Prostate: A lurking enemy

[KIFIS]

PROSTATE: A lurking enemy.

The number of friends, colleagues and acquaintances who are facing problems with their prostate appalls me and consequently I would like to put up something that may be of interest.
It’s fairly well accepted by the medical profession that zinc is one of the dietary elements essential for a healthy prostate and that white spots on the surface of one’s fingernails is a sign that the body is deficient in zinc. Now consider this. If one develops white spots on the fingernails is this a sign that the prostate is possibly being deprived of something it badly needs ?
Before you gentlemen of the medical profession start telling me to stick to flying and stay in my own pasture please consider this. A few years ago I developed white spots on my fingernails and after taking a zinc supplement of 25mg per day the spots went away. Is there a connection here? Are white spots a warning sign and if so isn’t it something we should all know about ?
Perhaps what I am implying is not correct in which case all you over forty aviators who are now looking at your fingernails can dismiss it. On the other hand there may be something in it and if it helps only one of you then it’s been worth the time taken to write this up. Maybe our friends the doctors can clarify the matter.

KIFIS


[This message has been edited by KIFIS (edited 27 September 2000).]

[Evergreen 41]

Does anyone know if there are particular foods rich in zinc we should be eating - rather than go for the expensive supplement pills?

[fobotcso]

My nurse says the following:

Zinc is in oysters, liver, meat and pulses.

Selenium is in fish, meat and cereals and brazil nuts are very rich in Selenium.

Zn and Se are reckoned to be good for reducing benign prostate hypertrophy. (Simple enlargement causing bladder difficulties.)

We call Brazil nuts Selenium pills here! Magnesium Citrate is also recommended.

My daughter (GP) tried to get me onto Cranberry juice but I couldn't stand the stuff!

With all these metals, watch out for the security detectors at check in.

[skua]

I find vodka helps the cranberry juice go down a treat (+ grapefruit juice if you want a Sea Breeze). I wondered why they made me feel so good....

[RVR800]

Question

I noticed white spots on a few of my fingernails. Should I be concerned?

Answer

May 8, 2000 -- In most cases, no. While there are many reasons for these white spots (called leukonychia), most of them are due to mild trauma -- such as hitting or slamming your fingernail on or into something -- and there's usually little cause for worry. The good news is they'll simply grow out with time.

Because a normal fingernail takes about eight months to grow out completely, you may not notice the mark of an injury for several months after the fact. If you see white spots about halfway up the nail, you can assume that the insult took place approximately four months earlier. But if you can' t remember slamming that finger keep in mind there are other causes for white spots.

If you use nail enamels, nail hardeners, or artificial nails, it's also possible that you're having an allergic reaction. Such products can cause nail fragility and very fine splitting or layering of the nail plate, which may result in whitish spots.

The white spots may also be something that you picked up at the gym or during your monthly manicure, namely a fungal, yeast, or bacterial infection that attacks the substance of the nail directly, leaving a whitish streak or spot behind. If you've forgotten to wear your flip-flops at the gym or if you're unsure about the hygiene at your nail salon, ask your doctor to take scrapings of nail tissue for fungal and bacterial cultures. If there's a pesky organism causing the spots, both topical and oral therapies can clear up this problem in a few weeks.

Two skin conditions that affect millions of Americans, psoriasis and eczema, could also be the cause. Both can occasionally leave whitish spots on the nails, either by disrupting normal nail production at the root or causing separation at the tip. Because both disorders typically involve the skin as well as the nails, they're almost always diagnosed as a result of the accompanying skin problems, so if you've got the spots alone, it's unlikely you've got psoriasis or eczema.

Finally, there are a number of total-body ("systemic") conditions that can leave white spots on your otherwise unblemished talons. Certain nutritional deficiencies, particularly a lack of zinc or protein in your diet, can cause a nearly total whiteout of your nail except for the tips or even a pattern of white bands across the width of the nail. Cirrhosis, a form of chronic liver disease usually brought about by alcoholism, can also result in nails that are almost completely white. Keep in mind, though, that white spots in that case are rarely the primary flag for diagnosis but usually occur well after this disease has made its presence known in other ways.

Given the number of conditions that can cause white spots, if you have a sudden crop of them on your nails (and you haven't caught your digits in the car door during the last six months), make an appointment to see your dermatologist.

Nelson Lee Novick, MD, associate clinical professor of dermatology, the Mount Sinai School of Medicine, N.Y., and author of You Can Look Younger At Any Age: A Leading Dermatologist's Guide (Holt, 1999). His private practice is devoted primarily to the treatment of hair, skin, and nail conditions and to cosmetic dermatology.

[Jaws3]

Interesting topic and especially the comments about exczema. The fact is that post mortems of males at 65+ reveal an exceptionally large number of benignly enlarged prostates. This is as a result of hormonal changes in the 'ageing' process. Nevertheless an interesting possible preventative agent.

[Nightflyer]

Prostate Cancer- a follow up

Last year I wrote an article in the BALPA Log regarding prostate cancer. I outlined my diagnosis and treatment of the disease which now affects over 45,000 men a year in the UK. The recent publicity surrounding the deaths from the disease of well know personalities such as Sir Alec Guiness, Cardinal Basil Hume and Archbishop Runcie has brought about a new public awareness. 11,000 men in the UK will die of the disease each year. 4% of all deaths amongst men is attributable to prostate cancer. What it has highlighted is the lack of financial resources, particularly in the field of cancer research. Last year of the £300 million spent on cancer research, only £4 million was spent on prostate cancer. Nearly as many men now die of the disease as women do from breast cancer, yet there are no plans for the similar screening of men. It is now nearly 18 months since I had my operation and the battle for a cure continues. I hope my experiences will be of assistance to anyone who may be confronted with treatment decisions and their long- term implications.

I was diagnosed with prostate cancer at the age of 60. I had no symptoms but I had over the past 10 years had had a regular P.S.A blood test that is an indicator that the disease might be present. It runs in my family and has killed an uncle and a cousin. I was left with three options:

Do nothing (known as watchful waiting). Prostate cancer is a slow growing disease and most men die with the disease, not because of it.
Treat the disease with radiotherapy or radioactive seed implants.
Have the prostate surgically removed, also know as a prostatectomy.[/list=a]

As long as the cancer is confined to the prostate, either radiotherapy or a prostatectomy are considered the gold standard cures for the disease. After an MRI scan and the advice of my consultant, I decided to have a prostatectomy.I had one of the most experienced surgeon’s in the north of England perform the operation which spare the erectile nerves on the right hand side. Possible impotence or incontinence are the two main risks involved with the operation and similar problems can arise with radiotherapy. Fortunately, my ‘leakage’ cleared up in 4 weeks but impotence (the ability to achieve an erection) problems still exist. I mention this as there is no doubt that the threat of impotence is probably the prime concern of most men (even though they will not openly admit it) who consider having the operation.

Viagra, which is dispensed free on the NHS for all men who have had a prostatectomy, has not really worked for me. The other treatment for achieving an erection is the injection technique. You’re probably thinking, "No way would I ever stick a needle into my penis!" but it a common treatment for this problem. It requires a tiny needle and a watery mixture of drugs; usually prostaglandin E. It is the exact same mechanism that creates a natural erection, except it is triggered by a drug rather than a nerve impulse. You need to find the correct dosage as too much of the drug can make for a rather painful and prolonged erection.

The post-operative treatment for a prostatectomy is to have follow up PSA tests, usually every three months. Even though the prostate has been removed, if there has been any ex-capsular invasion of cancer cells, this will be indicated by a rising PSA as the cancer cells will still release PSA into the blood. It is now well accepted that if the PSA starts rise after a prostatectomy, it is an indication that the operation has failed and that there has been a recurrence of the disease.

My surgeon had advised me after the operation that the histology report showed evidence of microscopic extension of cells beyond the prostate capsule and that there was a 50% risk that I might need adjuvant or additional treatment. The Gleason scale, which measures how aggressive the cancer is, was as also higher than what was found by a pre-operative biopsy. The first 4 quarterly PSA tests each showed .1, which is considered a zero reading, however, the next test showed .5 and my next one increased to 1.5.

Since my operation I had continued to educate myself via the internet about the disease. There are numerous web-sites in the US which are excellent and many case histories are openly discussed with qualified consultants. I discovered that I was not alone. Failed radical prostatectomies are a common occurrence, indeed one report claimed that 30% fail if measured by rising post-operative PSA levels. The same can also be said for radiotherapy treatments. The real key to being cured is early diagnosis and to make absolutely sure that the disease is organ confined. Americans are well advanced in this field and it seems that more effort is put into early diagnosis through a battery of tests before deciding on the type of treatment.

If the recurrence is in the prostate bed or fossa, then salvage radiotherapy to that area is an option. Very often the surgeon has not been able to get a negative margin around the prostate and some cancer cells will have remained. Often the rising PSA is due to the disease being systemic which means that the microscopic cancer cells have spread throughout the body. The treatment for systemic spread of prostate cancer is adjuvant hormone therapy.

It has long been known that there is a connection between testosterone and prostate cancer. In the early 1940’s Dr Charles Brenton Huggins removed the testes,where testosterone is manufactured, from a number of men suffering from prostate cancer. In almost every case, castration shrank their tumours. For his work,Huggins was awarded the 1966 Nobel Prize in medicine and physiology. Testosterone acts like a traffic signal for prostate and prostate-cancer growth. When molecules of this hormone enter the gland via the bloodstream, they give prostate-cancer cells the green light to grow and divide. Their absence brings this activity to a screeching halt.

There are two types of hormone therapy, surgical castration and medical castration with the later mainly in used today. Various drugs are available to reduce testosterone levels and they fall into two groups:

[list=1] LHRH Agonists: Compounds called LHRH agonists mimic the size and shape of the lutenisinzing-hormone-releasing hormone, the molecule that starts the cascade of reactions leading to testosterone production. The drug works by flooding LHRH receptors on the surface of the pituitary gland cells, making the pituitary pump out LH non-stop and in much larger quantities than it is used to. After a few days, the exhausted pituitary begins adsorbing LHRH receptors from its surface and shutting down LH production. The upshot is that testosterone falls to castration levels. Examples of such drugs are Lupron and Zoladex.

Antiandrogens: Several compounds have been discovered or developed that essentially blanket prostate and prostate-cancer cells with a protective coat that prevents testosterone and other androgens from getting inside. Trade names of such drugs are Casodex and Eulexin (flutamide)[/list=a]

Hormone therapy normally involves a combination of these type of drugs however monotherapy with such drugs as Casodex are now approved in the UK. The main problem in turning off the production of testosterone are side effects and these can lead to impotence, loss of libido, hot flashes, loss of energy and breast enlargement. The intermittent use of HT is now being used quite extensively. The drugs are usually administered for a period of one year until the PSA levels become undetectable and then discontinued. Some patients are sometimes off treatment for periods up to 5 years. Once the PSA starts to climb, HT is re-started.

When presented with the problem of my rising PSA, I came across a procedure used in the States called Prostascint. It involves the use of a radioactive ‘dye’ that has an affinity for prostate cancer cells. This is injected into the blood and then scanned by a dual-head Gamma Camera that will show up any recurrence in the prostate bed or in adjacent pelvic lymph nodes. The procedure is not yet approved in the EEU but I did find that Prof. Keith Britton at Barts School of Nuclear Medicine in London had a similar imaging procedure under development in London. He agreed to give me the test and I might add that BUPA, my insurer, agreed to pay for the £800 scan. I have doubts that my local health authority would have picked up the bill for what is a relatively new treatment, a word of warning if you don’t have private health care.

A week later the results in the form of glossy photographs drop through my letterbox. It showed no recurrence in the prostate bed or pelvic lymph nodes. If it had, no doubt the results would have gone directly to my consultant. My consultant now feels that the rise in the PSA is due to microscopic cells that escaped the prostate prior to my operation. He pointed out that it would be pointless to attempt salvage radiotherapy and that intermittent adjuvant hormone therapy was the next step. As I write this, I am about to start a high dose monotherapy with Casodex a drug that has limited side effects and should maintain a reasonable quality of life. Hopefully, the PSA should drop to undetectable levels and my ‘on’ treatment period should only last a year. Although I retired from flying 6 months ago, it will be very interesting to see if the CAA will pull my licence. My consultant has given then regular reports on my PSA levels since my operation.

I have learned a great deal about this disease since my diagnosis and most of my information has been through the Internet, particularly American websites.Dr Charles Myers, a leading prostate cancer specialist and a sufferer himself, has stated that none of the treatments for prostate cancer are perfect and none have been proven effective. For early prostate cancer, we have a choice between surgery, radiation therapy, hormonal therapy or watchful waiting. Serious questions remain about the effectiveness of each of these approaches. Dr Myers believes there is no single right choice for all men. Treatments need to be tailored to the individual. His recommended approach is:

Go for cure, kill as many cancer cells as possible and then do what you can to slow the re-emergence of this cancer, slow the disease as much as possible without compromising your quality of life, or ignore the cancer as long as possible.

I would offer the following advice:

[list=1] If you are over 50 years, have a PSA blood test and Digital Rectal examination every year. If it runs in your family, start in your 40’s.
If diagnosed, educate yourself. This is one disease where the patient must get involved in the treatment decisions. If you are not on the Internet, get a computer.
Treat the disease as early as possible. Your prognosis will be much more favourable if the disease is organ confined.
Always seek the best advice and look to centres of excellence when it comes treatment.
Don’t let it get you down. Get on with your life.[/list=a]

Odds of being diagnosed with prostate cancer

Age
[list] 20-39 insignificant
40-44 1 in 48,640
45-49 1 in 9,085
50-54 1 in 1,943
55-59 1 in 624
60-64 1 in 240
65-69 1 in 122
70-74 1 in 81
75-79 1 in 65
80-84 1 in 58
85+ 1 in 63

Sources: number of cancer cases by age from the American Cancer Society.

Edited for formatting only

[This message has been edited by Capt PPRuNe (edited 27 September 2000).]

[driftdown]

Thanks Nightflyer for the information. It has certainly made me think. Good luck and I hope it goes well in the future for you.

[KIFIS]

Nightflyer
Thank you for your superb reply in response to my simple question about white spots on the fingernails. You have laid it on the line in simple medical language in a way that everyone can understand. Much appreciated. I have a friend who was diagnosed with a PSA of around 9. He opted for the radioactive seed implant and after nearly one year he is fine with a PSA of 1. I have other friends who went for the full removal. One has a rising PSA and the other is short-term OK. It seems to me to be a real lottery. Your suggestion about second opinions and thinking it out certainly sums up the way to handle things. What you have written should be essential reading for all and I am sure the aviators who read this forum will appreciate your effort. May I take the liberty on behalf of all of them to sincerely thank you.

The very best wishes for the future.

KIFIS

[Tinstaafl]

Well said, Nightflyer.

Best wishes for your health.