Wednesday, April 13, 2005

Paging Dr. Pilot...Dr. Otto Pilot

Imagine you're flying in a commercial jet and the pilot tells you he'll be putting the aircraft on autopilot. That probably wouldn't be a concern. But imagine you're at your doctor's office and he tells you that he's just put his judgment on autopilot. Two questions: Where's the parachute, and where's the exit? Unfortunately, doctors often simply go with basic procedures they've always used. But things change, and when doctors don't stay on top of changes, patients sometimes suffer. One perfect example of an autopilot medical mindset concerns the prostate-specific antigen (PSA) test used to determine prostate cancer risk. I've shared this warning several times before, but the mainstream still hasn't picked up on it so it can't be repeated enough: Men, if your doctor suggests a biopsy based on a high PSA level, he may be flying on auto-pilot. A new supplement study inadvertently demonstrates that a PSA reading should be considered a useful tool, as long as it's viewed with healthy skepticism. PSA is a protein that's naturally produced by the prostate gland. Prostate tumors typically cause an over-production of PSA, so when a blood test reveals an elevated level of the protein, it's a red flag that warns of possible cancer. Urology researchers in Rotterdam, the Netherlands, created a trial to examine the effect of certain nutrients on PSA levels. As reported in the International Journal of Cancer, the Rotterdam team recruited 37 men who had prostate cancer and increasing PSA levels. For a period of six weeks, about half the subjects supplemented their diets with a formula that contained antioxidants, green tea extract, soy extract, vitamin E, selenium and plant sterols. The other subjects took a placebo. In the second phase of the study, those taking the supplement switched to placebo for six additional weeks, while the first placebo group began taking the supplement. Blood tests taken throughout the study showed that PSA continued to increase during the placebo phase, but the increase was significantly slowed during the supplement phase. Nevertheless, there was no indication that the nutrients had any effect on the cancer. In an interview with Reuters Health, the lead author of the study, Ries Kranse, M.D., admitted that a change in PSA progression does not necessarily mean that tumor size is reduced. What this study does help confirm is that something as simple as a dietary change may cause fluctuations in PSA levels. Alternative healthcare pioneer William Campbell Douglass, II, M.D., is no fan of PSA tests or their follow-up biopsies. Dr. Douglass refers to this one-two punch as, "the mainstream's slash-and-burn approach to prostate cancer." A 2003 editorial in the British Medical Journal put it another way: "At present the one certainty about PSA testing is that it causes harm." It's not the test itself that causes harm, of course, it's the reaction to the test. When PSA is elevated, many doctors recommend a biopsy of the prostate; a painful procedure that can result in bleeding and infection. But recent evidence shows that a great number of these biopsies are completely unnecessary. In a study from the Memorial Sloan-Kettering Cancer Center in New York City, researchers examined fluctuations in PSA levels to test the reliability of a single PSA result. Over a 4-year period, the Sloan-Kettering team collected five blood samples each from nearly 1,000 men whose median age was 62 years. More than 20 percent of the subjects were found to have PSA levels high enough that many doctors would have recommended a biopsy. Half of those men, however, had follow-up tests with normal PSA levels. The Sloan-Kettering team concluded that an isolated PSA screening with an elevated level should be followed with an additional screening several weeks later before proceeding with further testing or a biopsy. This research backs up another study I told you about in a previous alert in which doctors at the Fred Hutchinson Cancer Research Center (FHCRC) in Seattle estimated that PSA screening may result in an over-diagnosis rate of more than 40 percent. Although the Rotterdam research didn't show that supplements slow the progression of prostate cancer, other tests have indicated that certain foods may offer protection against the disease. In a previous alert I looked at an Italian study that surveyed the dietary habits of more than 1,700 middle-aged and elderly men. Researchers found that a high intake of any type of fiber reduced prostate cancer risk slightly. Soluble fiber intake appeared to offer some protection, but when fruit, vegetable and grain fiber intakes were compared, vegetable fiber was associated with the lowest risk. But was fiber responsible for the prevention, or was it the lifestyle? As one researcher noted, those who choose to include generous amounts of vegetables in their diets may be more likely to incorporate other healthy habits in their daily routines. That sounds like a pretty good plan for prostate cancer prevention.

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