in women.

Elevated testosterone in women with PCOS

Women with polycystic ovary syndrome (PCOS) can have increased testosterone levels when they go through premenopause or menopause.

Women with PCOS are at a higher risk to develop diabetes, heart disease and high blood pressure. 50% of women with PCOS have insulin resistance. 70% of women with PCOS in the US have lipid abnormalities in their blood.

Elevated testosterone levels in the blood can lower the protective HDL cholesterol and increase homocysteine levels. Both can cause heart attacks.

Women with PCOS have a 4-fold risk of developing high blood pressure.

Testosterone replacement in males

A 2010 study showed that low testosterone levels in males were predictive of higher mortality due to heart attacks and cancer. Low testosterone is also associated with high blood pressure, heart failure and increased risk of cardiovascular deaths. There was a higher incidence of deaths from heart attacks when testosterone levels were low compared to men with normal testosterone levels.

Low testosterone is also associated with the development of diabetes and metabolic syndrome, which can cause heart attacks.

It is important that men with low testosterone get testosterone replacement therapy.

DHT (Dihydrotestosterone)

DHT is much more potent than testosterone. Conversion of testosterone leads to DHT via the enzyme 5-alpha-reductase. While testosterone can be aromatized into estrogen, DHT cannot. Some men have elevated levels of DHT. This leads to a risk of heart attacks, prostate enlargement and hair loss of the scalp.

Andropause treatment

Only about 5% of men in andropause with low testosterone levels receive testosterone replacement in the US. Part of this is explained by rumors that testosterone may cause prostate cancer or liver cancer. The patient or the physician may be reluctant to treat with testosterone. Bioidentical testosterone has been shown to not cause any harm. It is safe to use testosterone cream transdermally. It does not cause prostate cancer or benign prostatic hypertrophy.

An increase of 6-nmol/L-serum testosterone was associated with a 19% drop in all-cause mortality.

Testosterone helps build up new blood vessels after a heart attack. Testosterone replacement increases coronary blood flow in patients with coronary artery disease. Another effect of testosterone is the decrease of inflammation. Inflammation is an important component of cardiovascular disease.

Testosterone replacement improves exercise capacity, insulin resistance and muscle performance (including the heart muscle).

Apart from the beneficial effect of testosterone on the heart it is also beneficial for the brain. Testosterone treatment prevents Alzheimer’s disease in older men by preventing beta amyloid precursor protein production.

4. DHEA

Dehydroepiandrosterone (DHEA) is a hormone produced in the adrenal glands. It is a precursor for male and female sex hormones, but has actions on its own. It supports muscle strength. Postmenopausal women had a higher mortality from heart disease when their DHEA blood levels were low.

Similar studies in men showed the same results. Congestive heart failure patients of both sexes had more severe disease the lower the DHEA levels were. Other studies have used DHEA supplementation in heart patients, congestive heart failure patients and patients with diabetes to show that clinical symptoms improved.

5. Melatonin

Low levels of melatonin have been demonstrated in patients with heart disease. Melatonin inhibits platelet aggregation and suppresses nighttime sympathetic activity (epinephrine and norepinephrine). Sympathetic activity damages the lining of coronary arteries. Melatonin reduces hypoxia in patients with ischemic stroke or ischemic heart disease. Lower nocturnal melatonin levels are associated with higher adverse effects following a heart attack. Among these are recurrent heart attacks, congestive heart failure or death. Melatonin widens blood vessels, is a free radical scavenger and inhibits oxidation of LDL cholesterol. Melatonin reduces inflammation following a heart attack. This can be measured using the C-reactive protein.

In patients who had angioplasties done for blocked coronary arteries intravenous melatonin decreased CRP, reduced tissue damage, decreased various irregular heart beat patterns and allowed damaged heart tissue to recover.

6. Thyroid hormones

It has been known for more than 100 years that dysfunction of the thyroid leads to heart disease. Hypothyroidism can cause heart attacks, hardening of the coronary arteries and congestive heart failure. Lesser-known connections to hypothyroidism are congestive heart failure, depression, fibromyalgia, ankylosing spondylitis and insulin resistance. Some cases of attention deficit hyperactivity disorder (ADHD) with low thyroid levels may successfully respond to thyroid replacement.

Thyroid hormones improve lipids in the blood, improve arterial stiffness and improve cardiac remodeling following a heart attack. Thyroid hormones help with the repair of the injured heart muscle. They also work directly on the heart muscle helping it to contract more efficiently. Lower thyroid stimulating hormone (TSH) values and higher T3 and T4 thyroid hormone levels lead to improved insulin sensitivity, higher HDL values (= protective cholesterol) and overall better functioning of the lining of the arteries.

Dr. Smith said that thyroid replacement should achieve that

  • TSH is below 2.0, but above the lower limit of normal
  • Free T3 should be dead center of normal or slightly above
  • Free T4 should be dead center of normal or slightly above

Most patients with hypothyroidism require replacement of both T3 and T4 (like with the use of Armour thyroid pills).

7. Cortisol

Cortisol is the only human hormone that increases with age. All other hormones drop off to lower values with age. The adrenal glands manufacture cortisol. With stress cortisol is rising, but when stress is over, it is supposed to come down to normal levels. Many people today are constantly overstressed, so their adrenal glands are often chronically over stimulated. This can lead to a lack of progesterone. It also causes a lack of functional thyroid hormones as they get bound and are less active. When women have decreased estradiol in menopause there is a decline in norepinephrine production, production of serotonin, dopamine and acetylcholine. Women with this experience depression, lack of drive and slower thought processes.

Heart Health Improves With Hormone Replacement

Heart Health Improves With Hormone Replacement

Conclusion

Seven major hormones have been reviewed here that all have a bearing on the risk of developing a heart attack. It is important that these hormones are balanced, so they can work with each other. Hormones can be compared to a team that works together and is responsible for our health. If one or several of the team players are ineffective, our health will suffer. For this reason hormone replacement is crucial. Hormones have effects on mitochondria of the heart muscles cells. They stabilize the heart rhythm as in the case of estradiol. But they can also strengthen the heart muscle directly through DHEA and estrogens in women and DHEA and testosterone in men. Thyroid hormones are another supportive force for the heart and can even be used therapeutically in chronic heart failure patients. When people age, many hormones are produced less, but blood tests will show this. Replacing hormones that are missing can add years of active life.

Taking care of the symphony of hormones means you are taking care of your most important organ, the heart!

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Sep
24
2016

Cancer Stem Cells

If you want to cure cancer, you need to know about cancer stem cells. In my opinion the most important breakthrough in cancer research in the last decade has been the realization that standard cancer treatment protocols don’t work very well. They consisted of using surgery, radiotherapy and chemotherapy. Surgery is effective for early cancer. But radiotherapy and chemotherapy have been disappointing. Instead cancer immunotherapy has emerged as the missing link in the last 10 years. The full truth about cancer can only be understood, when we realize that most, if not all solid tumors are having their own cancer stem cells (CSC). In the past this was only recognized for leukemia, largely because of a lack of testing methods for solid tumors. We now have at least two methods of proving the existence of CSCs in solid tumors, as I will explain in more detail below. Using this new cancer stem cell concept, cancer can only be cured when the CSCs are eradicated.

New assays for cancer stem cells

Originally the concept of regular stem cells was proven in mice by radiating them and injecting bone marrow cells into them to rescue them. When the animals were sacrificed colonies were detected in their spleens that were of the same cell type as the injected stem cells. This new thinking revolutionized the treatment of leukemia. Bone marrow transplants were introduced that allowed in some cases a cure for leukemia. Presently there is a new wave of stem cell treatment applications for a variety of conditions.

With regard to developing an assay for cancer stem cells in solid tumors researchers took a strain of hairless mice that are known to be immune deficient (they lack thymus derived lymphocytes or T cells). They are officially called nude mice.

When human cancer stem cell samples are injected into them, they develop the original cancer of human origin, and they succumb to metastases. Histologically the tumors in these mice are the same as the original human cancer. Another mouse model was also shown to be equally effective in demonstrating CSC activity. The immune system of regular laboratory mice can be paralyzed with prior chemotherapy treatment. Using these chemotherapy pre-treated mice the CSC assay works very similar to the one using nude mice. If isolated cancer stem cells are injected into the nude mouse or immunosuppressed mouse model, cancer cells, such as prostate cancer cells will grow in a short time that look histologically the same as prostate cancer found in prostate biopsies from a man affected by prostate cancer.

Cancer stem cells in prostate cancer

Prostate cancer seems to originate from a cancer stem cell (CSC). The CSC has no androgenic receptors contrary to the majority of prostate cancer cells. This may be the reason why radiotherapy, hormone ablation and chemotherapy do not affect CSCs in prostate cancer. Ultimately this is the reason why the patient dies when the resistant CSCs multiply in the end stage.

One of the important new insights into cancer is that CSCs have the same surface antigen components as the cancer cells despite the difference in other receptors like hormone receptors. One of the techniques of killing prostate cancer is ablation cryotherapy using Argon applicators that freeze the cancer cells, followed by thawing them again. The interventional radiologist, Dr. Gary Onik was the inventor of this technique. Using temperature probes this can be controlled and is done at least twice. This will eliminate all prostate cancer including the prostate CSC. At the same time it will stimulate human T cells to recognize the cancer cell surface antigens as foreign and mount an immune reaction to eliminate any remaining cancer cells and all the CSCs. Prior to doing the cryotherapy the cancer cells were secreting substances that disabled the immune cells from recognizing prostate cancer as foreign cells. Now the cryosurgery does a double task: this therapy kills cancer cells and CSC and vaccinates patients against their specific tumors. This eradicates metastases and either cures the cancer or prolongs survival.

Irreversible electroporation and cancer stem cells

Another technique pioneered by Dr. Onik is the NanoKnife or irreversible electroporation (IRE). This is another tumor ablation method using high voltage electrical impulses that put nano-sized holes into cancer cells, but not into surrounding healthy tissue. Dr. Onik has been pioneering prostate cancer treatment, but he has also shown in liver cancer that this method can double the survival rate, compared to conventional treatment methods. Again, CSC and cancer cells are killed by this method and the released surface antigens of cancer cells stimulate the immune system to further the healing.

Other solid tumors and cancer stem cells

In the last 10 years new methods have been developed to demonstrate the existence of CSCs in many solid tumors. Both the cryotherapy ablation method as well as the IRE method that stimulate the immune system in the sense of a cancer vaccination is not only effective in prostate cancer. It works for most solid tumors such as pancreatic cancer, liver cancer, melanoma, breast cancer, colon cancer and many more.

These new evolving cancer therapies are essentially avoiding the trap of chemotherapy and radiotherapy where only more resistant cancer cells are produced. By removing the original cancer with cryosurgery and/or IRE the immune system is specifically stimulated to recognize the surface antigens of the cancer cells and the CSCs at the same time. With this cancer vaccination process the CSCs are eliminated, and this prevents new cancer cell clones (metastases) from developing. Dr. Onik has recently treated incurable cancer patients and has a cure rate of about 30% (personal communication) in patients who previously would all have died. Others are partial cures, where patients live much longer than anticipated. Using these techniques it is possible in many cases to cure end stage cancer. This has been done with liver and pancreas cancer, cancers that are extremely difficult to treat otherwise.

Cancer Stem Cells

Cancer Stem Cells

Conclusion

Cancer seems to develop out of cancer stem cells that are abnormal cells with genetic mutations. They are resistant to chemotherapy and radiotherapy, but respond to surgery, to cryotherapy and to irreversible electroporation (IRE). The advantage of cryotherapy and IRE is that the tumor and the cancer stem cells are removed, but at the same time the killed cancer cells stimulate the immune system to produce cancer-fighting antibodies that kill metastases and any remaining cancer stem cells. Although initially shown to be effective in prostate cancer patients, this method has since been tested in terminal cancer patients with pancreatic cancer, melanoma, liver cancer, brain cancer and many more solid tumor types.

Cancer is a disease of the immune system, and it is only logical that immunotherapy will achieve successful treatment. Surgery can only be successful, if the entire tumor is removed, which in many cases is not possible. Radiotherapy leaves cancer cells behind that will become resistant to treatment. Chemotherapy has the dismal prospect of killing the immune system and ultimately the patient. It appears that cryotherapy (and/or IRE) and the associated immunotherapy are the way of future cancer treatments. This is the most important breakthrough in cancer research during the last ten years.

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Aug
27
2016

New Prostate Cancer Treatment

The June issue of Life Extension reviewed a new prostate cancer treatment. Prostate cancer affects about 180,000 men per year and 28,000 die every year from prostate cancer metastases. Dr. Gary Onik, interventional radiologist in Ft. Lauderdale, FL, developed a new prostate cancer treatment protocol. Two years ago he published a medical paper about a 10-year follow-up on a group of 70 prostate cancer patients who had been treated by him.

New prostate cancer treatment protocol

  1. Usually it is a rising prostate specific antigen test (PSA) that tells the treating physician that not all is well with the patient’s prostate gland. In the last two years a new more specific and very sensitive genetic screening test has been developed, called Oncoblot test. If this is positive for prostate cancer, it is almost as good as a prostate biopsy that shows the cancer cells directly. But at this point the medical profession does not accept the Oncoblot test as being proven reliable despite the fact that the FDA has approved it for cancer screening.
  2. The gold standard: a transrectal prostate biopsy has been considered the “gold standard” for the last several decades. However, 14 years back Dr. Onik decided to develop a more meaningful and more reliable prostate mapping biopsy. With this 3-dimensional mapping biopsy the examiner inserts many biopsy needles through the perineum, the skin between the base of the scrotum and the anus. The location of the needles are carefully kept track of and sent to the pathologist for histological analysis. This way the biopsy results can be projected as a 3-dimensional image of the prostate cancer on a computer screen. This becomes the basis for the next step in the treatment protocol.
  3. Cooling probes are introduced through the perineum and placed exactly where the prior prostate mapping biopsy located the cancer. It is this closely controlled placement of the treatment probes that ensures a much higher treatment success rate compared to the “gold standard” of the robotic prostatectomy (removal of the prostate gland).
  4. The patient is followed up with PSA blood tests at 3-monthly intervals until the level is low and stable. Should there be any rise in PSA the patient is reexamined with another prostate mapping biopsy and treatment may have to be repeated until the PSA is low or negative again.

10-year follow-up of 70 men with prostate ablation therapy

Dr. Onik followed 70 prostate cancer patients using the above protocol for a total of 10 years. The patient’s age was between 45 and 77 years at he time of surgery. 66 of Dr. Onik’s patients survived until the end of 10 years. The four who passed away, died of causes other than prostate cancer making the “disease-specific” survival rate 100%. PSA stability was achieved in 89% of the patients.

High risk and low risk survival data with new prostate cancer treatment

Prostate cancer patients can be classified into high-risk, medium-risk and low-risk. This is done based on the histological characteristics of the cancer, the Gleason score (a measure of how aggressive the cancer is), the stage (based on the extend of the cancer) and the height of the PSA level.

Using conventional treatment (prostatectomy) long-term follow-up data show that low-risk patients have a disease free survival of 85%, while high-risk prostate cancer patients have a success rate of only 45%.

In contrast to this Dr. Onik’s protocol achieved a biochemical disease-free survival of 90% for low-risk patients, 88% for medium-risk patients and 89% for high-risk patients. Surprisingly there seems to be no difference with regard to the long-term outcome of any of the risk levels. This is unique for the Onik method of focal cryoablation therapy.

What is focal cryoablation therapy, the new prostate cancer treatment?

The prostate cancer is frozen much like a wart is frozen by liquid nitrogen treatment in the doctor’s office. In the case of prostate cancer ablation liquid Argon is used for freezing. The application is closely controlled temperature wise using heat probes to ensure adequate freezing. Special cooling probes are brought to the cancer areas that were identified by the prostate mapping procedure beforehand. The freeze/thawing is done three times. This way a 100% kill of all of the cancer cells is achieved at the time of the procedure. The treatment for every patient is individually geared to his condition.

Comparison of focal ablation treatment with traditional prostatectomy

After 5 years of prostate mapping biopsies Dr. Onik published a study where he looked at 180 men who had been diagnosed with prostate cancer on one side of the prostate gland by standard rectal biopsies. When he did mapping biopsies involving the whole prostate gland he noticed the following:

  • 61.1 % (110 patients) had cancer on both sides of the prostate
  • 22.7 % (41 patients) who had been classified having a cancer with a low-grade score increased to an intermediate-grade score
  • 19.4 % (35 patients) had cancer growth in very close proximity to either nerve bundles or blood vessels.

69.4% of those patients who had been diagnosed as having only low-grade, one-sided tumors were found to have more extensive cancers. With the previous classification they were thought to need only active surveillance (also known as “watchful waiting”). But with the detailed mapping biopsy results they now had at least one finding that reclassified their disease to requiring a more aggressive cancer treatment protocol. Other physicians have found the same thing when looking at these patients with more sensitive MRI scans. The prostate cancers were more extensive than when depicted with simple MRI scans. In some patients where areas on one side of the prostate seemed free of cancer using traditional MRI’s, now showed cancer on both sides using the more sensitive MRI scanners. Also using blind rectal biopsies, which is the standard technique that most radiologists use, can often miss prostate cancers that are found with sensitive MRI scanners or Dr. Onik’s mapping biopsy.

Complication rate with new prostate cancer treatment

  1. The recurrence rate of prostate cancer treated with cryotherapy ablation therapy after 10 years was only 4%. Compare this to a study where prostate cancer was treated with radiotherapy. After 10 years the biochemical disease free survival for low risk patients was 78%, for medium risk 78% and for high risk 62%. This translates into cancer recurrences of between 22% and 38% depending on the risk stratification. The so-called golden standard procedure (robotic prostatectomy) showed the following: in a study that went on for 5 years there was a 28% overall recurrence rate. When the margins of the prostatectomy were examined, the following amounts of cancer had remained: 23% for low risk patients, 29% for medium risks and 42% for high risks.
  2. Urinary continence was maintained in 100% of the cases meaning that the nerves going through the prostate gland were preserved.
  3. Only 6% of patients treated with ablation therapy had problems with sex 10 years after the procedure. This compares favorably with the other treatment modalities that have much higher rates of sexual problems.

Overall cryoablation therapy is very well tolerated and removes tumor tissue exactly where the 3-D mapping biopsy findings show the prostate cancer to be located. This helps the patients’ survival rates.

Conventional treatment failures versus the new prostate cancer treatment

What are the reasons for treatment failures with conventional prostate cancer?

  1. Blind prostate cancer biopsies are generally trans-rectal procedures. They lead to infections of the prostate, in rare cases even to blood poisoning (septicemia), but they often miss cancers that are present when mapping biopsies are done. With rectal biopsies only 8 to 16 biopsies are done. They are blind, the physician does not know exactly where the biopsies came from. With the mapping biopsies the doctor keeps track carefully where the biopsies originated from and they are sent separately to the pathologist. With the mapping biopsy 60 to 90 biopsies are taken depending on the size of the prostate gland. There is a much higher resolution of the area where the prostate cancer is located. This helps the physician where to focus the cryoablation treatment.
  2. Poor diagnostic tests prior to cancer surgery lead to missed prostate cancer removal, which in turn lead to recurrences. Total prostatectomy (robotic prostatectomy) is not total, but only 70% are removed, leaving chunks of prostatic tissue behind. Often it is there where undiagnosed prostate cancer is left behind. This explains the poor 5-year follow-up results of 23% to 42% recurrence rates after the “gold standard prostatectomy”.
  3. Only the mapping biopsy that depicts the entire prostate gland (which is done perineally to prevent infection) can show exactly where the cancer is located. This is subsequently removed in its entity.
  4. The cryoablation therapy is likely stimulating the immune system to send killer T cells to help with the destruction of any remaining cancer cells. This may partially explain the low 10-year recurrence rate of only 4%.
New Prostate Cancer Treatment

New Prostate Cancer Treatment

Conclusion

Dr. Onik, an interventional radiologist from Ft. Lauderdale, FL, has developed a new focal ablative prostate cancer treatment. He showed in a study going on for 10 years that it is superior to either radiotherapy or robotic prostatectomy. With the baby boomers aging and prostate cancer being a disease of aging men, this has just arrived in time to be beneficial to any man who is diagnosed with prostate cancer. Most patients are suspected to have prostate cancer when their PSA value gets elevated above 4 or 5. Instead of taking a risk of blood poisoning with E. coli or developing prostatitis from the transrectal biopsy approach, the patient may want to consider having the 3-dimensional mapping biopsy done by Dr. Onik in Ft. Lauderdale. This is done through the perineal approach, which shows the exact location of the cancer. Using cryotherapy probes with liquid Argon the cancer is focally treated, which is similar to a lumpectomy in a woman with early breast cancer. Cancer recurrence rates at 10 years were only 4%. The good news is that a mapping biopsy of the prostate can be repeated, if rising PSA levels should occur in future. This shows whether there is a cancer recurrence, and this can be treated again with cryotherapy. The future will see more physicians embrace this method, as several centers are being planned in the United States. They will very likely replace a “gold standard” of prostate cancer treatment that is less than perfect.