Can taking dietary supplements help ward off prostate cancer? The National Cancer Institute has launched the largest-ever study of its kind to find out.

And it needs 32,400 men to step up and take part in the trial, the NCI announced today.

Called SELECT, which stands for the Selenium and Vitamin E Cancer Prevention Trial, the study will look at the role these two dietary supplements may play in preventing prostate cancer, which strikes nearly 200,000 American men each year. This year alone more than 31,000 men are expected to die from the disease.

Choosing a combination of selenium and vitamin E was arrived at incidentally, says Dr. Daniel Morganstern, an oncologist at Lahey Clinic in Burlington, Mass., one of the more than 400 sites nationally taking part in the study.

In a previous study of selenium and skin cancer, researchers found that although selenium didn’t help with non-melanoma cancer, it did decrease the prostate cancer in male participants by 60 percent, Morganstern says.

Another study in Finland on men who smoked and who took beta-carotene and vitamin E yielded similar incidental results. Although not helpful with the lung cancer that was the focus of the study, prostate cancer was reduced by 32 percent.

Selenium and vitamin E are antioxidants that help clear the body of toxins known as free radicals, which can cause damage to the genetic material of cells.

The 12-year double-blind study will separate the volunteers into four groups: one will take vitamin E and a placebo; another selenium with a placebo; the third will take a combination of vitamin E and selenium; and the fourth will be given placebos only.

Morganstern says the researchers hope to follow each person for a minimum of five years. Those entering the trial this year will be tracked for the full 12 years.

Men over the age of 55 or black men over the age of 50 are eligible for the study. (Black men have the highest rate of prostate cancer and the disease strikes them earlier.) Each participant will be asked to visit his local study site once every six months. Blood tests and digital rectal exams are encouraged but are not required.

John Williams, director of communications for the Cancer Therapy and Research Center in San Antonio, Texas, says he’s already signed on. “If nothing more, you’re going to get closely monitored with PSA [a prostate cancer detection blood test] and other kinds of care.”

“I believe if there’s some way to contribute that’s totally harmless, it’s worth the effort,” Williams says. Even if you’re among the 25 percent who take nothing but a placebo, you’ve got nothing to lose, he says.

Adds Morganstern: “Now is the time for people who share an enthusiasm for nutritional interventions and are concerned about their risks to come to bat. We can always think about whether these things work.” But, he adds, we’ll never know for sure unless we call on the spirit of volunteers.

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A few others agree. Says one, “I do not think health clubs should charge extra for specialty group exercise classes…. A membership package that is all-inclusive, except for special services like massage therapy and personal training, is usually easier to sell.”

Says another, “If [a] health club wants to allow people the opportunity to … enjoy all that the club has to offer…, these classes should be a part of membership. If people are hesitant to try something new, why would they pay for it? Free trial classes are fine, but do not always fit into someone’s schedule….”

Some respondents feel that it is the responsibility of the club to budget for the extra cost of these classes, instead of passing the fees along to members: “Clubs should not charge for specialty group exercise classes. Their monthly/annual rates should be set at a level that covers enough of their costs to [include] those classes….”

Another agrees: “All classes should be included. It is a real turnoff to [be] charged more so that a facility can recoup money for the ‘extra’ equipment for these classes. Why not budget the money to run the classes, rather than charge the participants?”

One respondent feels that instructor selection and training plays a role in this debate: “… Health clubs charge for specialty group exercise classes to pay for better quality instructors…. Let’s focus on improved procedures in staff selection, training and programming. Give members what they want — great classes all the time. They already paid for it.”

“Sooner or later these have to be removed and they can be very tiny — a millimeter or less,” said Zimmer, who adds that the scan can help surgeons better pinpoint a target.

The Hawkeye also can help doctors decide on treatments. For example, in the case of colon cancer metastasizing to the liver, the Hawkeye can identify whether it is a single or multiple metastases. If it’s only one site, surgery becomes a good option.

“Before, you couldn’t tell for sure,” Zimmer said.

The test likely will decrease patient stress because it’s quick, noninvasive and reduces the need for future tests, he adds.

“We’re making something that’s good even better,” Zimmer said. “Ultimately, we’re going to be saving more lives.”

Approximately 50 Hawkeye systems will be installed and operational worldwide in 2001, says Beth Klein, general manager of global nuclear medicine and PET at GE Medical.

And existing imaging systems, while not combining the two techniques, offer hope for thousands with brain tumors, says Keith Black, M.D., director of Cedars-Sinai Maxine Dunitz Neurosurgical Institute in Los Angeles. Black adds that PET scans will be very useful in the coming years to find tumors in the brain.

Other New Developments
Zimmer says he also has high hopes that the Human Genome Project will mean significant strides in cancer detection.

“Instead of assuming you’re at a higher risk for stomach cancer because you’re father died of it, you’ll be able to know for sure if you have the genetic predisposition,” he said. And it will require only a blood test, not annual invasive — and expensive — screenings, he adds.

“I think in the next two years, we’ll have that,” Zimmer said.

Virtual colonoscopy is another technique that will have those with risk factors breathing a little easier, says Robert Smith, director of cancer screening for the American Cancer Society in Atlanta.

The CT scan procedure, which doesn’t require an uncomfortable, internal scope, takes about the time of one breath hold and only requires introduction of some air into the colon, Smith says. It’s less expensive and less invasive, and the test, which is still in experimental studies, will give doctors a view of any interior or exterior cancers of the colon.

Women who have undergone an annual pelvic exam recently may be aware of the thin prep Pap smear.

In the past, Pap smears produced a thick layer of cells for technicians to study under a microscope, looking for darker cancer cell nuclei, Smith says. But the layers of cells often distorted the image.

The newer test lays down a mono-layer of cells, making cancer cells easier to see, Smith says.

Early detection and patients’ willingness to undergo regular screenings are a main cause of the decline in cancer death rates in recent years, Smith says. And he is excited that newer tests seem to be less invasive, cheaper and more accurate — good news for both patient and doctor.

“A colleague commented not long ago that most of the screening tests we do are rather medieval,” Smith said, considering the mechanics of mammography and colonoscopy. “Someday, we’ll have to look back on them and have a chuckle.”

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Kunio Doi, Ph.D., a professor of radiology at the University of Chicago, which is considered a hotbed of cancer-detection development, has been applying CAD to breast cancer study for 15 years. With the CAD Prototype Intelligent Workstation he developed with colleagues, a woman’s regular mammogram can be scanned into a computer programmed to locate microcalcifications, which are cancer markers.

“Some lesions may be so subtle that a radiologist may miss those,” Doi said. “A radiologist can use the output from the computer for a second opinion.” In one study, the CAD workstation identified 52 percent of these “missed” cancers roughly a year before they actually were detected.

The university optioned the technique to R2 Technology, which developed a prototype two years ago. With U.S. Food and Drug Administration approval, about 200 units of this technology are now available in the United States, Europe and Japan, Doi says.

He believes the technology also may be applied to lung cancer. Other researchers are working to make it available in colon cancer cases, perhaps by combining CAD technology with available computerized tomography (CT) scans.

Doi also touts the benefits of digital mammography, which is available in many centers and hospitals. The newer technique allows technicians to enhance the mammography image with color or magnify it to better detect small lesions that might not be noticed on conventional mammography, he says.

Millennium Technology
High-tech imaging is helping detect more cancers earlier, says Jack Zimmer, M.D., director of cardiac imaging and medical director of nuclear medicine at Baptist Hospital in Miami. His hospital is one of six that got an early look at the GE Millennium VG Hawkeye, a new imaging technology that quickly creates pictures of the body that reveal both the nature of abnormal growth and its precise location.

Unveiled in early June 2000 at the Society of Nuclear Medicine conference in St. Louis, Mo., the machine has the potential to eliminate procedures such as multiple diagnostic tests, biopsies and needlessly complex and invasive surgeries.

The Hawkeye system combines CT, which reveals the structural details of the body, with positron emission tomography, or PET, a nuclear medicine technology that detects the differences between diseased and healthy tissue.

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Just 20 years ago, leukemia, Hodgkin’s Disease and testicular cancer were devastating, often deadly diagnoses.

The advent of sophisticated cancer therapies and the promise of high-tech treatments such as stereotactic radiosurgery are extending lives and transforming once nearly untreatable cancers from death sentences into winnable wars.

But one crucial piece of the puzzle remains the same.

“The earlier you catch cancer, the better you can treat it,” said Richard Cote, M.D., a professor of pathology and urology at the University of Southern California Norris Comprehensive Cancer Center in Los Angeles. “Screening is so important.”

And, like their counterparts developing new treatment strategies, Cote and other researchers are finding new methods and tools to catch cancer early. Many techniques revealed in recent years are giving hope to those suffering from a variety of cancers.

Breast Cancer Hide and Seek
Cote and his team, culled from USC and the International Breast Cancer Study Group, have turned their attention to breast cancer, which will account for an estimated 182,800 new cases in 2000. He is working on a sensitive test he believes discovers hidden cancer cells in women with breast cancer more effectively than existing methods. This would help doctors predict which women will develop metastatic tumors.

“The problem with cancer is that is spreads,” said Cote, whose findings were published in the September 1999 issue of The Lancet. “It is cancer metastases that kill us and that are the hardest to treat.”

His test, which is in international trials, requires mixing two antibodies, which are highly accurate in detecting proteins that are present in breast cancer cells but absent in normal cells. The antibodies are placed on lymph node tissue routinely removed during breast cancer surgery. If cancer cells are present, they will be visible to a pathologist under the microscope, even in numbers as low as 1 to 5 cancer cells per 100 cells, Cote says.

The test will help cancer patients in two ways. It may detect the potential for metastases better than existing tests, and it may predict which women will not have any metastases.

“It may help identify women with breast cancer who can be spared the side effects and expense of chemotherapy,” Cote said, noting most breast cancer patients are placed on hormone or chemotherapy regimens after surgery.

Cote says this method appears to work with lymph node tissue, bone marrow and blood. Other researchers are working on possible applications for detecting melanoma and colorectal cancers. The test is used regularly at some U.S. cancer centers and is available commercially.

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Once you have ruled out the chance it might your partner’s problem — due to age, or ovulation or anatomical problems — what do you do?

Herbs, pharmaceuticals, nutritional supplements, tobacco, drugs and alcohol can affect sperm count and the degree of erections, said Dr. Donna Sessions, an OB-GYN at the Mayo Clinic in Rochester, Minn.

“It takes about 70 days for sperm to mature, so anything that happens in the last 70 days affects sperm count,” Sessions said.

Sperm count can also temporarily drop due to a virus, high fever or the effects of anesthesia from surgery, Sessions said. Low sperm count also is found in some men who are taking calcium channel blockers for high blood pressure, she said.

Other factors that can damage sperm include industrial chemicals and common cleaners found in the home. Such toxins as boron, benzene, cadmium, carbon monoxide, carbon tetrachloride, ethylene oxide and lead can reduce sperm count, decrease sperm motility, create abnormal sperm, decrease libido and sometimes cause impotence, Sessions said.

Genetic defects also may play a role in low sperm count. “There is a lot more information now concerning mutations of the Y chromosome,” Sessions said. “Genetic testing is offered at some big university research programs. It is relatively new, but promising.”

Depending on the amount of sperm, men have various medical options to improve their fertilization chances, Sessions said.

“If sperm counts are low, artificial insemination is an option,” Sessions said. “If the sperm count is severely low, then in vitro fertilization is the only option. With in vitro, we need only one sperm for each egg. For men who don’t have any sperm, urologists can retrieve sperm and then do in vitro. Another way to obtain sperm is do electro-ejaculation.”

Some herbalists and naturopathic physicians believe vitamins and herbs can help increase fertility, but Sessions is doubtful because of the lack of studies.

“No drug or vitamin has been shown to improve male infertility. There are several infertility drugs for women, but they don’t seem to work that well on men,” Sessions said. Initial studies have shown promise for the use of antioxidants to improve sperm count and address infertility issues. “None have yet to be shown effective,” she said.

For erection problems, Dr. Lyle Lundblad, president of Midwest Institute of Urology in Minneapolis, sometimes recommends the herb yohimbe. Yohimbe can influence blood flow in the penis, but it also affects blood flow throughout the entire body. “There are side effects, like edginess or insomnia, that would negatively affect some people, so I tell them to be careful,” he said.

“Before Viagra, I used to recommend yohimbe all the time,” Lundblad said.

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By hosting class parties, recognizing birthdays and including discussion sessions as part of the class format, you can facilitate friendship and camaraderie. A person who is not motivated as an exerciser may come back because she has made a friend in step class who encourages her.

I discovered how much impact the social element can have while teaching a class for the local YMCA. The class was small, and most of the ladies were struggling with their weight and self-esteem. Though they attended class fairly regularly, I felt something extra was needed to increase the fun factor and strengthen their commitment to keep attending.

After making special arrangements with the child-care workers to keep the students’ children, we began to have lunch together every month at a local restaurant. Besides being a nice break for the moms, we got a chance to know each other outside of the aerobics room, form some new friendships and reinforce our resolve to stay committed. Our small, quiet table of eight quickly grew into a room of 30.

Kids under the age of 4 and people over the age of 65 are particularly at risk from heat exposure, the CDC says. Heat stroke and heat exhaustion are the two most common problems of excessive heat exposure.

Heat stroke results when the body becomes unable to control its own temperature. Excessive heat causes the organism’s temperature to rise quickly, the sweating mechanism fails, and the body is unable to cool down.

Heat exhaustion is the body’s response to an excessive loss of water and salt contained in sweat. The most common symptoms of heat exhaustion are heavy sweating. muscle cramps, dizziness, nausea or vomiting and fainting.

San Bernardino also provides some funds to help seniors and low-income people pay those utility bills, says Charles Adams, deputy director the county’s Community Services department. “It’s a credit to the gas or electric bill that we pay directly to the utility,” Adams describes. “It’s a pretty elaborate formula and varies from individual to individual.”

The county provided additional funds for the program this year, Adams says, “but there’s just not enough funding. We are doing the best we can and it’s a greatly appreciated program. These senior citizens and low-income people often have to make some very difficult decisions on how to divide up their income.”

Arizona officials say they don’t expect to have a problem with heat exposure this year. “We don’t have the same problem as other states do,” says Norm Peterson, Arizona’s state epidemiologist in Phoenix. “We’ve had a few excess deaths from heat stroke,” although that typically happens when people are in the desert too long without protection, he adds. The state has seen a spate of heat-related deaths among people crossing the border from Mexico.

Moreover, Peterson says, “energy problems haven’t hit Arizona yet. We have an adequate supply of electricity.”

“I haven’t heard of any real concerns or issues,” agrees Becky Brooks, the interim deputy director of Yuma County’s Health Department in Yuma, Ariz. “There’s been no real increase in energy pricing here. Our usual summer rates for electricity range anywhere from $200 to $400 a month, and so most people are quite used to that.”

What To Do
If you’re going to be in the summer heat, drink a lot of liquids but avoid alcohol or drinks with caffeine or a lot of sugar, the CDC advises. Wear light-colored, loose-fitting clothing and stay indoors with the air conditioning on.

If your home does not have air conditioning, go to the shopping mall or public library; even a few hours spent in air conditioning can help your body stay cooler when you go back into the heat. Call your local health department to see whether there are any heat-relief shelters in your area.

If a neighbor or loved one is elderly, check on her every so often during heat waves. A 1995 scorcher killed more than 600 people in greater Chicago; many of the victims were older people who lived alone and without air conditioning.

Be extra careful if you take diuretics, which can be found in blood-pressure and some other generic pills. They tend to take salt out of your body, which can be a problem when you’re sweating and not replenishing what you’ve lost. Drinks with electrolytes (such as Gatorade) can help.

Energy problems in California and the Southwest could have a serious effect on heat-related injury and death, the Centers for Disease Control and Prevention warns. And with summer temperatures expected to be above normal in the Southwest, officials are gearing up to protect senior citizens and the very young.

The agency has posted a heat fact sheet on its Web site, says Alden Henderson, a health scientist with the CDC’s National Center for Environmental Health. “The key issue we wanted to get out to people is that they should get to air-conditioned rooms” when the mercury rises, he says.

But, he adds, “If there’s a brownout and you’re without air conditioning for a few hours, it’s not going to be much of a problem.”

“The heat is certainly is a big problem here,” says G.G. Crawley, deputy director of San Bernardino County’s department of Aging and Adult Services in San Bernardino, Calif. “It gets extremely hot out here — in some areas 110 to 120 degrees — given that a large percentage of the county is high desert.”

Although there have been no senior deaths because of heat exposure this year, Crawley says, a child died after being left in a hot car for a short time.

“And I don’t know if anyone died of heat exposure last year, but we are still very concerned about it, especially with the high cost of utilities,” Crawley adds. “We had unseasonably cold weather this winter, and our seniors complained that costs were extremely high and because of that they could not afford to pay their utilities. And in some cases, those utilities were turned off.”

Those high energy bills have officials in San Bernardino County concerned that seniors will turn off their air conditioning this summer. “It’s often a choice between eating, buying generic prescription drugs or keeping the air conditioning on,” Crawley says.

Crawley says San Bernardino County put together a publication to alert senior citizens, caregivers, and relatives on what kind of clothes to wear, what kinds of food to eat, and where to go if heat becomes a problem.

“What we advise people to do, if they need to cut back on their utility costs, and they can get up and about, is to go to what we call cooling centers — libraries, malls and senior citizens [centers], where there is air conditioning.

“But when they’re homebound, there’s not much we can do,” Crawley adds. “We’ve been trying to make providers and caregivers and relatives aware of what to do.”

Opened on March 1, 1997, the facility features a glass-enclosed design to maximize the clients’ view of the park-like landscaped campus from each area of the building, as well as to allow an abundance of light to flood the interior. Mirrors opposite the large glass walls reflect and enhance the exterior views. Complementing the design and layout of the facility, says senior vice president of medical center development Christopher Male, is the creation of a color palette of contemporary pastel colors to create a relaxing environment after an exercise or therapy session.

To encourage socializing, a central spine leads all corridors to the client social area located in the middle of the facility. The social area was designed with only one wall and three sides to provide views of the cardiovascular area and entrance to the aquatic center.

“This supports the program’s intent of making the facility not only an exciting place to exercise, but an environment conducive for social interaction,” says Male.

As of August 1, 1997, there were 3,100 members ranging in age from 14 to 85, up from the 1,750 members in February 1997. And the waiting list continues to grow. The facility has also succeeded in involving non-members in the community. “Whether a member or not, the community is invited to make use of the track and [it] has become a much appreciated addition to the neighborhood where exercise and social interaction can occur” says Male.