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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First, the program needs to be structured by a set of rules that are announced ahead of time and are easily understood. The fitness center staff should brainstorm possible situations, and look for any potential problems before the rules are distributed. For example, will exercise time count only at the fitness center, or can members use their time from working out at home while traveling? Rules should be decided and agreed upon by all staff members involved. Consistency is key here; you certainly do not want one staff member going by one set of rules, while another staff member goes by a different set. Believe me, this causes more problems than you can imagine!

Second, reward individuals for participation levels that are easily reached. If you offer several programs where no one is able to win, the last thing they will do is sign up for another one. Make sure that if most of your members come to the club three times a week for 60 minutes, and they continue this pattern, they have a good chance at winning. Or, make allowances for several winners by having a grand prize drawing at the conclusion of the program.

Third, the reward you give should be tangible. You may want to advertise what the prize is or display the prize alongside the game board so participants know what they are working toward. Also, the prize should be something like a T-shirt, water bottle or free membership. Simply posting the winners is a nice thought, but to really encourage participation, members want to have a tangible prize to attain.

Fourth, the reward should let others know who the winners are. Giving someone a T-shirt is OK, but giving them a T-shirt that says “1995 Fitness Olympics Gold Medal Winner” allows others to recognize that the person played an incentive game and won. This is a good way to advertise what your organization offers, and this will generate more interest in your next program. Additionally, signs can be posted indicating who the winners are. Putting the winners’ names in the company newsletter is also a good idea.

Fifth, the reward should be timely. As soon as the program is over, the winners should be quickly determined and the prizes awarded.

This means that prizes should be available by the end of the program, so keep this point in mind if they need to be ordered.

Personally handing out the prizes is a nice touch, or have a small “party” to distribute them.

Last, and perhaps most important, make sure that the length of the program is not too long or too short, especially with competitive games. We ran a program that lasted nine weeks, and by the seventh week, we had lost the interest of many of the participants. On the other hand, we offered a program that was two weeks long, and no one really got into the spirit of the game until it was over. With our members, four to six weeks seems to be a good length to enjoy the spirit of the game without it becoming too cumbersome or boring.

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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Why should I bother with perceived exertion?

Even if you are in a program that uses heart rate monitors to keep you below a specified heart rate, monitoring RPE can be beneficial for you. Over time, you may find that it becomes fairly easy to replicate your target exercise intensity just by sensing how difficult an exercise feels.

This ability to sense exercise intensity can be helpful in your everyday life. You will feel confident that when you are performing tasks of daily living such as walking to the store or going up stairs, you are not going above your target zone.

Why does the scale run from 6 to 20?

The research done by the scale’s originator, Swedish exercise physiologist Gunnar Borg, correlated RPE with exercise heart rate in young male subjects. So 6 represented a resting HR of 60, and 20 a maximal HR of 200 beats per minute. This relationship may or may not hold true for you, but it does not detract from the scale’s usefulness as a tool to measure exercise intensity.

In any event, it is important to know if the chosen person is motivated about heading up the program, is interested in teaching it, has the time to regulate upkeep of the equipment and is able to enforce the reservation policies.

Instructors who teach this program should be CPR-certified. Aerobics and fitness certifications, as well as cycling experience, are helpful but not absolutely necessary if the instructor has undergone a good training program.

Many different types of people make good instructors for this type of program. Some examples would be aerobics instructors, fitness instructors, personal trainers and cycling enthusiasts. Even yoga and karate teachers are good because of their ability to motivate people.

Paying these instructors is another issue. If you don’t charge for the classes, set a sliding pay scale based on the number of people who attend each class. This always motivates instructors to market their classes more aggressively. If you are charging and have 20 or more bikes, you may want to consider paying instructors $1 to $3 per participant. Or, pay them the rate instructors are normally paid for other one-hour class formats.

If you charge and only have 10 to 15 bikes, you may want to pay a low base rate plus a per-head charge for each person in the class. Or, just pay a flat rate with an agreement that the instructor will help motivate people to take classes. Be considerate with regards to time of day. Prime-time classes will always be easier to fill.

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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Butterfield, of the Las Vegas Athletic Clubs adds, “No matter how innovative your group fitness classes are, people still have the same old excuses for not working out. We’re making progress though. Years ago, people really didn’t know how to get fit. Partially through group exercise, we taught them. Today, even if they aren’t coming into the health club, people know they should work out. That’s a start.” FM
Instructor Savvy

Kathie Davis, executive director of IDEA, The Health & Fitness Source, San Diego, Calif., wants to continue to encourage group fitness instructors to diversify to meet the changing demands of club members. Here are some of her suggestions:

* Stop using the word “aerobics”; it pigeonholes you into a small slot on the schedule. It also misrepresents programming on the whole. Call yourselves group fitness leaders.

* Develop programs for beginners, the largest populations we haven’t yet touched with our expertise.

* Stop continuing to make things complicated! Go easy on participants. Let them leave feeling 100 percent successful.

* Get out into your communities in other health and fitness venues to reach those who may not be walking into your club.

* Continue your education to reflect new research, programming and technology.

* Concentrate on your business skills, too. More and more fitness professionals are in business for themselves.