Ronald E. Wheeler, M.D., Noted Urologist is releasing his book "Men at Risk: A Rush to Judgment". Click Here to read chapter one "Too Many Radicals Too Many Failures" and avoid a Rush to Judgment.

Do you have Prostate Cancer? If you do or you think you might, you need this book to help you navigate through the mine fields of failed treatments and wrong decisions. This book will answer every question you've ever had about Prostate Cancer. Before you make a rush to judgment about what to do, read this book. It could save your life!

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“Men at Risk, a Rush to Judgment”
Chapter One

“Too Many Radicals…Too Many Failures”

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When you hear the news that you have prostate cancer, what are you going to do? Rather than panic, you must accept the facts and start the learning process. Your exit strategy from this dilemma will be to define how your cancer will be managed. Proven treatment options range from conservative management called chronic disease management (CDM) with no impact to your quality of life to radical surgery with a major impact to your quality of life. Deciding how you will treat your prostate cancer will become the most important decision you will make for the remainder of your life. Ultimately, your decision process must be acceptable to you and your family while minimizing undue risk.

Prostate cancer is a disease that does not discriminate, wreaking havoc on all men irrespective of age, ethnicity, education, financial or social status. When it comes to prostate cancer, all men are equally ignorant. Prostate disease in general and prostate cancer specifically; represents a diseased organ that must be understood and embraced by men of all ages. Often times referred to as a disease of healthy men, the disease has no boundaries, no conscience, and will strike most times with no warning other than an elevated PSA (prostate specific antigen). Your only defense is to be educated on the disease, get motivated and become proactive while optimally maintaining a PSA of less than 1.0 ng/ml. Many men who fail to heed my warning will pay the ultimate price with their life. Many more will be spared but asked to endure a life of subtraction, losing the qualities from life that makes being a man so special.

Statistics on Prostate Cancer

While prostate disease is the number one health risk that men face, prostate cancer is the most prolific organ cancer that men acquire in their lifetime as well as the second leading cause of cancer death. To state more specifically, one in six men will be diagnosed with prostate cancer in their lifetime while it has been stated, ‘all men will get prostate cancer if we live long enough’. Unfortunately, African-American men have a rate of prostate cancer that is twice their Caucasian counterparts. According to the American Cancer Society, an estimated 230,000 men will be diagnosed with prostate cancer this year while in excess of 30,000 men will die from the disease. This translates into a new case of prostate cancer diagnosed every three minutes while a man dies from prostate cancer every16 minutes of every day. With the baby boomer generation aging into their 50s and 60s, the expectation is for 50,000 men to lose their life annually secondary to prostate cancer by the year 2020. While men in their 60s experience the news that prostate cancer has been detected most frequently, 30% of 30 year old men will acquire the disease only to have their lives spared initially as this renegade disease incubates for upwards of 15 to 20 years before the impact is realized with a rising PSA blood test; enabling the diagnosis to be made in the majority of patients. When you decide to become motivated to learn more about this disease is your decision; what you learn about the disease and how you treat the disease is my life’s work and the heart and soul of this book.

Radical Prostatectomy – Gold Standard or Educated Guess

Historically, radical prostatectomy (total prostate removal) has been the most common treatment offered and rendered when prostate cancer is diagnosed. The irony of treating the most prolific male cancer most frequently with radical prostatectomy is that the failure rate will be equally prolific. While prostate cancer is being detected earlier, there is no convincing data to suggest a survival advantage of radical prostatectomy over brachytherapy (seed therapy) with or without external beam radiation, external beam radiation alone, cryosurgery or a treatment strategy called chronic disease management (CDM)(refer to the CDM chapter for a comprehensive review of this concept). Only with watchful waiting (which I do not recommend) is there a slight survival benefit to radical prostatectomy. To put this concept in proper perspective, there is significant data to suggest alternative therapies like CDM may make the better first choice when the inevitable happens and the disease comes calling.

If 10 men with prostate cancer are lined up and evaluated, doctors cannot predict accurately who will be cured and who will fail regardless of who presents with the best disease characteristics. Equally unsettling is that all 10 men must receive the most aggressive and traumatic treatment (radical prostatectomy) to yield a 60-70% success rate at 5 years regardless of their choice of Operating Physician or Medical Center selected for the surgery. 10 year data is another story of limited success and will never equal the success at 5 years. In effect, regardless of our surgical skill level, the outcome from major surgery is unpredictable, thereby, reduced to a guessing game where the outcome always remains a question mark.

So why is radical prostatectomy performed so often? While this is a great question, the answer is very elusive. We hear phrases like, “that’s what I was trained to do”, “it’s the ‘Gold Standard’ in prostate cancer treatment”, “and it’s the only way that we can be sure that all of the cancer is gone” or “this procedure gives you the best chance for cure”. When a patient asks a doctor for his best recommendation and the only procedure he performs is a radical prostatectomy, what do you expect him to say? Even if the doctor performs seed therapy, cryosurgery and radical prostatectomy but believes the radical approach is best for most patients, do not expect him to give a glowing endorsement for either of the other two choices? While doctors are supposed to be unbiased in their educational approach, it is difficult to remain completely unbiased when the meeting between doctor and patient may be the only opportunity the doctor has to make an impact. Remember, despite the Hippocratic Oath, treating prostate cancer is also a business.

Physician Practice Patterns

In a survey of more than 500 Urologists reported on in the Journal of the American Medical Association (JAMA), the question was asked of Urologic Surgeons; what approach should be taken with a 65 year old male with a newly diagnosed prostate cancer associated with a Gleason score of 7 and a PSA of less than 10.0 ng/ml? For those unfamiliar with the meaning of Gleason score, I refer you to the glossary and/or the pathology section for a review. For those more familiar with the term, a Gleason score of 7 represents a moderate to poorly differentiated cell type, commonly encountered in approximately 30-35% of all cases of prostate cancer. Relevant to the questionnaire and to the surprise of no one, a traditional Urology line of thought was endorsed by 90% of the Urologists polled, thereby recommending a radical prostatectomy for this patient. While this opinion from a surgeon may come as no surprise, there is minimal documentation to support the strength of such an opinion.

In an effort to establish diversity of opinion, noting that doctors would only recommend what was best for the patient; Radiation Oncologists were asked their recommendation for the same patient type with the same cancer characteristics. Can we expect Radiation Oncologists to be more objective than the surgeon? No, not really! The majority of Radiation Oncologists followed the dictum of their residency training manual and recommended brachytherapy (radiation seed implantation) or external beam radiation or a combination of both. Patients, therefore, who seek these professional opinions, must be mindful that it may be difficult to get an unbiased opinion from a physician who is biased based on how he was trained and how he practices. It is often said and bears restating; “If all you have is a hammer, it is amazing how everything begins to look like a nail”. I am not trying to be overly critical but this is the perception that doctors are giving. If you can’t get a straight answer from your doctor; then who do you trust; who do you believe? In this imperfect world, the burden for an improved understanding of the disease and its various treatments, unfortunately, becomes the responsibility of an undereducated patient. This doesn’t seem quite fair as little has been done to diminish the anxiety the patient experiences when the diagnosis is made. Based on a likely rush to judgment that is commonly experienced when the diagnosis of prostate cancer is made, patients are encouraged to become increasingly aware of the peril and consequences associated with prostate disease treatment prior to an event; not after the event.

Patients are encouraged to become increasingly aware of the peril and consequences associated with prostate disease treatment prior to an event; not after the event.

Taking the time to study your options is supported by research performed at Johns Hopkins Medical Center. What they demonstrated is that while the diagnosis of prostate cancer must be taken seriously, a delay in treatment of months or even years may not change the course of the disease and the outcome. While this will likely depend on the specific characteristics of disease identified in a given patient, the news is nonetheless, heartening as the task to understand the disease and the various options is significant and will take a concerted effort and ample time by all who choose to be well versed.

Better Imaging, Better Decisions, Better Results

This book will, therefore, serve many worried men and families as an objective resource that must be completely understood before the decision is made on how to proceed when the diagnosis of prostate cancer is made. While it is critical to determine the extent of disease in order to select the best treatment strategy, it is equally important to realize that few of us understand the futility of our present diagnostic process based upon our current imaging tools and random biopsies. It is for this reason that I am very excited about Magnetic Resonance Imaging Spectroscopy (MRIS) discussed in more detail later in this book. MRIS performed with a 3.0 Tesla magnet may well be the best diagnostic modality for the detection of prostate cancer prior to a biopsy or to establish organ confinement when a biopsy had been previously performed. This diagnostic modality provides the most accurate decision making technology based upon excellence of image quality ensuring the best chance for ultimate success. This scan, which I call the “Ultimate Prostate Scan”, will provide precision prostate cancer localization allowing us to validate whether the tumor is truly organ confined prior to any proposed therapy. If organ confinement is not established, there is inadequate scientific data to support removal of the prostate. To state further, the 3.0 T MRIS scan provides a road map of objective imaging excellence to validate cancer localization while spectroscopy allows us to understand the biochemical components of the tissue in question. Together, these scan sequences are integral to changing the paradigm relevant to the diagnosis and treatment of prostate cancer.

If organ confinement is not established (with 3.0 T MRI-Spectroscopy), there is inadequate scientific data to support removal of the prostate

Chronic Disease Management

Conservatively speaking, when the diagnosis of prostate cancer is established, prospective study data associated with our research treatment protocol evaluates the benefit of diet and nutrition versus prostate cancer. The study entitled, “Is it necessary to cure prostate cancer when it is possible” supports the concept of allowing men the opportunity to live with prostate cancer much like patients would live with Diabetes or Arthritis rather than undergo organ removal or radiation. If men decide later to attempt to cure the disease, their chance of success should not have been diminished by the delay. In other words, time is an ally that allows us to avoid a rush to judgment. Quite frankly, by delaying a choice of definitive decision making, anxiety is reduced, as the advantages and disadvantages of every therapy become better known. Better stated, you cannot accept the consequences of your decision until you fully understand the lifestyle you have to accept when the choice is made. The key to the success of our research treatment protocol relates to the ability to suppress or resolve the signs and symptoms of inflammation (non-bacterial prostatitis) through a patented dietary supplement called Peenuts®. This formula represents a synergistic blend of vitamins, minerals, herbs and amino acids; validated by an improvement of white blood cells (sign of inflammation) associated with the prostate secretion obtained at the time of digital prostate exam. While diet plays a role, the protocol to success will become quite apparent once you have reviewed the dietary and nutritional sections in this book.

You cannot accept the consequences of your decision until you fully understand the lifestyle you have to accept when the choice is made

Relevant to the prospective study, 30 patients with known prostate cancer had been evaluated over an average time frame of 49 months. 28 out of 30 patients noted a marked improvement or decrease in their PSA (the recognized marker of disease activity) of 55%. This is truly remarkable and quite frankly has never been seen before in this large of a study group. While I am pleased with the outcome, I am not surprised as I have experienced significant improvement in thousands of patients over the years. To state further, this concept has not been studied adequately, heretofore, as it has never received priority funding. It is my hope that visionary philanthropists, who understand and embrace my beliefs, will come together to provide the capital expenditure that will validate the research that I have done as well as promote a prostate cancer prevention trial. The Prospective Study, touched on above, will be described in its entirety later in this book.

Clinical Case Study # 1

Let’s take a look at an actual clinical case that allows us to better understand the present state of prostate cancer treatment and the associated angst that comes with the diagnosis. Jon Freda, a 54 year old Caucasian male, was diagnosed with prostate cancer with a Gleason score of 6 (3+3) associated with a PSA of 4.2 ng/ml. A Gleason 6 prostate cancer designation comprises the most common cancer cell type identified, as well as recognized to be the cancer type that predicts the most favorable clinical outcome. This is the group of patients that Pat Walsh, M.D. and the team at Johns Hopkins and other major centers of excellence operate on to establish their respective outcome data, thereby, validating their treatment choice of radical prostatectomy for prostate cancer. This is also the group of cancers that many experts like Michael Barry from Harvard believe are over treated. In other words, many men with this classification of cancer would do equally well with a radical prostatectomy (assuming cure) or with a more conservative approach like Chronic Disease Management (CDM -reference the Prospective Diet & Nutritional Study) or active surveillance, if offered. It is for this reason that word needs to be promulgated throughout the world that CDM is a viable alternative to radical prostatectomy or radiation when this category of cancer is diagnosed.

Based on Jon’s relative youth and fear of impending death from a presumably predictable cancer, the patient agreed to a radical prostatectomy at the urging of his family and surgeon. Now 6 years later the patient’s PSA is rising consistent with treatment failure. A progressive rise in PSA following any attempt to cure signals the failure of the operation (or any definitive therapy) to cure the disease. This is also called biochemical failure or disease relapse. A rise in PSA despite the removal of the prostate tells you that the disease had escaped the prostate while looking to find a new source of nourishment in the lymph nodes or bones (or both). It is estimated that the range of disease recurrence following radical prostatectomy or radiation is 30-40% and possibly as high as 40-60% by 7-10 years. The earlier the rise in PSA following surgery or radiation and/or the failure to nadir the PSA to less than 0.5 ng/ml suggests that the disease is more aggressive and was likely systemic at the time when the disease was thought to be localized or confined to the prostate. Unfortunately this information does not help us after the fact except to predict a troubled and probable aggressive clinical course that will likely hasten the patient’s demise. The only way to have avoided this misstep is to have avoided the surgery that you thought would get rid of the disease in the first place. Confused? Join the millions, who like you, are going to learn first-hand from this book and the experiences of others. Minimally the failure of Jon Freda to be cured calls into question the ability to cure anyone with certainty and should slow the march of the ignorant or educationally challenged to the operating room door.

The literature suggests the failure to cure a patient when radical prostatectomy or radiation is performed, bodes poorly for the patient. Specifically, according to Anthony D’Amico and colleagues, when the PSA doubling time (the time it takes for the PSA number to double) is less than 3 months following radical prostatectomy or radiation, the patient has a 20 times increased chance of dying from prostate cancer within 6-10 years. Importantly, our clinical research concurs showing the clinical course observed for the patient who isn’t cured by radical prostatectomy or radiation will be a much more aggressive battle to fight than the individual who chose the more conservative treatment concept associated with a strategic CDM protocol, whereby, the patient learns to live with the disease. Examples will be provided throughout this book that will make this point very clear.

Returning to the case of Jon Freda; again, a gentleman who could have lived with this disease very easily with CDM, there were issues other than a rising PSA following the failed attempt at cure with radical prostatectomy. Ever since the operation, this patient has been a sexual cripple; meaning that he cannot achieve adequate erections despite the use of erectile stimulating drugs like Viagra (the little blue pill) or Caverject (an injectable known as a 5-PDE Inhibitor). He also complains of urinary leakage which would be tolerable if only the operation was a success. What is sad is that this patient should have been cured as his disease characteristics could not have been more favorable; suggesting that anything short of cure is a significant failure. This case history establishes very clearly why a more conservative approach may have been the better first choice. Unfortunately, Jon had never been told that he could live a long and prosperous life with the prostate remaining untouched using a CDM protocol. Had this happened Jon would not have been the first patient discussed in this chapter.

While hind site is 20/20, this is the reason, nonetheless, that patients must become increasingly aware that radical prostatectomy is not what it is made out to be. There are no guarantees even when you hear…the treatment represented ‘gives you your best chance at cure’. Improved awareness and understanding of the topic is the only defense that will allow the patient to comprehend the options discussed; but more importantly, to walk away and rethink what has been discussed absent the emotion of the moment. It is my opinion; while our patient Jon Freda made the ultimate sacrifice for an unnecessary chance at success, I believe he would have been willing to live with quality of life limiting side effects of impotency and incontinence had the cure been achieved. At this junction in Jon’s life, he is now facing off with the next set of questions that will require intelligent decisions related to how the disease will be managed moving forward. His choice at this point is to consider radiation or CDM (active surveillance). Radiation, replete with its own set of side effects, including but not limited to rectal bleeding and radiation cystitis, is also likely to worsen his already limited potency as well as worsen his ability to control his bladder. A much more reasonable approach would be the use of a CDM or active surveillance protocol.

At this point, Jon’s cancer will respond predictably to hormone manipulation utilizing an anti-androgen (Flutamide, Casodex or Nilutamide) given intermittently. While his PSA is just beginning to rise from the nadir of 0.2 ng/ml, I would defer the use of an anti-androgen until the PSA becomes substantially higher. This would allow us an opportunity to try other conservative measures to extend the doubling time as no one knows predictably that the disease cannot be stabilized when conservative measures are employed; noting no two cancers are alike. Besides, earlier treatment with an LHRH-analog or anti-androgen at a lower PSA number may hasten the onset of hormone refractivity (disease resistance), a well known consequence of hormonal manipulation. Furthermore, I would not discount the role of diet and nutrition to assist holding the cancer in check. In an effort to prevent the PSA from rising to a higher and more definable number, I would use various products or formulas associated with various mechanisms of action versus the disease process in an effort to enhance a successful outcome, and thereby, prolong life. Remember, while there is no clear decision choice, there are also no tests that can tell us with certainty where the cancer is located or that the cancer will not respond to conservative measures; now that radical prostatectomy has failed to be the treatment to cure the disease. At this point, I will assist Jon regardless of the choice he makes and do all I can to foster his success, including the application of a CDM protocol in the event radiation is chosen and fails. It is not as important why this clinical scenario happened with Jon, but rather, how we can prevent this from happening to the next generation of men diagnosed with prostate cancer!

Clinical Case Study # 2

Carl Lackey’s case history and clinical experience is equally riveting for even the most learned or savvy prostate cancer patient! A 60 year old former All-American hockey defenseman at Michigan State University, who now resides in Green Bay, Wisconsin, Carl learned he had prostate cancer when his PSA reached 8.2 ng/ml in October, 2004. The year prior, his PSA was 3.9 ng/ml. It is unfortunate, but when he asked if there was anything that could be done to try to lower the PSA, he was told by his Urologist, it was still in the normal range and not to be concerned. A 12 core biopsy, performed a year later based on the 8.2 ng/ml PSA, yielded a Gleason score 4+4 cancer in 3 out of 6 biopsies on the left side and a cancer precursor cell type called High Grade PIN (prostatic intraepithelial neoplasia) on the right side (See Glossary and Pathology Chapter for an improved understanding of these terms). His biopsy stage was T2b meaning that significant disease (cancer) was located in more than one quadrant on the left side of his prostate. Following the biopsy, the PSA value reached a high of 13.0 ng/ml. Given the poorly differentiated cancer cell type, Carl went about the process of trying to determine the best way to defeat the disease. 3 Urologists representing 3 different Urology practices had recommended that a radical prostatectomy was his only chance to survive the disease. One Urologist went so far as to state; if he did not have the radical surgery, he would be “dead within 1 year”. Concerned for his well being and quite frankly scared beyond belief, Carl had decided hastily that surgery seemed like the only option. He had completed his pre-op evaluation and had received the hospital wrist band, defining him to all hospital personnel, as scheduled for surgery. At home, his wife Sandy was feverishly looking for other options as she did not feel good about the choice that the man of her life had made. Several days prior to his early morning arrival at the hospital for the expected surgical procedure, Carl’s life changed. Sandy had come across my website, www.TheProstateCenter.com and placed a toll free call to the clinic. While I can’t recall if it was that day or the next day, I had a chance to talk to the man with the disease about his treatment and what, if any, was his expectation from the surgery.

After a brief factual and straightforward discussion, Carl cut the hospital wrist band from his arm and scheduled an appointment at my clinic in Sarasota, Florida. In our conversation, I had said nothing that would diminish his hope for a successful outcome, although, I had informed him that while radical prostatectomy may have provided his greatest percent chance for cure, as represented by his 3 urologic consults, no one informed him, the percent chance of cure was only 15%. In other words, 85% of all prostate cancer represented by Gleason Scores of 8, 9, or 10 would have disease recurrence within 5 years. He was incredibly disappointed that no one had discussed the literature based facts on the historical surgical futility associated with this cancer grade, but rather, opted for a leap of faith to try to save his life. No one had allowed Carl and Sandy the opportunity to understand that what they were about to do, made little sense and was obviously the wrong approach based on well documented statistics and therefore, should have been out of the question as an option.

The Clinic Appointment – A Difference Maker

By making the commitment to see me in the clinic, Carl and Sandy had become a member of my extended family. During the 3 plus hour clinical evaluation and interview process, I reviewed viable options including the option of allowing Carl to live with the disease through a protocol of CDM. Minimally, this option would buy us some time while not burning a bridge; allowing us to be more aggressive later if an option presented itself that made sense when the risk-reward discussion took place. My clinical experience allowed me to share other patient success stories using the CDM concept. Together we created and accepted a treatment strategy that was intended to minimally stabilize the cancer disease process. I made it very clear that we were in this together and I was as close as a telephone call. I was confident we could make a difference! Based on his heightened disease status and aggressive Gleason Score, I elected to start him on a CDM protocol that included various mechanisms of action to suppress the disease or make it less aggressive or even dormant.

First and foremost, Carl was placed on the Modified Mediterranean diet as well as the Peenuts® prostatitis formula to resolve prostate inflammation. This was an important step as prostatitis has been shown to evolve into prostate cancer by many research experts including the American Association of Cancer Research (AACR), headed up by Johns Hopkins and independently by David Bostwick, M.D., a world renowned Pathologist. Carl was also started on Avodart (a 5 alpha Reductase inhibitor) at 0.5 mg daily to decrease the conversion of Testosterone to Dihydrotestosterone (DHT) as well as promote an anti-angiogenic component (decreases new blood vessel formation) while reducing the size of the prostate. We knew full well that the PSA would be decreased by some number less than half based on the combined presence of benign prostatic hyperplasia cells and cancer cells. I was also cognizant of the Prostate Cancer Prevention Trial (PCPT) data where Finasteride (a 5 alpha Reductase inhibitor) was associated with a decreased incidence of prostate cancer by 25% when compared to placebo. While I had no data to show specific benefit versus prostate cancer with this class of drug, I did not want the cancer to be exposed to DHT, the more active form of the cancer growth promoting male hormone. Vitamin D3 (the active form of Vitamin D) was added for its benefit in decreasing prostate cancer cell proliferation, while Omega 3 fatty acids were added to enhance the heart healthy Omega 3:6 fatty acid ratio while also decreasing prostate cancer cell proliferation.

The last integral piece of the treatment strategy was the use of Casodex (Bicalutamide), a non-steroidal anti-androgen, used at 150 mg per day, similar to the dose effectively used in Europe. I have had tremendous experience using Casodex at the aforementioned dose as a monotherapy. This represents a higher dose than that typically used in the United States but is quite safe and effective when used intermittently. Specifically, the anti-androgen blocks the prostate cancer cell receptor, thereby, inhibiting the growth of cancer. To state this differently, Testosterone, which remains normal to high utilizing this treatment protocol, is preferentially blocked from its usual action of attaching to the cell receptor at the nucleus, allowing the cell to become disabled and die. The concept is analogous or similar to what you would expect to see when you put plastic child safety caps on an electrical outlet. No matter how hard you try to connect an electrical plug of a lamp (as example) to the source of electricity, you can’t do it. Thusly, Casodex blocks the interaction of DHT with the cell receptor and promotes cell death preferentially over cell growth.

While there are a few side effects from the use of Casodex, as a monotherapy, including but not limited to a transient elevation in liver enzymes, mild breast tenderness or swelling and the potential for diarrhea, the side effect profile is acceptable for the anticipated short interval of usage. The side effect profile, nonetheless, can be avoided using additional medications or supplements that would minimize and/or eliminate these concerns. Using this approach, we were able to avoid an LHRH-analog (Luteinizing Hormone Releasing Hormone), thereby, by-passing chemical castration associated with its host of undesirable side effects including but not limited to: lethargy, increased fasting blood sugars secondary to decreased insulin resistance, muscle wasting, hypercholesterolemia, anemia, bone loss, hot flashes, cognitive changes, depression, mood swings, and weight gain. When used as a monotherapy, intermittently, disease specific anti-androgen therapy has a tremendous lifestyle advantage when compared to the more traditional monotherapy of an LHRH-analog alone or in combination with an anti-androgen (combined androgen blockade), discussed elsewhere in this book.

The decision was made to use the anti-androgen intermittently between PSA action points of 10.0 ng/ml and 1.0 ng/ml. 10.0 ng/ml or higher would mark the point where Casodex would begin and 1.0 ng/ml or lower would mark the point where the Casodex is discontinued. For the short term, Carl remained on the treatment protocol for 17 months in total. During this timeframe, the Casodex was used for the first two months only, dropping the PSA (the marker of disease activity) from 13.0 ng/ml to 0.3 ng/ml. In effect, Carl had been off of Casodex for 15 months, while his PSA had remained stable at 1.7 ng/ml. This response represents a truly remarkable turn of events for a very aggressive cancer; possibly never recorded before in the annals of medicine. In his yearly follow-up appointment to the clinic, Carl’s white blood cell count associated with the expressed prostatic secretion had gone from TNTC (too numerous to count) down to 45 white blood cells when reviewed under 400X (microscopically). This represented a 91% decrease in the inflammatory response; a process that promotes prostate cancer evolution. While the reduction in white blood cells is attributed to the Peenuts® formula, Carl’s urinary symptoms had also improved from 10.5 (moderate symptoms on the International Prostate Symptom Score Index (IPSS-Index)) to 1.5 (mild symptoms) in the same time frame representing an improvement in symptoms of 86%; again attributed to the patented prostate formula. (refer to the addendum for the complete IPSS-Index).

In his follow up, rather than discussing his demise or worse yet, death, as predicted by one of his previous Urologists, the three of us celebrated a measure of victory versus an unpredictable and potentially deadly disease. We had demonstrated the success of CDM in a very difficult clinical scenario. While I believe this case represents one of the more spectacular responses of prostate cancer to CDM, highlighting Casodex as a monotherapy, this should not diminish the impact of key nutrients and medications as outlined previously. While I am sure I will hear from my colleagues that this case is “too good to be true”, I always welcome calls from any of my critics. More importantly Carl and Sandy would be happy to share their joyous experience with those who care to contact them. Maybe someday, Carl and Sandy will be able to tell their story on a bigger stage, thereby, bringing more than just hope to the hundreds of thousands of men who face the same uncertainty of prostate cancer every day. Now, with the disease suppressed, the Lackeys decided to take yet, another step; in effect, a calculated risk to get rid of the disease once and for all, by undergoing High Intensity Focused Ultrasound (HIFU) at a site outside of the USA under my supervision. HIFU is still under FDA scrutiny and therefore not offered on US soil as of June, 2006. Carl’s progress will be monitored by a spectral analysis of his prostate, using the 3.0 Tesla magnet from General Electric to validate an absence of disease without the need for additional biopsies to confirm. I refer you to the section on Magnetic Resonance Imaging Spectroscopy (MRIS) for an improved understanding of this technique, as well as rationale, for why prostate biopsies may soon be a technique of the past as the procedure of choice commonly used to confirm treatment success or failure.

What will you do when Cancer is Diagnosed?

So when the diagnosis of prostate cancer is made in your case, what will you do? Will you try to live with the disease or do you have to remove the cancer at any cost? Is your goal a cure and if so, is this realistic? While I never want to deprive you of hope, false hope and unrealistic expectations is unfair to you, the patient, who so desperately wants to succeed. If cure is possible, what are the chances of success? Is it worth the risk when your chance of success is less than 50%? If cure is impossible, what is the best strategy to ensure the best outcome? This is not as simple as applying a radical prostatectomy or radiation to a cancer but rather lies in a multi-factorial approach that may include a radical prostatectomy or radiation but only if the odds of success are overwhelmingly in your favor and you are willing to take the risk. Based on the inability to predict success predictably versus prostate cancer suggests that we should take our time and consider all options including CDM before the commitment is made to proceed. Get a second and a third opinion! If you act on impulse and make the incorrect choice, you will have, what will appear to be, a lifetime to lament the error in judgment.

If you act on impulse and make the incorrect choice, you will have what will appear to be, a lifetime to lament the error in judgment

An Icon in Urology Speaks Out

William Fair, M.D., former Chairman of the Departments of Urology and Surgery at the esteemed Memorial Sloan-Kettering Cancer Center was so frustrated with his inability to predict a successful outcome with radical prostatectomy or radiation for prostate cancer patients that he stated in a now famous speech from 2000; “Based on everything we know about prostate cancer, I am not sure that it should not be treated as a chronic disease”. While I am not saying that radical prostatectomy is obsolete yet, I am saying that if we continue to apply the same therapy to every patient without a realistic understanding for treatment success as well as limiting the procedure to only those who best qualify, the future of radical prostatectomy will be doomed based on the public’s perception suggesting a lack of physician understanding of the disease, greed and/or inappropriate dogma tied to a disease we know too little about. What Bill Fair may truly have been seeking was a moratorium on radical prostatectomy and radiation therapy until he and other research experts could figure out the natural history of the disease, thereby, selecting patients for a treatment based on a sound strategy as opposed to a “one size fits all” mentality. There is rarely a doctor among us who will share Dr. Fair’s commentary with his newly diagnosed prostate cancer patients, much less, investigate and embrace valid conservative options as appropriate care. These conservative, yet effective, options will be addressed later in chapters that discuss minimally invasive treatment like high intensity focused ultrasound (HIFU).

“Based on everything we know about prostate cancer, I am not sure that it should not be treated as a chronic disease” William Fair, M.D. Memorial Sloan-Kettering

Will you be Proactive or Reactive?

For men with PSA levels of greater than 1.0 ng/ml, it is not too premature to begin to think about the educational process as you will learn later in this book that 20-30% of all prostate cancers are present in the PSA range of 1.0-4.0 ng/ml. If you choose to wait as you believe yourself to be too healthy, you could face the same tough decisions that faced Jon Freda who never knew he had another option. On the other hand, you can think ahead and begin planning your strategy as if you had the disease while possibly avoiding the disease altogether. Will you be a willing participant when a biopsy is recommended when the PSA exceeds 4.0 ng/ml (20-30% of biopsies are positive in this range) or will you reach out first to an improved technology like that available at the Diagnostic Center for Disease in Sarasota for a conformational MRI-Spectroscopy scan, noting that more biopsy procedures are negative than positive? Random biopsies should be discouraged based on the sampling bias as well as the relatively low risk of prostate cancer on any given prostate biopsy procedure; not to mention the risk of spreading cancer cells (if present) beyond the prostate. Will what you have read thus far stimulate you to be proactive and try to avoid an inevitable disease by controlling prostatitis with a patented, scientifically proven, prostatitis formula called Peenuts® or are you content to be reactive and take your chances that the disease won’t come your way? Whatever your personality, whatever your choice, I am dedicated to making a difference with you when the time comes. If cancer is inevitable, I want your case to be predictably successful giving you the opportunity to continue to take from life all that is yours. The remaining chapters in this book are instructional and will make you think. What makes this book different from other prostate books is that I have brought together national, if not international experts who are prepared to present the facts in a fair and balanced format as well as respond to tough questions where they may not have the answer. For these and other reasons, I encourage you to use this book as a learning tool, as a reference and as a guide to keep you health conscious while protecting your prostate and your heart. It has taken me years to do my research and years to write this book, so please take your time to read it carefully and absorb it so that you are equipped to face the battle, should the disease present itself.

For more information, please contact Ronald E. Wheeler, M.D or to speak with one of our Patient Advocates, call toll-free at 1-877-766-8400 or email at staff@mrisusa.com

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