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A study on the integrated Chinese-Western medical treatment of Prostate cancer.

In Kin Zhong Yi (New Chinese Medicine) (2008;1:26-27), Lu Li-guo et al. published "Clinical Observations on the Treatment of 142 Cases of Prostate Cancer [Using] Integrated Chinese-Western Medicine [and] the Methods of Supporting the Righteous Repressing Cancer." A summary of this article is presented below.

Cohort Description

All 142 cases enrolled in this study were seen as either in-or outpatients in the urology department of the Guangdong Provincial Chinese Medical Hospital from January 2004 to May 2007. All these cases had been positively diagnosed as suffering from prostate cancer. Patients' ages ranged from 18-90 years, with an average age of 72.1 years. Among the cases, there were 134 cases of adenocarcinoma, three cases of squamous carcinoma, one case of small round cell cancer, and four cases of undifferentiated carcinoma. In 21 cases, tumor, node, metastasis (TNM) staging was T3-4NxM1c, meaning that the cancer was invasive and had spread to surrounding tissues, that surrounding nodes were not able to be/had not been examined, and that there were distant metastases. Among these 21 cases, there were eight cases of bone, lung, and widespread pelvic cavity metastases, 12 cases of just bone and lung metastases, and one case of only lung metastasis. !n 110 cases, TNM staging was T3-4NxM1b, while in the remaining 11 cases, it was T1-2N0M0. (1) The Gleason score was 8-10 points in 48 cases, 7 points in 69 cases, 5-6 points in 22 cases, and 2-4 points in three cases. (2) The duration of disease in these cases ranged from one to 51 months.

Western Medical Treatment

All the patients in this study had undergone retropubic radical prostatectomy, were being treated with androgen ablative therapy, and/or had undergone a bilateral ochiectomy. In particular, patients received 250mg of flutamide three times a day (t.i.d.). (3) Pain due to bone metastases was treated by local injection therapy. Basically, the Western medical treatments described correspond to standards of care for prostate cancer in the West.

Chinese Medical Treatment

The basic Chinese medicinal formula used in this protocol consisted of the following;

Huang Qi (Radix Astragali)

Bai Hua She She Cao (Herba Hedyotis Diffusae), 30g each

Xi YangShen (Radix Panacis Quinquefolii)

Cui Ban (Plastrum Testudinis)

Wang Bu Liu Xing (Semen Vaccariae)

Fu Ling (Porta), 15g each

Quan Xie (Scorpio)

Bai Zhu (Rhizoma Atractylodis Macrocephalae)

Can Cao (Radix Glycyrrhizae), 10g each

If there was spleen qi vacuity, 15 grams each of Shan Yao (Radix Dioscoreae) and Huang ling (Rhizoma Polygonati) and five grams of Chen Pi (Pericarpium Citri Reticulatae) were added.

If there was kidney qi vacuity, 15 grams each of Tu Si Zi (Semen Cuscutae), Ba Ji Tian (Radix Morindae Officinalis), and Niu Xi (Radix Achyranthis Bidentatae) were added.

If there was qi and blood dual vacuity, Huang Qi was increased up to 60 grams, and 15 grams of Gou Qi Zi (Fructus Lycii) and 30 grams of Dan Shen (Radix Salviae Miltiorrhizae) were added.

If there was yin vacuity and fire effulgence, Bai Zhu, Huang Qi, and Fu Ling were removed, and 15 grams each of Nu Zhen Zi (Fructus Ligustri Lucidi), Bie jia (Carapax Trionycis), Mu Dan Pi (Cortex Moutan), and Sheng Di Huang (uncooked Radix Rehmanniae) were added.

If there was yin vacuity with phlegm heat, Huang Qi and Bai Zhu were removed, and 15 grams each of Zhe Bei Mu (Bulbus Fritillariae Thunbergii) and Jian Hua Fen (Radix Trichosanthis), along with 10 grams of Huang Qin (Radix Scutellariae), were added.

If there was blood stasis, 10 grams each of Fu Bie Chong (Eupolyphaga/Steleophaga) and Shui Zhi (Hirudo) and 15 grams of Jiang Huang (Rhizoma Curcumae Longae) were added.

If there was lower burner damp heat, 15 grams of Che Qian Zi (Semen Plantaginis) and 30 grams of lu Fu Ling (Rhizoma Smilacis) were added.

If there was bone metastasis pain, two strips of Wu Gong (Scolopendra) and 15 grams each of i'tang Can (Bombyx Batryticatus) and Cu Sui Bu (Radix Drynariae) were added.

Although it was not stated as such, it is assumed that one packet of these medicinals was decocted in water and administered per day in divided doses.

Study Outcomes

1. Quality of fife

The European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30) was administered before and after treatment. Marked effect was defined as 20 points or more increase in score after treatment. Some effect was defined as a 10-20 increase in score, and no change was defined as an increase of 0-9 points after treatment. After treatment for 12 months using the above treatment protocol, 115 cases (81.0%) experienced some improvement in their quality of life. In addition, 22.4% had developed hot flashes, 13.8% had developed osteoporosis, and 11.7% had developed breast swelling and pain.

2. Survival rate & PSA relapse (i.e., time to progression [TTP])

These 142 cases were followed up for one to 50 months.

During that time, 16 patients died. Therefore, the total survival rate was 88.73%. The overall average survival time was 27.7 months. The overall average time of non-progression of disease was 25.2 months. Among the 21 cases that were T3-4NxM1c, their condition did not progress for an average of 24.3 months. In addition, after castration and a PSA of 0, their PSA relapsed within a median of 23.9 [+ or -] 19.2 months, while their PSA increased within a median of 24.1 [+ or -] 20.4 months. Among the 110 cases that were T3- 4NxM1b, their condition did not progress for an average of 24.3 months. Further, after castration and a PSA of 0, their PSA relapsed within a median of 20.1 + 15.2 months, while their PSA increased within a median of 22.3 + 1 7.4 months.

3. Bone metastases & emission computed tomography (ECT) bone scan. (4)

In the 110 patients who were T3-4NxM1b with bone metastases, those metastases disappeared In four cases and shrunk or became paler in 79 cases; in 18 cases, there was no further spread or increase; and in the other nine patients, there were no new metastases seen. Prior to treatment, the mean number of metastases seen with ECT was 7.6 [+ or -] 4.7. After 12 months of treatment, it was 3.4 [+ or -] 1.7; after 24 months of treatment, it was 2.6 [+ or -] 1.4; and after 36 months of treatment, it was 4.8 [+ or -] 2.1.

4. Changes in blood analysis from before to after treatment Table 1 shows mean numbers of white blood cells (WBCs), hemoglobin (Hb), and blood platelet count (BPC) from before to after treatment. (5)
Table 1: Mean numbers of white blood cells (WBCs), hemoglobin (Hb),
and blood platelet count (BPC) from before to after treatment

Blood Factor Before tx At 12 months

WBC(x[10.sup.9]/L) 6.47 [+ or -] 2.35 7.32 [+ or -] 2.51
Hb (g/L) 106 [+ or -] 12 120 [+ or -] 11
BPC(x[10.sup.9]/L) 206 [+ or -] 14 231 [+ or -] 23


Blood Factor At 24 months At 36 months

WBC(x[10.sup.9]/L) 7.46 [+ or -]1.94 7.37 [+ or -] 2.15
Hb (g/L) 128 [+ or -] 14 121 [+ or -] 12
BPC(x[10.sup.9]/L) 227 [+ or -] 25 224 [+ or -] 16


Based on these outcomes, after treatment for 24 and 36 months, WBCs were markedly higher than before treatment. In addition, at 12, 24, and 36 months of treatment, both Hb and BPC were markedly higher than before treatment.

Discussion

According to its authors, this study was designed to see if standard Western medical treatment combined with Chinese medical therapy to support the righteous and repress cancer (fu zheng yi ai) can improve the survival rates, quality of life (QL),and time to progression (TTP) of prostate cancer as well as mitigate some of the common side effects of the standard Western medical care for this difficult-to-treat disease. The supplementing or righteous-supporting medicinals in the above formula have an immune-modulating effect and can strengthen and increase lowered physical immunity. Hence, clinically, it was demonstrated that the above protocol did markedly increase WBCs, Hb, and BPC after treatment. On the other hand, Chinese medicinals that disinhibit dampness, dispel stasis, and clear heat and resolve toxins have been shown to either suppress or kill prostate cancer cells. In particular, Bai Hua She She Cao has been shown to promote prostate cancer cell apoptosis (death). The authors of this study conclude that the combination of Chinese medicinals to support the righteous and repress cancer with standard Western medical care can increase the survival rate and markedly improve quality of life in patients with prostate cancer.

Notes

(1.) In terms of the "T" in TNM staging, the four stages (1-4) correspond to the following:

Stage I

In stage I, cancer is found in the prostate oniy. It cannot be felt during a digital rectal exam and is not visible by imaging. It is usually found accidentally during surgery for other reasons, such as benign prostatic hyperplasia. The Gleason score is Sow. Stage 1 prostate cancer may also be called stage A1 prostate cancer.

Stage II

In stage II, cancer is more advanced than in stage I, but has not spread outside the prostate. The Gleason score can range from 2-10. Stage II prostate cancer may also be called stage A2, stage B1, or stage B2 prostate cancer.

Stage III

In stage III, cancer has spread beyond the outer layer of the prostate to nearby tissues. Cancer may be found in the seminal vesicles. The Gleason score can range from 2-10. Stage III prostate cancer may also be called stage C prostate cancer.

Stage IV

in stage IV, cancer has metastasized (spread) to lymph nodes near or far from the prostate or to other parts of the body, such as the bladder, rectum, bones, liver, or lungs. Metastatic prostate cancer often spreads to the bones. The Gleason score can range from 2-10. Stage IV prostate cancer may also be called stage D1 or stage D2 prostate cancer.

(2.) The Gleason scale Is the most common scale used for grading prostate cancer. This system assigns cancer cells a score from 1 to 10, by combining the two most common patterns of cells to give a total score (e.g., 3 + 4 = grade 7). Scores generally range between 4 and, most commonly, 6 or 7, These scores are broken down into three main levels:

Low-grade (well differentiated): This type of slow-growing cancer has an appearance most like normal prostate cells and is the least dangerous. It has a G leason score of 4 or less.

Intermediate grade (moderately differentiated): This type is somewhere between the low- and high-grade cancers and the most common of the three. Depending on PSA level and tumor volume, it can act like a high-or low-grade cancer. It has Gleason score between 4 and 7.

High-grade (poorly differentiated): This type of cancer has an appearance least like normal prostate cells. It is the most deadly since it is very aggressive and grows very fast--even into surrounding areas--such as lymph nodes and bones. These cancer cells also tend to be large, hard to treat, and reappear more frequently. They have a Gleason score between 8 and 10.

(3.) Flutamide is an oral antiandrogen drug primarily used to treat prostate cancer. It competes with testosterone and its powerful metabolite, dihydrotestosterone (DHT), for binding to androgen receptors in the prostate gland. By doing so, it prevents them from stimulating the prostate cancer cells to grow.

(4.) A bone scan is a diagnostic procedure used to evaluate abnormalities involving bones and joints. A radioactive substance is injected intravenously, and the image of its distribution in the skeletal system is analyzed to detect certain diseases or conditions. Bone scans are most frequently ordered to check whether a cancer that originated elsewhere has spread to the bones. Cancers which begin in the breasts, kidneys, lungs, prostate, thyroid, or urinary bladder are most likely to spread, or metastasize, to the bones. If metastases are found, periodic bone scans may be ordered to see if therapy is effective against a cancer.

(5.) Patients treated with androgen ablation therapy may develop low VVBCs, Hb, and BPC.

Keywords: Prostate cancer, integrated Chinese-Western medicine, prostate specific antigen (PSA), emission computed tomography (ECT) bone scan, Quality of Life Questionnaire (QLQ-C30)

by Bob Flaws, L.Ac, FNAAOM (USA), FRCHM (UK) www.bIuepoppy.com
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Title Annotation:Chinese Medicine
Author:Flaws, Bob
Publication:Townsend Letter
Article Type:Clinical report
Geographic Code:1USA
Date:Aug 1, 2008
Words:2072
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