Download WHAT IS CANCER - Healing and Cancer

Complete Prostate Cancer Care:
How to integrate the best of
conventional and complementary medicine
Rob Rutledge, MD, Radiation Oncologist
Associate Professor, Dalhousie University
CEO, the Healing and Cancer Foundation
OVERVIEW OF TALK
 Basics of prostate cancer
 Essential concepts for treatment decision-making
 Hormone therapy side effects and treatment
 How to get the best medical care
 Must-do healthy lifestyle habits
 An approach to complementary therapy
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# of
new
cases
50
AGE
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Prostate cancer in Canada in 2011
Each year: 26,000 men diagnosed, 4000 deaths
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Don’t turn slow growing prostate
cancer cells into fast growing cells
 Damage to the normal prostate cells causes them
to turn into prostate cancer cells
 Further damage to slow growing prostate cancer
cells cause them to become fast growing cells
 What’s good for preventing prostate cancer is
good after a diagnosis
 What’s known to cause prostate cancer should
be avoided
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What is prostate cancer:
A layperson’s guide
WHAT IS PROSTATE CANCER?
 Prostate cancer occurs when some cells in the
prostate begin to grow in an uncontrolled way
 Each man’s prostate cancer is different
 Majority are very slow growing cancers
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THE INSTRUCTIONS IN THE CELL
 Each cell has the control centre (nucleus)
 Instructions manual is made of words and sentences
(DNA)
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WHEN CELLS DIVIDE
 One parent makes two daughter cells
 The new cells are exactly the same
 The same control centre
 The same book of instructions
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How prostate cancer cells are made
 Prostate cancer cell is a normal prostate cell with
many mistakes
Three ways the mistakes are created:
1) Born with mistakes – genetic is rare
2) Accident when cell divides - mutation
3) Substance causing cancer - Carcinogen
 Fatty diet, agent orange
 Firefighters are at higher risk
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PROBLEMS WITH THE CELL’S
INSTRUCTIONS
If the instructions read:
“STOP dividing after coming in contact with
the lining of the prostate gland”
is changed to
“KEEP dividing after coming in contact with
the lining of the prostate gland”
The cell won’t stop growing!
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PROBLEMS WITH THE
CELL’S INSTRUCTIONS
If the instructions read:
“Grow slowly if testosterone is on the receptor”
is changed to
“Grow QUICKLY if testosterone is on the receptor”
The cell will keep on dividing quickly
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WHAT IS PROSTATE CANCER
 Normal prostate cell that has begun to grow in a fast
and uncontrolled way
 Requires dozens of changes to the cell
 Cancer cells will grow into normal tissue
 After more changes can get into lymph and blood
system to grow colonies at a distance (metastasis)
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Risk factors for prostate cancer
 Age and being male –
testosterone
 Family history
 Double risk with one 1st degree
relative
 5 times risk with two 1st degree
relatives
 Diet….
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USA - Black
USA - White
Canada
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Poor diet increases risk of
prostate cancer
 Animal fats
 Red meat – especially if well done
 Dairy products
 Transfats
 Diet low in vegetables (want >4 servings per day)
 Alcohol if more than 5 drinks per day
 Folic acid and zinc – from too much supplementation
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OBESITY AND SUGARY DIET
 Prostate cancer risk increases with increasing weight
 Associated with higher waist to hip ratio
 Increased weight associated with more aggressive
prostate cancer.
 Insulin and insulin-like growth factor released with
sugary foods – prime cancer cell turnover
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Don’t turn slow growing prostate
cancer cells into fast growing cells
 What’s good for preventing prostate cancer is
good after a diagnosis
 What’s known to cause prostate cancer should
be avoided
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EACH MAN’S CANCER IS DIFFERENT
 Each cancer has different mistakes and a different
personality
 One man cannot compare their cancer to any other
 Any man can always do better than expected!
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HOW A TUMOUR GROWS
 A tumour is a collection of cancer cells
 A tumour starts as one cancer cell
 1 cell then 2 then 4 then 8 …..
 Tumour growth if more cells are made
than die
 Tumour doubles in size over 1-3 years
or longer
 Tumour - 1 cm in size has a billion cells
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HOW PROSTATE CANCERS
CAUSE PROBLEMS
 Problem in the prostate
 Narrow the tubing – urinate more often
 Spread to lymph nodes – uncommon
 Spread to other parts of body especially bones
 Affect whole body - fatigue
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Prostate Specific Antigen PSA
 A chemical produced by both normal
prostate cells and prostate cancer cells
 Inflammation / infection of the normal
prostate cells causes the PSA to increase
 Whether or not prostate cancer cells are present
 Explains why the PSA can bounce up and down
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PSA Screening vs. Follow up
 PSA screening is for men who do not have a diagnosis
of prostate cancer and do not have symptoms
 Men who have symptoms like problems with urination should
see their doctors right away
 My view: By age 40-50 all men should have a
conversation with the family doctor about screening
 Once there is a cancer diagnosis, PSA is an excellent
test and predicts what will happen years in advance
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PSA does not localize
cancer cells
 Prostate cancer cells
produce PSA no matter
where they are in the body
 A rapidly rising PSA and a
very high PSA likely means
there are cancer cells
beyond the prostate area
 Eg. PSA doubling time < 3
months or PSA >50
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MAKING THE DIAGNOSIS
 Biopsy - take a piece of
tumor and look under
microscope
 8-12 cores of tissue – each
measuring 1cm by 0.1cm
 This is a tiny sampling of the
prostate gland
 May miss cancer completely
 May miss more aggressive
cancer
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Gleason Score – how
aggressive is the cancer
 Score is out of 10
 Made up of two grades, each out of 5
 First grade is the most common cancer seen
 Second grade is the second most common cancer
 Gleason score 6 or less is slow growing
 Example 3/5 plus 3/5
 Gleason score 8 or more is fast growing
 Gleason 7 is neither fast nor slow
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STAGING OF PROSATE
CANCER
 Rectal exam - T1C, T2, T3
 PSA - <10, 10-20, >20.
 How quickly it has increased
 Gleason score – and how much cancer
is seen on the biopsy
 Optional:
 Bone scan
 Cat scan
 MRI
 Genetics – look at the genetic mistakes
to predict how aggressive the cancer is
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Cross section of bone with a
single cancer cell
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Active surveillance
 Means watching PSA and re-biopsy of prostate
every 1-2 years if curative treatment is being
considered
 Go on to curative Rx if PSA jumps quickly, urinary
symptoms, or biopsy shows worsening cancer
 Best for men with very slow growing cancers
whose life expectancy is less than 10-15 years
 ** Don’t want to turn slow growing cancer cells into
fast growing cells
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Treatment for cure: operation
 Radical prostatectomy – removes the prostate and
seminal vesicles
 Has a specific side effects
 Related to major operation
 Urinary incontinence
 Erectile dysfunction
 Is an excellent option in a situation where prostate cancer
cells are likely restricted to the prostate gland
 Removing the prostate gland provides much more
information about the aggressiveness and extent of cancer
 Radiotherapy can be used after surgery if it looks like
cancer is likely left behind in the surgical bed or if PSA
begins to rise in follow up
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PSA after a prostate operation
 PSA should 0 if all normal prostate cells and
cancer cells have been removed
 An undetectable PSA does not mean there are no
prostate cancer cells left in the body
 It takes hundreds of cancer cells to produce enough
PSA for the blood test to detect it
 A rising PSA after an operation means that there
are cancer cells in the body
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PSA after radiotherapy
 PSA rarely gets down to undetectable value after RT
because some normal prostate cells are still alive
 PSA can bounce around a little because the normal
cells can get inflamed
 A rising PSA 2 points higher than the lowest PSA
value means the cancer has come back
 Rare to recommend surgery or cryotherapy if cancer
recurs
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PSA after hormone treatment
 Hormone therapy starves both normal prostate cells and
cancer cells of testosterone
 Hormone therapy kills / disables over 99% of cancer cells
and should bring the PSA down to an undetectable level
 Hormone therapy given as part of a curative plan increases the
chance of cure
 Once the effects of hormone therapy wear off, testosterone
will raise, and PSA levels will increase according to
whether normal prostate cells or cancer cells remain
 Hormone therapy by itself is not meant to be a cure for
cancer
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Treatment of cure: radioactive
seeds in prostate
 Seed brachytherapy best for men with early
disease when cancer cells likely in prostate
gland of just beyond capsule
 Very high cure rates similar to operation when
done by an experienced specialist
 Side effects
 Irritation of urinary tubing for 6 months
 Narrowing of urinary tubing in long term
 Erectile dysfunction in 50% over 5 years.
 Rectal problems rare
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Treatment of cure: radioactive
seeds in prostate
 Picture here
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Treatment of cure: radioactive
seeds in prostate
 Picture here
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Treatment for cure – external
radiotherapy
 Technology has advanced in last few years to
allow very high dose of radiotherapy to gland
while minimizing dose to surrounding tissue
 Especially good for situations in which prostate
cancer cells beyond capsule of the prostate but
not spread elsewhere
 Side effects
 Irritation of the front part of the rectum – bleeding in
stool (5-10%)
 Irritation of the urinary tubing and bladder
 Erectile dysfunction – in at least 50%
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External beam radiotherapy
Technological advances in
Radiotherapy
 High-dose conformal radiotherapy
 IMRT
 IGRT
 Protons
 High dose brachytherapy
 All: Spare the normal tissue, deliver as high a
dose as possible to cancer cells
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Treatment for cure: adding
hormone therapy to radiotherapy
 Six months up to 3 years
 Can increase the chance of cure by 5-10%
 Increasing effectiveness of radiotherapy
 And/or killing off cancer cells floating in blood stream
 This is the same type of hormone treatment that is
used if the cancer becomes incurable
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Long survival times even
after recurrence
 2007: 70-year-old very well executive
 PSA rising up to 9.5
 Biopsy shows Gleason Score 9 (fast growing)
 Lump in prostate is confined
 Bone scan and cat scan show no obvious spread
 He goes on a clinical trial
 Hormones for 2.5 years, full dose radiotherapy, and
weekly chemotherapy during the radiotherapy
 His PSA is undetectable for 4 years
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Long survival times after
recurrence – Example case
 May 2011 PSA is 0.07 (testosterone is low normal)
 His exam is normal
 November 2011 PSA is 0.15 (testosterone same)
 Doubling time is about 6 months
 Not defined as a recurrence until PSA >2 but likely
incurable cancer now
 PLAN: Wait for PSA > 10-15 - this will take 6
doubling times or 3 years
 Start on hormone therapy – will hold cancer in check
for 3-5 years
 Last 2-3 years of life (or longer) will be on special
chemo
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Long survival times after
recurrence – Example case
 He has many more years to live
 Don’t turn slow growing cancer cells into fast growing
cells
 He can do something about the side effects of
hormone therapy which can influence his quality of life
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Side effects of hormone therapy
 Thanks to Dr. Shabbir M.H. Alibhai of University
Health Network in Toronto for overview
 Loss of libido and erectile dysfunction from lack
of testosterone
 Hot flashes
 Can try a medication (effexor) to help these
 Acupuncture and hypnosis may help
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Side effects of hormone therapy
 Bone loss and risk of osteoporosis / fractures
 Weight gain
 Decreased muscle strength
 Lowering of hemoglobin count by 8-15 g/L
 Mood changes – mild depression, irritability
 Slight decrease in some mental function
 Diabetes
 Increase in lipids / cholesterol
 Slight risk of heart attack –especially > 65 years old
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Osteoporosis & Fractures
from hormone therapy




Hormone therapy leads to progressive
declines in bone mineral density (BMD)
Range from 2-5% in first year, slower in
subsequent years but never stabilizes1,2
Seen across bone sites (e.g. hip, spine,
wrist, forearm)
Some recovery of BMD during off periods
with intermittent hormone Rx
1. Isbarn I. Eur Urol 2009; 55:62
2. Wadhwa V. BJU Int 2009; 104:800
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Normal
Moderate Osteoporosis
Severe Osteoporosis
Courtesy Dr. A. Boyde
Age-Related Changes in Bone Mass
Bone Mass (mg/cm 2)
1500
Men
Women
1000
500
0
10
20
30
40
50
60
Age (years)
70
80
90
100
Age-Related Changes in Bone Mass
with hormone therapy
Bone Mass (mg/cm 2)
1500
Men
Women
1000
Hormones
500
0
10
20
30
40
50
60
Age (years)
70
80
90
100
Prevention of osteoporosis

Calcium/Vitamin D !!!!

Supplements are insufficient to improve bone density (unless severe
deficiency) but can attenuate losses



1000 IU vitamin D daily
1000-1200 mg elemental calcium from all sources
All Men starting hormone Rx should have bone
density measured at start and every 1-2 years
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Muscle atrophy/Frailty/Falls
from hormone therapy

2.8% reduction in lean body (muscle) mass
over 12 months of ADT use1

Loss of upper extremity and lower extremity
muscle strength and fitness compared to
non-users of Hormone Rx2,3
1. Haseen F. J Cancer Surviv 2010; 4:128
2. Basaria S. Clin Endo 2002; 56:779
3. Galvao DA. Prostate Ca Prostate Dis 2009; 12:198
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Cognitive dysfunction from
hormone therapy
47-69% of men on hormone therapay had a
measurable decline in at least 1 cognitive
domain on formal neuro-psychological testing
 Domains most often affected were visuospatial and executive function
1. Nelson CJ. Cancer 2008; 113:1097
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Intermittent hormone
therapy
 Used in place of continuous hormone therapy in
the incurable situation
 Give 9 months of hormone treatment
 Example: 3 injections each lasting 3 months
 PSA should go very low – then wait for PSA to
surpass 10-20
 REPEAT above (for years) until the PSA no
longer goes down
 At which point it’s called castrate-resistant prostate
cancer
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Intermittent hormone
treatment
 Appears equally effective to continuous
hormone therapy in controlling cancer
 Less declines in BMD, fatigue during off period
 Dependent on testosterone recovery
 Impact on other side effects uncertain
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Castrate-resistant
prostate cancer
 Classic hormone therapy is no longer working
including trying steroids (prednisone)
 Standard therapy has been chemotherapy for
men who are strong enough and interested
 Best to see a medical oncologist about options
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Prostate cancer therapy milestones
Abiraterone Acetate
Cabazitaxel
Docetaxel
Mitoxantrone
1994
Denosumab
Zoledronic acid
2002
Current Treatments
MDV 3100
2004
2008
2011
Emerging Treatments
60
First line therapy for castrate
resistant prostate cancer
 Standard therapy is taxotere every 3 weeks
combined with daily prednisone
 Reasonably well tolerated
 Lowering of blood counts, risk of infection
 Hair loss
 Numbness in extremities
 Many more
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Taxotere for castrate
resistant prostate cancer
Petrylak, NEJM, 351: 1513, 2004; Tannock, NEJM, 351: 1502, 2004; Berthold, J Clin Oncol, 26:242, 2008
62
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Tumours growing despite
taxotere can go on to
new therapies
 Abiraterone (Zytiga) is a special type of hormone




therapy which can block the testosterone production
even better than standard hormone therapy
It’s given in pill form once daily along with prednisone
Much easier than classic chemotherapy
May cause mild high blood pressure and fluid
retention, or lower blood potassium, or mild irritation
of the liver
Hope is to use this medication at earlier stages –
PLEASE ENROLL IN CLINICAL TRIALS
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Overall Survival with new type of
hormone therapy
Abiraterone acetate Improved
Overall Survival in Metastatic CRPC
Hazard ratio = 0.646 (0.54-0.77) P < 0.0001
100
Abiraterone acetate:
14.8 months (95% CI, 14.1-15.4)
Survival (%)
80
60
Placebo:
10.9 months (95% CI,10.2-12.0)
40
20
0
ABI
Placebo
ABI
Placebo
0
3
6
797
398
736
355
657
306
de Bono et al. NEJM. 2011; 364(21): 1995-2005.
3.9
months
9
12
15
Time to Death (Months)
520
282
68
210
105
30
18
21
2
3
0
0
64
Bone Builders for metastatic
prostate cancer
 If cancer grows despite hormone treatment there
is a high risk of cancer spreading to bone
 Using bone builders in IV (zometa) or
Subcutaneous (Xgeva) can decrease bone
problems like fractures, spinal cord compression
and delay painful problems
 Keep taking vitamin D and calcium!!
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Complete Prostate Cancer Care
 Understanding what’s happening to you
 Getting the best from the medical system
 Empowering yourself with healthy lifestyle
 Exercise, diet, sleep, weight control
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Purpose of Information
 Learn to speak the language of the
medical system
 Increase your sense of control and
well-being
 Help you make the best medical
decisions
 Empower yourself with non-medical
ways to improve your health and
outcome
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Too Much Information?
 If information gathering is making you tired
 If you find conflicting information
 See your doctor to clarify
 Trust what you are doing is the best for you
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Best Sources of Information
 Your physician/oncologist - individualizes the
information and gives you the best medical advice
 Prepare for these conversations by researching
and understanding prostate cancer in advance
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Sources of General Information about
Prostate Cancer and its Treatment
 Librarian at a cancer centre or hospital
 Prostate Cancer Canada – www.prostatecancer.ca
 Canadian Cancer Society - www.cancer.ca
 1 888 939 3333
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How to Get the Most from the
Health Care System
Learn to advocate for yourself by:
 Preparing for each doctor’s visit
 Contacting your doctor/nurse if you have
questions or concerns
 Drawing on extra services if needed
 Asking for a second opinion if needed
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Getting the Most from your Doctor’s Visit
Before the visit:
 Create a concise summary of symptoms
 Bring a list of current medications and allergies
 Write down your questions before the visit
 Someone should accompany you
 Decide who will make record of the visit
 You may create a file with all your test results
 You can get a copy by visiting medical records
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Getting the Most From Your Doctor’s Visit
 Be honest and open
 Speak up if you’re feeling overwhelmed:
 “I’m not sure I understand”
 Wait until the summary then ask all your questions
 Take notes or record the interview
 Find out what to expect
 Know what to do for each side effect
 When do I need to act?
 Who you should call in case of problems?
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After Your Doctor’s Visit
 Keep a journal and list of results
 If need be ask for a family
conference
 You are the most important person
 Call to clarify information or ask for
appointment
 You are entitled to a second opinion
 Ask to speak to a different type of
specialist
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Getting More Physical Care
 Multiple services are available in medical system
 Nutrition
 Psychology
 Home care nursing
 Rehabilitation
 Spiritual care
 Palliative Care Team
 Social worker can help coordinate if needed
 Ask your nurse or doctor for a referral
 Talk to an expert
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Dealing with Difficult Emotions
 There’s no one right way
 Find a wise person to talk to
 Realize emotions change with time
 Be kind to yourself
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When to Get Help with
Emotional Problems
 Emotional distress is expected but if you:
 Feel overly depressed e.g., crying constantly
 Are withdrawing from all social contact
 Unable to enjoy life / feel hopeless
 Are so distressed can’t decide on treatment
 Can’t sleep because of anxiety
 Talk to a psychologist
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How to Get Help with
Emotional Distress
 Tell your oncologist or nurse during the next apt.
Schedule a visit to your family doctor
 Call the psychologist / counselor at the cancer centre
 Support groups
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Prostate cancer support groups
 Can help you with:
 Getting information
 Learning ways to cope
 Practical tips and support
 A safe place to express your
emotions
 Improve quality of life!
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MUST-DO HEALTHY HABITS
(stop slow growing cells from becoming fast growing cells)
 Diet….
 Vitamin D, Calcium, Omega 3
 Exercise
 Maintain a healthy weight
 Sleep
 Practice relaxation
HealingandCancer.org
The Importance of Nutrition
 Effective way to improve your overall health
 Individualize to what works for you
 Different diet during different phases of treatment
 Ask your doctor and/or professional
nutritionist if persistent problems
 Weight gain
 Loss of muscle
 Side effects from chemo
HealingandCancer.org
General Nutrition Advice
 Follow Canada’s Food Guide recommendations
www.hc-sc.gc.ca/fn-an/food-guide-alimentindex_e.html
 Choose a variety of food from all food groups daily
 5-10 servings of fruits and vegetables/day
 Cruciferous vegetables – brocholli and cauliflower
 Choose lower fat food groups
 Fat to make up < 20% of caloric intake
 Choose high fiber foods
 Whole grain breads and cereals
 Drink plenty of healthful fluids
HealingandCancer.org
Foods to Inhibit Prostate Cancer Cell Growth
•
•
•
•
•
•
•
•
•
Garlic (100)
Brussels Sprouts
Spring Onions
Leeks
Broccoli
Cauliflower
Cabbage
Onion
Kale
~ Anti-Cancer Leaflet (D.S. Schreiber)
•
•
•
•
•
•
•
•
•
Beets
Fiddlehead fern
Jalapenos
Celery
Turnips
Orange Peppers
Spinach
Cucumbers
Asparagus (65)
Breakfast
• Local/seasonal fruits
• Oatmeal/whole grain porridge
– Raw honey, maple/brown rice syrup
– Cinnamon
– Walnuts
• Smoothie
– Brown rice/pea/hemp protein, raw nuts or seeds, quinoa
– Unsweetened almond/brown rice milk
– Frozen locally-sourced berries
– Spirulina/Chlorella
*Purchase organic as much as possible
Lunch
• Dark green leafy salad with…
– Grated beets, cucumbers, kohlrabi
– Chopped walnuts, pecans, hazelnuts
– Dressing of cold-pressed, extra-virgin olive oil,
raw apple cider vinegar, garlic
• Frittata with organic, free range eggs
– Sautéed orange peppers and tomatoes in
coconut oil, turmeric, garlic
– Sautéed leafy greens and/or assorted sprouts
– Spelt flour traditional sourdough bread
Dinner
• Poached wild salmon with dill
– Quinoa
– Steamed kale/swiss chard sautéed in
organic butter and garlic
• Legume (beans/lentils) soup
– Add broccoli, cauliflower, celery
– Season with garlic, turmeric, black
pepper, unrefined salt
Taking Your Vitamins




See your Doctor or nutritionist
Omega 3 – 250-500mg per day
Vitamin D 1000 IU / day
Calcium 1,200 mg / day
 Healthy diet should provide the rest
HealingandCancer.org
The Benefits of Exercise
 Effective way to improve energy,
sleep, mood and overall health
 Improves strength and
decreases risk of falls
 Data suggest 3 hours of vigorous
exercise per week improves
outcome
 Aerobic exercise - 3 to 5 times per
week (20-60 minutes)
 Resistance exercise - 2 sets of
8–12 reps
 Balance exercises
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Complementary/Integrated Medicine
 Find a balance between doing
research + following intuition
 Tell your doctor what you’re
taking and doing
 Don’t forego proven treatments
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Conventional Medicine
 Scientific method relies on proof
 Clinical trials
 Documentation of toxicity
 Doctor as therapist / consultant
 Risks vs. benefits
 Prostate cancer - higher cure
rates
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What is Complementary medicine?
"a group of diverse medical
and health care systems,
practices, and products that
are not presently considered
to be part of conventional
medicine…”
Body-based
Mind-body
Biologically-based
Energy
Whole systems
© Lynda Balneaves/CAMEO
Disadvantages of
Complementary Medicine
 Can be expensive
 Some practitioners make unproven and false claims
 Some toxicities unknown
 Cancer centre librarian can do search on natural medicines
database
 Beware of extreme diets
 Recommended daily intake of vitamins and minerals
 www.hc-sc.gc.ca/fn-an/nutrition/
reference/table/index-eng.php#rvv
HealingandCancer.org
What to ask your Complementary
Practitioner
 Credentials of practitioner
 Where they trained, for how long…?
 Evidence of benefits of treatment
 Any randomized trials?
 Toxicity of treatment
 Documented?
 Does it interact with other medications?
 Benefit vs. risks?
 What is the total cost?
HealingandCancer.org
There is no magic pill which
cures all prostate cancer
 All the complementary medicines have been tested in
scientific experiments
 Society of Integrative Oncology published report in
2009 based on evidence:
 Journal of the Society for Integrative Oncology, 7(3), 85-120
HealingandCancer.org
Massage and other Body-Based
“Touch” Therapies
Recommended:
Massage therapy for anxiety & pain.
 Manual lymph drainage with compression bandaging for
lymphedema.

Caution:
Massaging on or near radiation treatment field
 Excessive rocking motions for patients with nausea

Not Recommended: Deep or intense pressure:
Near lesions; enlarged lymph nodes, radiation field sites, medical
devices, or surgery sites
 In patients with a bleeding tendency

© Lynda Balneaves/CAMEO
Meditation, visualization and
other Mind-Body Therapies
Recommended:
Mind-body therapies practiced over time can reduce anxiety,
mood disturbance, chronic pain, stress and improve quality of life
and sleep quality.
 For Nausea and Vomiting – Visualization, Meditation,
Relaxation, Biofeedback, Prayer

Caution:
 Hypnosis may cause dizziness, nausea, or headache when being
brought out of a trance by an inexperienced hypnotherapist.
Not Recommended:
 Hypnosis on individuals with psychosis or certain personality
disorders
© Lynda Balneaves/CAMEO
Energy Therapies
Recommended:
Reiki & therapeutic touch are safe and may reduce stress and
enhance quality of life.

Caution:
Limited evidence as to efficacy for symptom management, including
reducing pain and fatigue

Not Recommended:
Bio-electromagnetically based therapies due to concern over toxicity
and increased cancer risk. No controlled trials showing effectiveness
for cancer treatment or symptom control

© Lynda Balneaves/CAMEO
Acupuncture
 Regulates the flow of ‘qi’ (vital energy)
 Needle, heat, or pressure stimulation on certain
points on the body through meridians
 Causes nerve cells to release neurotransmitters,
affects the pituitary gland, and changes function in
parts of the brain
 Influences…
 Blood pressure,
 Immune system
 Chemical release (i.e. endorphins)
Deng et al., 2009
© Lynda Balneaves/CAMEO
© Mark Parisi
Acupuncture
Recommended:




Poorly controlled pain, nausea and vomiting with chemo or surgery
Acupressure wristbands on day of chemo for nausea & vomiting
For hot flashes not amenable to pharmacologic treatment.
Radiation-induced dry mouth
Caution: More clinical studies needed to confirm benefit in:
Shortness of breath or fatigue or neuropathy.
Not recommended:
If you are pregnant, have low platelets or white blood cells, severe
thrombocytopenia, bleeding problems, or neutropenia
 AVOID acupuncture at tumor and metastasis site, limbs with
lymphedema, and surgery sites

© Lynda Balneaves/CAMEO
Biologically Based: Natural Health Products
 Vitamins, minerals, animal materials,
herbal therapies, biological
supplements, dietary supplements, or
combinations
 Used frequently by people living with
cancer
 Evidence is lacking on some NHPs, but
is a rapidly growing field of study
 www.mskcc.org/mskcc/html/11570.cfm
 www.naturaldatabase.com
 ods.od.nih.gov
© Lynda
Balneaves/CAMEO
Credible Complementary Med Information
 UBC/BCCA Complementary Medicine Education and
Outcomes (CAMEO) Program
 bccancer.bc.ca/cameo
 NIH - National Centre for Complementary and
Alternative Medicine
 nccam.nih.gov/health/cancer
 National Cancer Institute – Office of Cancer
Complementary and Alternative Medicine
 cancer.gov/cam/health_index.html
 NEW! CAM-Cancer (National Centre for CAM,
Norway
 www.cam-cancer.org
© Lynda Balneaves/CAMEO
Intensive lifestyle changes may affect
progression of prostate cancer
Ornish et al J Urol Sept 2005 174 (3) 1065-9
 Randomized trial, n=93 men with biopsy-
proven prostate cancer, psa 4-10, Gleason<7
 All men were on observation – no active Rx
 Experimental arm: stress management, lowfat vegan diet with antioxidants, moderate
exercise, and psychosocial group support
 PSA measured at baseline, every 3months
for 1 year
HealingandCancer.org
CAN LIFESTYLE CHANGES
REVERSE PROSTATE CANCER?
 Control - PSA up 6% (p=0.016), 6/43 needed Rx
 Experimental arm - PSA down 4% at one year
 Control group followed diet 75% as well as
experimental group yet PSA increased
 2nd experiment : Serum from men inhibited
prostate cancer cell growth in test tubes in
70% in experimental group vs 9% in controls
 Greater adherence to program inhibited
prostate cancer cells more often
HealingandCancer.org
Empowering Yourself
 Don’t let the slow growing cells turn into fast
growing cells
 Take care of yourself and enjoy life
 You can make a real difference
HealingandCancer.org
Thank you!
ProstateCancer.ca
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