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May, 2004
Vol.9, Issue 5
May, 2004
… by Thomas Dorman, M.D.
Exploring Issues of Philosophy, Principle and Conscience in Contemporary Health Care
The Prostate
This article was excerpted from Dr. Ronald Wheeler’s
writing and reproduced with permission of the McAlvany
Health Newsletter’s editor.
This article will explore the dangers to American
men from prostatitis and prostate cancer; approaches to
treating this problem that work and don’t work - and
what you can do to keep a healthy and functioning
prostate for the rest of your life.
INTRODUCTION
Prostate problems will become a reality for all men
during their lifetimes, with manifestations usually beginning between ages 40 and 50 and accelerating from
that time forward. Cancer of the prostate is responsible
for the deaths of about 40,000 men each year in the
United States and is the number two cause of male
cancer deaths after lung cancer. (It is actually the most
commonly occurring form of cancer in men. ) An additional 300,000 American men will be diagnosed with
prostate cancer each year (according to the American
Cancer Society).
For men over 50 years of age, the probability is 40%
that they will ultimately contract prostate cancer; at 60,
the probability is 50%; at 70, it is 70%; at 80, it is 80%; at
90, it is 90% and at 100, it is 100%. In other words, if you
live long enough, the medical statistics indicate that you
will get prostate cancer and perhaps die from it.
Almost all men above 40 develop chronic prostatitis
(i.e., inﬂammation or infection of the prostate), which
may or may not have overt symptoms (i.e., pain, frequent
urination, impotence, infertility, etc.). Very few doctors
know how to effectively diagnose, treat or manage prostatitis and this ultimately becomes a serious problem for
the patient, since prostatitis often sets the stage for or
is the forerunner of prostate cancer.
Most prostatitis (and prostate cancer) is treated by
outdated and largely ineffective means, (i.e., antibiotics,
surgery, radiation, etc. ) which leave the individual with
continuing pain or other symptoms and a progressive
slow slide toward prostate cancer, or crippling surgery
which can eventuate in no sex life, use of “Depends,”
and other very unattractive lifestyle changes.
But the good news is that most of the prostatitis
and prostate cancer can be avoided, arrested, or managed by diet and lifestyle changes; by supplementation,
which is very speciﬁc to prostate health; and by alternate
medical approaches, which in all but the most severe or
advanced cases can avoid crippling surgery, radiation,
prostate freezing (i.e., cryosurgery), etc.
It is possible that most prostate cancer can be avoided, and that most prostatitis can be reversed, minimized,
or managed. Though prostatitis may have no symptoms,
some patients report severe pain. An individual’s PSA test
(which is the most widely used test for men’s prostate
health) may register over 4. However, close examination
typically does not indicate prostate cancer. Nevertheless,
an elevated and rising PSA can be like a falling barometer,
which warns of (or forecasts) a coming storm (in this case,
the approach of prostate cancer). An elevated PSA is a
major red ﬂag or barometer for coming problems, but is
not always associated with prostate cancer.
Several standard procedures for treating the prostatitis
(including antibiotics, prostate massage, hydrotherapy, dietary changes, etc. ) were employed, in the example given,
and the symptoms diminished - but the PSA remained
elevated at about 4. In this person, Dr. Wheeler (director
of the Prostatitis and Prostate Cancer Center of Sarasota, Florida) suggested a new herbal formulation called
PEENUTS for the care and feeding of the prostate.
After about six months of taking this formulation,
this person’s PSA dropped from over 4 to 0.7 (and has
remained under one for over six years). The American
Cancer Society publicizes that the “normal” range for
PSA is 1. 0 - 4. 0. However, recent studies have suggested
that a more conservative number, probably 3. 0 be used
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
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Fact, Fiction & Fraud in Modern Medicine
Hopkins recent study suggesting that PSA of greater
than 0.7 in ages 40-50 leads to a 300-400% greater likelihood of prostate cancer in ages 60-70, a better target
number would be 1.0. Some urologists use “age-correlated” PSA numbers, which has not been universally
embraced. Another way of looking at this number is that
in any male the PSA, when over 0.7, bears a correlation
to the risk of the two important prostate diseases, i.e.,
prostatitis and cancer.
Chronic prostatitis (inﬂammation or infection of
the prostate) is common to all adult men. It’s associated
with virtually all cases of prostate cancer and present in
every prostate biopsy regardless of other ﬁndings. Chronic
prostatitis may not cause signiﬁcant symptoms in many
men, but in others it can be a devastating disease that
severely affects the quality of life of those afﬂicted. It’s
difﬁcult to diagnose and even more difﬁcult to treat. A
wide variety of therapies are available but few actually
work in more than a small percentage of cases. None of
the standard treatments is able to improve the health
and wellness of the prostate but a promising new approach may accomplish this. We’ll review the current
knowledge about chronic prostatitis, its treatment and
a possible connection to prostate cancer.
I. THE PROSTATE
Dr. Wheeler writes, “the prostate gland is a walnut
sized mucus-producing organ that lies just below the
urinary bladder. All men are born with a prostate that
grows and enlarges throughout life. There is a channel
through the prostate which carries urine from the bladder to the outside. This is why prostate problems often
cause difﬁculties in urination. The only known function
of the prostate is to produce a secretion that nourishes
and protects the sperm during reproduction. It has no
other known purpose.
Prostatitis is deﬁned as inﬂammation or infection of
the prostate. While prostatitis may be acute, associated
with systemic ﬁndings of fever, chills and rigors, most
cases of prostatitis are chronic and tend to be incurable
with relatively frequent recurrences despite optimal
standard therapy.
A. THE CLINICAL PRESENTATION
The most common symptom of chronic prostatitis
is pelvic pain, followed by various voiding symptoms,
impotence and infertility. Pain from prostatitis is usually located in the groin, testicles, penis, just above the
rectum, or in the suprapubic area over the bladder. Pain
is frequently associated with ejaculation. Typical voiding
symptoms produced by prostatitis include getting up
at night to void (nocturia), frequency, urgency of urination, incomplete voiding, decreased force of the urinary
stream, intermittency of the stream and a need to push
or strain to void. Impotence or erection difﬁculties and
male infertility are also associated with prostatitis.
Prostatitis is a troubling disease that remains a
health risk to most of the adult male population. John
Krieger, M.D. and Richard Berger, M.D., [Urologists at
the University of Washington], believe that all men will
acquire prostatitis in their lifetimes. Historically, men
under 50 years old with voiding symptoms or pelvic
pain had prostatitis until proven otherwise. Men over
50 years old with the same symptoms were assumed
to have enlarged prostates. A recent study has shown
that most men with voiding symptoms regardless of
age actually have prostatitis when properly tested. In
a trial of 121 consecutive men who exhibited voiding
symptoms, 80% were found to have chronic prostatitis
regardless of their age.
B. THE DIAGNOSIS
Prostatitis has been termed “the waste basket of
clinical ignorance” by prominent Stanford University
Urologist Dr. Thomas Stamey because of the difﬁculty it
presents in diagnosis and treatment. Prostatitis is usually
indicated or suggested by the symptoms it produced and
the ﬁndings of a sore or tender prostate when a digital
rectal examination is performed. Prostate Speciﬁc Antigen (PSA), a blood test designed to identify patients at
risk for prostate cancer, will also be elevated in cases of
prostatitis. The presence of a speciﬁc urinary infection
together with pelvic pain, voiding symptoms and a sore
or tender prostate on rectal examination will identify
those 5% of patients with bacterial prostatitis, a true
infection. But the only truly accurate and reliable way to
diagnose prostatitis is from a microscopic examination
of the prostatic ﬂuid or expressed prostatic secretion
(EPS). The prostatic ﬂuid is obtained by gentle massage
of the prostate during the digital rectal examination.
When the ﬂuid is examined under the microscope, a
ﬁnding of more than 10 white blood cells per microscopic
ﬁeld is considered deﬁnitive proof of inﬂammation and
prostatitis. Histological examination of a prostatic biopsy can also show deﬁnitive signs of inﬂammation and
diagnose prostatitis. Despite the fact that examination
of the prostatic ﬂuid or EPS makes the deﬁnitive diagnosis, few family physicians and only about 33% of all
urologists perform it because of difﬁculty in obtaining
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May, 2004
a proper sample, inadequate testing equipment or just
lack of knowledge.
In prostatitis, any combination of pelvic and urinary
symptoms are possible, as well as the rare individual
who is without pain, discomfort or urinary problems yet
still has prostatitis based on an abnormal examination
of the prostatic ﬂuid or EPS.
THE ETIOLOGY (POSSIBLE CAUSES)
Virus Idiopathic (Unknown)
• Bacteria Stress and Psychological Factors
• Yeast Immune System Based
• Dietary, and a Combination of Above
• Crystal Deposition Social, Genetic or Environmental
•
C. TREATMENT OPTIONS
Treatment of prostatitis has been anything but a
sure proposition. According to noted prostatitis expert
Dr. Curtis Nickel of Kingston, Ontario, “there is widespread frustration, discomfort, and lack of knowledge in
both primary cases. Those patients who truly have an
identiﬁable infection of the prostate will certainly beneﬁt
from antibiotics. These need to be continued for at least
6-12 weeks and in some cases long-term or indeﬁnite antibiotic suppression therapy is necessary. We don’t have
any data that looks at recurrent disease over many years.
Campbell’s Urology, the urologist’s most authoritative
reference text, identiﬁes only about 5% of all patients
with prostatitis as having bacterial prostatitis which
can be ‘cured’ at least in the short term by antibiotics.
In other words, 95% of men with prostatitis have little
hope for a cure with antibiotics alone since they don’t
actually have any identiﬁable bacterial infection.”
In the treatment of prostatitis, physicians have traditionally recommended everything from doing nothing
to multiple and extended courses of antibiotics, other
drugs and lifestyle changes. Alpha-blockers (Hytrin,
Cardura and Flomax) are designed to relax the muscle
tension in the prostate and improve urinary ﬂow. They
do tend to improve voiding difﬁculties and relax tension
in the prostate but they are expensive, need to be taken
indeﬁnitely in high doses, may often have signiﬁcant
side effects and don’t cure the underlying problem or
prevent recurrences.
Finasteride (Proscar) can shrink prostate tissue but
there is no proof it helps in the treatment of prostatitis.
Allopurinol, a drug which reduces uric acid levels in the
body, has been used to treat prostatitis based on the
theory that uric acid crystals may form in the prostate
and cause inﬂammation. Most clinicians who have tried
Allopurinol for prostatitis report disappointing results
from this therapy. [This medication also has a serious side
effect proﬁle -Ed]. Anti-inﬂammatory agents (Motrin or
Advil) and hot sitz baths have been helpful in treating
the discomfort caused by prostatitis in many patients,
but neither of these treatments actually cures the disease and the beneﬁts wear off rapidly. Irritative voiding
symptoms may be relieved by bladder relaxing agents
such as oxybutynin (Ditropan) while antidepressants
such as amitriptyline (Elavil) have been helpful in various
chronic pain conditions such as prostatitis associated
with depression. Biofeedback, behavioral therapy, referral to a pain clinic, and psychological treatment, have
all been recommended for patients with prostatitis and
occasionally offer some relief to selected individuals. For
the most part, current treatment methods for prostatitis
are generally rather disappointing.
Prostatic massage plus antibiotics deserves further
review. Proponents of prostatic massage (championed
in the Philippines) have little reproducible data to support their methods. Other drawbacks include intense
discomfort/pain at the time of massage, the need for accurate cultures of the prostatic ﬂuid and a dependence on
antibiotics to ultimately affect the cure. Dr. John Krieger
appropriately points out that the following multiple factors preclude accuracy of the culture technique involving urine, semen or prostatic secretion for diagnosing or
treating prostatitis:
1. The presence of inhibitory substances.
2. The unknown effects of many previous courses of
antibiotics.
3. The fact that most bacteria from the prostate do not
readily grow on conventional culture media.
4. The high number of uncharacterized bacteria that
infect human prostate tissue.
5. The difﬁculty in obtaining a pure specimen from the
prostate, which has not been contaminated by possible
infectious organisms of the urethra or urinary passage.
6. The fact that most cases of prostatitis are not infections in the ﬁrst place.
II. PROSTATE SPECIFIC ANTIGEN (PSA)
AND PROSTATITIS
PSA is a Surrogate Marker for Prostatitis and the
‘Barometer’ for Prostate Health. Through research that
Dr. Wheeler presented at the National Institute of
Health (NIH), it was demonstrated that Prostate Speciﬁc
Antigen (PSA) is a surrogate marker for the diagnosis of
prostatitis. In a study of 177 men, if the PSA was greater
than or equal to 1. 0 ng/ml, 100% of the participants had
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Fact, Fiction & Fraud in Modern Medicine
prostatitis as deﬁned by the expressed prostatic secretion
(EPS). [This is frequently performed at the Paracelsus Clinic
and evaluated with dark ﬁeld microscopy by Dr. Dorman
-Ed]. Most men understand that EPS is the diagnostic
marker for prostatitis. Despite this fact, fewer than 30%
of Urologists and the rare Primary Care Physician perform this critical evaluation of the prostate secretion.
Once again, the relevance is based on making the correct diagnosis, as it will encourage an improved treatment plan with a predictable outcome. That said, most
physicians choose to ignore the facts, while following
the dictum they learned in medical school ten or more
years prior. My data was corroborated by research from
Johns Hopkins and Ballentine Carter, M.D. that showed
men aged 40-60 with a PSA greater than 0. 7 ng/ml had
a 3-4 fold increased incidence of prostate cancer within
their subsequent 20 years (reference – The Baltimore
Longitudinal Study). This is cutting edge data that supports the concept of normalcy for a PSA to be less than
one. Therefore, living with a PSA of greater than one
provides an individual with an increased risk for prostate
cancer. In this manner, PSA represents disease activity
and serves (for many) as the “Barometer of Prostate
Health. ”It is common for men as they age to note PSA
elevation secondary to components of prostatitis, BPH,
and/or prostate cancer. Notwithstanding that statement,
the number one reason that PSA rises is secondary to
prostatitis, not benign prostatic hyperplasia (BPH) or
prostate cancer.
As mentioned earlier, Prostate Speciﬁc Antigen or
PSA was originally designed as a blood test for prostate cancer screening. PSA blood levels of 0-4 were
designated as “normal,” but this range was arbitrarily
selected as a guide for possible prostate cancer screening
and does not necessarily indicate a healthy prostate. We
now know that up to 30% of all prostate cancers occur
in patients with PSA levels less than 4.0. Since prostate
cancer obviously cannot be considered normal, this
suggests that the original “normal” PSA range of 0-4 is
much too high. It’s been suggested that any PSA level
greater than 1.0 indicates an unhealthy prostate with
active prostatitis.
It’s well known that prostatitis increases the PSA
level. In fact, it is much more likely that any unexplained
increase in PSA level is due to prostatitis than to prostate
cancer. Many urologists will currently treat their high
PSA patients with one month of antibiotics and repeat
the PSA level before recommending a biopsy. Only if
the second PSA level remains elevated will a biopsy be
ordered.
We believe that a signiﬁcant percentage of any el-
evation of PSA level in the blood should be considered
prostatitis until proven otherwise. While prostate cancer
is certainly a concern and should be considered carefully
and appropriately, prostatitis is much more likely. PSA can
serve as a very useful marker or indicator of the degree
of prostatic inﬂammation present and help determine
the effectiveness of prostatitis therapy.
III. THE LINK BETWEEN CHRONIC
PROSTATITIS AND PROSTATE CANCER
All men develop prostatitis. This has been shown
in several studies including one done in 1979 by Drs.
Kohnen and Drach who found 98.1% of 162 prostates
removed surgically had evidence of inflammation.
Dr. Timothy Moon, urologist at the University of Wisconsin, and many others report that virtually 100% of
the biopsy and surgical prostate specimens they examine
show evidence of prostatitis.
We also know that all men eventually get prostate
cancer if they live long enough. Annually, 40,000 men die
from prostate cancer while over 300,000 new cases are
diagnosed. Prostate cancer is the most common cancer
to affect men and the second leading cause of cancer
death in men (lung cancer is ﬁrst). In the United States,
one in four men who undergo prostate biopsy will be
found to have prostate cancer, but all of them will have
prostatitis. These ﬁndings have led Dr. Timothy Moon
and others to suggest that prostate cancer is always associated with prostatitis.
Prostatitis leads to Prostate Cancer
At the 2002 Naples, Florida meeting of the American Association of Cancer Research (AACR), national
experts in microbiology and genetics, representing our
ﬁnest institutions of higher learning, demonstrated that
prostatitis (an inﬂammatory, non-bacterial event common to the prostate) evolves to prostate cancer. Despite
this very important ﬁnding, the majority of physicians
treat prostatitis as a disease of exclusion and continue
to offer antibiotics as their only form of therapy. Notwithstanding the above, antibiotics suppress the immune system and provide added risk for the evolution
of “super resistant organisms. ”
In the AACR paradigm, the pathway from prostatitis (the non-bacterial, inﬂammatory process in 95%
of all cases) leads to cellular dysplasia. Early cellular
atypical change, consistent with dysplasia and oxidative
change, results in Proliferative Inﬂammatory Atrophy
(PIA) that induces the mutagenic process to Prostatic
Intraepithelial Neoplasia (PIN). This entire process
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May, 2004
involves cellular instability through the promotion of
“free radicals.” As we know, PIN frequently evolves to
prostate cancer. Whether men have prostate cancer or
the diseases of BPH or prostatitis, the PEENUTS formula
makes sense for all men as it works versus the cellular
oxidative process that enhances the risk of or the growth
of prostate cancer.
Young men in their 30s typically are quite prone to
prostatitis and are not generally thought to be at risk
for prostate cancer. But a study from Memorial Sloan
Kettering Cancer Center in New York found that 30% of
525 American men aged 30-39 actually had microscopic
prostate cancer. Is it possible that chronic prostatitis
may increase the risk or promote the growth of prostate
cancer? There is evidence that suggests this may be so.
It’s well known that chronic inﬂation of several
other organs is associated with various cancers. Examples include the inﬂammation of the lower esophagus
(Barrett’s esophagitis), which leads to esophageal cancer,
hepatitis that eventually becomes hepatic cancer and
ulcerative colitis, which develops into colon cancer. Since
chronic inﬂammation causes cancer in other organs, it is
reasonable to suggest that chronic prostate inﬂammation (prostatitis) if left unattended may ultimately lead
to prostate cancer.
Prostate cancer is always found together with prostatitis and all men will probably get both diseases if they
live long enough. Both prostate cancer and prostatitis
raise Prostate Speciﬁc Antigen (PSA) levels and occur
most often in older men. Both conditions are currently
at epidemic levels. Zinc levels are low or absent in both
prostate cancer and chronic prostatitis. While prostate
cancer and chronic prostatitis are clearly associated in
some way, further research and epidemiological studies
are required to determine the exact nature of the relationship as well as the cause and effect mechanism.
IV. THE RESEARCH
Present research dollars in prostatitis are so few that
at our present pace a millennium will pass with countless
innocent men suffering and possibly dying needlessly
before the true answers are known. At the 1998 National
Convention of the American Urological Association (attended by American and International urology experts),
51% of all the papers and studies presented involved
prostate cancer while only 3% addressed prostatitis.
While a few studies of various antibiotics for the treatment of prostatitis are underway (funded largely by the
pharmaceutical industry that makes the antibiotics),
there is virtually no other signiﬁcant research currently
being done in the United States on this disease.
Practically every man alive has prostatitis, making
it one of the world’s most common diseases. Diagnosis is difﬁcult and current treatments are frequently
inadequate. The association between prostatitis and
prostate cancer is irrefutable. With all this in mind, it is
particularly disturbing that prostatitis research has been
so seriously underfunded for years. Leroy Nyberg, M.D.,
Head of Urology Research for the National Institute of
Health (NIH) has stated: “It’s amazing to me that we
can’t reliably treat the majority of men with prostatitis.”
The NIH has organized a research arm that expects to
bring a fresh look to chronic prostatitis, but the results of
this research are not expected for several years. Today,
chronic prostatitis remains the single most under-diagnosed, misunderstood and under-treated medical
disease in the world.
The Prostate Merry-Go-Round
A classic example of a typical patient’s experience
involved a 65-year old man from Lubbock, Texas who
had noted a PSA of 18. His urologist appropriately performed an ultrasound examination and prostate biopsy.
The result was chronic prostatitis with no evidence of
cancer. Antibiotics were given, but no other therapy was
offered. (Remember that only 5% of cases of prostatitis
are actually caused by bacteria, which are potentially
curable with antibiotics.) His PSA was repeated after
six months and found to be unchanged. The patient underwent a second prostate biopsy, which again showed
only chronic prostatitis. When the patient asked the
doctor what he could do, the urologist offered to repeat
the PSA in another six months and consider an additional biopsy then. The patient got onto the Internet
and researched prostatitis. Eventually, he discovered a
nutritional product that improved his voiding problems
substantially and reduced his PSA by almost half in only
three months.
V. NUTRITIONAL THERAPIES
Natural herbal remedies, although not highly regarded by most physicians in the United States, are
among the most promising new treatments available for
prostatitis at this time. They have been used extensively
in Asia and Europe but are only now becoming popular
in America. While usually recommended for prostate
enlargement, there is growing evidence that they may
be quite effective for prostatitis when used in the right
combinations. These products appear to be quite safe and
have no known side effects or drug interactions.
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Fact, Fiction & Fraud in Modern Medicine
Saw Palmetto is the most popular plant product
used for prostate problems in the world. It seems that
an extract from this plant is somehow able to reduce
prostatic inﬂammation and swelling as well as improve
many bothersome urinary symptoms. Pygeum africanum is made from the bark of African evergreen tree.
It appears to work as an anti-inﬂammatory agent. It
improved urinary symptoms in 66% of patients tested
in several European studies.
Selenium has been shown to reduce the incidence
of prostate cancer by up to 66% in various studies. This
theoretically occurs because of an improvement in the
general health and immunity of the prostate.
A Finnish study showed that Vitamin E reduced
prostate cancer by 32%. Zinc has also been linked to the
prevention of prostate cancer and an improved prostatic
immune system. It also exerts an anti-inﬂammatory effect on the prostate.
Combining these remedies along with other herbal
products, vitamins, antioxidants and amino acids seems
to improve the overall beneﬁt and effect. For example,
Vitamin E and Selenium together are able to stimulate
T cells, which help the immune system work to better
protect and heal the prostate. Zinc may need substantial
amounts of Vitamin E and Selenium as well as other
nutrients to be able to effectively enter and treat the
prostate.
My patented and promising all natural combination product developed recently is called “PEENUTS.”
PEENUTS is an acronym for Power to Empty Every Time
while Never Urinating Too Soon and stands for normal
urinary function and prostatic health. This particular
combination product contains all the natural remedies
known to improve prostate health in a unique formula,
which seems to be particularly effective in treating both
male urinary symptoms and especially prostatitis. In
an effort to qualify the effectiveness of “PEENUTS,”
Dr. Wheeler’s group has conducted a prospective,
randomized, double blind, placebo controlled study.
“PEENUTS” was shown to be statistically and clinically
signiﬁcant. All men in the study improved 3 out of 7
voiding symptom categories. Sixty-nine percent of the
men improved 6 or 7 out of 7 categories.
In a follow-up to the study, more than 300 men have
been evaluated in the clinical ofﬁce setting. The average
improvement in voiding symptom score was approximately 13 points (50%). The PSA, a barometer of prostate
health, improved in all patients by an average of 41. 3%,
while the EPS, our most sensitive marker for prostatitis,
noted a 65% reduction in white blood cells. There were
no side effects or drug interactions noted during testing
or clinical follow-up. As these ﬁndings can be conﬁrmed
by other researchers, it would mean that “PEENUTS”
could be the medical breakthrough we’ve been looking
for in the treatment of prostate disorders, male urinary
problems and especially chronic prostatitis.
Through our research, the inability of the PSA to
fall while on PEENUTS is likely associated with the
diagnosis of prostate cancer. This is important, as this
is the group that should consider a prostate biopsy with
the “Color Flow Doppler” ultrasound technique. In Dr.
Wheeler’s practice, men need to qualify for prostate
biopsy through the failure of PEENUTS to lower the
PSA, as 70-80% of all biopsies are negative. Therefore,
the failure to decrease the PSA on the PEENUTS formula would suggest the likelihood of bigger problems.
This ultrasound technique is similar to Doppler radar
applied to our local weather forecasts. The application
of Doppler ultrasound to the prostate identiﬁes areas
of movement associated with blood ﬂow. Blood ﬂow is a
well-recognized component of prostate cancer evolution
and growth. I have had many patients who had a negative biopsy using the traditional “gray scale technique,”
who were diagnosed with cancer using the “Color Flow
Doppler” methodology. Our experience with the “Color
Flow Doppler” ultrasound evaluation has made the gray
scale technique obsolete. I frequently remind patients
that stability of the PSA blood test is not a favorable
factor when the number is between 4. 1 ng/ml and 10. 0
ng/ml or even higher as this indicates signiﬁcant oxidative
disease or prostatitis. Prostate cancer, therefore, is often
a result of years of oxidative cellular stress associated
with prostatitis.
SLOPE OF DISEASE
The slope of disease reﬂects whether the prostate is
getting healthier or less healthy. Statistically speaking,
as men age the PSA generally rises. The reason for this
is associated with an increase in prostate disease. While
I understand the thinking process, it does not have to
happen. That said, the PSA blood test result is a “dot”
on a speciﬁc disease or health curve. In an effort to understand this, a good analogy would be a thermometer
measuring your body temperature at 100 degrees (the
dot on the disease curve), only to realize that 4 hours
later it is 102 degrees. The slope of this disease is upward
indicating a worsening of the temperature marker which
probably also reﬂects a worsening of disease. In the case
of PSA, the number represents a similar point on the
clinical reference curve and in fact may be associated
with an intensifying problem. This is mentioned, as
Page 6
May, 2004
men may need to take the PEENUTS product for 6-12
months to change the slope of disease. In this manner,
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
months. I have found that 4 factors play a major role in
this in the timeline to PSA reduction. The four factors
are: prostate size, severity of disease, duration of disease and the possibility that cellular mutation may be
taking place through the PIN mechanism (a precursor
process to prostate cancer), as example, or that prostate
cancer is also present. In this regard, men need to be
patient and take either two or three PEENUTS per day
in divided dose with meals.
“NIGHTTIME VOIDING”
My ﬁnal comments involve the possible need for
alpha blockade in addition to the PEENUTS formula
for optimal bladder/prostate function. While PEENUTS
works on the overall integrity of the prostate at the cellular level (ﬁghting oxidative reaction), alpha blockade
such as Flomax, works primarily at the bladder neck
effectively relaxing this area in a hammock-like manner. My clinical acumen suggests that 20-25% of all men
have this bladder neck anomaly. In this regard, it is not
uncommon for many men to beneﬁt from PEENUTS
and Flomax. My preference for treatment of voiding
symptoms would always be to try the natural product
ﬁrst and add the synthetic (Flomax) secondarily. On the
topic of nighttime voiding, men need to understand the
inability to sleep well is the primary reason men still get
up while using the PEENUTS product. In other words,
men who are easily aroused during their sleep cycle
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
possibility the disease may return. Until then, I remain
your consultant and advisor to a healthier prostate.
SUMMARY
A PSA of over 1 may indicate an unhealthy prostate.
It’s obvious that the lower the PSA the lower the risk
of prostate cancer. Anything you can do to lower your
PSA level will probably reduce your risk of eventually
getting prostate cancer.
Keep track of your PSA level yourself. If the level
is rising, even if it remains below “4,” make sure your
physician is aware of it.
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,
such as Blacks and men with a positive family history
of prostate cancer, should be checked starting at age 40.
Men with known elevations in their PSA levels and those
with inconclusive or “suspicious” previous biopsies may
need to be checked more often.
Don’t be afraid to ask questions of your physician or
get a second opinion about your health. A true professional will take the time to answer your questions and be
open to suggestions about alternative therapies.
There may be a link between prostatitis and prostate
cancer. Practically all men eventually are expected to get
both and they are often found together.
Find out all you can about prostatitis and treat it as
aggressively and effectively as you can. It may delay or
even prevent the development of prostate cancer.
Be aware that your physician may not be an expert on
the treatment of prostatitis. Ask him about the various
diagnostic tests and therapies available and which ones
are appropriate for you.
Page 7
Thomas A. Dorman, MD
is now practicing at
The Paracelsus Clinic
2505 S. 320th Street, Suite 100
Federal Way, WA 98003
253-529-3050
Fax 253-529-3104
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
ADDRESS CORRECTION REQUESTED
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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
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report accurately, however, no guarantee for the veracity of any information
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