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A Different Way to Heal
Body on a Bench

Photo of Small Eric Small
E-mail Your Questions Before June 18th

Eric 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).

After 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.

Small's 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.

A 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.


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Small responds :

Steve and Elizabeth ask:
Dr. 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 help.

Small's response:
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.

Bill Jolly asks:
My 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.

Small's response:
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 biopsy.

Linda Cooper asks:
Dr. 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? Thank you.

Small's response:
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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