Using Darwin's Theory Of Evolution To Design Cancer Treatment

The recent finding that early signs of cancer can appear years or even decades before diagnosis, bears directly on the types of treatment to deal with it.  This revelation  according to the most comprehensive investigation to date of the genetic mutations that cause healthy cells to turn malignant.  (These findings, based on samples from more than 2,500 tumors and 38 cancer types, reveal a longer-than-expected window of opportunity in which patients could potentially be tested and treated at the earliest stages of the disease.) The study revealed that about half of the earliest mutations occurred in just nine genes, meaning there is a relatively small pool of common genes that serve as triggers for cells to diverge from healthy development to a path towards cancer.

In the words of one co-author of the research (Peter Van Loo)  based at the Francis Crick Institute in London:

"Unlocking these patterns means it should now be possible to develop new diagnostic tests that pick up signs of cancer much earlier."

The work was carried out as part of the Pan-Cancer Analysis of Whole Genomes project, the most comprehensive study of cancer genetics to date.  The import and significance of this finding coincides with the push toward a different sort of treatment modality - based on the principles of Darwinian evolution.  This  novel approach to cancer treatment has now come on stream and is using lessons from Darwin’s theory of evolution.  (WSJ, Jan. 9, p. A12)

The unique approach is called adaptive therapy,  and stems from the recognition that cancerous cells, just like other forms of life, mutate and evolve in response to a changing environment. Traditional cancer treatments— such as I've had with high dose radiation for prostate cancer- continuously bombard cancer cells - but can encourage drug-resistant cells to multiply, eventually creating an untreatable tumor.

Well, I didn't develop an "untreatable tumor" but a resistant one, with resistant cells, which then had to be subjected to focal cryotherapy (freezing them to nearly 90 below zero) for a secondary treatment, e.g.

Fighting Prostate Cancer At -90 C: My Cryo-thera...

By contrast, adaptive therapy doesn’t try to eradicate the entire cancer like my brachytherapy treatment did (using Ir 192) . Instead, it seeks to reduce the treatable cells, stop treatment, the wait for those cells to grow back before treating them again.   Well, interestingly, in a way that's what I did, what happened to me. I had the original adenocarcinoma bombarded by high dose radiation in September, 2012.  The tumor then grew back as diagnosed from rising PSA and an MRA scan  e.g.

What I Got Wrong About My MRI Fusion Biopsy

It was then re-treated with the cryotherapy but now five years after the original therapy.

It is possible then that presence of the treatable cells kept the resistant cells at bay, as they competed against each other for resources. The idea, for now (for me) is to keep the size of the tumor in check  (disclosed by PSA and MRI if needed) and manage the cancer as a chronic condition.  In fact, most oncology now is changing to accepting prostate cancer as a chronic condition and not a "one off" anomaly to be cured.   (And if you've read the stories of all those whose cancers have returned after radical prostatectomy you'd see why)

In the larger, more generic sense, adaptive therapy as a concept is still largely experimental, and experts caution that it needs more trials with larger groups of patients. A few doctors are starting to bring the idea into practice—primarily for late-stage, incurable cancers. But a  growing number of researchers are paying attention and looking at cancer through an "evolutionary, survival-of-the-fittest perspective."  (WSJ, ibid.)

Robert Gatenby, the co-founder of Florida-based Moffitt Cancer Center’s new Center of Excellence for Evolutionary Therapy, is a pioneer in the field and driving the bulk of the work in the U.S. on adaptive therapy. He is also a co-author on a small, pilot study, with initial results published in 2017 in Nature Communications, that showed that patients lasted at least 27 months on average without their tumors growing, compared with the usual 16.5 months, while receiving less of the same drug. 

Dr. Gatenby, who had a background in physics before going into medicine, often points to pest control to describe therapy, and others in the field have picked up the analogy as well. In pest management, managers often don’t try to eliminate all of the insects but instead reduce their numbers, keeping the spray-sensitive bugs around to compete against the resistant bugs. Pest management developed the technique after overusing insecticides, which eliminated most of the insects. But some resistant bugs came crawling back.

Quoted in the WSJ piece, one oncologist opined:

“I think pest managers are about 30 years ahead of the oncologists,” 

To be sure, evolutionary oncology, is decades old but it has gained more clinical traction in recent years as mathematical modeling has better enabled researchers and mathematicians to predict how tumors will change in response to specific treatments.  According to Christine Iacobuzio-Donahue, director of the David M. Rubenstein Center for Pancreatic Cancer Research at Memorial Sloan Kettering Cancer Center, who researches cancer genetics:

“The field is small but it’s growing.  Right now, people hear evolution and cancer and it’s intellectually stimulating, but we want to get past intellectually stimulating and save lives.”

Nonetheless,  the idea of not completely destroying a cancer isn’t always easy to sell, especially since cancer research and treatment has focused firmly on a cure for decades.  A misplaced emphasis in my opinion, given how many patients are devastated - especially after having a radical surgery that destroys their sex lives (as in RP) and then learn the prostate cancer has returned.   Certainly, if many cancers are now found to originate earlier than believed it makes sense to keep treatment "powder" dry, until really needed, in line with the Darwinian adaptive solution.

Although the mathematical modeling predicted that the optimal time to halt treatment would be after the tumor had shrunk by 25%, the researchers decided to wait until the tumor had shrunk in half to make the concept more palatable, said Alexander Anderson, the chair of the Integrated Mathematical Oncology department at Moffitt, who works closely with Dr. Gatenby

The Moffitt pilot study originally enlisted 11 patients with late-stage, metastatic prostate cancer that was resistant to earlier treatments. The patients were put on the drug abiraterone, or Zytiga, and researchers tracked the tumors by monitoring the  PSA  (prostate specific antigen) in  their blood.  Once the PSA levels drop by half, the doctors halted all treatment until they rose again.    This is a smart approach that directly reflects the adaptive method. (See top graphic)   As we learn in the piece:

"The treatment length was patient-specific: Some patients cycled through the treatment regimen every few months, while others took longer. At least one patient was able to go without the treatment for over a year. Patients, on average, lasted 27 months without tumor progression by the time the initial results were released. Dr. Gatenby says that the continued treatment has extended that average to 33 months, and the project expanded to 20 patients.

The patients also cumulatively reduced the use of the drug to roughly 40% of standard dosing, Dr. Gatenby says, meaning they spend less time dealing with side effects. One month of the drug can cost upward of $6,000, according to the paper, so a pause in treatment can also save a patient thousands of dollars."

This is also the plan I intend to use if and when the currently contained PSA roars back and I may need hormone treatments, or androgen deprivation therapy. So, as I informed my primary care doc, I plan to postpone beginning ADT  until I become symptomatic and then cut it off after 6- 12 months, by which time the most grievous side effects (such as enlarged breasts, cardiac issues, weight gain, cognitive decline etc.) should subside.

It will also provide an adaptive attack plan, such as described in the graphic shown at top, where the drug (e.g. Casodex) eliminates some of the sensitive cells but not all.   The remnants to be cleared out or contained in subsequent administrations.  Interrupting- limiting  Casodex therapy is a good idea in any case, to spare metastatic prostate cancer victims some of the worst side effects, including being reduced to mental vegetables!

See also:

https://www.cnbc.com/2020/01/17/america-is-about-to-get-a-powerful-tool-in-the-war-against-cancer.html

Contributions of Physics To Advancing Cancer Research Have Been Profound

Human cancer (fibrosarcoma) cell studied at Johns Hopkins University Physical Sciences -Oncology Center for identifying metastatic agents.


It was two years after I received my first cancer treatment (at UCSF) using its high dose rate afterloader, see account here:

The Longest Day...And Then Some...

That I learned how advanced physics was contributing to the study of cancer and improving our understanding, mainly via PS- OC (Physical Science - Oncology  Centers) at different universities. Their origin goes back to 2009 when a dozen PS-)Cs were created by the National Cancer Institute. Their purpose was to team physical scientists with biologists and oncologists to seek a new understanding of cancer development.  This in turn could lead to new and improved treatments as well as diagnostics.  In the words of Paul Davies - a cosmologist who is the lead investigator at Arizona State University's PS-OC: (PT, Nov., 2014, p. 23)

"Cancer research is far too much money chasing far too few ideas. We need to think our way to a solution, not spend our way to a solution."

Davies then goes on to observe that both experimental and theoretical physics are useful in understanding and modeling metastasis.  At ASU one such synergistic project requires cancer cells to transition from static to slippery and motile, then squeeze through the tissue around the rumor and secrete membrane -dissolving chemicals to get into the bloodstream.

Once that occurs then other organs can be colonized and full metastasis is underway.  For example, in prostate cancer - which I have dealt with for 7 years now (latest PSA held steady at 4.8 from 6 months earlier) -   once the cancer cells get into the bloodstream they often migrate to the bones and especially the spine, where they become "mets". e.g.


PET  scan of patient with advanced prostate cancer showing extent of bone metastasis (dark spots) congregated in the spine and even brain.  These are actual prostate cancer cells that have migrated from that gland to these other, distal locations.

For the advanced prostate cancer patient the only way known to get a further lease on life is via hormone therapies. such as ADT (androgen deprivation therapy) which slows tumor growth by cutting off the cancer's primary fuel: testosterone.  Since the side effects can be horrific, i.e. constant brain fog and cognitive incapacity - memory loss, depression, gynecomastia, weight gain, diabetes, cardiac issues etc. it's regarded as a desperation, last resort option by many.   Given all of this it is easy to comprehend why figuring out the metastatic process is important in cancer treatments, diagnostics.

At ASU one project that's received attention concerns the use of atomic force microscopy to measure the degree to which cancer cells (like the fibrosarcoma cell shown at top) soften as the disease progresses. The approach entails obtaining the Young's modulus of the cancerous cells being investigated.

The Young's modulus is a dimensionless quantity in the elastic mechanics of solids defined as the tensile stress divided by the tensile strain, e.g.

Y  =  (F/A) /  (D L/  L _o )

The tensile stress then (numerator) is the ratio of the external force acting F, to the area A.  The tensile strain is the ratio of the change in length D L (the quantity Y is usually applied to wires) to the original length ( L _o ).  In terms of the ASU experiments, the researchers - to get Y-  prodded the cancerous cells with the tip of the atomic force microscope. According to lead investigator Davies:

"That change in Young's modulus is critical to the whole metastatic process, the squeezing through gaps."

The takeaway? Limit the cancer cells ability to stretch themselves and "squeeze" (e.g. keep D L  a minimum) and it might be possible to control metastasis.  As Davies adds:

"What has become abundantly clear the last few years is that the physical mircoenvironment can play a critical role in cell behavior. Just pressure forces or even shear stresses can affect gene expression."

Given all this, we certainly should expect much more cancer research funding to find its way to the physicists working at PS-OCs and now playing an equally important role to oncologists in extending our comprehension of cancer metastasis.

Is Proton Beam Therapy Worth It?

Comparing degrees of localization of proton beam therapy with other treatment  modalities, in terms of dose v,  tissue depth. 'SOBP' denotes 'spread out Bragg peak' - or the collation of several such peaks via different beams, for different depths. Red line denotes depth dose plot of x-ray beam..


The Wall Street Journal article 'Making A Case for Proton-Beam Therapy', to treat cancer - actually posed an interesting conundrum. On the one hand "six new proton beam centers are set to start delivering state of the art radiation to cancer patients around the country by y ear's end" - with no fewer than ten additional centers expected by 2018 bringing the total to 30.

On the other hand, these centers are "entering an uncertain market" since the therapy still "lacks evidence that it is better than traditional radiation despite costing significantly more".   Indeed, as the WSJ piece notes, Aetna and United Health Group, Inc. have stopped covering it for prostate cancer, "once seen as a main source of patients".

I also (briefly) considered getting proton beam therapy when my prostate cancer was diagnosed back in July, 2012.  However, my wife (a former radiotherapy software specialist) convinced me that high dose rate brachytherapy - which her company specialized in - was the better option.  Plus,  she knew the best center in the nation to get it: the Helen Diller Cancer Center at University of California - San Francisco and had worked with the world-famous oncologists there .  She was  also  skeptical proton beam centers existed that could give 100 percent assurance and confidence that through all the 30 or so days of treatment one would not see a "geographical miss". That is, the proton beam hitting a critical region like the bladder or lower bowel instead of the cancer, putting an  unwanted micro-hole in either..

For those not aware,  proton beam treatment is a form of external beam therapy in which positively charged particles (protons) are accelerated to 60 percent of the speed of light, or 180,000 kilometers per second. They are constrained to form a powerful beam that can be programmed to deposit most of its energy directly into a target tumor - say in the prostate gland - minimizing radiation exposure to surrounding healthy tissues (say bladder and lower bowel in the case of prostate tumors)

While the therapy - according to existing evidence - isn't necessarily "better" than traditional radiation treatments, the proponents (which include now the top ten cancer treatment centers)  insist it can reduce many harmful side effects, especially for localized cancers.  As the WSJ noted:

"The benefits are undisputed for rare pediatric brain cancers, adult eye tumors and cancers at the base of the skull."

But for prostate cancer the jury is still out, and certainly the benefits of the radiation treatment I received have to be considered at least as good and much more cost effective. (I was in the treatment center for one day, and received one high dose of 1930 cGy via Iridium 192 needles introduced in situ, see e.g.

http://brane-space.blogspot.com/2012/09/thge-longest-dayand-then-some.html

While the advocates for  proton beam therapy brag of its accuracy - assuming it's done in the right hands- my own therapy relied on a specialized inverse planning, or "IPSA" software, see e.g.

http://radonc.ucsf.edu/research_group/jpouliot/pages/ipsa/ipsa_hdr.htm

For which testing of the algorithm at multiple sites disclosed  automatic protection for critical organs  achieved by generating contour solutions that cleared a 3D "tunnel" around the urethra and rectum (for example)  to spare them from the maximum delivered dose.
 
The worst side effects for me were in the immediate three or four month aftermath and included frequent urge to urinate and some burning upon urination. Also burning accompanying sexual activity. (Only a bit later I learned I could control the burning effects by taking one cranberry sofgel a day)

Medicare covered almost 95% of the total treatment costs, which - if I'd  had Paul Ryan's stingy "premium support" (voucher)  plan - would have likely bankrupted us - given it would only cover $10k or so a year.

It should also be known, as the WSJ notes, that Medicare also covers proton beam therapy  "at about $1,100 per treatment session" . Nonetheless,

"several major insurers stopped after a 2012 study found it has no long term added benefit. "

Originally, as the WSJ notes,  men with prostate cancer had made up 70 percent of patients at some proton centers, and that is now 50 percent.  

Meanwhile, the manufacturers themselves are designing more compact machines as opposed to the Hitachi machine - nearly the length of two thirds of a football field. But smaller is no guarantee of success and as the Journal piece pointed out, ProTom International Inc.  - maker of compact systems- already had to file for bankruptcy protection.

My advice to anyone considering this option is to look into it carefully, also consider that a simpler, less complex system might actually be better for your cancer treatment needs!

What I'm Thankful For: A Cancer Under Relative Control

A remote brachytherapy afterloader of the type that delivered my cancer radiation treatment exactly one year ago, Sept. 25, 2012. It's an electro-mechanical system by which 16 transfer tubes  with radioactive Iridium -192 needles are inserted into catheters in a fixed template (stitched to the perineum) to deliver radiation directly to the prostate gland. I received a total dose of 1920 cGy (centigray), in a treatment delivering one single high dose

It was my sister-in -law, Krimhilde - an Eckist- who first reminded me that gratitude is a "metaphysical concept" that transcends all human cultures and religions. As she put it during our last extended conversation: "Gratitude acknowledges one's basic relationship to the universe as a whole, and giving thanks acknowledges one's place as a spiritual being within it."

In terms of Thanksgiving there are always the usual things people have to be thankful for: good home, loving wife or family, ample food, successful kids, and maybe a general joie de vivre. Others have additional cause, beyond the normal gratitude, especially including having a cancer under relative control, or even being cancer-free.

In my case, the prostate cancer detected in July, 2012, for which I had treatment at the Helen Diller Cancer Center at University of California- San Francisco, in September that year, e.g, see:

http://brane-space.blogspot.com/2012/09/thge-longest-dayand-then-some.html

at first shocked me, including that I had to have treatment (radiation or surgery) as opposed to just watching and waiting. The months after the final PSA spike was detected were intense and included not only a biopsy but also flying to San Francisco to be evaluated for treatment and then receiving one of the first single high dose brachytherapy administrations. The follow-up PSA - done two months after treatment- showed 2.0 and seemed to indicate the single dose radiation had worked (radiation which also triggered severe urinary urgency and burning)

In my most recent PSA test result, taken 9 months after the last, it was up slightly to 2.68 (from 2.5) I sent this info to my radiation oncologist at UCSF (Dr. Hsu) and he replied that there was no worry, as the result is only up very slightly from the last time. This means that after two years of testing the PSA is just about 0.68 above what the lowest value - two months after treatment. If I am correct, the 'bounce' period is over (PSA varies somewhat at each test) but I have not yet reached the PSA "nadir" the lowest possible value. Dr. Hsu doesn't believe that will happen until the 5 year mark.

He also inquired into the main side effects, which so far appear to be minor burning during urination - which I control by using cranberry extract in capsule form, and erratic erections - which can vary by time of day, from quite hard to flaccid. (Also, with the potential to 'collapse' within a minute or so!) The reason for this behavior was originally described by Dr. John  P. Mulhall:

"Radiation attacks the DNA in our cells. It causes breakages in the DNA, and when this occurs, the cells commit suicide, a process known as apoptosis. Normal cells have better repair machinery to fix some radiation damage while cancer cells do not.  As well as killing off the actual prostate cancer cells, radiation causes injury to the blood vessels that supply the cancer."

The last effect is confirmed at a cancer.gov site (of the National Cancer Institute) which states:

 "Radiation damage to nerves and blood vessels may occur with brachytherapy, and higher doses of radiation may cause more damage"

Re: adverse effects on the arteries from the high dose (1920 cGy) of radiation delivered, I originally tried to counteract these by eating more Omega 3 rich foods, more often and also more veggies. However, by about a year or so ago, I noticed have reached a stage of "diminishing returns" for lack of a better term. Interestingly, if Dr. Mulhall is to be believed (and I am certain he is) then "erectile success rates for surgery and radiation reach the same stage after 24 months."  And since I have now just passed the 24th month, going into the 26th, I can say he is correct.


Some might ask, 'Why be thankful for losing the reliance on your sexual apparatus?', but that misses the point. The point is one is striving for quality of life that first and foremost allows life! Secondly, I can be thankful I don't have to be running around wearing 'Depends" as 50 % of men do after radical prostatectomy-- and 25% after radiation. In the end, it is all a matter of placing things in proper perspective- and besides the "sexual apparatus" can be used in more than one defined way for a loving couple.

Last year, according to Johns Hopkins University stats, there were some 239,000 cases of prostate cancer diagnosed with 29,000 deaths. It remains the 2nd leading cause of cancer death for American males. Rather than fretting about losing one's sex drive, men need to be more concerned at catching it before it spreads secondaries - which can lead to a slow, painful death.

Milk: How To Make It Better - Without the 'Moo'

Despite the image of the young lady gulping milk down from the bottle, let us admit that milk doesn't have the best rep or PR. While our ancestors, some 8,000 years ago, got the brilliant idea to collect and drink animal milk - leading to a kind of natural consumption - things had changed radically by the 21st century. Now, milk production is an industrial process and cows are actually administered special hormones(e.g. rBGH)  to induce higher milk production. Many (e.g. PETA) believe these hormones are responsible in large measure for many problems - including spurring adolescent females to earlier sexual maturity, and inducing prostate cancer in male milk drinkers.

PETA generated an intense campaign a couple of years ago, including an over the top video ("Milk Gone Wild") featuring gyrating young women equipped with giant udders,  dancing in a club  and  spurting milk all over the place to the delight of delirious males lapping it up. The point they wanted to try to get over is that cow's milk is bad for you and they paired the "Got Milk?" ads via parodies against "Got Prostate Cancer?", "Got Gas?", "Got Pus?" and other high impact PR, imagery.

The video - if you can stomach it- can be seen here:

http://www.peta.org/tv/videos/vegetarianism-cows/1389647429001.aspx


Carol J. Adams (The Sexual Politics of Meat: A Feminist-Vegetarian Critical Theory) and a vocal advocate of veganism has argued:

"Eating meat and ice cream is a privilege of being a human being who can oppress other animals. It comes as no surprise to me that we take something oppressive -the extraction of milk from a cow -- and extend it to women!"

She was referring to a fad whereby ice cream makers had incorporated breast milk. Citing a familiar vegan principle, she called drinking any species' milk "symbolically infantilizing."


PETA, meanwhile, asked:

“Why is it that, as adults, we find human milk distasteful, but we find animal milk palatable Humans are the ONLY species who drinks the milk of another species. Now that's distasteful!! So, if you were looking for a perspective even higher on the "gross-o-meter" than cheese made from human milk-you just found it!”

As the milk battles continue a new way may have appeared to produce milk proteins without having to worry about the adverse effects of hormones, or antibiotics.  The basic steps were reported in an issue (June 28) of New Scientist, noting first that each of the key milk proteins has a known amino acid sequence in a free database. Thus, "it is easy to convert the amino acid sequence into a DNA sequence."

It is then "simple to order this DNA from research companies". One then mixes the genes into a population of yeast using a chemical or electrical stimulus to get the DNA into the yeast cells. The internal machinery of the cells then churns out the proteins, " a lot like brewing beer."

The only remaining ingredient, but primarily for taste, is fat. Fortunately, dairy scientists have already developed healthy, plant-based oils with aromatic fatty acids - the same ones that give rich ice cream its flavor. All that remains is to combine everything with sugars, minerals and clean water in the right ratios to obtain a tasty, nutritious, white liquid which consumers will buy.

Beyond the chemistry, the transition from animal-based milk to the non-moo form is a business problem: How to scale the process up and ensure that it's economical? How to then get this milk onto shelves where it will have to compete with the real cow-extracted version?

Those are the questions to be addressed.

Will PETA and other activist groups accept this novel form, as opposed to making over the top videos about it?

That remains to be seen.

Low T Therapy For Bigger Muscles? Blame This "Remedy" For Medical Interventions You Don't Want!

Kristen was still distraught after losing her hubby Rob, a year earlier. What had been planned as a trip for two to Barbados this year ended up a trip for one. The saga isn't new and will likely unfold in many more households as low T mania continues unabated. How bad is it? According to the article, 'Low T: Real Problem or Ad-driven Fad?' in the AARP Bulletin (July-August, p. 18):

"A 2013 study in JAMA Internal Medicine found testosterone prescriptions grew more than threefold between 2001 and 2011. Data from IMS Health shows T sales rose from $324 million in 2002 to nearly $2.3 billion in 2012. Sales could hit $5 billion by 2018."


As the article also notes, most of this increase isn't based on any genuine medical issue. It is based on ads shamelessly playing to male insecurities. The loss of muscle mass , sex drive or energy -  once described as "getting older" -  suddenly was transmogrified into a condition dubbed "low T" by the Madison  Avenue Ad makers. Thus were unleashed a torrent of print and TV ads from the makers of testosterone replacement meds and gels. One ad actually advised: "Millions of men 45 or older may have low T so talk to your doctor!"

Really? Gimme a break!

In Kristen's husband's case, Rob (then 47) felt he needed an edge at work so began the low T prescription solution. He did feel his energy rebound, his muscle mass increased and his renewed sex drive pleased Kirsten. Only she worried about taking increased testosterone which as a medical person (urology RN) she already knew provided a fuel for prostate cancer.

According to Dr. Mark Scholz, in 'Invasion of the  Prostate Snatchers', p. 42:

"testosterone fuels prostate cancer growth  and prostate cancer is the only type of cancer susceptible to testosterone inactivating pharmaceuticals"

Alas, Rob dismissed all such concerns, according to Kristen, and even increased his testosterone use. If some is terrific, more got to be better, right? Not quite. Within a year Rob's PSA had doubled, and six months later tripled. Finally, under pressure from his wife he reluctantly submitted to a prostate biopsy and prostate cancer was found in five cores with Gleason scores 4 + 5, and two with 5 + 5. The urologist pronounced "advanced prostate cancer" and recommended radical prostatectomy in combination with female hormone treatments.

The next year or so was 'hell' as he descended into depression following the surgery which left him incontinent, his penis shrunken, zero sex drive and with large breasts - arising from the hormone treatments.  Kristen confided that at least he hadn't ended up like another T-using patient who - after his operation around the same time - experienced a vesicularectal fistula-   farting through his penis and saddled with other complications before having to get a colostomy.

Despite all the horrific side effects Rob had to endure, the prostate cancer spewed secondaries into bones and lungs - and he died 6 months ago.  Kristen said if she had one wish it would be to "get men to back off from this silly, idiotic non-solution".

She may well have a point. Even if by some miracle prostate cancer isn't spawned, other negative medical impacts abound. According to Dr. John La Puma, quoted in the AARP article,

"When you take testosterone your body shuts down production. As a result the testicles shrink and you could be using supplementation indefinitely."

He noted this circumstance meant "expense, inconvenience and  worst of all, possible catastrophic health consequences."

Think aggressive prostate cancer. But as the AARP article also pointed out:

"A study published last year in the Journal of the American Medical Association reported a 30 percent jump in the risk of stroke, heart attack and death among men undergoing testosterone therapy."

It would seem that any guy seriously thinking of aspiring to be muscle-bound  and energetic using T, would be advised to watch the video below first and pay close attention! Note the particulars of treating low testosterone, including the fact: a) testosterone can vary during the day so the time you get the blood test is critical, and b) the low testosterone can be due to multiple other causes than natural, including stress, fatigue, diabetes or other hormonal imbalances.


http://www.webmd.com/prostate-cancer/video/testosterone-replacement-prostate-cancer

The AARP article also adds (ibid.):

"But what is a healthy T level for an older man? Doctors can't agree. Many laboratories use wildly varying reference numbers based on the average testosterone levels of young men, anywhere from 300 to 900 nanograms per deciliter."

The Bulletin adds that,  incredibly, just about any purported "symptoms list" will ensure a low -T diagnosis.

The fact is, as Dr. La Puma observes,  most men (maybe 80%) don't need this "therapy" at all, period.  As he puts it:

"All men need to do is eat a healthier diet and be more active."

To reinforce that, "it's found that when obese men shed an average of 17 pounds,  testosterone levels climb 15 percent."

This in addition to quality sleep and regular exercise can help any guy improve his energy and muscle mass as well as sex drive.

Trouble is, too many guys want the "quick fix".  For those who want the T-quick fix to “muscle up” to look better or get more energy, I'd say just be prepared for what’s coming later. It might also help to imagine yourself long past the cancer treatment stage when your dick is U-shaped, your breasts are bigger than Mariah Carey’s (so much you want to hide from your wife) and you have to wear giant diapers just to go to the corner 7-11.

Mail Brane Blog: Readers Seeking Answers to Questions

I was very interested in your blog post on Josh Fox's Gasland II and how your wife found it too intense to keep watching (on to Part 2).  But I still find it incredible that these fracking interests and state security folks would put citizens onto terrorist rolls. Do you really believe that, or is Fox exaggerating for effect?  -  Alicia, Louisville, KY

A. I don't think Fox is exaggerating at all. As a person involved in deep politics I am well aware of the extent of the existing spy-surveillance state and how it networks (through fusion centers) throughout the country.  I also noted (June 19th) on the COG or 'continuity of government' program, and the recent discovery that a representative for the Tennessee Department of Environment and Conservation told a group of concerned citizens that "complaining about water quality could be considered an act of terrorism,”.  (See: http://www.alternet.org/environment/tennessee-official-says-complaining-about-water-quality-could-be-considered-act)

Make no mistake the same rubric was adopted to harass and persecute Occupy protestors two years ago. Idealistic kids merely trying to exercise their supposed 1st amendment rights, but actually put in the sights of sniper rifles, e.g. in Houston. So no, it's not a stretch to accept that now all domestic protests are to be considered "terror",  ever since the Bushies' expanded such adaptations to COG  which haven't been altered. And to reinforce that, you might also wish to read William Rivers Pitt's recent blog:

http://www.smirkingchimp.com/thread/william-rivers-pitt/50167/you-terrorist

I am interested if you ever found out for sure if you contracted the corona virus in Europe? Were any tests ever done to confirm it? -  Ramone, Pacifica, CA

A. No tests were ever done, because as I noted in the blog post I had no intention of seeing a doc. However, about two weeks after the post went up the symptoms vanished entirely and I was back to my usual jogging-walking exercise routine 3-4 times a week.  So what I suspect is that I'd actually caught a bad (cold) virus that might have been exacerbated because of a depressed immune system (this brought on by the long, sleepless plane flight home). If it was the worst (MERS) form of the corona virus I doubt the symptoms would have ended with no other effects. Of course, I could be wrong and you are right that only a test would confirm it, or negate it.


I enjoyed your posts about Germany, especially the one about Garmisch-Partenkirchen and the one on how the Germans you met dissed Tom Hanks' upcoming HBO series. I have two questions here: 1) Is Hanks really considering still going through with it, after all the buzz? and 2) Why do you suppose the National Archives refuses to release the records on George Joannides the CIA guy who tried to set up Oswald? - Murray, in Enid, OK

A.  Hanks definitely plans to go ahead, from all accounts I've heard. But he's also wise to try and stay under the radar until the immediate premier because he likely knows how it will be skewered by those in the serious research community. This is why there really isn't that much "buzz" - except on a few blogs like mine, which let's face it - don't have the audience of Politico, Daily Kos or Buzzfeed.  Maybe very soon they will catch wind of what Hanks is up to and scrutinize him and his self-professed reasons for doing it. (Which I still believe make for sophisticated brainwashing)

As to why the National Archives refuses to release the Joannides' files, it's fairly obvious: if the government was involved at any level in the assassination - and it's pretty clear it was - then they'd surely want to suppress anything that would impugn guilt or association. This also serves another purpose: keeping the process of ambiguation ongoing. That is, by not releasing anything definitive most people (not in the research loop) are kept guessing and their doubts keep growing: 'Hmmmm....maybe I'm wrong and Oswald is guilty after all!'. Indeed, recent polls now show only 59% reject the Warren Report compared to 73% a few years earlier. Ambiguation works because most people, average citizens, aren't confident enough of their sources or their own research to stand with a position and so flow or blow whichever way the last pundit heard or seen on the tube blows.

Look for the 'Oswald did it' reactionaries (including embedded CIA and NSA assets)  to pump up the volume of their PR- disinfo cant as we approach Nov. 2nd  this year, since it's the 50 th anniversary. The astute reader, however, can obtain a number of excellent antidotes for his brain, mental health by obtaining books such as James Douglass' 'JFK and the Unspeakable' and the new book, Dallas 1963 (available by Oct.) which shows what a nasty, reactionary place Dallas was ca. 1963 and why it wasn't Oswald that put up those ten thousand or more "Wanted for Treason" posters.  I am also planning to have my scifi novel, The Lancer Expedition, out at least by early October, and will keep readers informed.



After all your posts on fracking, I am really REALLY worried about it! I've seen Gasland II but is there any book you can recommend that is worth reading?- Cary B., Tampa, FL

A. I would say it's Robert Heinberg's Snake Oil: How Fracking's False Promise of Plenty Endangers Our Future.  Recall Heinberg is the author of The Party's Over, which warned of the imminent approach of Peak Oil (and the consequences - which we're seeing all over now) years before it happened. Thus, I'd actually advise getting both books because to me, they represent a continuity of argument. Peak Oil transpired when the easiest available, high EROEI (energy returned on energy invested) oil bottomed out, now we're forced to put up millions of natural gas and shale oil frack wells to make up for it. Most people don't even know that the natural gas taken from all the wells marring the countryside isn't even for American use, it's dispatched overseas to places like China where the market price for natural gas is much higher than in the U.S.


You've written a lot on the NSA mass spying stuff. What is your opinion of the Bradley Manning verdict and what do you think will become of Snowden?- Albert H., Detroit


A. Personally, I believe the Manning verdict (20 odd "espionage" charges) was nonsense,  but the judge did get one thing right: tossing out that idiotic "aiding the enemy" charge. As Chris Hayes' explained last night ('All In With Chris Hayes'), had THAT stood, we'd all(using the internet) be in a bad situation, because anything we ever wrote, say in a blog,  complaining about the country, how it does things, its aggressive military empire, the killing of JFK in a coup d'etat, the inequality, the Wall Street vultures, and infrastructure decline - found later on an al Qaeda laptop- could have us condemned for "aiding the enemy". It is total horse manure and based on the egregious use of the 1917 Espionage Act, in the era where the U.S. first began to get neurotic about "Reds". This was after the Russian Revolution, and the resident capitalists in the U.S. had just begun to get paranoid about "Reds" or anarchists, especially making complaints about U.S. entry into WWI.

It is incredible that Obama, a constitutional scholar and former prof, would even remotely consider resorting to this draconian measure to try to stifle speech and let's admit it - letting the people know what their gov't is doing in their name in these misbegotten "wars".   I have to believe, as I wrote earlier e.g. http://brane-space.blogspot.com/2013/06/one-blog-every-citizen-needs-to-see.html, that Obama is so fearful of the shadow players who really run things, that he feels he has no alternative. After all, what happened to JFK 50 years ago still conveys a terrifying message to any sitting president not to rock the boat. JFK did, in multiple ways, and he paid dearly.

My other problem with the "justice" thrown at Manning is that it ignores the true traitors (Cheney, Wolfowitz, Richard Perle, Gee Dumbya etc)  who got us into an illegal war in Iraq, killing hundreds of thousands, as well as condoning the practice of torture on dozens of people - violating the Geneva conventions. WHY let those bastards go while you pile on to Manning, who merely exposed war crimes? Hell, the man did us all a favor showing how low the militarists will go to preserve their war -spy state. But such is the nature of "law" and "justice" now in this nation that the traitors escape it and the patriots get prosecuted. It's nuts! NO wonder 44% of the American population is certifiably mentally ill!

As for Edward Snowden, another TRUE patriot, as opposed to the state terrorists who try to claim the label, I believe he will ultimately get asylum in Russia and live there. I certainly don't believe he'd be dumb enough to turn himself in despite those ridiculous promises not to torture or kill him. And the Russians will make no deals unless they can get something out of it, like some of their own (e.g. Viktor Bont)  returned. Quid pro quo.


I just read a book, How We Survived Prostate Cancer,  by Victoria Hallerman, which was depressing as she related the horrible after effects of the brachytherapy radiation treatment her husband received and how he totally lost his sex drive. Is this book really serious? How does it compare to your experience?  - Abby W., Des Moines, IA

A.  Hallerman's book was written before  high dose rate brachy  (using the "IPSA" contouring procedures) became available. Hence, the method she described was still based on the actual implantation of radioactive iodine seeds into the prostate which of course, wrought havoc on the poor guy having it done - ok, many of them. Such was the case with her husband, for whom the burning at urination was so bad he apparently screamed aloud in agony - even when using urinals in restaurants.  Well, when you place 100 odd seeds into the prostate this is what can happen.

In my own case, I received one high dose (1920 CGy) which was geared to a specific region and which targeting could be done superbly because of the IPSA (inverse planning) contouring program (that avoided bladder, rectum) which had been perfected at the Univ. of California at San Francisco Helen Diller Cancer Center, see e.g.

http://radonc.ucsf.edu/research_group/jpouliot/pages/ipsa/ipsa_hdr.htm

 The bottom line is that the method her husband received and that I received is like comparing chalk and cheese. My total treatment (administered by the hDR afterloader) lasted barely 20 minutes, though granted the prostate implantation surgery lasted about an hour. But the worst effects I had - burning urination, frequent bowel movements- were gone within 2 weeks. His lasted months. Bear in mind Hallerman's husband also had to go on a regimen of hormone therapy to try to reduce the size of his prostate from 95 grams to about half - so the seed implantation could be done properly. The hormone treatment itself is what apparently stole his sex drive, as it would any male's.

Is There Sex After Prostate Cancer Treatment? Good Question!

Perhaps the more apt question, given we KNOW the sex has to be different, is: What is the quality of sex after prostate cancer treatment? And to answer this question presumes not only knowing which treatment modality we are talking about, but the manner in which delivered. For example, if radical prostatectomy, then was it delivered via “robot” as in the da Vinci procedure, or via the hands of a skilled surgeon. (Typical books, and medical sites like Hopkins suggest the robotic surgeon ought to have at least 1,000 under his belt for a decent outcome).


If radiation, then what form: external beam or HDR (high dose rate) brachytherapy – where the source is directed inside the gland (such as I had done – see my blog on it “The Longest Day and Then Some”). If HDR Brachy, then where was it done, at which site?Do they specialize in it (like UCSF's Helen Diller Cancer Center) or is it one of many modalities they offer but for which prostate cancer treatment is no more focused on than say, breast cancer. All these matter. But given the lack of specifics let’s employ a more overarching addressing of the question.


Let’s understand first that testosterone presence is critical for prostate cell growth and function.Thus, these cells and their function are sensitive to the presence or absence of testosterone. Since prostate cancer cells are derived from the prostate gland it ought to come as no surprise that they’re also dependent on testosterone for survival. Cancer cells proliferate when testosterone is present and shrivel up and die in a mass cellular suicide called apoptosis when absent. Removing the whole gland can effect this, and also dosing it with high levels of radiation ….or having the cancer patient take large amounts of female hormones. (TIP treatment)


Cut the gland out and you also cut out the basis for testosterone production associated with semen production. Dose it with radiation and you ‘fry’ the prostate cells and cancer cells and reach basically the same result. Ingest enough female hormones and ditto.  The issue for most guys who choose a treatment then, is twofold: 1) get rid of the unwanted cancer cells or growth, and 2) Preserve some semblance of sexual function. Obviously if the whole gland is removed and ancillary erectile tissue – say in a radical prostatectomy, then achieving (2)  will be more difficult. It’s also one reason many guys on radical prostatectomy and de Vinci procedure net forums often complain about not having been fully informed of the loss of sexual function and the extreme lengths they must go to in order to recover it. As one guy put it on one forum after reading how another member complained about priapism after taking too large a dose of Viagra to stay hard ….”Well, there are some guys who can’t even dredge up enough desire to even want sex if we have to go to those lengths.”


The concerns are less for radiation therapy such as the HDR brachytherapy (single treatment)  I had, since the basic organs, gland and tissues remain in situ. The entire pelvic floor isn’t re-adjusted as it is for radical prostate surgery or da Vinci surgery. Still, treatment modes vary and so does the competence of those who deliver them. As my wife put it, even putting the prostate template in place – suturing it to the perineum- can vary significantly from one treatment site to the next. One small error in the template placement means the indexers will not deliver the dose to the correct locations. That can be catastrophic. The dose delivered is also critical – too much and you can't preserve function, too little and you do but the cancer comes back. You need the maximal optimal dose for the grade and stage of the cancer!


As for surgery, another risk which isn’t much mentioned (but ought to be according to the men on the surgery forums, some of whom have threatened “legal action” against their urologists for not giving them the full lowdown) is penile shrinkage. Dr. John Mulhall, in his book, Sexual Function in the Prostate Cancer Patient, notes an average of ½” shrinkage after radical prostatectomy - no matter how done. Overcoming this often demands an aggressive regimen including: Viagra, vacuum pumps and injected prostaglandins. But as Dr. Mulhall notes, to be effective the therapy needs to be started almost right after the operation. Trouble is most men are in no mood after having to have Foley catheters inserted in their urethras for days or weeks, not to mention a good deal of post-op pain and possible complications (i.e. need for a pelvic drain in case of abdominal infection after da Vinci robotic surgery)

In terms of HDR monotherapy (brachytherapy) effects, the St. Joseph Prostate Cancer Center notes (in terms of HDR brachytherapy – such as I had):

“Erectile dysfunction (ED) is often difficult to quantify; however, men who do not have ED prior to HDRB most often maintain sexual function after HDRB. Men with ED prior to HDRB will likely continue to have ED after the treatment as HDRB is not a treatment for ED”


Other than this it’s hard to gain a handle. The UCSF Patient Guide for Sexual Rehabilitation – in terms of post HDR monotherapy sexual indicators- notes that the initial ejaculations will be either bloody (laced with black blood, or old blood), “thick” and off color, or non-existent. Up to now I’ve no idea but suspect likely bloody ejaculate if there was anything. Just a guess. Obviously, from my point of view, any remote consideration of even attempting ejaculation is out of the question so long as urinating delivers a burning sensation! (So try to imagine what forcible expulsion of prostate contents would do!)

One site run by an RN who also offers massage therapy and other post-op aids, notes serious difficulties following just about any kind of prostate cancer treatment and observes even healthy males post-op will likely have much difficulty gaining and sustaining erection. She actually recommends males in this predicament just agree to use “mutual masturbation” with their wives (assuming they're willing) as a solution though she acknowledges some patients – out of religious inhibitions or proscriptions- might have problems with that.

The UCSF Guide includes a section on “solutions” to any sexual dysfunction, which range from using a “penile implant” (i.e. an inflatable device surgically implanted into the penis) to the use of a suction device or “penis pump”. Neither of these will likely be very appealing to most guys, so they also include use of Levitra or Cialis but at higher doses than what would ordinarily take - say for ordinary ED. (This may be why the guy cited earlier on the radical prostate surgery forum complained of priapism, which is a painful erection lasting 4 or more hours.)


Another aspect not much discussed is that of “dry orgasm” or retrograde ejaculation. This is normally associated with a prostatectomy but can also occur after radiation therapy. In the former case tissues associated with the muscle that normally blocks off the entrance to the bladder have been removed. In the normal case prior to the surgery, contracting muscles always force the semen unidirectionally through the penis outwards.


After the surgery, with the loss of muscle tension and control, this is no longer possible, plus the bladder neck is frequently enlarged after surgery so that it cannot close completely. Hence when the muscles associated with the urethra contract the semen is ejaculated backward through the open internal sphincter and into the bladder. This is later flushed out in the urine.


IN the case of radiation treatment, the dry orgasm is of different physiological origin since the sphincter muscles are not affected. In this case, since the whole volume of the prostate has been irradiated. My wife actually corrected me on that, as I’d earlier believed it to be a more directional treatment. Her point was that the IPSA software contour solutions provide a 3D "tunnel" around the urethra and rectum to protect them from the maximum delivered doses.  The point is that  the cells that produce prostatic fluid (the milky stuff that mixes with sperm to produce semen) are basically killed off with the affected prostate cells. Since the seminal vesicles also receive a dose of radiation (perhaps up to 10 Gray in my case or 1000 cGy) any sperm cells produced are also killed off.

In other words, after the last 'old blood' is ejaculated there’s really nothing left: all or most of the sperm cells are “cooked away” as well as the cells that generate prostatic fluid (this of course is also why one expects PSA to fall). Given there’s basically nothing left “in the tank” then there’s nothing to ejaculate. You get the sensation (at least part of it) of doing so, but nothing is being expelled.

No, I’ve not experienced any of this yet because I haven’t attempted anything! However, it falls within the bounds of what a former Nucletron Corp. radiotherapy consultant told me before I received my own treatment (he also went to UCSF for early HDR brachy), but at that time they were still delivering the dose in two treatments. Only in the last 5-6 months have they adopted the one time HDR treatment based on a study done by Dr. Alvaro Martinez at William Beaumont Hospital-Center which showed that the results for a single treatment were good, with low toxicity. (See, e.g. http://dr.beaumontphysician.com/news/pages/single-dose-brachytherapy-treatment.aspx )

So UCSF changed over to that regime.


Here’s the skinny: While many may insist that men make too big a deal out of post-treatment sex activity and add ‘You ought to be glad you’re just alive!” the truth is more complex, and the self-identity of most of us is bound up with our ability to sexually perform. Erase that, and you erase a lot of self-worth, though true …not all and not necessarily the most crucial aspects. But from reading many of the prostate cancer blogs and forums, and the degree of depression and anger in many men (especially a LOT of younger guys in mid to late 30s and early 40s, whose wives left them because of their difficulties in performing post-treatment) it is still no small deal. And little wonder 90% of these depressed guys had the radical prostatectomy and were neither informed fully of the side effects in terms of prolonged incontinence or concerning the loss of erectile ability and sexual function in 75% of cases. This may be one reason most weren’t merely depressed but bloody angry to the extent of threatening legal action against urologists.

It seems that not only do we have lots of work to do in getting information – full information – to men facing prostate cancer and treatment options – but we also need the urologists, oncologists to deliver the flat out truth instead of wishful thinking fantasies – as per their patients' expected post-op sex lives!

SU2C Telethon: Good, But Why Not More On Prostate Cancer?

A few of the celebs featured last night (L-R):Stacy Keibler, Jeremy Renner and Minka Kelly

Having not long been diagnosed with prostate cancer, I decided to watch last night's telethon: "Stand Up to Cancer" - on all the major networks. (I settled on HBO). The presentation was good and laced with performers, such as Alicia Keys, as well as spots featuring people (especially several pediatric cancer patients) fighting the disease, including an 11-year old, Justin Miller, who distracts himself from treatment by building battleships with Legos. He's been fighting his neuroblastoma since the age of 3.

At one point, in a spot video, he says:

"I don't really think about me passing away. But if I ever do, I'm taking my Legos with me,"

There were other extended segments ("vignettes") including of a woman (actually the director who has done all the Stand up for cancer presentations) with breast cancer, now deceased. Another spot featured a woman with pancreatic cancer who managed to survive, and a former K9 cop from Baltimore dealing with lung cancer.

Michael Douglas, no longer looking as brash as "Gordon Gekko", came on early, announcing:

"It picked a fight with the wrong guy. Cancer didn't bring me to my knees, it brought me to my feet. I stand tonight because I want to be part of this effort to find an end to cancer. This is possible."

Douglas found he had stage 4 throat cancer about two years ago.

Then there was Samuel L. Jackson who did about a two minute spot on prostate cancer, joking about men's distate for doctors (he's correct) and warning that men (especially African-American) need to "get their butts to their doctors, literally" to see about this disease. Not mentioned at all, was the fact it's the 2nd leading cancer and killer of males (29,000 deaths a year, 220,000 new cases diagnosed each year) and also is eminently treatable if caught early.

Basically, given the status of this killer cancer, I believed it was given short shrift, in favor of the more emotionally-grabbing (and heart rending) pediatric cases which consumed at least one fourth of the program, if not more.

While prediatric cancer is assuredly not a "blip", at least 13,500- 14,000 are diagnosed each year between birth and the age of 19 (according to stats from the American Childhood Cancer Orgnization) this can't compare with the more than 15 times greater frequency for prostate cancer.

Also, while the incidence of childhood cancer deaths is not insignificant, at about 2,500- 2,800 each year, this can't compare to the morbidity for prostate cancer at more than ten times that rate. Yes, cancer in a child is certainly gross, and we think in terms that this is somehow "against nature" or the order of the way things ought to be. Kids maybe get colds, flu or even whooping cough- but never cancer! That's a disease for the middle-aged or elderly, e.g. those "who've already lived most of their entire lives", so who cares about particular "old man" cancers of the prostate (there's more than one type) anyway? (Well, everyone with a father, brother, uncle, cousin should!)

But this is exactly the wrong tack and mindset to take, and it also contributes to the dire splitting of resources to tackle all cancers, as well as the causes.

At the very least, after Samuel L. Jackson's brief mention, there could have been a short personal story, say of someone's loved one losing their life to this disease, or maybe the new technologies - especially in the case of modern radiation planning treatments - which spare men the costly side effects of surgery. But there was nothing, which was disapppointing. Yes, The Prostate Cancer Foundation (http://www.pcf.org/ ) was mentioned, but how many viewers would really visit the site?

Near the end, Tom Hanks said: “Let’s build a world where cancer is no more”

That's a fine sentiment, bold to be sure, but such a world will never materialize unless we address the tens of thousands of toxic chemicals, carcinogens that are flooding the environment. These chemicals play an enormous role (never mind their manufacturers say "there's no empirical evidence of any connections to cancers") See, e.g.

http://brane-space.blogspot.com/2011/10/america-toxic-1.html

Unless we can control and monitor those toxins, and people's exposure to them (which will be very difficult under a hyper-deregulated Romney administration) cancer rates will never be cut, no matter how much we change to veggie diets, or how many pounds we take off. The show last night contained a crawler blurb that 40% of cancers are traceable to these factors, and maybe genetic too, so that leaves up to 60% arising from environmental causes - which Devra Davis also cited in her 'Secret History of the War on Cancer'.