is surgery called pelvic lymph node dissection. Clearly, this invasive exploratory operation, where the surgeon searches with his hand for hard lumps in the abdomen, cannot find all the tiny sites to which cancer spreads. Moreover, the metastases to nodes are generally subcentimeter and so are likely to be missed clinically and radiographically. In addition, the most reliable sign of metastatic adenopathy is in the perirectal space, which is not routinely examined at surgical dissection. The MRL exam is so accurate that a negative exam translates into a 96% chance that there is no metastatic disease to the lymph nodes. In addition to sparing patients from the risk and pain of surgery, this methodology reduces health care costs.
PROACTIVE MONITORING
The monitoring approach presented here is based on Dr. Bard’s 39-years experience in the field of diagnostic ultrasound, 15-years of imaging the prostate with power Doppler blood flows, and 6-years of performing 3-D PDS and comparing the results with high resolution MRI scans of the pelvis with special sequences formulated specifically for the prostate. Dr. Bard has diagnosed, observed, and shared in the treatment of some 5,900 patients. Through nutritional support, medical treatment when appropriate, and 3-D monitoring on a schedule dictated by each individual’s current situation, only 5 of these 5,900 men have died from their PCa in a 10-year time period. (This compares very favorably to the expected 239 deaths from PCa within 4 years of diagnosis, based on figures from the Health Professionals Follow-Up Study for men diagnosed with nonmetastatic PCa observed from 1990 to 2008.6)
ProActive Monitoring couples 3-D Doppler and MRI imaging at regular intervals with the B-Sit/AOX) nutritional support. The B-Sit/AOX approach was first developed out of Arthur Bartunek’s early work with coenzyme Q10 (CoQ10) and cofactors that improved Q10 outcomes, especially for cancers. The formulations and protocols used during proactive monitoring were further refined with feedback from the progressive 3-D Doppler monitoring of men with varying stages of PCa. During the 10-years of this process, improvements in imaging have allowed changes to be tracked more accurately, and to make appropriate nutritional adjustments based on this. In addition, the use of several nutritional items, notably curcumin and tocotrienols, have been independently developed for use with cancer and are reaching phase II and phase III clinical trials. These have been included in the protocol and are discussed here.
BETA-SITOSTEROL/ANTIOXIDANT MATRIX (B-SIT/AOX) NUTRITIONAL SUPPORT
One way of phrasing the question we posed about 10-years ago was: What could happen when essential nutrition for cell membrane integrity and healthy cell reproduction was returned to the diet through supplementation? This is a quintessential naturopathic nutritional intervention. This was based on more casual observations of improvement in PCa in men following a rigorous program of lifestyle and dietary change. From another realm, it was observed that CoQ10 was proving more efficacious for PCa in subjects who were also eating beta-sitosterol (B-Sit) rich foods, however, this was based primarily on change in PSA (prostate specific antigen) and not direct examination of the prostate.7 After reviewing diets of populations with extremely low cancer, cardiovascular, and hypertension rates, a high-B-Sit based supplement was produced, with antioxidants derived from these same diets. The combination provides nutrition that is integral to cell membrane health and a healthy cell environment. Combining the B-Sit/AOX formulation with appropriate CoQ10, and a highly-rated multi-supplement with a high vitamin B Complex, became the basis for ProActive intervention. With this, watchful waiting became ProActive Monitoring.
The 3-D color power Doppler sonogram provides a means to track changes and progress in the condition of the prostate and PCa. By correlating the 3-D exam with state-of-the-art DCE-MRI grading of the cancer, Dr. Bard was able to both evaluate procedures for optimal timing of re-exam, and provide feedback for modification of an individual’s nutrition program, and in increasingly rare circumstances, recommendations for procedures such as HIFU (high-intensity focused ultrasound). Routine feedback also gave the information needed to further develop the core protocol, based primarily on changes in prostate size, tumor size, location and density, vascularity, and capsule integrity.
Prostate Nutrition
The walnut-sized prostate gland is a mucus-producing organ in males that lies just below the bladder. Growth to functional size is triggered by puberty, and continues until about age 30 when equilibrium is established between cell growth and apoptosis. Normal mid-life hormone changes, when coupled with diets that do not provide adequate nutrition for prostate cell integrity and hormone balance can trigger benign enlargement (BPH) and set the stage for other prostate conditions including prostatitis and PCa. The typical hormone pattern leading to BPH is elevated estradiol combined with elevated dihydrotestosterone (DHT), and typically estrogen dominance. This also sets up the circumstances for chronic prostatitis. While there is substantial evidence that BPH does not develop into cancer, the same underlying factors of cellular environment and integrity set the stage for PCa, and therefore, both can be considered nutritional in origin.
There are several key factors that are known to influence the development of PCa, these include:
•Inflammation: While only a relatively small percent of prostatitis – any form of inflammation of prostate tissue – is caused by bacterial infection, increasing evidence indicates a link to an imbalance in sex steroid hormones in all chronic prostatitis. An elevated level of the inflammatory cytokine interleukin (IL)-8 is a second and critical inflammation factor. IL-8 promotes stromal and epithelial cell proliferation. It is upregulated in both BPH and PCa, and it is also implicated in angiogenesis. IL-8 has been shown to have a pervasive role in promoting tumor cell survival and proliferation for all cancers. Although BPH is not a causal factor for PCa, any form of chronic inflammation of the prostate can now be considered a risk factor for PCa. (Some nutritional approaches have gone further, declaring inflammation the single “driving force” behind PCa and relying on non-nutritive supplements in an attempt to address this issue. However, this does not restore underlying nutritional imbalances which can redress the inflammation, and adds an extra, mostly unnecessary layer of complexity.)
•Prostate cell membrane elasticity: There is substantial evidence from two sides that disruption in the cell membrane’s elasticity that increases rigidity is a precursor for the development of cancer cells. It is also a factor in insulin resistance. On one side, there is evidence to suggest that rigidity leads to focal adhesions and aberrant growth [cancer] by increasing tension in the cell that is normally generated by elevated Rho factor (GTP-binding protein family).7,8 On the other, ultrasound units that can read the elasticity of cell membranes are now being shown to be accurately able to detect cancer. The primary dietary reason for alteration to a cell’s elasticity and fluidity is an imbalance between B-Sit (B-Sit) and cholesterol in the cell membrane.9,10
•Membrane permeability and intracellular environment: There are many cell functions dependent upon normal cell membrane permeability. Of interest here is an alteration in the isoprenoid pathway, the alteration of the balance of calcium and magnesium with excessive entry of Ca2+ and the release of calcium stores, a critical factor in cancer metastasis, which can be triggered when this imbalance is accompanied by critically low CoQ10 levels in the immediate intracellular fluids.
The nutritional protocol described here, addresses the above issues but also increases PCa cell apoptosis, reduces proliferation, reduces excess estrogen production, supports/restores normal cell reproduction and differentiation, and reestablishes several mechanisms of homeostasis, especially for copper homeostasis. In other words, the B-Sit/AOX Matrix provides the nutritional substructure missing from today’s food supply for the body’s normal, dynamic anticancer functions, and when balanced properly accomplishes this at physiological levels.
Diet and Prostate Cancer
A great deal of research has been published
