05 may 2004.indd

Exploring Issues of Philosophy, Principle and Conscience in Contemporary Health Care The Prostate
This article was excerpted from Dr. Ronald Wheeler’s surgery, radiation, etc. ) which leave the individual with writing and reproduced with permission of the McAlvany continuing pain or other symptoms and a progressive Health Newsletter’s editor. slow slide toward prostate cancer, or crippling surgery which can eventuate in no sex life, use of “Depends,” This article will explore the dangers to American and other very unattractive lifestyle changes. men from prostatitis and prostate cancer; approaches to But the good news is that most of the prostatitis treating this problem that work and don’t work - and and prostate cancer can be avoided, arrested, or man-what you can do to keep a healthy and functioning aged by diet and lifestyle changes; by supplementation, prostate for the rest of your life. which is very specific to prostate health; and by alternate medical approaches, which in all but the most severe or INTRODUCTION
advanced cases can avoid crippling surgery, radiation, prostate freezing (i.e., cryosurgery), etc. Prostate problems will become a reality for all men It is possible that most prostate cancer can be avoid- during their lifetimes, with manifestations usually be- ed, and that most prostatitis can be reversed, minimized, ginning between ages 40 and 50 and accelerating from or managed. Though prostatitis may have no symptoms, that time forward. Cancer of the prostate is responsible some patients report severe pain. An individual’s PSA test for the deaths of about 40,000 men each year in the (which is the most widely used test for men’s prostate United States and is the number two cause of male health) may register over 4. However, close examination cancer deaths after lung cancer. (It is actually the most typically does not indicate prostate cancer. Nevertheless, commonly occurring form of cancer in men. ) An ad- an elevated and rising PSA can be like a falling barometer, ditional 300,000 American men will be diagnosed with which warns of (or forecasts) a coming storm (in this case, prostate cancer each year (according to the American the approach of prostate cancer). An elevated PSA is a Cancer Society). major red flag or barometer for coming problems, but is For men over 50 years of age, the probability is 40% not always associated with prostate cancer. that they will ultimately contract prostate cancer; at 60, Several standard procedures for treating the prostatitis the probability is 50%; at 70, it is 70%; at 80, it is 80%; at (including antibiotics, prostate massage, hydrotherapy, di-90, it is 90% and at 100, it is 100%. In other words, if you etary changes, etc. ) were employed, in the example given, live long enough, the medical statistics indicate that you and the symptoms diminished - but the PSA remained will get prostate cancer and perhaps die from it. elevated at about 4. In this person, Dr. Wheeler (director Almost all men above 40 develop chronic prostatitis of the Prostatitis and Prostate Cancer Center of Sara- (i.e., inflammation or infection of the prostate), which sota, Florida) suggested a new herbal formulation called may or may not have overt symptoms (i.e., pain, frequent PEENUTS for the care and feeding of the prostate. urination, impotence, infertility, etc.). Very few doctors After about six months of taking this formulation, know how to effectively diagnose, treat or manage pros- this person’s PSA dropped from over 4 to 0.7 (and has tatitis and this ultimately becomes a serious problem for remained under one for over six years). The American the patient, since prostatitis often sets the stage for or Cancer Society publicizes that the “normal” range for is the forerunner of prostate cancer. PSA is 1. 0 - 4. 0. However, recent studies have suggested Most prostatitis (and prostate cancer) is treated by that a more conservative number, probably 3. 0 be used outdated and largely ineffective means, (i.e., antibiotics, as the maximum normal range. In light of the Johns- Author: Thomas A. Dorman, MD. Copyright 2004 by DORMAN PUBLISHING, 929 S. 291st Street • Federal Way, WA 98003-7300 Fact, Fiction & Fraud in Modern Medicine Hopkins recent study suggesting that PSA of greater is frequently associated with ejaculation. Typical voiding than 0.7 in ages 40-50 leads to a 300-400% greater like- symptoms produced by prostatitis include getting up lihood of prostate cancer in ages 60-70, a better target at night to void (nocturia), frequency, urgency of urina-number would be 1.0. Some urologists use “age-cor- tion, incomplete voiding, decreased force of the urinary related” PSA numbers, which has not been universally stream, intermittency of the stream and a need to push embraced. Another way of looking at this number is that or strain to void. Impotence or erection difficulties and in any male the PSA, when over 0.7, bears a correlation male infertility are also associated with prostatitis. to the risk of the two important prostate diseases, i.e., Prostatitis is a troubling disease that remains a health risk to most of the adult male population. John Chronic prostatitis (inflammation or infection of Krieger, M.D. and Richard Berger, M.D., [Urologists at the prostate) is common to all adult men. It’s associated the University of Washington], believe that all men will with virtually all cases of prostate cancer and present in acquire prostatitis in their lifetimes. Historically, men every prostate biopsy regardless of other findings. Chronic under 50 years old with voiding symptoms or pelvic prostatitis may not cause significant symptoms in many pain had prostatitis until proven otherwise. Men over men, but in others it can be a devastating disease that 50 years old with the same symptoms were assumed severely affects the quality of life of those afflicted. It’s to have enlarged prostates. A recent study has shown difficult to diagnose and even more difficult to treat. A that most men with voiding symptoms regardless of wide variety of therapies are available but few actually age actually have prostatitis when properly tested. In work in more than a small percentage of cases. None of a trial of 121 consecutive men who exhibited voiding the standard treatments is able to improve the health symptoms, 80% were found to have chronic prostatitis and wellness of the prostate but a promising new ap- proach may accomplish this. We’ll review the current
knowledge about chronic prostatitis, its treatment and B. THE DIAGNOSIS
a possible connection to prostate cancer.
Prostatitis has been termed “the waste basket of I. THE PROSTATE
clinical ignorance” by prominent Stanford University Urologist Dr. Thomas Stamey because of the difficulty it Dr. Wheeler writes, “the prostate gland is a walnut presents in diagnosis and treatment. Prostatitis is usually sized mucus-producing organ that lies just below the indicated or suggested by the symptoms it produced and urinary bladder. All men are born with a prostate that the findings of a sore or tender prostate when a digital grows and enlarges throughout life. There is a channel rectal examination is performed. Prostate Specific Anti-through the prostate which carries urine from the blad- gen (PSA), a blood test designed to identify patients at der to the outside. This is why prostate problems often risk for prostate cancer, will also be elevated in cases of cause difficulties in urination. The only known function prostatitis. The presence of a specific urinary infection of the prostate is to produce a secretion that nourishes together with pelvic pain, voiding symptoms and a sore and protects the sperm during reproduction. It has no or tender prostate on rectal examination will identify other known purpose. those 5% of patients with bacterial prostatitis, a true Prostatitis is defined as inflammation or infection of infection. But the only truly accurate and reliable way to the prostate. While prostatitis may be acute, associated diagnose prostatitis is from a microscopic examination with systemic findings of fever, chills and rigors, most of the prostatic fluid or expressed prostatic secretion cases of prostatitis are chronic and tend to be incurable (EPS). The prostatic fluid is obtained by gentle massage with relatively frequent recurrences despite optimal of the prostate during the digital rectal examination. standard therapy. When the fluid is examined under the microscope, a finding of more than 10 white blood cells per microscopic A. THE CLINICAL PRESENTATION
field is considered definitive proof of inflammation and prostatitis. Histological examination of a prostatic bi- The most common symptom of chronic prostatitis opsy can also show definitive signs of inflammation and is pelvic pain, followed by various voiding symptoms, diagnose prostatitis. Despite the fact that examination impotence and infertility. Pain from prostatitis is usu- of the prostatic fluid or EPS makes the definitive diag- ally located in the groin, testicles, penis, just above the nosis, few family physicians and only about 33% of all rectum, or in the suprapubic area over the bladder. Pain urologists perform it because of difficulty in obtaining a proper sample, inadequate testing equipment or just Allopurinol for prostatitis report disappointing results lack of knowledge. from this therapy. [This medication also has a serious side In prostatitis, any combination of pelvic and urinary effect profile -Ed]. Anti-inflammatory agents (Motrin or symptoms are possible, as well as the rare individual Advil) and hot sitz baths have been helpful in treating who is without pain, discomfort or urinary problems yet the discomfort caused by prostatitis in many patients, still has prostatitis based on an abnormal examination but neither of these treatments actually cures the dis-of the prostatic fluid or EPS. ease and the benefits wear off rapidly. Irritative voiding symptoms may be relieved by bladder relaxing agents THE ETIOLOGY (POSSIBLE CAUSES)
such as oxybutynin (Ditropan) while antidepressants such as amitriptyline (Elavil) have been helpful in various • Bacteria Stress and Psychological Factors chronic pain conditions such as prostatitis associated with depression. Biofeedback, behavioral therapy, refer- ral to a pain clinic, and psychological treatment, have • Crystal Deposition Social, Genetic or Environmental all been recommended for patients with prostatitis and occasionally offer some relief to selected individuals. For C. TREATMENT OPTIONS
the most part, current treatment methods for prostatitis are generally rather disappointing. Treatment of prostatitis has been anything but a Prostatic massage plus antibiotics deserves further sure proposition. According to noted prostatitis expert review. Proponents of prostatic massage (championed Dr. Curtis Nickel of Kingston, Ontario, “there is wide- in the Philippines) have little reproducible data to sup- spread frustration, discomfort, and lack of knowledge in port their methods. Other drawbacks include intense both primary cases. Those patients who truly have an discomfort/pain at the time of massage, the need for ac-identifiable infection of the prostate will certainly benefit curate cultures of the prostatic fluid and a dependence on from antibiotics. These need to be continued for at least antibiotics to ultimately affect the cure. Dr. John Krieger 6-12 weeks and in some cases long-term or indefinite an- appropriately points out that the following multiple fac- tibiotic suppression therapy is necessary. We don’t have tors preclude accuracy of the culture technique involv-any data that looks at recurrent disease over many years. ing urine, semen or prostatic secretion for diagnosing or Campbell’s Urology, the urologist’s most authoritative treating prostatitis:reference text, identifies only about 5% of all patients 1. The presence of inhibitory substances. with prostatitis as having bacterial prostatitis which 2. The unknown effects of many previous courses of can be ‘cured’ at least in the short term by antibiotics. antibiotics. In other words, 95% of men with prostatitis have little 3. The fact that most bacteria from the prostate do not hope for a cure with antibiotics alone since they don’t readily grow on conventional culture media. actually have any identifiable bacterial infection.” 4. The high number of uncharacterized bacteria that In the treatment of prostatitis, physicians have tra- ditionally recommended everything from doing nothing 5. The difficulty in obtaining a pure specimen from the
to multiple and extended courses of antibiotics, other prostate, which has not been contaminated by possible
drugs and lifestyle changes. Alpha-blockers (Hytrin, infectious organisms of the urethra or urinary passage.
Cardura and Flomax) are designed to relax the muscle 6. The fact that most cases of prostatitis are not infec-
tension in the prostate and improve urinary flow. They tions in the first place.
do tend to improve voiding difficulties and relax tension
in the prostate but they are expensive, need to be taken II. PROSTATE SPECIFIC ANTIGEN (PSA)
indefinitely in high doses, may often have significant AND PROSTATITIS
side effects and don’t cure the underlying problem or
prevent recurrences.
PSA is a Surrogate Marker for Prostatitis and the Finasteride (Proscar) can shrink prostate tissue but ‘Barometer’ for Prostate Health. Through research that there is no proof it helps in the treatment of prostatitis. Dr. Wheeler presented at the National Institute of Allopurinol, a drug which reduces uric acid levels in the Health (NIH), it was demonstrated that Prostate Specific body, has been used to treat prostatitis based on the Antigen (PSA) is a surrogate marker for the diagnosis of theory that uric acid crystals may form in the prostate prostatitis. In a study of 177 men, if the PSA was greater and cause inflammation. Most clinicians who have tried than or equal to 1. 0 ng/ml, 100% of the participants had Fact, Fiction & Fraud in Modern Medicine prostatitis as defined by the expressed prostatic secretion evation of PSA level in the blood should be considered (EPS). [This is frequently performed at the Paracelsus Clinic prostatitis until proven otherwise. While prostate cancer and evaluated with dark field microscopy by Dr. Dorman is certainly a concern and should be considered carefully -Ed]. Most men understand that EPS is the diagnostic and appropriately, prostatitis is much more likely. PSA can marker for prostatitis. Despite this fact, fewer than 30% serve as a very useful marker or indicator of the degree of Urologists and the rare Primary Care Physician per- of prostatic inflammation present and help determine form this critical evaluation of the prostate secretion. the effectiveness of prostatitis therapy. Once again, the relevance is based on making the cor-rect diagnosis, as it will encourage an improved treat- III. THE LINK BETWEEN CHRONIC
ment plan with a predictable outcome. That said, most PROSTATITIS AND PROSTATE CANCER
physicians choose to ignore the facts, while following
the dictum they learned in medical school ten or more
All men develop prostatitis. This has been shown years prior. My data was corroborated by research from in several studies including one done in 1979 by Drs. Johns Hopkins and Ballentine Carter, M.D. that showed Kohnen and Drach who found 98.1% of 162 prostates men aged 40-60 with a PSA greater than 0. 7 ng/ml had removed surgically had evidence of inflammation. a 3-4 fold increased incidence of prostate cancer within Dr. Timothy Moon, urologist at the University of Wis-their subsequent 20 years (reference – The Baltimore consin, and many others report that virtually 100% of Longitudinal Study). This is cutting edge data that sup- the biopsy and surgical prostate specimens they examine ports the concept of normalcy for a PSA to be less than show evidence of prostatitis. one. Therefore, living with a PSA of greater than one We also know that all men eventually get prostate provides an individual with an increased risk for prostate cancer if they live long enough. Annually, 40,000 men die cancer. In this manner, PSA represents disease activity from prostate cancer while over 300,000 new cases are and serves (for many) as the “Barometer of Prostate diagnosed. Prostate cancer is the most common cancer Health. ”It is common for men as they age to note PSA to affect men and the second leading cause of cancer elevation secondary to components of prostatitis, BPH, death in men (lung cancer is first). In the United States, and/or prostate cancer. Notwithstanding that statement, one in four men who undergo prostate biopsy will be the number one reason that PSA rises is secondary to found to have prostate cancer, but all of them will have prostatitis, not benign prostatic hyperplasia (BPH) or prostatitis. These findings have led Dr. Timothy Moon prostate cancer. and others to suggest that prostate cancer is always as- As mentioned earlier, Prostate Specific Antigen or sociated with prostatitis. PSA was originally designed as a blood test for pros-
tate cancer screening. PSA blood levels of 0-4 were Prostatitis leads to Prostate Cancer
designated as “normal,” but this range was arbitrarily
At the 2002 Naples, Florida meeting of the Ameri- selected as a guide for possible prostate cancer screening can Association of Cancer Research (AACR), national and does not necessarily indicate a healthy prostate. We experts in microbiology and genetics, representing our now know that up to 30% of all prostate cancers occur finest institutions of higher learning, demonstrated that in patients with PSA levels less than 4.0. Since prostate prostatitis (an inflammatory, non-bacterial event com-cancer obviously cannot be considered normal, this mon to the prostate) evolves to prostate cancer. Despite suggests that the original “normal” PSA range of 0-4 is this very important finding, the majority of physicians much too high. It’s been suggested that any PSA level treat prostatitis as a disease of exclusion and continue greater than 1.0 indicates an unhealthy prostate with to offer antibiotics as their only form of therapy. Not-active prostatitis. withstanding the above, antibiotics suppress the im- It’s well known that prostatitis increases the PSA mune system and provide added risk for the evolution level. In fact, it is much more likely that any unexplained of “super resistant organisms. ” increase in PSA level is due to prostatitis than to prostate In the AACR paradigm, the pathway from prosta- cancer. Many urologists will currently treat their high titis (the non-bacterial, inflammatory process in 95% PSA patients with one month of antibiotics and repeat of all cases) leads to cellular dysplasia. Early cellular the PSA level before recommending a biopsy. Only if atypical change, consistent with dysplasia and oxidative the second PSA level remains elevated will a biopsy be change, results in Proliferative Inflammatory Atrophy ordered. (PIA) that induces the mutagenic process to Prostatic We believe that a significant percentage of any el- Intraepithelial Neoplasia (PIN). This entire process involves cellular instability through the promotion of being done in the United States on this disease. “free radicals.” As we know, PIN frequently evolves to Practically every man alive has prostatitis, making prostate cancer. Whether men have prostate cancer or it one of the world’s most common diseases. Diagno-the diseases of BPH or prostatitis, the PEENUTS formula sis is difficult and current treatments are frequently makes sense for all men as it works versus the cellular inadequate. The association between prostatitis and oxidative process that enhances the risk of or the growth prostate cancer is irrefutable. With all this in mind, it is of prostate cancer. particularly disturbing that prostatitis research has been Young men in their 30s typically are quite prone to so seriously underfunded for years. Leroy Nyberg, M.D., prostatitis and are not generally thought to be at risk Head of Urology Research for the National Institute of for prostate cancer. But a study from Memorial Sloan Health (NIH) has stated: “It’s amazing to me that we Kettering Cancer Center in New York found that 30% of can’t reliably treat the majority of men with prostatitis.” 525 American men aged 30-39 actually had microscopic The NIH has organized a research arm that expects to prostate cancer. Is it possible that chronic prostatitis bring a fresh look to chronic prostatitis, but the results of may increase the risk or promote the growth of prostate this research are not expected for several years. Today, cancer? There is evidence that suggests this may be so. chronic prostatitis remains the single most under-di- It’s well known that chronic inflation of several agnosed, misunderstood and under-treated medical other organs is associated with various cancers. Ex- amples include the inflammation of the lower esophagus
(Barrett’s esophagitis), which leads to esophageal cancer, The Prostate Merry-Go-Round
hepatitis that eventually becomes hepatic cancer and
A classic example of a typical patient’s experience ulcerative colitis, which develops into colon cancer. Since involved a 65-year old man from Lubbock, Texas who chronic inflammation causes cancer in other organs, it is had noted a PSA of 18. His urologist appropriately per-reasonable to suggest that chronic prostate inflamma- formed an ultrasound examination and prostate biopsy. tion (prostatitis) if left unattended may ultimately lead The result was chronic prostatitis with no evidence of to prostate cancer. cancer. Antibiotics were given, but no other therapy was Prostate cancer is always found together with pros- offered. (Remember that only 5% of cases of prostatitis tatitis and all men will probably get both diseases if they are actually caused by bacteria, which are potentially live long enough. Both prostate cancer and prostatitis curable with antibiotics.) His PSA was repeated after raise Prostate Specific Antigen (PSA) levels and occur six months and found to be unchanged. The patient un-most often in older men. Both conditions are currently derwent a second prostate biopsy, which again showed at epidemic levels. Zinc levels are low or absent in both only chronic prostatitis. When the patient asked the prostate cancer and chronic prostatitis. While prostate doctor what he could do, the urologist offered to repeat cancer and chronic prostatitis are clearly associated in the PSA in another six months and consider an addi-some way, further research and epidemiological studies tional biopsy then. The patient got onto the Internet are required to determine the exact nature of the rela- and researched prostatitis. Eventually, he discovered a tionship as well as the cause and effect mechanism. nutritional product that improved his voiding problems substantially and reduced his PSA by almost half in only IV. THE RESEARCH
Present research dollars in prostatitis are so few that V. NUTRITIONAL THERAPIES
at our present pace a millennium will pass with countless innocent men suffering and possibly dying needlessly Natural herbal remedies, although not highly re- before the true answers are known. At the 1998 National garded by most physicians in the United States, are Convention of the American Urological Association (at- among the most promising new treatments available for tended by American and International urology experts), prostatitis at this time. They have been used extensively 51% of all the papers and studies presented involved in Asia and Europe but are only now becoming popular prostate cancer while only 3% addressed prostatitis. in America. While usually recommended for prostate While a few studies of various antibiotics for the treat- enlargement, there is growing evidence that they may ment of prostatitis are underway (funded largely by the be quite effective for prostatitis when used in the right pharmaceutical industry that makes the antibiotics), combinations. These products appear to be quite safe and there is virtually no other significant research currently have no known side effects or drug interactions. Fact, Fiction & Fraud in Modern Medicine Saw Palmetto is the most popular plant product or clinical follow-up. As these findings can be confirmed
used for prostate problems in the world. It seems that by other researchers, it would mean that “PEENUTS” an extract from this plant is somehow able to reduce could be the medical breakthrough we’ve been looking prostatic inflammation and swelling as well as improve for in the treatment of prostate disorders, male urinary many bothersome urinary symptoms. Pygeum africa- problems and especially chronic prostatitis. num is made from the bark of African evergreen tree. Through our research, the inability of the PSA to It appears to work as an anti-inflammatory agent. It fall while on PEENUTS is likely associated with the improved urinary symptoms in 66% of patients tested diagnosis of prostate cancer. This is important, as this in several European studies. is the group that should consider a prostate biopsy with Selenium has been shown to reduce the incidence the “Color Flow Doppler” ultrasound technique. In Dr.
of prostate cancer by up to 66% in various studies. This Wheeler’s practice, men need to qualify for prostate theoretically occurs because of an improvement in the biopsy through the failure of PEENUTS to lower the general health and immunity of the prostate. PSA, as 70-80% of all biopsies are negative. Therefore, A Finnish study showed that Vitamin E reduced the failure to decrease the PSA on the PEENUTS for-
prostate cancer by 32%. Zinc has also been linked to the mula would suggest the likelihood of bigger problems. prevention of prostate cancer and an improved prostatic This ultrasound technique is similar to Doppler radar immune system. It also exerts an anti-inflammatory ef- applied to our local weather forecasts. The application of Doppler ultrasound to the prostate identifies areas Combining these remedies along with other herbal of movement associated with blood flow. Blood flow is a products, vitamins, antioxidants and amino acids seems well-recognized component of prostate cancer evolution to improve the overall benefit and effect. For example, and growth. I have had many patients who had a nega-Vitamin E and Selenium together are able to stimulate tive biopsy using the traditional “gray scale technique,” T cells, which help the immune system work to better who were diagnosed with cancer using the “Color Flow protect and heal the prostate. Zinc may need substantial Doppler” methodology. Our experience with the “Color amounts of Vitamin E and Selenium as well as other Flow Doppler” ultrasound evaluation has made the gray nutrients to be able to effectively enter and treat the scale technique obsolete. I frequently remind patients prostate. that stability of the PSA blood test is not a favorable My patented and promising all natural combina- factor when the number is between 4. 1 ng/ml and 10. 0 tion product developed recently is called “PEENUTS.” ng/ml or even higher as this indicates significant oxidative
PEENUTS is an acronym for Power to Empty Every Time disease or prostatitis. Prostate cancer, therefore, is often
while Never Urinating Too Soon and stands for normal a result of years of oxidative cellular stress associated
urinary function and prostatic health. This particular with prostatitis.
combination product contains all the natural remedies
known to improve prostate health in a unique formula, SLOPE OF DISEASE
which seems to be particularly effective in treating both
male urinary symptoms and especially prostatitis. In
The slope of disease reflects whether the prostate is an effort to qualify the effectiveness of “PEENUTS,” getting healthier or less healthy. Statistically speaking, Dr. Wheeler’s group has conducted a prospective, as men age the PSA generally rises. The reason for this randomized, double blind, placebo controlled study. is associated with an increase in prostate disease. While “PEENUTS” was shown to be statistically and clinically I understand the thinking process, it does not have to significant. All men in the study improved 3 out of 7 happen. That said, the PSA blood test result is a “dot” voiding symptom categories. Sixty-nine percent of the on a specific disease or health curve. In an effort to un-men improved 6 or 7 out of 7 categories. derstand this, a good analogy would be a thermometer In a follow-up to the study, more than 300 men have measuring your body temperature at 100 degrees (the been evaluated in the clinical office setting. The average dot on the disease curve), only to realize that 4 hours improvement in voiding symptom score was approxi- later it is 102 degrees. The slope of this disease is upward mately 13 points (50%). The PSA, a barometer of prostate indicating a worsening of the temperature marker which health, improved in all patients by an average of 41. 3%, probably also reflects a worsening of disease. In the case while the EPS, our most sensitive marker for prostatitis, of PSA, the number represents a similar point on the noted a 65% reduction in white blood cells. There were clinical reference curve and in fact may be associated no side effects or drug interactions noted during testing with an intensifying problem. This is mentioned, as men may need to take the PEENUTS product for 6-12 possibility the disease may return. Until then, I remain months to change the slope of disease. In this manner, your consultant and advisor to a healthier prostate.
it may take 6-12 months before the PSA stabilizes and then starts to go down. Some men have a more rapid response than others but the most appropriate time to evaluate may be 12 A PSA of over 1 may indicate an unhealthy prostate. months. I have found that 4 factors play a major role in It’s obvious that the lower the PSA the lower the risk this in the timeline to PSA reduction. The four factors of prostate cancer. Anything you can do to lower your are: prostate size, severity of disease, duration of dis- PSA level will probably reduce your risk of eventually ease and the possibility that cellular mutation may be getting prostate cancer. taking place through the PIN mechanism (a precursor Keep track of your PSA level yourself. If the level process to prostate cancer), as example, or that prostate is rising, even if it remains below “4,” make sure your cancer is also present. In this regard, men need to be physician is aware of it. patient and take either two or three PEENUTS per day Have your PSA and rectal examination performed regularly, usually at least every year for men 50 or over. Men at higher than average risk for prostate cancer, “NIGHTTIME VOIDING”
such as Blacks and men with a positive family history of prostate cancer, should be checked starting at age 40. My final comments involve the possible need for Men with known elevations in their PSA levels and those alpha blockade in addition to the PEENUTS formula with inconclusive or “suspicious” previous biopsies may for optimal bladder/prostate function. While PEENUTS need to be checked more often. works on the overall integrity of the prostate at the cel- Don’t be afraid to ask questions of your physician or lular level (fighting oxidative reaction), alpha blockade get a second opinion about your health. A true profes-such as Flomax, works primarily at the bladder neck sional will take the time to answer your questions and be effectively relaxing this area in a hammock-like man- open to suggestions about alternative therapies. ner. My clinical acumen suggests that 20-25% of all men There may be a link between prostatitis and prostate have this bladder neck anomaly. In this regard, it is not cancer. Practically all men eventually are expected to get uncommon for many men to benefit from PEENUTS both and they are often found together. and Flomax. My preference for treatment of voiding Find out all you can about prostatitis and treat it as symptoms would always be to try the natural product aggressively and effectively as you can. It may delay or first and add the synthetic (Flomax) secondarily. On the even prevent the development of prostate cancer. topic of nighttime voiding, men need to understand the Be aware that your physician may not be an expert on inability to sleep well is the primary reason men still get the treatment of prostatitis. Ask him about the various up while using the PEENUTS product. In other words, diagnostic tests and therapies available and which ones men who are easily aroused during their sleep cycle are appropriate for you.
will generally get up to use the bathroom out of habit, more so, than the need to empty. Despite this common finding among men, most men continue to improve the nighttime voiding process on PEENUTS. Please remember that regardless of the disease we encounter, I would be happy to guide you to the least invasive, least traumatic, yet equally effective form of therapy that highlights your quality of life. In our next prostate disease update, I will talk about the best treatment options when prostate cancer is discovered. You will learn why it may be preferable to treat your prostate cancer as a chronic disease and avoid radical prostatectomy and radiation therapy. In this manner, men may avoid the predictable loss of Quality of Life issues associated with incontinence and impotency as well as avoid the potential for disappointment given the Fact, Fiction & Fraud in Modern Medicine Exploring issues of Philosophy, Principle and Conscience in Contemporary Health Care May, 2004
The Prostate
216 Railroad Ave. N.
Kent, WA 98032
Fact, Fiction & Fraud in Modern Medicine is published monthly by DORMAN PUBLISHING. MAILING ADDRESS for subscription matters and renewals: 216 Railroad Ave. N., Kent, WA 98032 USA. Editorial correspondence to: Dr. Thomas Dorman, 929 S. 291st Street, Federal Way, WA 98003-7300. Fax: 253-529-9782. E Mail: TD@Dormanpub.com. Yearly Subscription Price: $69.95. Single copies $5.95. Please Note: The information in this Newsletter is not intended for individual use and should not be construed as specific advice for any individual. Every effort is made to report accurately, however, no guarantee for the veracity of any information should be assumed. Web Page: http://www.dormanpub.com.

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Prostate ultrasound and biopsy instructions for patients

NSUA NORTHWEST SUBURBAN UROLOGY ASSOCIATES, S.C. PROSTATE ULTRASOUND AND BIOPSY INSTRUCTIONS FOR PATIENTS Dear Patient: You have been scheduled for a prostate ultrasound exam at our Elk Grove Village office on _______________________ at _____________. Please arrive at your scheduled time as another examination is scheduled to be performed immediately following yours. Pl

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