John Swanson, MD
staging is extremely important in assessing mortality and morbidity risk for any cancer. The diagram, table and this discussion are meant to help illustrate and explain some of the difficulties associated with prostate cancer staging. First, clinical staging in the absence of pathology reports of the prostate gland is frequently inaccurate. One study found that 66% of clinical stages were upgraded (worsened) after pathologic examination. Information given in Table 1 shows the need for pathological staging. Clinical staging often involves guesswork. This has particular importance for us in underwriting as external radiation therapy, brachytherapy and watchful waiting gain in popularity.
Next, there is the problem of 2 different staging classifications. The American Urological Association established he modified Whitmore-Jewett A through D staging system. For consistency with other cancers, the American Joint Committee on Cancer (AJCC) recommends use of the TNM system. T1 equates with stage A, T2 with stage B, and T3 and T4 with stage C. Table 1 compares the 2 classifications
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Bob Leibowitz, M.D, Isaac Gorbaty, M.D, Mary Duong, P.A.-C
The package insert that accompanies any type of prescription for testosterone replacement products states that testosterone is “contraindicated in men with prostate cancer.” This means that you should never use any form of testosterone if you have prostate cancer. 99.9% plus of all physicians believe that if you give testosterone to a patient with prostate cancer, it’s “like adding gasoline to a fire.” We are taught that testosterone will markedly stimulate the growth of prostate cancer cells, cause widespread metastatic disease, and greatly hasten death. Testosterone replacement therapy has also been reported to cause permanent paralysis.
A number of years ago, I reviewed the medical literature regarding the relationship between testosterone and prostate cancer, especially in men who were previously treated for prostate cancer. I previously discussed this subject in detail in my September 2003 paper, “High-Dose Testosterone Replacement Therapy,” and the interested reader is directed to this paper.
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Prostate cancer is an important concern for all men since it poses a health threat especially to men over he age of 40. However, there is a higher prevalence of this disease among Black men compared to men from other racial or ethnic groups in the United States. Actually, According to the American Cancer Society facts and figures (2002), American Blacks are seen as having the highest incidence rates of prostate cancer in the world. In general, Blacks are more likely to have prostate cancer detected at a later stage and the incidence as well as mortality rates of prostate cancer among Blacks are disproportionately higher than White males. Blacks are more prone to die from the disease when compared with Whites (Merrill, & Lyon, 2000). In addition to late detection, socioeconomic status is an important factor in the morbidity and mortality rates of prostate cancer (Boring, et. al. 1992; Bal, 1992). There is still a lack of knowledge regarding prostate cancer screening as well as symptoms and treatment modalities more so for Black men than for Whites (Nash & Hall, 2002).
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International Congress on Hormonal Steroids and Hormones and Cancer
G P Risbridger, J J Bianco, S J Ellem and S J McPherson
Monash Institute of Reproduction and Development (Centre for Urological Research), Monash University,
Melbourne, Victoria, Australia

Men and women synthesise both androgens and oestrogens, but the relative ratio of the two hormones between the two sexes is markedly different. The importance of androgens to the male is unequivocal whereas the roles of oestrogens are less clear. Oestrogen synthesis occurs via aromatisation of androgens utilising the aromatase enzyme (cytochrome P450arom); therefore the aromatase enzyme is a critical regulator of the balance between the androgens and oestrogensthat contributes to circulating and tissue levels of these hormones. In men, the balance between systemic levels of androgens and oestrogens is altered significantly upon aging; plasma androgen levels decline whereas oestradiol levels remain relatively constant (Vermeulen et al. 2002). In specific tissues of the body, the balance between androgens and oestrogens may differ significantly from that in theplasma but is nevertheless dependent upon the presence and activity of locally produced steroid metabolising enzymes, such as 5á-reductase and aromatase (Voigt & Bartsch 1986,

Negri-Cesi et al. 1998, 1999, Weber et al. 1999, Steers 2001). The role of local synthesis of steroids has assumed increasing importance in some disease states, particularly in glandular tissue such as the breast, wherein abnormal levels of oestradiol promote the development and proliferation in the early stages of malignant transformation of epithelial cells (Simpson et al. 1994, Santen et al. 1997).
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Prostate Cancer Priority Strategic Plan
since 1991, prostate cancer has been the most frequently diagnosed cancer (other than skin cancers) in Michigan. In 2003, Michigan had the third highest incidence rate of prostate cancer in the nation; 8,119 Michigan men were diagnosed with prostate cancer. African American men in Michigan were diagnosed with prostate cancer at almost one and a half times the rate of Caucasian men in Michigan in 2001.
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Nutrition & Prostate Cancer
Scientific evidence suggests that differences in diet and lifestyle may account in large part for the variability of prostate cancer rates in different countries.
Good nutrition may reduce the incidence of prostate cancer and help reduce the risk of
prostate cancer progression. There are many studies currently being conducted to help
further understand how diet and prostate cancer are related. We do know, however,
that improved nutrition reduces risk of heart disease, diabetes, and obesity, and usually
improves overall quality of life. It is estimated that one-third of cancer deaths in the U.S. can be attributed to diet in adulthood, including diet’s effect on obesity. Additionally, a healthy diet helps to increase energy levels, facilitate recovery, and enhance the immune system
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