Jay Small is Clinical Professor of Medicine and
Urology and Chair of the GenitoUrinary Committee,
Cancer and Leukemia Group B (CALGB) at the University
of California, San Francisco (UCSF).
graduating from Stanford University with a B.S.
in Biology, Small obtained his medical degree
from Case Western Reserve University of Medicine
in 1985. He completed his internship and residency
at Beth Israel Hospital in Boston, MA before obtaining
a fellowship in Hematology/Oncology at UCSF.
research investigates the treatment of prostate
cancer. In 2000, he and his colleagues published
"A prospective trial of the herbal supplement
PC-SPES in patients with progressive prostate
cancer," in the Journal of Clinical Oncology.
member of numerous professional committees, Small
sits on the editorial boards of six professional
journals, including the American Journal of
Medicine, and The Oncologist. Small
also acts as reviewer and referee for other professional
peer-reviewed journals, including the New England
Journal of Medicine and The Prostate.
He has published more than two hundred peer-reviewed
articles, abstracts and reviews.
For links to Eric Small's home page and other related
infomation please see our resources
and Elizabeth ask:
Small, My father who is 76, and otherwise in very
good health (non-drinker & non-smoker) had his
prostate gland removed two years ago. We just
found out that his PSA level is at .3 as of mid
May, and further that it was at .2 back in Sept
of '01. His urologist is concerned and is suggesting
he undergo radiation, but the general practitioner
is not convinced that this is the way to go and
has ordered a bone scan and cat scan. She suggests
he hold off on radiation for now. We are worried
and do not know who's advice to take...if this
is not an appropriate question to ask in this
forum would it be possible to take our dad up
to you for a second opinion. We really would like
the opinion of an expert in this specific field.
We don't mind taking him to San Francisco for
a consult, we live in San Diego and have found
it difficult to find an expert in the field. Please
The issue of timing of radiation therapy after
radical prostatectomy continues to be debated.
The first step is to get a sense of the rate of
climb of PSA. If slow, as seems to be the case
here, there is a higher chance that this is locally
confined, and that radiation may be of benefit.
A faster climb implies system-wide disease that
is sometimes treated with hormone or investigational
therapy. What is clear is that a bone scan and
cat scan are seldom useful in this setting, as
they are not sensitive enough to detect microscopic
disease the way PSA does. The experts in the field
are often (not exclusively) found at academic
medical centers. Near you, consider Scripps, UCSD,
UCLA or USC.
PSA ran between 4.5 in 1994 to 3.6 in 1997 then
to a high of 5.1 in 2000. At that time I started
taking Saw Palmetto. In Sept. 2001 it dropped
down to about 3.9. I am still taking it. In Sept.
'01 I also started using a prescription testosterone
patch of 5mg called androderm as blood test showed
my testosterone level was low. I am not scheduled
for a PSA test until Sept. 02. Is it likely these
two drugs are fighting each other? I'm concerned
my PSA and resultant side effect of increased
risk of prostate cancer. Would appreciate you
thoughts. Thank you.
If you have a diagnosis of prostate cancer,
then taking supplemental testosterone is potentially
dangerous until the prostate cancer is taken care
of. Yes, saw palmetto and testosterone are fighting
each other. The saw palmetto inhibits the conversion
of testosterone to its active metabolite, di-hydro
testosterone (DHT). What we don't know is if it
just suppresses PSA without killing prostate cancer.
If you don't carry a diagnosis of prostate cancer,
there is no evidence to suggest that saw palmetto
will reduce your likelihood of getting it. My
recommendations are to stop the saw palmetto,
and see what happens to your PSA. If elevated,
you should see a urologist about ultrasound and
Small-- My 84-yr-old father was diagnosed 5 years
ago with stage IV PC. Hormones stopped working
after 4 years, and he just finished 20 sessions
of radiation to his back where the tumor was dangerously
close to his spine. His oncologist is suggesting
Chemotherapy at the next sign of advancement.
He is otherwise in good health, but we would like
to put off chemo for as long as possible. We recently
heard of 2 herbal remedies in the fight against
prostate cancer--AHCC and GCP. What are your thoughts?
After conventional hormones we frequently
will move to second line hormones like Ketoconazole
or DES (which was found in PC-SPES). Thereafter,
we consider chemo. The thing to be aware of with
good chemo agents is that they have very good
efficacy against prostate cancer, often are well-tolerated,
and in general are best used when there is less
cancer on board- i.e. NOT as a last ditch effort.
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