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Prostate Cancer Study Heartening

Analysis: Dr. Dean Ornish applies techniques used to reverse heart disease. But critics are unimpressed.


Five years ago Tom McMahon was diagnosed with prostate cancer. "I got the news and basically withdrew from life," said McMahon, 73, a retired psychotherapist who lives in San Jose. Nonetheless, McMahon actively researched possible treatments for his cancer. He talked with numerous men who had tried surgery (to remove the prostate gland) or radiation therapy.

"It seemed every one of them experienced something screwy," McMahon said. He decided to choose what doctors call "watchful waiting," monitoring the tumor size through regular physical exams and testing for prostatic-specific antigen, or PSA, in blood tests. The concept is that prostate cancer spreads slowly in many men, while treatments sometimes can result in impotence, incontinence or both.

About a year after diagnosis, McMahon heard about a new study by Dr. Dean Ornish, the Sausalito-based physician who has so successfully demonstrated how lifestyle changes (diet, physical activity, relaxation techniques, support groups) can prevent and reverse heart disease. Ornish and his colleagues at UC San Francisco were recruiting men who chose watchful waiting to see if his program's benefits applied to prostate cancer.

"We didn't have an ethical issue with not treating our experimental group because these men had chosen non-intervention," Ornish said. For his part, McMahon saw his own perfect fit: "I went to the program to get something. I didn't know what."

Entering the Ornish program, McMahon's PSA reading was nearly 10; 4 or less is normal. PSA doesn't itself indicate cancer but heightened activity in the prostate. McMahon's doctor found a palpable tumor by a digital rectal exam and confirmed it with ultrasound images.

McMahon fervently followed the program, which most famously requires a diet high in vegetables, fruits and grains and low in any sorts of fat (less than 10% of daily calories). He takes a walk every morning either around a lake or in a park, losing himself in the "awesomeness of creation." He cooks low-fat meals for his wife, who works at a local health club. Each Thursday, he takes a train to San Francisco, then "long-hikes" the city to catch a ferry to Ornish's Preventive Medicine Research Center in Sausalito for workouts, support therapy and cooking/eating classes. Last May, McMahon returned home from an extended trip to Europe with one of his two sons. He went to see his doctor for a routine ultrasound. The news was good, very good.

"The doctor said, 'I cannot find any evidence that you have a tumor,'" recalled McMahon, whose PSA has fallen to 7. "I got reexamined in February this year. The doctor said the same thing. He couldn't find any trace."

Earlier this month, Ornish presented the one-year data from the study of 84 men at the International Scientific Conference on Complementary, Alternative and Integrative Medicine Research at Harvard University. The findings show a potential new option for men worried about prostate health--provided they can follow Ornish's guidelines for diet (soy products replace dairy, no alcohol), exercise (three hours of aerobic workouts each week), meditation and relaxation techniques (a daily hour) and weekly support group meetings. Patients such as McMahon, who closely adhered to the program (defined as following the program 88% of the time), decreased PSA readings by 9% in the year. Those men in the experimental group who had great trouble adhering (less than 58% of the time) observed increases averaging 6%. Men who were evaluated as "medium adherers" experienced no change in PSA.

Individuals in the control group, including seven men who received conventional treatment because their conditions worsened, scored significantly higher PSAs than did members in the experimental group. "The results are very much like the cardiac studies when I first started doing them 25 years ago," Ornish said. "There is a strong correlation between adherence and positive results."

Some urologists have criticized the study. They say 9% decreases are not impressive, that a 50% decline would catch their attention. "You don't need to go down with PSA," Ornish said. "You just need it not to go up."

Ornish heard similar criticism before when he first introduced his ideas about reversing heart disease.

The criticism won't stop him from completing four years of following each study participant. He emphasized that reversing heart disease and now, perhaps, prostate cancer "takes bigger changes than most people are recommending or doing."

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