Malignant or Benign?
© Kenneth J. Lashutka, NMD
The acknowledgment of the individual man who is suffering the disease ultimately allows a patient to make the treatment plan their own and promotes better outcomes in health.
An asymptomatic, middle-aged, male patient presents to his allopathic primary care physician for a yearly physical examination. As part of the preventative screening, the physician performs a digital rectal examination (DRE) to palpate the prostate, and orders a prostate specific antigen (PSA) blood test. The physical findings include an enlarged prostate without nodule on physical exam, and an elevated PSA. The patient is then referred for a reflex biopsy. If the Gleason score of the biopsy is elevated enough, a diagnosis of prostate cancer is established. Recommendations for surgery, radiation, and, possibly and eventually, anti-androgenic prescription medications may follow. This hypothetical situation may represent the typical course of action for the typical male patient.
Please allow a re-evaluation of this patient, and the series of events that led to his assessment and treatment plan. As part of these naturopathic considerations, we will consider the anatomy of the prostate. We will consider the limitations and options of objective measures, such as blood tests and imaging, available to assess the overall health of the prostate. Based on the assessment drawn from the abnormalities of anatomy and the findings of the objective measures, we will consider the assessments of prostate cancer, along with benign prostatic hypertrophy (BPH) and prostatitis. Finally, we will consider treatment plans, from vigilant prevention to more aggressive interventions.
The prostate is divided into three anatomical zones: the central, the transitional, and the peripheral. The peripheral zone is that area of the prostate that is not only the largest area and the area palpated on DRE, but it is the area where most of the malignant tumors are found. This will present to a physician as an asymmetrical, firm, fixed nodule upon palpation. The central and transitional zones are where BPH and prostatitis most often occur. These benign disease processes can enlarge the overall size of the prostate upon palpation, but this enlargement does not immediately indicate a malignancy.
All three of the above prostate diseases can elevate a patient’s total PSA. PSA is specific to the prostate, not prostate cancer. Although biopsy of the prostate is considered the standard of care according to mainstream urology to establish a firm diagnosis, a number of tests may be performed that would indicate the percentage of likelihood a biopsy would show malignancy. Changes in PSA from one office visit to another, also known as PSA dynamics or trajectory, can show how aggressive a disease process may be. Additional blood tests, such as percent free PSA and prostatic acid phosphatase (PAP), can help clarify the likelihood of malignancy. Prostate cancer antigen-3 (PCA-3), a test that requires an attentive DRE and a specialized urine test, combines physical examination with an innovative test that specifically checks for prostate cancer, and not just prostate disease. These tests should be combined with studies of radiology such as transrectal ultrasound of the prostate (TRUSP) or MRI/MRS of the prostate to form a clear picture of any potential tumor burden.
Prostate cancer, BPH, and prostatitis may present separately, or in combination with one another. Additionally, based upon the results of biopsy and Gleason scores, prostate cancers can range from indolent to extremely aggressive. Allopathic medicine treats all prostate cancers similarly, regardless of the presence of absence of co-diseases such as BPH and prostatitis, as well as the level of aggression of the malignancy.
According to the principles of naturopathic medicine, the physician must first do no harm (primum non nocere). According to the American Association of Naturopathic Physicians, naturopathic physicians follow three guidelines to avoid harming the patient:
Utilize methods and medicinal substances which minimize the risk of harmful side effects, using the least force necessary to diagnose and treat;
Avoid when possible the harmful suppression of symptoms; and
Acknowledge, respect, and work with individuals’ self-healing process.
Regarding the first guideline, the above tools to assess a patient’s prostate health greatly reduces the risks involved with immediate biopsy and invasive medical procedures. Treatments may include botanical, supplemental, dietary, and lifestyle interventions for any of the three prostate conditions listed in this article.
Regarding the second guideline, removal or radiation of the prostate, or chemical castration with pharmaceuticals, do not change the underlying constitution that led to the disease process in the first place.
Regarding the third guideline, and most importantly, the patient is the man suffering the disease, and must be honored and educated regarding his medical choices. This acknowledgment of the individual ultimately allows a patient to make the treatment plan their own and promotes better outcomes in health.
Kenneth Lashutka, NMD practices at Center for Natural Medicine.