Inside Issue #4
Radical Prostatectomy vs. Brachytherapy
Snake venom vs. PCa
Suicide risk in PCa patients
How does lifestyle affect long term cancer patients?
Namograms for predicting PCa
Fermented soy supplements
2026: The Most Important Papers 01/22 - 01/28
(1 minute read)
Brachytherapy is a form of internal radiation that places radioactive “seeds” directly into or next to a tumor.
This is a paper I wish more newly diagnosed men were shown, because it cuts through one of the most emotionally charged decisions in PCa care. Many men struggle with, should I treat it or should I have it taken out. The authors pooled data from seven observational studies involving more than 5,600 men with low- and intermediate-risk PCa, comparing radical prostatectomy with brachytherapy. Brachytherapy is a form of internal radiation that places radioactive “seeds” directly into or next to a tumor.
What they found is brachytherapy was associated with better relapse-free survival, meaning fewer PSA recurrences over time, while overall survival and prostate cancer–specific survival were essentially the same between the two approaches. In other words, how long men lived and whether they died from PCa, did not differ based on whether they chose surgery or brachytherapy.
PROSTATECTOMY VS. BRACHYTHERAPY
In men with low- and intermediate-risk disease, brachytherapy showed a statistically significant advantage in PSA-related relapse-free survival, with about a 16% relative reduction in PSA recurrence compared with surgery.
Clinical symptom, relapse-free survival also leaned in favor of brachytherapy, though this difference did not consistently reach statistical significance across all analyses.
Overall survival and cancer-specific survival were equivalent between surgery and brachytherapy. Neither approach showed a clear mortality advantage.
This was a meta-analysis of observational studies, not randomized trials. Selection bias likely plays a role, especially since surgery is often chosen by younger, healthier men.
The findings reinforce a central point I emphasize often: there is no single “best” treatment, only the best-informed decision for a specific person.
(1 minute read)
I want to share a very early-stage but really intriguing laboratory study (in vitro) that crossed my desk this week. Researchers looked at a purified compound called Pllans-II, derived from snake venom, and tested its effects on several PCa cell lines. In cell culture, this compound selectively reduced the viability of PCa cells while largely sparing normal prostate epithelial cells.
Of particular interest wasn’t just cell death, but the consistent suppression of behaviors linked to metastasis, including migration, adhesion and the ability to form colonies. Even more interesting, the mechanism did not appear to involve outright membrane destruction or classic apoptosis (programmed cell death), but pointed toward a cellular self cleanup pathway.
This is basic science, not a treatment, but it reflects a broader trend I watch closely: highly selective molecules that disrupt cancer behavior without the collateral damage we see with standard chemotherapy.
SNAKE VENOM VS. PCA CELLS
This is in vitro research only. The findings come from PCa cell lines in the lab, not animals or humans. Please don’t interpret this as a therapy or supplement option.
Selectivity is the key signal here. Unlike docetaxel, Pllans-II spared non-tumor prostate cells in these experiments, which is exactly the kind of profile researchers look for when trying to reduce treatment toxicity.
The strongest effect was seen in androgen-sensitive cells. That detail may be important when thinking about disease stage and biology, but it also limits how broadly we can extrapolate.
The venom-derived compound slowed migration, adhesion and colony formation, all behaviors tied to metastatic potential. Preventing spread is often more important than killing cells outright.
(1 minute read)
This abstract stopped me cold, and I think it deserves attention even in its early form. Using more than 400,000 men from the SEER database, researchers examined suicide risk following a PCa diagnosis and found a striking pattern: the highest risk occurs in the first six months after diagnosis, then steadily declines over time.
Survival from PCa has improved dramatically, yet this paper reminds us that the period immediately after hearing the words “you have prostate cancer” can be psychologically destabilizing in ways that don’t always show up on the surface.
What I found especially important is that the authors built a predictive model designed to help clinicians identify which men are most vulnerable early on, when support could make the biggest difference.
SUICIDE RISK IN PCA PATIENTS
The first six months after diagnosis appear to be the most fragile window. Suicide risk was dramatically elevated during this period compared with the general population.
Risk declined substantially after five years, suggesting that time, adaptation, and support change the psychological landscape for many men.
Several identifiable factors were associated with higher risk, including age, race and Gleason score. These are data points clinicians already have, which makes early screening feasible.
The researchers developed a predictive nomogram with reasonable accuracy, designed to flag higher-risk individuals rather than relying on gut instinct alone.
(1 minute read)
One of the most encouraging themes I keep seeing in the research is that what you do even years after diagnosis still makes a difference. This large, well-designed German study followed more than 6,000 long-term cancer survivors, including over 2,100 men with PCa, for up to 12 years.
These weren’t newly diagnosed patients or men in active treatment. Most were eight years out from diagnosis. What the researchers found is simple: survivors who maintained healthier lifestyle habits lived longer, regardless of cancer type, age or treatment history. Even small improvements added up.
This reinforces something I believe strongly: survivorship isn’t passive. Your choices continue to shape outcomes well beyond the end of treatment.
DEVELOP HEALTHIER LIFESTYLE HABITS
Lifestyle changes stack up. Men in the healthiest lifestyle group had about a 32% lower risk of death compared with those in the least healthy group. Each step toward healthier habits lowered risk further so it is additive.
Smoking was the single biggest driver. Never-smokers had roughly half the mortality risk of current smokers, making smoking cessation the most impactful change in this study.
Movement helps more than most people realize. Meeting physical activity guidelines (150 minutes per week) was consistently linked with longer survival, even years after diagnosis.
Weight stability beat extremes in either direction. Maintaining a healthy or slightly overweight BMI was associated with lower mortality compared with obesity or being underweight!
Consistency makes a big difference. The benefit held across prostate, breast and colorectal cancer survivors and across different ages and comorbidities, reinforcing that steady habits over time make the biggest difference.
(1 minute read)
I believe this paper will make a difference in treatment protocols. One of the most stressful moments for men is being told their PSA is elevated and a biopsy is “probably next.” This paper addresses that exact gray zone. Researchers developed and externally validated practical prediction tools (called nomograms) for men with PSA levels between 4 and 20 ng/mL, a range notorious for false alarms.
By combining age, PSA and modern MRI features from biparametric MRI (not full contrast MRI), they were able to predict not just PCa, but clinically significant PCa, with impressive accuracy. What stands out to me is how focused this work is on precision: identifying who truly needs a biopsy and who may safely avoid one, without missing aggressive disease.
NOMOGRAMS FOR PSA BETWEEN 4-20
PSA alone is a blunt tool in the 4–20 ng/mL range. This study confirms that PSA density and MRI data dramatically improve accuracy compared with PSA by itself.
The models performed especially well for detecting clinically significant prostate cancer, with accuracy (AUC) over 0.90 in both the peripheral and transitional zones of the prostate.
These tools were externally validated using independent, multi-center data, making the results more reliable than single-center prediction models. This just means the results are highly reliable.
Used properly, these nomograms could reduce unnecessary biopsies while still identifying men who truly need targeted therapies.
(1 minute read)
This is one of the more thoughtful nutrition-based prostate cancer studies I’ve read recently. In the PRAECAP trial, Belgian researchers followed men at elevated risk for PCa who had negative biopsies and gave them a fermented soy–based supplement for six months. The goal was to see whether PSA behavior, urinary symptoms and diagnostic testing outcomes changed in any meaningful way.
What they found was striking: more than 80% of participants experienced PSA stabilization or reduction, a subset saw clinically meaningful improvement in urinary symptoms and, most interesting to me, men whose PSA responded were far less likely to undergo repeat MRIs, biopsies or be diagnosed with higher-grade disease over the following two years.
FERMENTED SOY SUPPLEMENTS
This study focused on men at increased risk with prior negative biopsies, not men already diagnosed with PCa.
A PSA response occurred in about 81% of participants over six months, defined as a decrease or stable PSA within expected biological variation.
About one in four men experienced a clinically meaningful improvement in urinary symptoms (IPSS), even though prostate size did not change.
The supplement included fermented soy with equol. Most Western men do not naturally produce equol from soy. Fermentation bypasses that limitation.
Equol acts as a functional anti-androgen, interacts with estrogen receptor-β, binds dihydrotestosterone (androgen) and influences androgen receptor signaling, without behaving like drug-based hormone therapy.
OTHER NEWS
You may have noticed that I have shifted the focus of this newsletter toward more recently diagnosed men or those just monitoring their PSA. I would LOVE your suggestions on how to improve it and make it more user friendly.
Please check your spam folder for a message I sent out on Tuesday the 27th. Mine went to my spam folder. It’s a preview of my “to be published” book on PCa. It can be shared as a standalone info guide if you’d like.
Thank you to those of you who comment!!!
Please share with others who may benefit from the work we’re doing 🙂
And, THANK YOU!!