The potential cancer-fighting attributes of a new class of drugs called “COX-2 inhibitors” (COX-2 stands for the enzyme cyclooxygenase-2) was discussed in the July 21 issue of the “Journal of the National Cancer Institute” (JNCI). The COX-2 inhibitors are able to restrain the development of tumors in animal tests, giving hope that they may soon become another weapon in the struggle against cancer.

Researchers first began their studies when elevated levels of the enzyme, COX-2, were found in tumors. Experiments were then designed to see if reducing the levels of this enzyme would reduce the size of such tumors. It was known that commonly used anti-arthritis drugs and pain relievers, such as aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs), actually did lower levels of COX-2. Therefore, scientists used NSAIDs in trials to evaluate the possible anti-tumor effect of lowering COX-2 levels.

Many trials are under way in order to evaluate the cancer-fighting potential of COX-2 inhibitors. Among them is one led by Dr. Raymond DuBois. Dr. DuBois is the principal investigator of the first program to receive a grant from the NCI in support of research studying the effect of drugs intended to prevent, rather than to treat, cancer. This concept is embodied in the term “chemoprevention.” Dr. DuBois commented on recent trials of his program, “The use of COX-2 inhibitors for chemoprevention in humans is still in the experimental stages, but results have been encouraging.”

Blocking this enzyme interferes with production of fatty acids (prostaglandins) that are widely distributed in the body. In trials involving the COX-2 inhibitors, researchers monitor the amount of this enzyme, as well as other markers indicative of the presence of a tumor. Participants in the studies include those who have had tumors removed as well as those who are carriers of certain genetic defects responsible for specific cancers.

Since these recent developments, the producers of the two leading COX-2 inhibitor drugs, rofecoxib and celecoxib, (Searle and Merck & Co., respectively) have begun preparations to expand the testing of the drugs into cancer-related research. While long-term use of NSAIDs sometimes comes at the price of ulcers and other gastrointestinal problems, COX-2 inhibitors are promising because studies have shown that they are less likely to cause these serious adverse health effects.

Past research seems to suggest that after years of therapy with COX-2 inhibitors, reduction of tumor recurrence is possible, but there still remains the question of primary prevention. Also, still to be explored is the question of whether the inhibitor drugs would be used for any tumor that is found to have high levels of the enzyme COX-2, or only a specific class of tumors. We must keep in mind Dr. DuBois? cautious optimism in expectations of what future studies will reveal. He notes that “Without more data, it is too early to recommend the use of COX-2 inhibitors as a treatment to fight cancer.”

What is apparent is that we have come to the beginning of a new era in the fight against cancer. Up until now, medicine has only been able to offer slow gains in cancer death rates, due to gradually improving surgical techniques, and more effective chemotherapy. But with the new data on COX-2 inhibitors and the more extensive results from breast cancer trials using tamoxifen, the era of chemoprevention of cancer may be close at hand.

Dosage
1) One half to two 50 mg pills are usually prescribed for pain, to be ingested four to six hours apart. You may be started at a low dose of tramadol with a gradual increase. This will acclimate your body to the drug so that you will experience few, if any, side effects. 400 mg is the maximum allowable for Tramadol in a 24 hours period.

Adverse Effects
2) Tramadol can cause drowsiness as well as light-headedness. You may also experience nausea or vomiting, particularly at the inception of adopting the medication. If can be beneficial to begin with a weaker dose and steadily increase the strength, as well as lie down when feeling sick of faint.

Seizure
3) Tramadol may lead to incidence of seizure. The severe symptoms such as seizures are rare, but your risk may be greater if you have had trauma to the head, epilepsy, or alcohol or drug problems. The possibility of suffering seizures can go up if Tramadol is taken with antidepressants or sedatives.

Interactions with other Medications
4) Do not drink or take other central nervous system depressants/sedatives such as sleeping pills or allergy medications while taking tramadol. Consult your physician about the possibility of negative drug interaction. The effects of these drugs are intensified by tramadol, so combining them can be dangerous, particularly if you are taking high doses.

Who Should Avoid Tramadol
5) Potentially addictive, Tramadol no prescription should be avoided by those with a tendency toward drug or alcohol abuse. Never to be taken by anyone with suicidal tendencies, Tramadol should be used with special care by those using MAO inhibitors. Tramadol should be avoided by pregnant women due to possibility of miscarriage or stillbirth, as well as infant seizure and withdrawal. You should not take Tramadol if you are breastfeeding, because the substance will penetrate breast milk.

Jimmy

A.From a patient’s standpoint, I understand the desire to try alternative forms of treatment. Unfortunately, many of these are quite costly, are of questionable benefit and can occasionally cause harm. In a patient such as your brother-in-law, who has suffered so much destruction of the joints, it is unlikely that any of these alternative forms of treatment are going to rebuild the cartilage or give significant relief.

A.I once had a patient who developed severe arthritis of the hip while she was in her 50s. After evaluating her, I recommended hip replacement. Instead, she sought out various forms of alternative arthritis treatment, including herbal remedies, acupuncture and psychotherapy. She even went to Mexico for special treatments. She spent over a year trying different things and, unfortunately, got no relief. When she finally had her hip replacement, she couldn’t believe the amount of relief that she experienced. Afterwards, she was upset at herself for having “wasted one year” of her life.

I do feel that there is a role for some alternative forms of treatment, but I think it is important that a patient be realistic. For some reason, there is a misconception that alternative treatments are harmless. Unfortunately, some of these treatments do have complications that patients are usually unaware of. Furthermore, the supplement industry is very poorly regulated, and there is a great concern about impurity of the products. Also, many of these companies make outrageous claims without having any scientific proof.

A.I tried doing a search for “Nutrajoint” and was unable to find information on this product. I suspect that, with his degree of arthritis, it would be unlikely to give your brother-in-law significant relief. I would recommend that he be evaluated by an orthopedic surgeon who specializes in joint replacement surgery. One point worth mentioning is that when a joint is removed to allow replacement, the arthritis is also removed. Problems can develop down the road with a joint replacement, but that would not be related to arthritis.

The Arthritis Foundation has published a Guide to Alternative Therapies that I think is an excellent resource for patients. You can purchase this by calling toll-free to (800) 207-8633. It explains in simple terms the risks and benefits of many of these forms of treatment.

Later I studied with Jerre and practiced this bodywork. I was constantly amazed at how different clients would respond to the work. It was a powerful therapy that helped people have profound breakthroughs in their lives. My only disappointment was that not very many clients were willing to delve so deeply into their psyches; most preferred relaxation massage, which I also provided.

Nine years went by. I got married, had a son, got divorced. I got out of the massage profession and moved to another state. There I found my way back into bioenergetics therapy, through the back door once again. This time my son was having problems acting out with aggressiveness, a result of the divorce and school environment. A friend recommended a therapist; after discussing my son’s problems with her, she asked if I had had any therapy since the divorce.

Nancy runs groups for both children and adults utilizing bioenergetics techniques. As far as I know, her children’s groups are unique. I can attest to the fact that they are incredibly effective; my son’s behavior has much improved! Children seem to instinctively respond to the physical release of emotions and can also easily relate to the idea of grounding their energy. This is not always so easy for adults.

Nancy’s groups for adults are equally powerful. Sometimes group members just talk about their issues; if they are willing and time allows, Nancy guides them through bioenergetics exercises designed to tap into and release childhood emotions. I found that witnessing others is a very dynamic experience in that it can be highly cathartic for your own issues. The fundamentals of breathing fully and grounding are an integral component of Nancy’s groups. She strives to make participants feel safe. I also worked with her one-on-one at times, which was highly effective as well.

Bioenergetics goes to the root of our problems. By releasing the energy trapped in our bodies where we stuffed our emotions, it frees the mind to more competently deal with the problems of our day-to-day lives. This form of therapy is a highly effective means of reclaiming our aliveness, our joy in life, and our ability to fulfill our dreams.

Bioenergetics therapists are sometimes medical doctors, sometimes psychologists. They go through extensive training, often with Alexander Lowen himself, who is still a vital teacher at age 70. Therapists who use bioenergetics techniques, such as my body worker, can also prove helpful. Bioenergetics is a powerful tool for rejuvenating ourselves: by utilizing the wisdom of the body we can access profound realms of vitality in our lives.

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Most of us have experienced such overwhelming emotions at one point or another in our lives. Unfortunately, in our culture such overt expressions of emotion are generally frowned upon. I say ‘unfortunately’ because in my experience using our voices and our bodies is the most effective way to release these powerful feelings.

Bioenergetics is a type of psychoanalysis that encourages people to express emotions in just this way. Developed by Alexander Lowen, MD, and based on the work of Wilhelm Reich, it is a true mind-body technique in that it uses the language of the body to heal the problems of the mind. Lowen postulated that unexpressed emotions actually become stored in the tissues of the body, and by consciously using the body to release these old emotions, we can heal traumas and approach full functionality.

Bioenergetics could thus be termed the first truly holistic therapy. By working with areas of chronic tension in the body’s musculature, one is able to access long buried emotions. These childhood traumas affect our adult functioning, both in our bodies and our minds. By releasing the emotions associated with trauma, we are able to release not only chronic muscle tension but also the dysfunctional patterns of relating we have developed for the protection of our psyches. The therapist guides this process both with talk and specific body movements.

Breathing is fundamental to bioenergetics. One of the first physiological responses to anxiety and stress is shallow breathing. Often as children, as we go through traumatic experiences, we get into the habit of shallow breathing; sometimes the muscles of the abdomen and thorax actually become chronically tense so that full breathing seems impossible. During a bioenergetics session, the therapist will keep the client focused on deep, abdominal breathing. Sometimes merely breathing in this manner will bring up emotions.

Grounding is another basic bioenergetics technique. Often our physical experiences as children are so painful that we disown our bodies, tending to live only in our minds. When the emotions we feel seem overwhelming, if we consciously connect our energy to the earth, we are able to feel safer. Thus during a bioenergetics sessions, grounding through specific exercises is vital as we release intense and long repressed emotions.

My first exposure to bioenergetics came at a time in my life when I was not only experiencing a lot of back pain but also was feeling very stuck. I wanted to write, but my creativity seemed inaccessible. I also felt a general sense of emotional numbness. Because the physical pain was foremost in my consciousness, I looked for a body worker to help ease me out of the pain. The woman I found used deep tissue massage similar to RolfingTM combined with the breathing and grounding techniques of bioenergetics.

I went to this woman weekly for about three months. What an intense time that was for me! As Jerre would do the massage strokes, I breathed deeply, exhaling with sound. Often anger or sorrow would bubble up, turning these sounds I was making into yells or wails. Sometimes Jerrre would have me pound my fists or kick my feet on the massage table, wring a washcloth, or just shake my head from side to side. Every bodywork session began and ended with grounding exercises.

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Tramadol has been in use as an analgesic since the late 1970s, and was a very popular analgesic in Germany. International interest in the medication resurfaced when researchers discovered that Tramadol acts similarly to opioids, but inhibits the re-uptake of serotonin and noradrenaline.

How Tramadol Works

Tramadol is a special medication that acts in a unique way. It can be distinguishable from other opioids due to its method of action and its safety profile. It possesses both opioid and non-opioid qualities, and is considered to be an atypical analgesic that acts centrally. Tramadol is a synthetic form of codeine, and does not have strong opioid agonist qualities. Similarly to antidepressant medications, it inhibits norepinephrine and serotonin reuptake.

The antidepressant venlafaxine is similar in structure to Tramadol. Some patients who suffer from chronic pain could experience an antidepressant effect from this drug.

Side Effects

As far as side effects are concerned, Tramadol does not cause many side effects; nausea and vomiting seem to be the most common side effects. When patients on Tramadol are given similar dosages to those of morphine and pethidine, respiratory depression does not normally occur. Respiratory effects of other medications can be increased when taking large doses of Tramadol. It has a low occurrence of cardiac depression and, unlike morphine, does not cause side effects such as dizziness and drowsiness.

The potential for abusing Tramadol or becoming dependent on it is not very high due to its weak opioid effect. Post-marketing data indicates that Tramadol does not have a high potential for abuse.

Urinary disorders, such as micturition difficulties and urinary retention, seem to be common in both Tramadol and other opioids.

People who have epilepsy should not take Tramadol, and people who take medication that lowers epileptic seizure thresholds should approach Tramadol with caution.

Uses of Tramadol

Tramadol can successfully treat moderate to severe pain, as well as neuropathic pain. This medicine possesses an efficacy whose dose-dependency is somewhere between dosages of codeine and morphine, with a parenteral strength that can be compared to that of pethidine.

Research indicates that more successful results can be obtained in controlling post operative pain when patients are given Tramadol instead of NSAIDs. Tramadol can be successfully combined with NSAIDs, because Tramadol’s method of action does not coincide with the mode of action in NSAIDs. Fewer side effects occur when the patient uses a combination of Tramadol and NSAIDs; the combination enables the dosage amount of Tramadol to be lowered.

Tramadol online can be especially useful in treating elderly people who suffer from osteoarthritis, because even though nonsteroidal anti-inflammatory medications can aggravate high blood pressure and cardiovascular symptoms, Tramadol does not possess this trait, nor does Tramadol cause peptic ulcers.

Tramadol has been successfully used, without the necessity of respiratory depression of the neonate, for managing labor pains. It can effectively treat pain that is caused by myocardial ischemia, renal colic or acute trauma.

Recommendations

Tramadol should be taken every 4 to 6 hours with a dosage between 50 and 100 mgs; the dosage of Tramadol should not exceed 400 mg per day; one single oral dosage of 100 mg of Tramadol has an analgesic effect for approximately 6 hours.

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A. TENS stands for transcutaneous electric nerve stimulation. The device is intended to relieve pain by preventing pain signals from reaching your brain.

TENS is safe and painless, but it isn’t always effective.

With TENS, small electrodes are placed on your skin, generally near the area of your pain. The electrodes are attached to a small portable stimulator that you wear. The stimulator delivers tiny electrical impulses that pass through the electrodes to nearby nerve pathways. You turn the TENS unit on and off as needed to control pain.

Exactly how the impulses may relieve pain is uncertain. One theory is that they stimulate production of endorphins, your body’s natural pain killers.

TENS must be prescribed by a doctor. Often, a physical therapist working with the doctor will determine where the electrodes need to be placed and instruct you on how to use the device. The units can be rented or purchased.

TENS works best when used to relieve acute pain associated with a pinched nerve, such as sciatica. It’s less successful for chronic pain, although some people with chronic pain are occasionally helped by the device. Most often, TENS is used in conjunction with other pain-relief treatments, including exercise. People who have pacemakers usually aren’t candidates for TENS treatment.

Fortunately for many of us today, a lot more is known about migraines thanks to a heightened awareness of the devastating physical, emotional and economical effects of migraine. It’s estimated that 28 million Americans suffer from migraine. Women are the biggest sufferers, outnumbering men eight to one.

Yet, as a migraine sufferer, I still talk to people almost every day who have a relative, friend or neighbor who is debilitated by them. Why? Because many people don’t go for help, don’t realize they have migraines or have been herded through so many unsuccessful therapies that they have given up trying to find a solution and have decided to “just live with it.”

Well, I know that you don’t have to “just live with it.” I have been on a 17-year-quest to find a solution. In that time, I was literally a human guinea pig — being prescribed everything from painkillers to anti-seizure medications from a bevy of traditional medical specialists.

Unfortunately, my story is not uncommon among migraine sufferers. In 1996, I spent a week at the clinic in Chicago and every patient there could share similar stories of misdiagnosis, ineffective medicines, less than stellar medical care and being told, “it’s all in your head.”

One of my friends who also suffers from migraines, always tells me that I am like “a dog with a bone.” The bone is migraine and I’m looking for some place to bury it! My long and complicated journey for a successful therapy sent me in many different directions, and even with failure after failure I persisted. I’d like to share with you what I have learned.

Lessons Learned

First, migraines are a disease. The whole body undergoes physiological changes during a migraine attack. I have common migraine without aura. There are a few different classifications such as common or classic migraine, but all migraines end up the same — horrible pain that leaves you unable to function at even the most basic level. My migraine usually starts with an upset stomach, proceeding to extreme fatigue and then searing pain behind my left eye. The migraines also occur on my right side with less frequency. I used to get three to four migraines a week, work a full-time job and go to school part-time, spending whatever time I had left in my darkened bedroom.

No one, not even the doctors at the clinic, can say with certainty what causes migraines. The traditional belief is that a series of mechanisms starting with a drop in the brain chemical serotonin cause the blood vessels to dilate and then constrict, setting off pain nerves. Some holistic healers believe that migraines are a disease caused by toxins circulating in the brain; a lack of sufficient blood sugar; a lack of oxygen due to constricted blood vessels; or a lack of proper hydration. Remember, the brain cannot feel pain, so the pain messages start somewhere else in the body and are sent to the brain. One thing is sure; if someone or something offers you a “quick fix” for migraine you better look for another option. You cannot cure migraines; you can only learn how to control it.

Migraines are triggered by many things: foods, weather, stress, insomnia, hormone imbalances, liver malfunction, PMS, etc. Tyramine-containing foods are most often the source of migraine food allergies and these include: aged cheeses, chocolate, citrus, red wines and coffee. Different people have different sensitivities that can also include gluten, corn, tomatoes, milk products or food additives (especially MSG and nitrites).

So you say, what’s left to eat? Well, believe it or not there is plenty, but it’s mostly fresh, including lots of vegetables, fruits, rice, other whole grains and cereals. Once you modify your diet, you can even get by with “cheating” a little now and then. It outlines not only what you shouldn’t eat, but the foods you can include in your diet that actually help your body fight pain and a good elimination diet regimen.

When you start to investigate triggers, the most important thing to remember is they are highly specific to the individual. I might be bothered by chocolate, but you might not. A huge storm front and drastic drop in the barometer pressure is almost always a trigger for me; it might not be for someone else. Sleep is one of the biggest triggers overlooked by many people. For many years I assumed that sleeping was the best thing I could do to heal myself. Yet the opposite is true. Migraine sufferers should never take long naps (a short 20-minute nap is all anyone needs to rejuvenate). If you take long naps as I once did, you interrupt your deep sleep at night and your body doesn’t “repair itself.” In essence, you get caught in a vicious cycle of light sleep, long naps and more migraines. Doctors told me that my bed is for two things: sex and sleep. No reading, napping, lounging, standing on your head, etc.

Thousands of Dollars and Years Later

Meanwhile, after spending thousands of dollars on traditional medicine with no relief, I began to look at vitamins and supplements and the holistic approach of alternative medicine. What I discovered is when you have a chronic disease such as migraines you can’t just “pop a pill” and get relief (or as I call it the “American way to fix it”). I began to re-evaluate my lifestyle.

The following are some of the things that have worked for me. This is in no way a prescription for migraines, it is “food for thought” from information that I have researched and lived out over the last 17 years.

The first thing I did was modify my diet.

I now eat largely vegetables, fruits, fish, chicken, rice, pasta and salads. I drink only pure fruit juices and mineral water. I do not eat processed foods, and I buy most of my snack foods from the local health food store to ensure that the ingredients are natural or organic.

* I walk for at least 35 minutes five times a week on a treadmill.

* I have two massages a month with a neuromuscular therapist (who is also an herbalist).

* I learned to meditate and do it whenever possible (after all, I do have a four-year-old son), and I avoid stress whenever possible.

* I have also gotten in touch with my God and my spiritual side.

That’s a far cry from a 40-plus hour-a-week high stress job, night classes and a bruising exercise routine.

Supplements, Vitamins and Herbs

It’s important to take a great multi-vitamin and mineral formula everyday. Read the labels, find a nutritionist and a herbalist you trust and ask for recommendations.

For migraine prevention, I take the following, once a day:

Daily multi-vitamin/mineral formula

* 800 mg. of magnesium,
* 400 mg. of No Flush Niacin
* 60 mg of Gingko Biloba (increases circulation to the head and brain)
* 1000 mg. of Vitamin C with Bioflavinoids (also could get this in a multi-vitamin)
* 800 mcg of folic acid

In addition, for many women, hormonal fluctuations trigger migraines and that is certainly the case with me. To keep my hormones regulated, I take 1300 mg. of Evening Primrose Oil (doubled five days before the onset of menses and continued through my cycle), and 400 mg. of Chaste Berry Extract per day. B-vitamins are also very important for women.

If I do get a killer migraine, I will take the drug Soma. It is the only drug that has ever worked, but it leaves me extremely fatigued and with flu-like symptoms.

Prescription Drugs Without a Prescription
Today, I don’t take preventive migraine drugs on a daily basis, instead I use a variety of herbs, vitamins and minerals and my migraines are manageable. I believe the pain of migraines lead me down paths that I would have never discovered otherwise making me a more compassionate, spiritual and knowledgeable human being. For that, believe it or not, I am thankful. I still haven’t completely buried that “bone,” and I’m not running as fast trying to find that perfect spot. I know that it’s all up to me to make healthy and informed choices and live with the consequences.

Once you decide to give radiotherapy a chance, you will need to make an appointment with a radiation oncologist. He or she will give you several options depending on your stage of disease.

The staging of prostate cancer is broken down into three important distinctions. First is the size of the cancer and if it has broken through the capsule and/or invaded local organs. TI is the earliest and smallest cancer. With T2 the cancer involves about half of either the right or left lobe of the prostate up to both lobes. T3 extends through the capsule and into the seminal vesicles. T4 invades surrounding structures such as the rectum or bladder.

The next markers for staging are the lymph nodes and/or any chance of distance spread. This is checked by CT scans and bone scans done after the diagnosis is made.

After diagnosing prostate cancer, the pathologist studies the differentiation (maturity) and growth pattern of the population of the cancer cells. This shows the aggressiveness of the disease. The Gleason grading system is used for this with 2 being the least aggressive and 10 being the most. For example, after a man has all of his pre-staging work-ups completed, he might have a stage of T2; No (lymph nodes are negative), Mo (no distance spread), Gleason 6, PSA12. These are the numbers that the doctors should use to determine the form of treatment.

Now that the staging is done and you’ve made your appointment with a radiation oncologist, what can you expect to hear?

In radiation therapy, high-energy rays are used to damage cancer cells and stop them from growing. The radiation is directed at the prostate and can be delivered in a variety of ways. The patient and the radiation oncologist should decide the type of radiation therapy used. Based on the patient’s stage of disease and the chance of extracapsular involvement, the following choices are available.

External Beam Irradiation: This consists of daily radiation therapy for about eight weeks. The treatments are Monday through Friday and take about 20 minutes a day. Diarrhea and bladder irritations are frequent side effects. Complications may include ulcerations of the rectum, but this happens in less than three percent of patients. New conformal therapies maximize the radiation to just the prostate and spare the rectum even more. Incidences of impotence are around 10 to 30 percent. Doses delivered are about 7000cGy.

External Beam Irradiation and Temporary Brachytherapy: This procedure consists of six weeks of external beam irradiation. Then the doctor temporarily places radioactive material into the prostate. This can be done using high doses of radiation over a few hours or lower doses over a few days. While in the hospital for either, trans-rectal ultrasound guides the doctor in placing long hollow needles into the prostate. This is done under anesthesia. After the needles are placed in the prostate, either low dose or high dose ribbons of radioactive material are slid into the needles thereby irradiating the prostate. Because the treatment is tailored to correspond to the location of the disease, local control rates (controlling cancer inside the prostate) of 90 percent can be achieved. Impotence rates drop to 10 percent. The side effects of diarrhea and bladder irritation and rectal damage are reduced. The dose to the prostate is increased to be biologically equivalent to 10,000 cGy without any additional external to the surrounding organs.

Note: If your doctor has hyperthermia it can be used during this procedure. Hyperthermia is a unique heating treatment that works very well on large prostatic tumors. It also works for benign prostatic hypertrophy (BPH). Many men have both prostate cancer and an enlarged prostate. While an enlarged prostate is benign by nature, it can still disrupt the flow of urine and can be addressed while the doctor is treating the cancer. The biological equivalent of an implant with hyperthermia is approximately 12,000 cGy to the prostate.

Permanent Iodine Seed Implant: Before deciding on this procedure, make sure to review the Partins Table with your doctor. (See the discussion later in this article.) This procedure was all the rage some years ago, but fell out of favor because of poor local control. Today, because of better diagnostic work-up, it is being offered again. But it should only be for men with T1 or T2a lesions with Gleason < 6 and a PSA of <10. The biological equivalent is 11,000 cGy.

For this procedure, the doctor will use ultrasound to permanently place very low levels of radioactive seeds into the prostate. Its main advantages are that it doesn’t require any external beam irradiation and is an easy outpatient procedure. However, you must be wary of any doctor who offers it to all of their patients. Only the earliest stage patients should have this procedure. It will not adequately treat any disease that extends beyond the capsule and if it does those patients will not be cured by seed implants alone.

To summarize, deciding a course of treatment needs to be based on the patient’s stage of disease, not the doctor’s specialty. Make sure to talk to both a surgeon and a radiation oncologist before deciding on a treatment. If, because of scheduling problems or insurance delays (or your just too confused to decide which way to go) and the treatment isn’t going to happen soon, there is a third option that can buy you some time. As mentioned before the prostate is fed by testosterone. If you take away this hormone, the prostate cancer will starve and rapidly shrink. It DOES NOT cure the disease, but hormone therapy takes three months to be delivered, and while it is shrinking your prostate cancer, you’ll have three months to decide what to do. Of course, there are side effects with the hormones, so discuss this option with your doctor. But you must eventually decide. Nothing, of course, is black and white. Different stages of disease need different treatments. I would love to be able to tell you exactly which treatment option to choose, but without specific details that would be impossible. I have, however, talked to hundreds of men with prostate cancer and have heard all of the pros and cons of the treatments out there, and I would definitely choose radiation over surgery.

Before discussing radiation therapy for prostate cancer, let’s discuss the prostate itself. The prostate is a gland and is responsible for producing some of the seminal fluid that feeds the semen.

The prostate needs the male hormone, testosterone, to function. The prostate is about the size of a walnut and is located in the front of the rectum, behind the base of the penis and below the bladder. The prostate surrounds the upper part of the urethra. The urethra is the tube that carries urine and semen out of the penis. A thin membrane known as the capsule surrounds the prostate.

Cancer can begin in any portion of the prostate, but most seem to occur on the posterior portion adjacent to the rectum. The first tests to rule out prostate cancer are usually the digital rectal exam and the PSA. Digital rectal exams are important because physicians can feel approximately 80-percent of all palpable tumors.

The other important tool in diagnosing prostate cancer is the Prostatic Specific Antigen (PSA) blood test. This test measures a substance emitted by both normal prostate tissue and prostate cancer. Very little escapes the normal prostate so the PSA usually measures 0-4. When the PSA begins to rise it can be a sign that prostate cancer is present. If cancer is suspected, an ultrasound-guided biopsy is performed and the cancer is diagnosed.

Once cancer has been diagnosed the headache really begins. Anyone who has ever talked to a man newly diagnosed with prostate cancer will find someone confused and frustrated, AND RIGHTFULLY SO! How can a patient decide on a course of treatment when the medical community cannot even agree? Each medical specialty — surgeons, radiation oncologists etc., favor their own approach. Consultations are filled with one specialist politely refuting in faux-respectful terms, the advice of the previous specialist. Surgeons want to operate, and radiation oncologists push for radiotherapy. Each may be a viable option, but it is ultimately up to the patient to decide their course of treatment.

My goal is to educate you on radiation therapy. Radiation therapy always took a back seat to surgery in the treatment of prostate cancer. Early studies show clearly that patients who underwent surgery fared better than patients receiving radiation therapy when compared at five years post-treatment. In fact, studies went so far as to say that the radiotherapy accelerated the cancer because the radiotherapy patients had much more metastases (distance spread) after treatment. The studies haunted radiation oncologists for years until the patient’s pretreatment stages were studied more closely. The patients that were given surgery had the earliest stages of the disease. Of course, these patients did well because the disease hadn’t broken through the capsule. The group of patients that were placed in the radiation therapy protocol had stages II to IV with greatly elevated PSAs. Some PSAs were as high as 200! Obviously, the study was slanted towards surgery and many men had it performed when it would not have been indicated.

In fact, radiotherapy is a valuable tool in the fight against prostate cancer, and recent advances have made it equal to surgery for early-stage cancers and the treatment of choice for later stages.
to be continued…