Sizing Up Surgery for Prostate Cancer? Q. What alternative treatments to surgery, radiation, or cryosurgery can you recommend for cancer of the prostate? My PSA count is 21 and I have a Gleason index of 4+3. I am taking Casodex daily and receive a shot of Lupron once a month. My doctor at the Mayo Clinic is telling me to have surgery ASAP. I am also taking Essiac, drinking lots of fresh juices, vitamins, etc. I am not thrilled about having surgery because of what I've read about its complications. Any suggestions? Prostate cancer is the second greatest cause of cancer deaths among men, after lung cancer. About 30,000 men in the United States alone die from it every year. At the same time, in most cases this cancer grows slowly. Many, many men have survived for decades with low-grade prostate cancer. In fact, it's estimated that four out of ten men over 50 have at least some cancerous cells in their prostate, but most don't develop any symptoms, and only 3 percent of men will die from it. Fortunately, we're learning more and more about prostate cancer. Just last month, geneticists located a gene segment that may cause susceptibility, starting the chain of events that leads to about 3 percent of prostate cancer cases. Researchers are also exploring genetic influences on the aggressiveness of the cancer. For one thing, it appears that a certain sequence that repeats over and over in a particular gene can be somewhat protective. African American men, who have the highest incidence of the most aggressive prostate cancer, tend to have the smallest number of these repeats. White men have the next highest number of repeats, and Asian men generally have the most - and also the lowest risk of prostate cancer. The prostate-specific-antigen (PSA) test you mention measures the presence of a substance that breaks down semen after ejaculation. When it's present in high levels in the blood at any time other than soon after ejaculation, it could mean a problem with the prostate. PSA levels vary a great deal, but generally, prostate cancer has been found in about 22 percent of men with PSA levels above 4 ng/ml, and 60 percent of those with levels above 10. Less than four is considered normal. The range between four and ten is known as a diagnostic gray zone, and there the level of "free" PSA to total PSA can be helpful. A fraction lower than 23 percent of free PSA is more likely to indicate cancer. There is a good deal of new research that suggests that prostate cancer can be influenced by diet. For example, in Japan there's a much lower incidence of prostate cancer than in the United States. And when it does occur, it tends to be much less aggressive. A recent study at Harvard Medical School showed men who eat at least 10 servings a week of tomato-based foods had a 21 percent to 35 percent lower risk of developing prostate cancer. Tomatoes are rich in an antioxidant called lycopene, which is credited for the reduced risk. It may be that a high animal-protein diet - which is typically also low in fruits and vegetables - or a high-fat diet promote prostate cancer. Researchers put mice on low-fat diets and found prostate tumors in the rodents didn't grow very fast. Soy - from soybeans, tofu, soy milk - has also been shown to be beneficial. When soy is fed to mice with prostate cancer, tumor growth slows or stops. You may want to aim for getting less than 15 percent of your calories from fat. In addition, I would eat soy products on a regular basis. I can't give you specific advice about the surgery - I would need to know a lot more about your particular case. The most important thing to do is research your options carefully and make a decision, one way or another. If your cancer looks aggressive, the Gleason score (based on observation of cells obtained by biopsy) is one way of assessing this, and if it is confined to the gland, the surgery can be curative. On the other hand, radical surgery for a nonaggressive cancer could be a mistake. But you are doing many good things to create a positive environment for healing, whichever way you go. There are also mushrooms and other nutritional supplements you can take to boost your immune system. Polyporus umbellatus, source of a Chinese remedy called zhu ling, is a good cancer fighter. Or you may want to try a close relative, maitake, also known as hen-of-the-woods. I also would recommend taking antioxidant supplements, and using mind-body techniques like visualization and hypnotherapy.