Introduction

Section I: What Is Prostate Cancer?
   Prostate Cancer Basics
   Risk Factors
   Screening
   Diagnosis
   Prognosis

Section II: Treatment
   Selecting Your Doctors
   Watchful Waiting
   Surgery
   Radiation
   Brachytherapy (SEEDS)
   Cryotherapy (Cryosurgery)
   Hormone Therapy/Androgen Blockade
   Bisphosphonates
   PC-SPES: A Complementary Herbal Remedy
   Advanced Disease, Recurrence, and Metastases
   Choosing Among Treatments for Newly Diagnosed Prostate Cancer
   Prostate Cancer Care Down Under
   Nutrition
   Antioxidants
   Exercise and Prostate Cancer
   Attitude
   Stress Reduction
   Putting It All Together

Section III: New and Future Developments
   What’s On the Horizon

Appendix I
Appendix II
Appendix III
Appendix IV
Key References/Abbreviations

Index

    At age 55, I underwent a routine PSA (prostate-specific antigen) blood test. I’d spent the previous five years living in remote parts of Asia where this screening test for prostate disease was unavailable. A visiting doctor friend of mine (general practitioner) had done a digital rectal exam (the dreaded “finger wave”) three years prior, and he found that my prostate was generally enlarged, but there were no areas of hardness. The prostate border was smooth and regular. I’d had minor urinary symptoms for years, getting up two to three times each night to urinate. This was compatible with my age and the moderately enlarged prostate my doctor friend felt when he examined me, but it was certainly no cause for concern. Benign prostatic hypertrophy (BPH), as this condition is called, is quite common in men over 50 and usually responds to medicinal treatment.
     I started taking a remedy containing saw palmetto oil to shrink the prostate gland. I also started taking a new over-the-counter “wonder drug” called DHEA. I really liked the effects of DHEA. I felt much more energetic and focused. As you’ll read later, however, DHEA and prostate cancer don’t mix.
     When my PSA (prostate specific antigen) came back at 11.2 (normal is less than 4.0), I was shocked, to put it mildly. I had been extremely health conscious since graduating from medical school nearly 30 years earlier. I ate very little red meat, used only “good” oils, exercised regularly, and took antioxidant-rich vitamin supplements. Surely this was a lab error. I repeated the test and the result was the same. From my medical training, I knew that at my age a PSA of this magnitude meant that the probability of prostate cancer was high.
     I sought out a top-notch urologist who did another digital rectal exam (DRE). Unlike the one three years earlier, this test revealed an area of hardness in the right base of the prostate. A few more blood tests and a prostate biopsy later and the diagnosis was confirmed—prostate cancer.
     I felt scared and confused. What to do? As I had done so often in medical school, I decided to find out as much as possible about this disease and its treatment. What I discovered was one of the most muddled areas in modern medicine.
     Recognized experts in the field diametrically disagreed with each other as to the preferred treatment. To be sure, there were many options, but none was a clear-cut magic bullet. And there were many nasty potential side-effects to consider. Despite my medical training, given my level of confusion, I found it hard to imagine how someone who was not a doctor could successfully navigate the maze of options.
     Indeed, most don’t. They simply put themselves in the hands of their local urologist, do what he says, and hope for the best.
     My purpose in writing Prostate Cancer—Prevention and Cure is to familiarize as many readers as possible with the current state of the art in the diagnosis and treatment of prostate cancer. This book is not only for someone who’s been diagnosed with prostate cancer, but also for anyone who’s a potential candidate for it—in other words, all men. It’s also for women whose partners are either prostate cancer patients or who simply want to understand the disease in the event that it enters their lives.
     In writing this book I reviewed more than 2,000 papers in the medical literature. Armed with this background information, I then spoke with many of the top doctors in the field of prostate cancer—urologists, medical oncologists, and radiation oncologists. Each expert has his own view of the disease: which treatment to use, how to evaluate side-effects, and an overall approach, or philosophy, for dealing with prostate cancer at different stages.
     However, this book has been written with the best interests of the patient as the overriding paradigm. I’ve tried to demystify the way doctors think in order to provide you with clearer insights, allowing you to take control of your illness. Then, once you’ve gotten rid of the cancer cells, I teach you the most optimal course for staying healthy.
     The fact is, there’s only one person whom you can rely upon to significantly improve your chances of cure from prostate cancer: You! Your active involvement in managing your disease is likely to increase your chances of success.
     From this book and other sources, learn all you can. Ask questions, even if you think they might be dumb or embarrassing (such as those that concern sexual implications, incontinence, or bowel problems). Do not blindly accept medical pronouncements.
     Optimistic and informed action is likely to improve your overall health and outlook.
     Cancer is usually a defining event in someone’s life. It can be viewed as a curse or a wake-up call. If you choose to behave as a passive victim, you are less likely to survive, and the quality of your life may erode. However, if you choose to view it as a catalyst for change in lifestyle and thinking, it can become a blessing in disguise. The course you set now will shape the balance of your life. It’s up to you.

Attention All Men

     The two most common cancers in men are skin cancer and prostate cancer. If you're male and over 50, statistically you have a 50% chance of getting clinically significant prostate cancer at some point in your life. Contrary to the statistics, prostate cancer is often preventable. And it's curable in most men. But awareness is key. Prostate Cancer—Prevention and Cure tells you all you need to know about preventing, controlling, and curing this disease.
     The author, Dr. Lee Nelson, is a prostate cancer survivor. He has successfully navigated the maze of treatment choices, side effects, and meaningful lifestyle changes that can significantly effect outcome and quality of life. His pursuit of wellness led him to study thousands of articles, interview dozens of experts, and draw some eye-opening conclusions about how to prevail in the battle against prostate cancer.
     Prostate Cancer—Prevention and Cure is the definitive book on the second most common cancer for men.

"Superb! Nelson explains this incredibly confusing subject in a way most lay people can understand. He goes over every scenario clearly and concisely. The sections on nutrition stand by themselves as a gudie to good living."
     Bernard Larner, M.D., head of Pathology, John Muir Hospital, Walnut Creek, CA 

"An exceptionally detailed resource ... completely accessible for the non-specialist general reader and covers everything from risk factors and screening, to the many types of applicable therapies, to new and future medical developments and more. Recommended reading for all men over 50 with family histories of prostate cancer—as well as their wives, friends, children and companions." 
     —Midwest Review of Books

"Dr. Nelson has written a complete and understandable book on almost all aspects of prostate cancer. There are many books about this cancer that are written for the non-expert; this one ranks among the best." 
     —Paul H. Lange, M.D., FACS; Prof. and Chairman, Dept. of Urology, U. of Washington

"A much-needed, detailed, and fact-filled resource for men with prostate cancer from the viewpoint of someone who understands the key issues facing the newly diagonsed prostate cancer patient."
     —David Heber, M.D., Ph.D., Prof. of Medicine and Founding Dir., UCLA Center for Human Nutrition

"Dr. Nelson's ideas work. I'm walking proof of it. He helped me cut my PSA reading in half without the use of drugs. Also, a whole battery of chronic conditions cleared up due to lifestyle changes I made per Dr. Nelson's advice. Very powerful stuff."
     —Harry Schultz, author of the Harry Schultz International Letter