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2009-10-07 Ronald Wheeler MD Prostate Cancer

October 7, 2009, By Kirkham R. Hamilton, PA-C
© copyright 2009, Prescription 2000, Inc.
www.prescription2000.com

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KIRK HAMILTON: Welcome to Staying Healthy Today, a health-oriented radio show committed to bringing you key experts in the fields of nutrition, prevention and integrative medicine.

Hi, my name is Kirk Hamilton, your host of Staying Healthy Today, and our mission is simple: To provide you credible usable health information from interviews and our educational resources to help you Stay and Be Well in the busy modern world. Please take a few moments before or after listening to this interview to browse through the Prescription2000.com website, the home of Staying Healthy Today Radio, for our free educational services.

Today's show topic is "Learn The Connection Between Prostatitis And Prostate Cancer, And How To Prevent, Diagnose And Treat Prostate Diseases With The Latest Medical Technology And Nutrition Science." Our guest today is Dr. Ronald Wheeler, medical director of the Diagnostic Center for Disease in Sarasota, Florida, a medical center committed to the prevention, early detection and treatment of diseases of the prostate using the most modern, noninvasive technologies when possible and lifestyle changes. Dr. Wheeler has been a practicing urologist for more than 20 years with a focus on male health issues including impotence, benign prostatic hypertrophy, prostatitis and prostate cancer. He is the creator of Peenuts®, a branded and patented prostatitis formula whose goal is to resolve prostatitis and thereby prevent prostate cancer. He is a much sought-after speaker by professional and public organizations regarding the prevention and treatment of diseases of the prostate using novel lower-risk therapies and lifestyle change.

So welcome Dr. Wheeler. Thank you very much for coming on the show today.

DR. RONALD WHEELER: Kirk, thank you very much. It's a pleasure to be here.

KIRK HAMILTON: You know I was going through the National Cancer Institute's website looking at some facts and figures on prostate cancer and in 2009 they estimate that 192,280 new cases of prostate cancer will be diagnosed and another 27,000 plus deaths will occur from prostate cancer. So that makes it the second most common cancer in men next to skin cancer. With that background, how did you develop your intense passion for the prevention, detection and treatment of prostate cancer, and, when did you begin to think that there might be a better way to approach prostate cancer than the traditional approach?

DR. RONALD WHEELER: First of all I want to say that I want to make a difference in what I do and as a urologist who is in charge of basically everything regarding the genitourinary tract. We are often times pushed and pulled from the bladder to the kidney to urinary issues to prostatitis to prostate cancer to infections in the prostate to bladder, etc., operating on kidneys, this, that and the other. My point is that there is a variety of things that urologists are entrusted to do and I realized early on that I couldn't do all those things to the very highest of levels. And no urologist that fails to specialize will be able to do any of that to the highest of levels in all regards. So I decided early on that the prostate was a territory that was the least known about if you will, many may know a lot about the prostate but very few doctors know all that they need to know to advance the cause of prostate research and cancer specifically. So I would say that it was probably maybe 12 years ago or so, I have been a practicing physician of 24 years, but 12 years, maybe 14 years ago I decided that I was going to move toward dedicating the rest of my career to just prostate disease. As you pointed out it's an epidemic disease if not pandemic disease throughout the world. All men face off with prostate cancer if they live long enough. Virtually 100% of us will have cancer at age 100 if we are fortunate enough to live that long. Given the fact that we are secondary to skin cancer, the most prominent visceral cancer that there is in men, the SEER data is the data that really captures me, the SEER is the Surveillance Epidemiology and End Results data out of the National Cancer Institute or NCI. They basically have stated that within the next 10 to 15 years a new case of prostate cancer is going to go from being diagnosed one every three minutes to a case every 1.5 minutes, and that's a pretty scary piece of data. This is related primarily to the tsunami effect of baby boomers getting older, and so again I have decided that I needed to dedicate my career to this topic. I am pleased that I have. Obviously I know a lot about it. I compete with every major institution in this country and I tell people all the time when you go to a university you're getting institutional medicine. When you come to see me you're getting a personal guide to prostate health.

KIRK HAMILTON: What makes prostate - I know the word cancer sounds terrible, but if the cancer stays within the prostate what is the lethality of it? In other words, why do we have to treat it so aggressively, or do we?

DR. RONALD WHEELER: Well that's a great question. Thirty to 56% of all cases of prostate cancer are overtreated. The problem is that we really do know from cancer to another, or one person to another with prostate cancer, which of those patients are lucky enough to be treated less aggressively and which of those patients should be treated more aggressively. So there's really lots of things that we have to do as we try to discern who's in which category. Given all of that you know we're often asked to tell people whether you can live with your disease or not. The bottom line is if you have a Gleason 6, and just plain and simple, cancer is graded from 1 to 5 in what we call a Gleason grade, and then the most prominent type of cancer cell found is the first number of a Gleason score, and the second most prominent type of cancer cell found is graded and that's the second part of the score. So basically Gleason scores of cancer and cancer aggressiveness go from 6 to 10, and 50 to 60% of all cancers are Gleason 6's so these are cancers that I tend to call ‘pussycats' of disease. So these are cancers that men can live with. The problem is that when men have a Gleason 6 diagnosed as an example, they really don't know the extent of disease based on the biopsy because of an issue called sampling bias. So sampling bias just really means that that's the tissue that we found at the end of the needle that we stuck into the prostate at a certain place. We have really no idea of the totality of the prostate by sticking needles randomly into the prostate. What we do here at our center, we have MRI spectroscopy using our 3.0 Tesla HDX magnet from GE that allows us to specifically see the global positioning view of the prostate and know really the extent of disease with an individual. I make a case in point. I had a fellow who's 48 years old from Mississippi and he has had prostate cancer for the last three years and his PSA is 1.8. He thought that he was doing pretty well with his 1.8 but decided that he really didn't have the coaching, and so I am a coach. I'm the kind of guy that can sit down with you and help your organize your thoughts and decide what's the best way to treat this dietarily, what's the best nutrition, what else can we do to help offset this disease, how else can you live with this disease. In the course of action we decided to get a MRIS scan on this individual and we detected that his cancer was significant on his right side at the base, but more alarmingly in this case the capsule of the prostate was actually being pushed laterally. So as I visited with him I said I thought that the bulk of disease, even though the PSA was relatively quiet, the bulk of the disease and where the disease was located dictated that we probably shouldn't be watching this disease. It doesn't appear to be quite as indolent as the PSA would indicate so we're going to treat him with high-intensity focused ultrasound (HIFU) which is the ‘new boy' on the block, if you will, in terms of treatment. Not yet currently FDA approved but patients leave the country, I leave with them, we treat them again outside the country and in this case will treat the entirety of the prostate and we will allow that patient to have the most patient-friendly procedure, such that if he were a golfer he would be back hitting golf balls the day after his procedure. There is no cancer procedure around, radiation or otherwise, that will give you those kinds of results and allow that kind of pattern, such that you can get back to doing what life offers as opposed trying to convalesce from a treatment.

KIRK HAMILTON: Let's backtrack a bit then with that same patient. If they had been approached, let's say traditional urologic approaches, what is wrong with that approach or is it wrong that they might go right into surgery or radiation or aggressive hormone therapy? Can you backtrack and tell us how the traditional urologist differs from you?

DR. RONALD WHEELER: Sure. The traditional urologist in that case would say well he's a young man with prostate cancer and the younger the man the more aggressive the disease tends to be, and and the reason we should in fact probably take out his prostate. I disagree with that 180 degrees. I believe that because he is a young man we need to do a procedure that in fact protects that individual from spreading cancer cells. Pat Walsh at Johns Hopkins, and every body knows John Hopkins and their great work in cancer research, Pat Walsh admits that during the process of taking a prostate out that we spread cancer cells. What Pat doesn't recognize is that while we spread those cancer cells, those cells potentially can set up small sites of metastasis throughout varying parts of the body and develop into significant cancer centers once the prostate has been removed. I don't see that as being a conservative form of therapy. I see that as being somewhat of a therapy that's going to advance the cause of the disease and obviously we know that 40 to 60% of all patients treated for prostate cancer fail by 7 to 10 years. That's out of the Journal of the American Medical Association as well as Journal of Urology. So in the bigger picture this fellow would have been scheduled for surgery and they would have told him that this would give him his best chance at cure. Well it may give him a chance of cure, but the best chance of cure when you have procedures like HIFU, high-intensity focused ultrasound, which is a thermal energy delivered to the prostate and basically treated capsule to capsule, top to bottom and apex to base, allows us to treat the prostate in place so we do not remove the prostate with high-intensity focused ultrasound, so therefore we do not spread cancer cells and that's very, very important. Additionally, if this individual at age 48 has a radical prostatectomy, and let's assume the worst and always I assume the worst because if we can understand the disease and the protocols, the progression of disease and how we do things in the worst case scenario, then anybody can take care of the patient in the best case scenario.

KIRK HAMILTON: How would you approach then, if you didn't have the MRI spectroscopy? Are there other modalities of assessment that other urologists might have like color Doppler ultrasound or other less invasive ways than a biopsy to assess prostate health?

DR. RONALD WHEELER: Well color flow Doppler, if you look at Pelts and others, they've demonstrated that if the ultrasound in the color flow Doppler mode, power Doppler mode, notes an area of interest - that area of interest will represent a cancer about 27% of the time. If we're looking at grey-scale ultrasound, which most doctors have in their office, those grey-scale ultrasonic findings, in this case dark findings or hypoechoic zones, they yield a cancer about 20% of the time. We have other tests like PCA3 which is a genetic test that basically looks at the post massage urine and it's looking for a gene. People ask me, "Does that help me with my understanding for prostate cancer?" and I would tell them, "No." And the reason the answer is no is because it doesn't give me any information that I can take away and advance the patient's educational process by telling them they have the gene. And the reason that is, is they could have the gene and have no cancer. They could not have the gene and have cancer.

KIRK HAMILTON: Let's talk about how prostate cancer develops. I know you're big into prostatitis. So can you explain what prostatitis is and maybe what lifestyle factors go along with that, that might help progress it to a cancer?

DR. RONALD WHEELER: Well the vast majority of prostatitis cases, which is an inflammation of the prostate, but the vast majority are nonbacterial. Despite that fact that I would say that 98% of all cases of prostatitis are nonbacterial, so there's pus in the prostate but there's no bacterium that is stimulating that pus. So there's some other factor that's creating this that is unknown to us. We believe that it might be an autoimmune phenomenon as an example not dissimilar from rheumatoid arthritis. So in the bigger picture as we look at this disease process we know through the work of the American Association of Cancer Research that prostatitis actually leads to prostate cancer, not dissimilar to colitis leading to colon cancer, cervicitis leading to cervical cancer, esophagitis leading to esophageal cancer, gastritis and so forth leading to their related organ cancers. So we know that, and the bottom line is that as we go along what we're trying to do is prevent prostatitis from taking place. We're trying to offset that. As you mentioned earlier we do have a patented product called Peenuts® that actually works versus prostatitis. We are able to actually assess the white cell count and see that white cell count drop with this particular formula which is a compilation of 15 vitamins, minerals, herbs ands amino acids. From my perspective, I'm just not looking to mix up something in my favorite lab and offer it for sale. I'm looking for something that makes a difference and I wish I had the opportunity to just give it away because it's that good. It's patented all over the world and people can just dial it up at Peenuts.com. But given all of that from my perspective we're trying to prevent that disease from progressing, which will ultimately prevent prostate cancer for evolving.

KIRK HAMILTON: Tell me the lifestyle factors starting with diet that you would incorporate in a person that you're trying to prevent prostatitis going to prostate cancer? And then you talked about some nutritional supplements. Can you be specific about omega-3 fats, maybe vitamin D and that progression?

DR. RONALD WHEELER: Yes. There are basically five tools to systemic health. So prostate health just falls under that umbrella. So the proper diet. Proper diet is typically the modified Mediterranean diet. It avoids things like the fats associated with dairy and the fats associated with red meat. So I ask people to avoid dairy and red meat in their dietary selection process. The reason for that is based on a fatty acid called arachidonic acid. Arachidonic acid is an omega-6 fatty acid that promotes the growth and stimulates aggressiveness in cancer when present. It is also proinflammatory. So obviously we don't want anybody to consume things that are inducing inflammation and much worse inducing aggressiveness or accelerating aggressiveness in cancer itself. Beyond the diet is nutrition. Specifically with nutrition we look at multiple things. People know about resveratrol which is the active ingredient in grape juice and red wine as an example. It's a wonderful antioxidant. Curcumin is a wonderful spice. It's the active ingredient in tumeric root. So this is a spice that many people know in the kitchen and it happens to be also a spice that affects the growth of prostate cancer so that's also a benefit. Omega-3 fatty acids, fish oil basically, is something that I really think the world of. It's antiproliferative in terms of cells so it disallows cells to replicate as quickly as they want to replicate. It also helps by decreasing deposits of fat, oxidized cholesterol into our arteries and vasculature in general, and also helps us with cognitive function. Vitamin D3 is another key ingredient in the nutritional world and has shown tremendous benefit first in prostate cancer in various studies in the literature. In fact the literature is replete with studies that speak to the benefit of vitamin D3, and D3 again is antiproliferative and it's really a staple I believe with multiple oncology products that are available for patients with cancer, and probably just not good for prostate cancer, probably all cancers. In addition to that, I talked a little about COX-2 inhibitors. These are things that really block oxidative change and curcumin as an example is a COX-2 inhibitor. In addition, green tea extract is a COX-2 inhibitor. So as we look at these types of things we put these together in a treatment wheel, if you will, that allows the patient to have these select items as a part of their daily routine. And certainly I'm not giving you a list that is totally inclusive. There are other things that can be added to the program. But I don't encourage, do not encourage things like flax because flax is an omega-3 which is great for you, but it is also an omega-6 which is counterproductive because as I spoke earlier, it really promotes inflammation. So beyond the diet, the nutrition, beyond exercise, beyond stress reduction, lies education. As people get better educated about these various tools that we have and staying healthy, putting some exercise into their daily routines they're going to find that they have a better body to defend against these diseases down the road. And if they really break some of these bad habits like smoking as an example, eating chicken fat as an example, eating hamburgers as an example, if they can break some of these bad habits, they legitimately have a chance to live a life without cancer. But they have to start early, and I would say they have start by age 30. And the reason is that 30% of 30-year-old men have prostate cancer. That's data out of Sakr's work (J Urol, 1993 150:379-385/In Vivo 1994, 8(3):439-443, 1994), the Detroit Autopsy Study and, as well as Sloan-Kettering, Memorial Sloan-Kettering in New York independent of each other. So prostate cancer is a ubiquitous disease. It's all around us. We need to prevent it if we can. We want to treat it appropriately when we have to.

KIRK HAMILTON: How do you follow generally a healthy person? Let's say a 40-year-old comes in like today, 42-year-old male comes in the practice today and he just kind of wants me to make a few comments about his health. How would you just look at his prostate and he doesn't have any active disease at the moment, or we don't know? How would you follow that person over the next five years?

DR. RONALD WHEELER: What I would tell the patient is that prostate disease is a disease of healthy men. So based on the fact that he comes in and he tells me he has no problems, I would say what I want you to do is get a PSA. The PSA is truly the barometer of prostate health. So it's a poor, a very poor cancer marker. So just because the number can be high it doesn't mean that you have prostate cancer, but it does mean that you have a very sick prostate. And obviously sick prostates can turn into cancerous prostates because minimally when the PSA is 1.0 or higher, 100% of men have prostatitis. Prostatitis is again a nonbacterial inflammatory condition of the prostate that evolves into prostate cancer over the years. So the bottom line is I would say to this individual, "Let me check your prostate," and in fact in my office I say, "It doesn't cost any more for me to do it, so let me just check your prostate and see where you are. And if I don't feel anything going on in your prostate I will leave you alone and we'll just follow the PSA." If the PSA comes back and it's higher than 1, or basically 1.0 or higher, I will challenge that individual once prostatitis is determined to lower that PSA. He must lower that PSA. The vast majority of patients that have prostatitis are nonsymptomatic. So these are guys that are just coming in, they're looking for a routine check. But those are the guys that need to begin the educational process so they know how to handle this disease going down the road, and then assuming that the individual has no issues, I would see that individual back in a year with another PSA result. We respond to that. We might check the EPS, or expressed prostatic secretion, again in a year to see where that individual is with regards to the treatment of the prostatitis that he has no symptoms for and continue to monitor him at yearly intervals for the next five years.

KIRK HAMILTON: How do you assure that the patient gets an accurate PSA level? I've heard that you don't have sex a night or two before. You don't ride a bicycle. You don't do a digital rectal exam and then get the PSA. Can they fluctuate by those mechanisms?

DR. RONALD WHEELER: They do fluctuate by those mechanisms, and while there's no statistical reason that somebody could not have sex the night before, or you can't do a ride a bike as an example and get a PSA. Or even do a digital exam just before you do the blood test and you should be able to get an accurate number. What I tell people is if there's even one person in 100 or one person in a thousand that would have an altered number because I did the digital exam prior to the PSA blood draw, or, that individual was out doing horseback riding or riding a tractor or something like, or even a bicycle as an example, I would say that what I want guys to do is avoid any kind of activity. No sexual activity 48 hours prior to the blood test and avoid bike riding or anything that you straddle, motorcycle included, probably a week ahead of time. And the reason is, is if you get a PSA result that is higher than it ought to be, you will suffer many, many hours of anguish as you try to figure out what in the heck is going on with you and you're going to be deeply concerned. So I want to see the patient under proper conditions and I only want to deal with those individuals that truly have a problem and give those guys without a problem a little bit of education but allow them to see me on another day if they don't listen quite so well.

KIRK HAMILTON: How about body weight and central fatness? How much does that play a role in inflammation and prostate health?

DR. RONALD WHEELER: Well body fat and things like that, I don't know that they deal so much in inflammation as much as they basically pose a threat to the patient such that, that individual could in fact store more estrogen in that body fat. By storing estrogen, the PSA itself can actually be lower when a cancerous situation is detected. So in effect we can be tricked into thinking that guys have a PSA of maybe 2.5 and we use the number of 4, anything above 4 we are concerned about, and this guy's got quite a bit of belly fat, maybe his waist is a 48 as an example. So the process is such that he could in fact be somewhat hypogonadal or maybe not have the amount of gonadal production in terms of testosterone that he needs. I would tell a guy, I'd say, "You know let's just check your levels and testosterone total, free testosterone, let's do the serum-hormone binding globulin. Let's just take a look at some various components and see where you are. And you might be a pint low," as I say to these guys and you know if I give you a supplement as an example, if your PSA's normal I don't feel anything on your prostate, we can give you some replacement therapy as an example. Maybe it makes it easier for you to exercise, maybe it makes your fat go away quicker. I can change your diet. So we're always trying to alter individuals and try to make them healthier going forward and to your point trying to eliminate inflammation wherever we can.

KIRK HAMILTON: How about, since you're on the topic of hormones, is testosterone protective of the prostate health or an aggravant of prostate health?

DR. RONALD WHEELER: Well we have to get a little more specific. Testosterone does it really protect against prostate cancer, yes or no. I don't know that answer's in. Does it protect if you have prostate cancer? The bottom line is testosterone, generally speaking, if you use it exogenous which means you use it through a gel or a cream or an injection as an example, the bottom line is testosterone while it does not cause prostate cancer, it does in fact cause prostate cancer to grow. So it's very, very important for individuals that are interested in getting replaced with hormone or balanced with hormones to remember that if their PSA is 2.0 or higher, that they want to get the 3.0 Tesla MRIS scan preferably here at our center in Sarasota because we know what to do with that information so that we can determine whether or not that individual is truly at risk for prostate cancer going forward. I had an interesting case from out your way, just north of you in Sacramento, and this individual was on testosterone replacement and his PSA went from 3 to 15. Well the bottom line is that didn't make me feel very good and the doctor involved said that testosterone had no effect on PSA at all and cancer, and it just wasn't an issue. We scanned him and he had prostate cancer throughout his prostate. I offered him a biopsy for his prostate that would be targeted to those areas, we would protect him with a special protocol for needle tracking, and he say's "Doc, if I've got cancer and the scanner shows I've got cancer, I want to treat it." Long story short, we treated him with high-intensity focused ultrasound, his PSA is less than 0.1 right now.

KIRK HAMILTON: Does the HIFU, high-intensity frequency ultrasound, does it kill the tissue or what does it do to it?

DR. RONALD WHEELER: High-intensity focused ultrasound is a thermal energy that basically heats the prostate tissue very similarly to a magnifying lens. If you take the sun's rays and they are going through this convex lens the energy is actually bent down to a point. It's at that point in the case of the prostate 3-4 cm away from the treating transducer. The tissue is actually heated to the tune of 70 to 90 degrees centigrade, so it's extremely hot. It's so hot in fact that it actually causes the cells to suffer from what we call coagulative necrosis. So the cells cannot withstand that heat. So they do die, basically it causes the cells to bubble up and just basically coagulate much like an egg white would coagulate when it hits the hot pan.

KIRK HAMILTON: Sounds great!? Why don't you - I'd like to wrap this up here a little bit. Tell us you know what makes your Diagnostic Center for Disease® in Sarasota, Florida so special? I know you've kind of said little parts of it. But kind of put it together for me in a nutshell.

DR. RONALD WHEELER: Yes. I am the only urologist in the country that has the Florida Protocol. And the Florida Protocol is really the protocol of diagnostics that includes grey-scale ultrasound, color-flow power Doppler ultrasound looking for vascular sites that may be sites of cancer growth, as well as the MRI spectroscopy scan at 3.0 Tesla. So we're the only one in the country with all of these things. And so as a urologist that's pretty special. Relevant to what I do as a treating physician, I no longer do radical prostatectomies and with the vaccine scheduled to come out at some point in time down the road we don't want to have the patient lose his antigenic stimulus for his immune system by having his prostate removed. So therefore we want to do some procedure if one's indicated that would allow us to use a vaccine down the road if for any chance that the procedure that was given did not achieve success that we expected. So I am one of the top three HIFU doctors in the United States and probably in the world. And I am in terms of HIFU, I have seen more patients from more states that any other practicing HIFU doctor in the country.

KIRK HAMILTON: Tell us how to get in contact with the Diagnostic Center for Disease®.

DR. RONALD WHEELER: Well our toll-free number to the center is 877-766-8400. People can get onto our website at MRISUSA.com. They can get onto my HIFU site if they want to learn more about that by going to PanamHIFU. So just like the airline. PanamHIFU.com. And bottom line is they can catch us there. We do free interviews, 30 minute interviews actually with patients discussing their particular issues and we're happy to be on with doctors, as example, wives, family members, and the point of all this is I want to guide people to get to where they need to go in terms of the decision-making process and we always want to take the path that makes the most sense. We want to do for the disease what is required. We don't want to be creative and we don't want to try to go out of our way to do more than what the disease really needs.

KIRK HAMILTON: Well Dr. Wheeler, thank you very much. That was an information-packed half hour and I want to acknowledge you for your great work because you really enlightened me. I don't know, maybe five or six years ago after I heard your first...one of your first talks and it empowered me to look at the prostate much differently. So I want to thank you for your great work regarding the prevention, diagnosis and kind of a whole-person approach to the treatment of prostate diseases.

And I want to thank you the audience, for listening today on this edition of Staying Healthy Today Radio. And remember until next time, Stay and Be Well.

© copyright 2009, Prescription 2000, Inc.
www.prescription2000.com

No part of this interview may be copied or reprinted in any form, electronic or print, without written permission from Prescription 2000, Inc.