Western Medicine

Prostate cancer is one of the most common cancers affecting men, especially elderly men in their sixties, seventies and eighties. It has been suggested that if every man lives long enough, he will eventually develop prostate cancer. In western countries, it is the cancer most frequently found in men after skin cancer. The disease is less common among Asian men, though rates in Asian populations are rising; something thought to be due to the increased levels of red meat and animal fat in Asian diets.

The prostate is a walnut shaped gland that wraps itself around the urinary outlet tube, the urethra, just under the bladder and in front of the rectum in human males. Females do not have this organ or any equivalent organ. The prostate produces a protein-rich fluid that nourishes and supports the sperm produced by the testicles. The sperm and prostatic fluid together form the semen ejaculated by males during orgasm.

As men age, the prostate enlarges, a condition known as benign prostatic hypertrophy, and symptoms caused by pressure on the bladder and the urethra develop. These include more frequent urination, a difficulty starting urination, pain on urinating and difficulty passing urine. In some cases, when the prostate enlarges the cells undergo a cancerous change. In many men, this happens so slowly they never know they have cancer. Some cases have been diagnosed as an "incidental finding" during the post-mortems done on men who have died from other causes. But in others, the cancerous change can be rapid and the prostate cancer can spread beyond the prostate into other organs, usually the bones of the pelvis and spine, before the man has symptoms. There is new evidence that a particular tumour gene, known as P53 indicates whether the man has a tumour likely to spread rapidly or grow slowly. If P53 is present in the tumour, it is usually a much more aggressive and dangerous cancer.

Chinese Medicine

The incidence of prostate cancer is low in China, but has risen significantly in recent years. This is thought to be due to lifestyle changes such as eating increased levels of red meat and animal fat. The current western thinking about prostate cancer did not exist in ancient China. Instead, prostate cancer would have been described according to its symptoms of "strangury", "retention of urine" (inability to urinate) and "haematuria" (blood in urine). In Traditional Chinese Medicine (TCM) like western medicine, "strangury" means dribbling urination and frequent urination with prickling pain or pain radiating to the lower abdomen. This symptom can also be present in other health conditions such as certain types of venereal disease, benign prostatic hypertrophy, and some bladder diseases. "Retention of urine" occurs when the prostate enlarges, as is often the case with prostate cancer, and blocks the bladder's outflow.

The TCM perspective of how fluid is processed and urine is made is important in the development of prostate cancer:
Because there is no historical understanding of the prostate organ in Traditional Chinese Medicine, the organs that control urine production and excretion play a crucial part in the treatment of prostate cancer. The lung, spleen and kidney all have roles in fluid metabolism and in regulating its distribution. The upper, middle and lower burners act together as the distribution pathway for body fluids. All body fluids will gather finally in the kidney, where they will be separated into fluid that can be reused by the body or "turbid' water that cannot. The "turbid" water is then sent to the bladder for excretion as urine. TCM describes this fluid regulation and the excretion function as "vaporization". The bladder, as in western medicine, is responsible for storing and excreting urine. Disharmony of the bladder can lead to urinary problems such as incontinence or difficultly urinating. Kidney function complements bladder function so a problem with the bladder often indicates kidney problems as well. The kidney organ, in TCM, is additionally responsible for sexual function.

Understanding how urine is formed from a TCM perspective

Western Medicine

The cause of prostate cancer is not yet proven, though it is known that it never develops in men whose testicles do not function. A family history of prostate cancer puts men at higher risk suggesting it has a genetic element. Living in urban areas, a high animal fat diet and heavy alcohol use have also been linked to prostate cancer along with occupational exposure to cadmium and rubber.

Types of prostate cancer:

Around 95 percent of prostate cancers are made up of gland cells, a type known as adenocarcinoma. The other five percent can be made up of connective tissue cells, epidermal (skin) cells or cells impossible to identify.

While most prostate cancers are made up of gland cells, some are more like normal gland cells than others. When assessing the type of prostate cancer, pathologists consider how many features of a normal gland cell the cancer cells have. If they are very similar to a normal gland cell, they are described as "well-differentiated" but if they bear only a superficial resemblance to a gland cell they are described as poorly differentiated. Poorly differentiated cell tumours tend to spread more rapidly and behave more aggressively. The genetic profile of the tumour also indicates how aggressive it is. As mentioned in the definition section, the presence of the P53 gene suggests that, no matter what cell type it contains, the tumour is likely to spread more rapidly.

Chinese Medicine

TCM believes health is achieved when yin and yang are in harmony. The body's physical form belongs to yin while the body's activities or functions belong to yang. Because both the body's physical form and functions are dynamically balanced, they mutually restrict and depend on one another. Hence, in TCM disease results from either a deficiency of vital energy (qi) (diagnosed as a deficiency of yin fluid or a deficiency of yang qi) or an excess of the "pernicious evils" (excess of yin evils or yang evils). Pernicious evils are factors outside the body that cause disease. The conflict between resuming vital energy and getting rid of the "pernicious evils" is what allows the disease to either progress or transform back to a healthy state.

According to TCM theory, prostate cancer is caused by heat, stasis or deficiency problems. Heat is considered a pernicious evil. (See above for definition.) Stasis or deficiency problems, which are described below in more detail, stem from a deficiency of vital energy (qi).
Heat:

The concept of heat includes two types: "damp-heat evil" and "hyperactivity of excessive ministerial fire." Damp heat evil occurs when there is an over consumption of greasy foods and alcohol. This leads to a malfunction of the stomach and spleen and causes a build up of damp heat that flows downwards, attacks the bladder and impairs the vaporization function responsible for fluid regulation. (See definition section.) Symptoms like dribbling urine, frequent urination with or without prickling pain and periodic retention of urine can develop when this happens.

Ministerial fire is the source of heat power in the human body. In TCM, it is believed that when a man is overly sexually active, the kidney essence is consumed and the internal ministerial fire becomes excited. The excessive ministerial fire is a kind of "evil fire" which makes the body produce heat. This "evil fire" affects the lungs, bladder and triple burner and impairs the passage of body fluids. As a result, symptoms of urinary frequency and dribbling urine with prickling pain may occur.

Stasis:

Stasis occurs when a particular substance cannot flow smoothly. In TCM, stasis happens when there is stagnation of qi or blood flow. The kidneys play an important part in the vaporization of body fluids. In this process, fluids are separated by the kidneys to ones that can be reused by the body or into "turbid water" which is eventually excreted as urine. When the emotion rage impairs liver function, the surrounding vital energy or qi stagnates and cannot flow properly, eventually transforming into an "evil-fire." As the "evil fire" accumulates in the lower burner, the vaporization process is affected and so is normal urination.

Qi is the commander and controller of the body's blood. Once qi flow stagnates, blood circulation will not be smooth, and this can lead to difficulty urinating and to bloody urine (haematuria).

Deficiency:

Deficiency problems refer mainly to kidney failure, which results from the damage done by the above mentioned causes of heat and stasis. In summary, sexual excess and improper diet both lead to an accumulation of damp heat and ministerial fire, which contribute to qi stagnation and blood stasis. These, in turn, eventually exhaust kidney -yin, which is the foundation supplying fluid to the entire body for moistening and nourishing purposes. Once kidney yin is completely exhausted, kidney failure will ensue.

Other Causes of Prostate Cancer:
Other factors associated with the development of prostate cancer are still under further investigation.
These include:

• high levels of male hormones
• excessive sexual activity
• gonorrhea
• other causes of urinary tract infections
• A chronic intake of greasy food leading to a disorder in hormone metabolism.

Western Medicine

Prostate cancer is famous for being silent: that is, causing no symptoms able to warn of its presence. Many are diagnosed during a routine physical examination or after a screening blood test known as a Prostate Specific Antigen (PSA) has been done. When symptoms do appear, they are usually similar to those caused by enlargement of the prostate (benign prostatic hypertrophy-described in the definition section).

These include:

• Increased urinary frequency, especially at night
• Difficulty starting urination
• Difficulty passing urine
• Pain on passing urine

Symptoms more suggestive of prostate cancer include:

• Blood in the urine
• Pain in the pelvis and spine
• Weight loss
• Night sweats
• Severe tiredness

Chinese Medicine

Modern TCM practitioners mostly follow western theories when assessing prostate cancer symptoms. Initially there may be no symptoms present at all. When the prostate cancer enlarges to a level where it blocks urinary outflow, dribbling urination, frequent urination with prickling pain or pain radiating to the lower abdomen (strangury) and urine retention are commonly seen. Haematuria (blood in the urine) usually appears at a later stage of disease involvement.

The presence of damp heat in the body or overstrain strangury can cause thirst with a lack of desire to drink, constipation, burning and stabbing pain during urination, or dribbling urine. Overstrain strangury means the body is overworking and makes the strangury symptoms more severe.

Stagnation of qi flow and blood stasis are usually present when urine retention occurs. (See causes section.) Symptoms related to these conditions include lower abdominal distension, localized pain, difficultly urinating or inability to urinate.

Haematuria can be a manifestation of hyperactive and excessive ministerial fire. Related symptoms arising from excessive ministerial fire include face blushing, excessive thirst, feeling annoyed or distracted, insomnia, urinary hesitancy and pain on urination.

Other signs that may be present with prostate cancer:

The tongue signs:

Individuals with damp heat usually have a red tongue with yellow and greasy fur. Those with blood stasis have a dark tongue with pinpoint bruises, and those who suffer from exhausted kidney yin have a red or deep red tongue without fur.

The pulse signs:

A rolling and rapid pulse is present in people with damp heat problems. Individuals with blood stasis often have a hesitant pulse, and those with kidney-yin exhaustion have a soft, thready and weak pulse.

Western Medicine

Because prostate cancer is usually silent, there are very few symptoms or aspects of a person's history able to give clues that they may have prostate cancer. If close relatives have suffered from prostate cancer, especially at an early age (below the age of 50) your risk of developing it is higher. However, being a male over the age of fifty increases your risk enough to make it sensible to have your medical adviser check you once a year for signs of prostate cancer. This is usually done by feeling the prostate through the wall of the rectum with a finger, looking for enlargement, hardness or irregularity. The prostate is normally a smooth organ the size and shape of a walnut. However, diagnosing prostate cancers this way means the cancer is already quite advanced by the time it can be felt. In the late eighties, a blood test that measures a protein linked to prostate gland activity called the prostate specific antigen, (PSA), was developed to give an earlier warning of possible prostate cancer. Unfortunately, this test can be positive in people with normal prostates so some medical experts say it leads to unnecessary testing and anxiety. Things like a bladder infection or even just a prostate examination can raise PSA levels. However, it has been widely adopted in western countries like the USA and Australia, and as a result, many cases of prostate cancer are being diagnosed earlier.

If a case of prostate cancer is suspected, the next step is to take a tissue sample (a biopsy) using an ultrasound probe inserted into the rectum to locate the suspect prostatic tissue. The tissue sample will be examined by a pathologist who will then report on whether or not cancerous cells are present.

Because prostate cancer usually sends secondary tumours to the bone, a bone scan will be done to locate any secondary tumours, especially in the spine and pelvis. A computerised Tomography (CT) scan or Magnetic resonance Imaging (MRI) scan may also be done to determine whether the tumour has spread beyond the prostate. This information is used to "stage" the tumour, that is give it a numbered ranking, with stage one being the earliest and easiest to treat.

Other tests that may be done include a full blood count and biochemical profile, an electrocardiogram (ECG) and a general physical examination to determine whether you are a suitable candidate for the extensive surgery needed to remove a prostate cancer.

Chinese Medicine

Diagnosis of prostate cancer mainly depends on western methodologies because the concept of a prostate organ did not exist originally in Traditional Chinese Medicine. Examination of a man's prostate organ through the rectum is usually done during routine physical check ups to detect its size and texture. Ultrasound and CT (computed tomography) scans are very helpful for diagnosis and locating areas to which the disease may have spread. Other measures include looking for cancer cells in prostatic fluid or from a fine needle biopsy of the prostate. Recently prostate specific antigen (PSA) blood tests have been used to screen for early prostate cancer in older men, usually those over fifty.

Prostate cancer can only be differentiated from benign prostatic hypertrophy by using modern medical investigations. Benign prostatic hypertrophy occurs when the prostate gland enlarges and puts pressure on the bladder and urethra (the urinary outflow tract from the bladder). In TCM and western medicine, there are no big differences between prostate cancer and benign prostatic hypertrophy symptoms. Likewise, the TCM tongue and pulse signs are similar for both conditions. However, benign prostatic hypertrophy, while able to cause significant discomfort and put dangerous backpressure on the kidney, is not a form of cancer and does not metastasize (spread to other parts of the body).

In TCM, the diagnosis is not prostate cancer per se but rather a classification of its symptoms into five different syndromes, which are outlined below. The general progression of prostate cancer from a TCM perspective goes from damp-heat flowing downward in the body to stagnation of qi and blood stasis to hyperactivity of heart-fire and hyperactivity of excessive ministerial fire, finally leading to kidney failure.

Diagnosis is based on four important examination techniques. The first is "questioning." The TCM practitioner will want to know important information such as what your current complaints are, your past medical history and family health history. The second technique is "observation." Looking at the physical features of the body such as the face, tongue, hair, nails, sputum and area of pain all give clues as to what the problem may be. The third technique is "hearing and smelling." Smelling the sputum and breath and listening to the sounds coming from the chest are important. The last technique used in examination is "touching." Feeling the pulse is a cornerstone of TCM diagnosis and gives the TCM practitioner a lot of information about imbalance in the body. If the TCM practitioner suspects there might be a serious problem that Chinese medicine alone cannot treat he or she may recommend that the individual see a western doctor for further follow up.

Features of the TCM syndromes associated with prostate cancer are:

Damp-heat
Damp-heat is heavy and likes to flow downward and accumulate in the lower burner (bladder, large intestine) region, which results in frequent, difficult and/ or urgent urination. The tongue appears red with a yellow and greasy covering, and the pulse is rolling and rapid with this syndrome.

Kidney-Yin Exhaustion
Under normal conditions, kidney-yin & kidney-yang restrict, promote, and depend on each other in order to maintain a dynamic balance of yin & yang. This means the kidneys are kept in a constant state of functioning where they are not over or under functioning. When kidney-yin becomes exhausted and cannot perform its usual functions, kidney yang cannot be kept in check and the body experiences virtual heat symptoms. These symptoms manifest as urinary frequency and urgency, dry throat, restlessness, dry and hard stools, hot feelings in the palms, lower back, knee soreness and weakness of the lower extremities. The tongue appears red without a mossy covering, and the pulse feels thready and soft.

Decline of Kidney-Yang
This type is seldom encountered but is very serious. Kidney-yang is the main source of energy for life's activities. Therefore, if kidney-yang declines, the body will be unable to perform warming and promoting functions, causing a yang-deficiency in many other organs, which may lead to death. Individuals usually feel weak and fatigued. They have pale complexions, cold limbs, sore loins (waist area) and experience an aversion to cold temperatures. Urinary symptoms associated with this condition include urinary frequency, dribbling urination and a weak urine stream. The tongue appears pale with a thin fur layer, and the pulse feels deep and weak.

Stagnation of Qi
When qi movement is sluggish, it causes improper fluid circulation. Symptoms related to improper fluid circulation include difficulty urinating, inability to urinate, emotional depression, irritability, quick temper and chest and abdominal distension. The pulse is stringy, and the tongue is red with a yellowish, thin fur. Those who also have blood stasis (poor blood flow) will have a dark tongue with pinpoint bruises and a hesitant pulse.

Hyperactivity of Heart-fire
A kidney-yin deficiency can also affect the heart by disrupting its normal functions and creating a "heart fire evil" or heart-yang excess. When this happens, the blood vessels become damaged and the blood leaks out. Urinary symptoms related to this condition include haematuria (blood in the urine), prickling pain on urination and dark-colored urine. Other symptoms include insomnia, feeling annoyed and the presence of boils on the mouth and tongue. On examination, the tongue usually has a red tip, sometimes with a prickly appearance and a thin or yellowish fur coating. The pulse feels thready and rapid.

If one suffers from hyperactivity of excessive ministerial fire, symptoms such as hyper-sexuality, a red tongue with a thin or yellowish fur and a rolling and rapid pulse will be present. (See causes section under heat for further explanation.)
Click here to see diagram

Western Medicine

Surgery

If the cancer has been diagnosed early, is still within the prostate gland itself and is of a type considered unlikely to spread rapidly, surgical removal of the entire prostate, an operation known as a radical prostatectomy, may be considered. However, this operation has a high rate of complications, leaving up to up to sixty percent of men impotent and more than ten percent with incontinence (where they cannot control urine flow). This is because the nerves controlling these functions are very close to where the prostate sits under the bladder. The sphincter, a muscle that holds the bladder closed, is located just above the prostate and is also vulnerable to damage during surgery. In expert hands, that is, when done by a surgeon who does many of these procedures at a hospital where the operating theatre and nursing staff are very experienced in prostate surgery, the complication rates are much lower. Some surgeons in top American hospitals report incontinence in only two percent of their patients and impotence in ten percent. For this reason, choosing your surgeon very carefully once you have been diagnosed with operable prostate cancer is essential. It is worth getting several opinions and asking each surgeon for their post-surgery complication rates. If they will not give you this information, ask your usual medical adviser to help you find out who has the lowest complication rates.

Radiotherapy
Those men whose tumours are too advanced for surgery, who are considered unsuitable for surgery, or who would like to avoid the complications of surgery, may be given radiotherapy, where a radiation beam is directed at the prostate to burn away the cancer. This treatment may also be used to burn away secondary prostate cancers in the pelvic bones and spine to stop the pain caused by such tumours. In the right men, who are carefully selected according to the size and stage of their tumour, brachytherapy, a treatment where tiny radioactive implants are inserted into the prostate cancer, has been very successful.

Chemotherapy

Advanced tumours or those thought likely to spread even after surgery may be treated with a combination of drugs able to kill cancer cells, known as chemotherapy. Doses and courses vary according to the oncologist's assessment of which chemical is likely to be most effective but courses are usually given over several months.

Hormone therapy

Because prostate cells are very sensitive to the male hormone testosterone, hormone therapy is given, usually as a long-acting injection, to block the effect of testosterone and delay the spread of advanced prostate cancer. Sometimes both testicles are surgically removed to achieve the same effect without using drugs. Unfortunately, this has marked side effects such as breast development, impotence, loss of sexual desire, and a change from a low to a higher voice, but it can effectively slow down the progression of the disease.

Chinese Medicine

There are many ways to treat prostate cancer after a definitive diagnosis has been made. Western treatment methods: hormone therapy, surgery, chemotherapy and radiotherapy are important for curing or arresting disease progression. (See western medicine section.) However, due to the different side effects each option causes (i.e. inability to control urination, impotence and loss of sexual desire), these clinical methods still have limitations.

TCM focuses on holistic healing and creating a harmonious balance in the body. The yin and yang philosophy is central to achieving balance and is used to identify good and evil health influences, distinguish between body excesses & deficiencies and to regulate the functions of the organs, qi, and blood. TCM can complement western medicine by helping to increase therapy efficacy, improve quality of life and in some cases prolong the lifespan.

Surgery is an area in which TCM treatments can be especially useful. The mere act of surgery causes damage to a person's body by exhausting its healthy energy and increasing blood loss causing an imbalance of yin and yang. TCM herbal preparations and other treatments such as acupuncture or qi gong used before and after the operation can reduce the damage from intra and post-operative complications, improve operation tolerance and promote health restoration. Before surgery, TCM preparations that invigorate qi, enrich the blood, strengthen the spleen and nourish the kidney and liver are generally chosen. Afterwards, preparations that tonify qi, nourish yin, promote blood circulation, resolve blood stasis, regulate the function of the spleen and stomach and improve the function the kidney and liver are used to restore the body's health. Herbal prescriptions are adjusted when complicating factors such as a build up of phlegm, dampness, stasis, toxins and heat evils are impeding recovery. Aside from surgery, TCM herbal preparations have been shown in research studies to improve the efficacy of chemotherapy and radiotherapy and reduce their side effects. When deciding what herbal treatments to take, it is always best to consult a qualified TCM physician who can plan follow up visits with you to monitor how successful a particular treatment has been and to ensure the right care is being given.

Below are some examples of selected herbal prescriptions that are used by TCM doctors to treat the different syndromes associated with prostate cancer.

Pathogenic Damp-heat accumulation in lower burner
Therapeutic aim: Clear away damp-heat in the lower burner
Prescription: Sanmiao pellet

cang shu	atractylodes root
huang bai	amur cork-tree
niu xi	twotooth-achyranthes root

Addition for individuals with dribbling after urination:

shi wei	shearer's pyrrosia leaf
bi xie	dioscorea hypoglauca root
tu fu ling	glabrous greenbrier root

Addition for individuals with haematuria: (Blood in urine)

da ji	Japanese thistle herb
xiao ji	field thistle herb
niu xi	twotooth (charred)

Therapy for Kidney-Yin Exhaustion Therapeutic aim: Nourish kidney-yin. Prescription: Zhibai Bawei pellet

zhi mu	common anemarrhena root
huang bai	amur cork-tree
sheng di	rehmannia root
shan yu ru	Asiatic cornelian cherry fruit
fu ling	Indian bread
ze xie	oriental water plantain root
shan yao	common yam root

Addition for individuals with severe cases:

gui ban

tortoise shell

Therapy for Decline of Kidney-Yang Therapeutic aim: Warm and nourish kidney-yang.
Prescription: Jisheng Shenqi pellet

shu di	rehmannia root (processed)
shan yu ru	Asiatic cornelian cherry fruit
shan yao	common yam root
niu xi	twotooth-achyranthes root
che qian zi	plantain seed
fu zi	prepared common monkshood daughter root
rou gui	cassia bark

Addition for individuals with severe cases:

lu jiao shuang	(degelatined)deerhorn
or	or
lu rong	pilose antler
ren shan	ginseng

Syndrome differentiation must be accurate when using these medicinal substances for warming and nourishing kidney-yang. They should not be used for those with hyperactivity of excessive ministerial fire.

Therapy for Hyperactivity of Heart-fire Therapeutic aim: Eliminate heart-fire. Prescription: Daochi powder

sheng di	rehmannia root
zhu ye	bamboo leaf
sheng gan cao	unprocessed liquorice root
mu tong	vine of clematis armandi

Addition for individuals with urgency or dribbling after urination:

niu xi tan	charred twotooth-achyranthes root
ren dong hua	honeysuckle flower
tu fu ling	glabrous greenbrier root

Therapy for Stagnation of Qi
Therapeutic aim: Regulate the functional activities of vital qi.
Prescription: Chenxiang powder

chen xiang	Chinese eaglewood wood
shi wei	pyrrosia leaf
chen pi	dried tangerine peel
Huang bu liu xing	cowherb seed
dong kui zi	cluster mallow seed

Addition for individuals with blood stasis:

tao ren	peach seed
hong hua	safflower

Western Medicine

There is increasing evidence that a diet rich in phytoestrogens (such as soybean products, the cruciferous vegetables like broccoli, cabbage, sprouts and cauliflowers; wholegrain foods and red clover) protects against prostate cancer. It has recently been suggested that high soy food consumption might explain the relatively low rates of prostate cancer in Asian countries like China and Japan. Unfortunately, many Asian men are turning their backs on the food their grandmothers raised them to eat and are now eating more high animal fat and highly refined foods considered likely to raise their risk of prostate cancer.

The mineral selenium and vitamin E are also considered protective against prostate cancer as are lycopenes found in tomatoes and watermelon. The traditional Asian diet consisting mostly of rice, green vegetables, soybean products and fish is considered a powerful weapon in the prevention of prostate cancer.

Chinese Medicine

Do physical exercise to strengthen the body's resistance to illness and maintain health.

Try to maintain emotional stability in your life and avoid depression and anger because these can cause liver dysfunction and affect qi movement. Smooth qi movement is especially important since it controls the flow of blood in our body.

Avoid holding the urge to urinate. Do not eat too much fatty food and do not indulge in an over abundance of sexual activity nor do excessive physical work. These latter two weaken the body and allow "pernicious evils" such as damp heat to attack and cause disease.

Food Pyramid

Have strangury (dribbling urination and frequent urination with prickling pain or pain radiating to the lower abdomen) and urine retention symptoms evaluated by a qualified health professional immediately. This is necessary to detect prostate cancer or other urinary conditions detrimental to your health.

Western Medicine

Chinese Medicine