Friedrich R. Douwes, M.D., andShari Lieberman, Ph.D., C.N.S.,

F.A.C.N.

P rostate cancer (PC) is a major healthproblem in the Western worldbeing the second most common

male malignancy in the European Union.1

The age-standardized incidence of PCva r i es more than one hundred fo ldbetween areas with the highest incidence(e.g., the United States) and the lowestincidence (e.g., Japan) in the world. Incertain parts of the world, in particularthe Western countries, the incidence ofthis disease has increased rapidly over thepast 20 years. There are several environ-mental and genetic factors that partiallyexplain these variations, although theincidence probably depends most of allon the extent to which small latent tumorsare detected. Being that the clinical signif-icance of small tumors is uncertain, thevalue of early diagnosis and early aggres-sive treatment is controversial.2

More than half of patients with diag-nosed PC do not have metastatic disease.This may be the result of better and earli-er screening processes.3,4 Common treat-ment of PC with local manifestations

includes radical prostatectomy and lym-phadenectomy. More than 50 percent ofall patients who are diagnosed with atumor stage of T1-2 are free of lymphnode involvement and metastatic disease.If surgery is not possible, radiation thera-py is recommended. In advanced cases,androgen blockades are used such asgonadotropin-releasing hormone and/ororchidec tomy. Treatment s , such asprostatectomy, orchidectomy, and radia-tion therapy, yield a high risk of inconti-nence and impotence, making thesetreatments less than ideal.1–3

This article provides an overview oflocal hyperthermia, discusses key studies,and then details the authors’ study of 184patients with PC who were treated withtransurethral hyperthermia (TUH) andcomplete androgen blockade (CAB).

Overview of Local Hyperthermia

Local or regional hyperthermia is theuse of heat applied directly to an area ofthe body; for cancer treatment the heat isapplied to a tumor. This kind of hyper-thermia has been used alone or in combi-n a t i o n w i t h s u c h t h e r a p i e s a schemotherapy and radiation for treating awide variety of cancers in addition to PC,with excellent results. These cancersinclude melanomas, esophageal or stom-ach cancers, pancreatic cancers, sarcomas,bone tumors, cervical cancers, head andneck cancers, and rectal cancers. Hyper-thermia causes direct cytotoxicity in thetumor, enhances its radiosensitivity, andimproves the effec t iveness o f manychemotherapeutic agents in drug-resis-tant cells.4 Hyperthermia kills cancer cellsselectively (because cancer is more sensi-tive to heat than healthy cells are). This isachieved via:

� Tissue acidosis� Destruction of tumor capillaries� Damage to tumor membranes and pro-

teins� Failure of cellular-repair mechanisms� Changes in DNA and RNA synthesis� Increase of free radicals� Failure of antioxidant systems� Induct i on o f heat shock pro te in s

(HSPs) , which help to “unshield” atumor, making it more susceptible todestruction by immune factors.5,*

I t i s impo r tan t t o no te t ha t on lymic rowave hyper th erm ia ha s beenapproved for legal use in the UnitedStates by the Food and Drug Administra-tion and that it must be given with radia-tion therapy.†Immunotherapy of mice with preexisting

cancers, using HSP preparations derivedfrom autologous cancer, has retarded pro-gression of the primary cancers, reducedmetastatic loads, and prolonged the ani-mals’ lifespans.6,7 HSP may have immuno-logic effects because the heat-inducibleHSP70 expressed on the cell surface of cer-tain tumor cells acts as a positive recogni-t i on s igna l fo r na tu ra l -k i l l er ce l l s .Therefore, in addition to causing direct cellcytotoxicity, hyperthermia has the addi-tional potential for use in immunotherapyin clinical applications.Substantial clinical data exist, demon-

strating that combining radiation andhyperthermia to treat early stage andadvanced tumors of different types wasmore efficacious and produced less nor-mal tissue toxicity compared to radiationtherapy alone.8

Phase I and II trials achieved impressiveresults in terms of objective response rate,local tumor control, and relapse-free sur-vival for hyperthermia used alone or inconjunction with radiation therapy. Phase II

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Radiofrequency TransurethralHyperthermia and Complete

Androgen BlockadeA Nonsurgical Approach to Treating Prostate Cancer

*Observation from Dr. Douwes’ clinical experi-ence.†For more information on the legal status ofhyperthermia devices and for more on the useof hyperthermia, see: Gould, D. Clinic profile:Hyperthermia and electrochemical therapy atS t . Georg Hospital , Germany. Fr iedri chDouwes, M.D.’s, Innovative, Integrative CancerCare. JOURNAL OF ALTERNATIVE & COM-PLEMENTARY THERAPIES 7:6:291–295, 2001.

trials have also produced excellent resultsusing hyperthermia with chemotherapyand phase III trials are currently underway.Most of these trials are being conducted in Europe .5 Most s tudies have usedmicrowave hyperthermia to heat tumors toa temperature of 42.5ºC–45ºC. Other formsof hyperthermia include electric field, mag-netic field, and radiofrequency hyperther-mia. Higher temperatures appear toproduce the best results.

Key Hyperthermia Studies

It has been suggested that a temperatureof 43ºC or higher is the optimum tempera-ture to induce the most tumor destructionvia apoptosis during hyperthermia. Apop-tosis is an important mode of death inheated cells. No significant apoptosis wasinduced in PC-3 cancer cells when theywere heated at 42ºC for 240 minutes.Apoptosis is not an important mechanismof death in irradiated PC cells althoughradiation therapy is used to treat all stagesof PC. Clinical and radiobiologic evidenceindicate that PC cells are relatively resis-tant to radiation.9

Several experimental data are availabledemonstrating the efficacy of combininginterstitial hyperthermia and conformalradiation therapy.

Thermoradiotherapy Study Researchers from the German Research

Society conducted a phase II trial to deter-mine the efficacy of thermoradiotherapy,using interstit ial cobalt-palladium ther-moseeds for treating patients who hadlocalized PC. Forty-one (41) patients withlocalized PC were enrolled in the studybetween July 1997 and April 2000. Intersti-tial hyperthermia induced in a magneticfield was applied in six sessions, once per

week. Conformal three-dimensional radia-tion therapy was given simultaneously indaily fractions. Intraprostatic tempera-tures ranged between 42ºC and 46ºC.No major side-effects were observed

during the hyperthermia sessions. Themedian levels of prostate-specific antigen(PSA) decreased from 11.25 ng/mL to 0.88ng/mL 3 months after treatment and to0.38 ng/mL 12 months after treatmentwith a median follow-up of 10 months.The mean prostate volume decreasedfrom 32.6 mL to 26 mL after 3 months oftreatment and to 18.5 mL after 12 months.A significant PSA decrease was observedin the subjects. The researchers concludedthat interstitial hyperthermia is a feasible,well-tolerated procedure for PC therapy.10

Local Microwave Hyperthermia StudyFor another study, short- and long-term

results of treating patients with stage IIIand IV PC were compared in 147 patientswho did not have distant metastases. Thir-ty-eight (38) patients were exposed toradiation and 109 patients underwentradiation treatment and local microwavehyperthermia. The response of the prima-ry tumor in each subject was evaluated viapalpation, ultrasonic investigation, andcomputed axial tomography (CAT) scan.Adjuvant local hyperthermia enhancedantitumor activity of the treatment, raisingthe rate of a complete response from 69percent with radiotherapy alone to 94 per-cent with thermoradiotherapy (hyperther-mia plus radiation). Five (5)-year survivalin patients with PC at stages III and IVincreased from 48 percent to 65 percent.11

Transrectal Ultrasound Applicator StudyA study using a transrectal ultrasound

applicator for delivering prostate hyper-thermia was combined with radiation

therapy to treat 26 patients whose medianage was 69. Nine (9) patients had well-dif-ferentiated adenocarcinoma, 11 patientshad moderately differentiated adenocarci-noma, and 6 patients had poorly differen-tiated adenocarcinoma. All of the patientsin this study had American Urologic Soci-ety Stage C2–D1 adenocarcinoma. Themedian pretreatment PSA level was 29ng/mL. Hyperthermia was administeredconcurrently with radiation therapy attemperatures of 42.5ºC for 30 minutes,using a transrectal ultrasound applicatorwith 3 thermometry probes, administeredas either a single treatment (for 9 patients)or as two treatments (for 17 patients).The median time to PSA nadir was 15

months, with a median PSA value of 1.0ng/mL. The median and 5-year overallsurvival was 88 months and 73 percentrespectively, and the median and 5-yearbiochemica l no evidence of disease(bNED) survival was 36 months and 35percent respectively. Multivariate analy-sis revealed only the pretreatment PSAleve l (P = 0 .0 3 ) and the PSA nad i r(P<0.01) to be signif icant predictors ofbNED survival. The duration of hyper-thermia therapy showed a trend towardsignificance for overall survival (P = 0.06).This phase I/II protocol, evaluating thecombination of prostate hyperthermiaand external beam radiation therapy fortreating patients with locally advancedPC suggests that prostate hyperthermia isfeasible with no apparent significantincreased toxicity.12

Radiofrequency Interstitial Tumor AblationHyperthermia Study

For yet another study, radiofrequencyinterstitial tumor ablation (RITA) hyper-thermia was used as a sole method oftreatment for inpatients with localized PC.

150 ALTERNATIVE & COMPLEMENTARY THERAPIES—JUNE 2002

Several experimental data are available demonstrating the efficacy of combining interstitial hyperthermia and conformal radiation therapy.

In 10 patients whose mean age was70.4, a total of 21 marker lesions werebiopsied under general, spinal, or localanesthesia. Radiofrequency energy wasdelivered transperineally under transrec-tal ultrasound guidance. Radical prostate-ctomy was performed on all patients 1–7days after RITA.

The findings of intraoperative transrec-tal ultrasound and histologic examinationof the specimens were correlated. Lesions2 x 2 x 2 cm were targeted. Postoperative-ly, patients were catheterized for an aver-age of 1.8 days.

Average lesion diameters, defined bycoagulative necrosis at histologic exami-nation, were 2.20 ± 0.23 x 2.10 ± 0.31 x2.38 ± 0.14 cm (average volume 5.86 ±1.63 cm3). Each lesion was well-definedand did not extend beyond the prostaticcapsule. No complications (e.g., rectal-wall injury) were noted. RITA-biopsiedlesions were safe, feasible, technicallysimple, and resulted in lesions that werevery predictable in size and location. Onhistologic examination, well-def inedareas of coagulative necrosis were docu-mented. No damage to the periprostatictissue was noted.

The procedure can be performed withspinal or local anesthesia only.13 Thisstudy suggests that RITA can destroy atumor internally, forms scar tissue, willnot harm nontumor t issue, and mayreduce the need for radical prostatecto-my.

Transrectal HyperthermiaTransrectal hyperthermia (TRHT) was

administered during a 15-month periodto 15 patients with progressive adenocar-cinoma of the prostate (i.e., PC). Therewere 5 patients with stage T4 disease and11 with stage T3 disease, including 6

patients with skeletal metastases. Nine (9)of the patients had severe and 6 had mod-erately severe signs and symptoms of PC.Treatment was given six times, with atemperature of 43.5ºC for 30 minutes.Cell-mediated immunity tests were per-formed before TRHT and at 2, 4, and 6months post-therapy.The results of these tests were com-

pared to those of 15 patients with benignprostatic hyperplasia (BPH) who weretreated with the same TRHT and with 30untreated normal volunteers. TRHT waswell-tolerated, with mild acute toxicitynoted in 3 patients. Of the 15 patientswho were treated, 2 (13 percent) hadscintigraphic evidence of regress ion ofbone metastases. Five patients survivedmore than 5 years since treatment and 3pa t i en t s had no ev iden c e o f PC. Adecrease of marked or moderate degree ofPC signs and symptoms was noted in 8patients (53 percent).The results of cell-mediated immunity

tests were of interest. The 15 patients with PC, prior to TRHT, had a lowerOKT4–OKT8 ratio and lower concavalin-AT-cell suppressor activity compared to the15 patients with BPH and the 30 healthyvolunteers who had normal immuneparameters. This demonstrated significant-

ly suppressed immune function. FollowingTRHT, there was a significant increase inmonitored immune parameters noted inthe 15 patients with PC (P<0.01). Thisimmune stimulation peaked at 2 monthsand gradually decreased to near pretreat-ment levels at 6 months.14

This study demonstrates augmentationof immune function as a direct conse-quence of hyperthermia in patients withPC with lowered immune function.

ThermoimmunotherapyAn early study combined immunother-

apy with hyper therm ia ( thermoim-munotherapy) in patients with late-stageprostate or breast cancer. Propionibacteri-um granulosum KP-45 was used as theimmunomodulator. The results, after 1–2years of observation, indicated that thenumber of responders was higher in thegroups treated with thermoimmunothera-py than in those who were treated withhyperthermia only. The researchers sug-gested that thermoimmunotherapy offersa real alternative for treating advancedneoplasms and opens a new field forexperimental and clinical investigation.15

Despite these excellent results, thermoim-munotherapy appears not to have beenfollowed up in subsequent studies.

ALTERNATIVE & COMPLEMENTARY THERAPIES—JUNE 2002 151

Researchers suggested that thermoimmunotherapy offers a real alternative for treating advanced neoplasms

and opens a new field for experimental and clinical investigation.

Table 1. Staging of PC in 184 Patients Enrolled in Study

Diagnosis/age range Stage Number of patients

Prostate cancer, histologically verified, T1, NO, MO 18patients’ age range 50–87 T2a, NO, MO 16

T2b, NO, MO 14T3, Nx, MO-x 136

PC = prostate cancer.

Materials and Methods for the TUH Study

To test the efficacy of radiofrequencyTUH, 184 patients , a t the K l inik St .Georg, Bad Aibl ing , Germany, ages50–82, with histologically veri fied PCwere staged (see Table 1). Patients witheither early stage (T1) or later-stage (T3)

PC participated in this study. Thesepatients had refused prior surgery orradiation because of their anxiety aboutthe procedures and fear of complications,such as incontinence, impotence, metas-tasis, castration, retrograde ejaculation,anesthesia-related problems, infection,and bleeding. Psychologic reasons alsoplayed a role in these patients’ refusal to

receive surgery or radiation treatment.Informed consent was recorded for allpatients. Treatment was performed with the Ther-

mex II (Direx Medical Systems, Ltd. PetaTikva, Israel) using a transurethral antenna.(This antenna is used to apply heat directlyto the area around the urethra and providescontinuous measurement of the highesttemperature, allowing safe and effective dis-tribution of heat throughout the prostate.)Patients received a total of 2–3 treat-

ment sessions, with each session lasting 1hour under local anesthesia. Prostate tem-peratures were between 47ºC and 48ºCfor the duration of each session. Monitor-ing of the temperatures was performedvia direct measurement at the thermalelectrode.The patients also received CAB for 6

mon th s , us ing th e comb ina t i o n o fluteinizing hormone–releasing hormoneantagonists, androgen antagonists, or 5-a -reductase inhibitors. The subjects weremonitored regularly in an outpatientdepartment. Checkups were performed at6 weeks, 3 months, 6 months, and 12months. Monitoring was performed regu-larly via clinical examinations, laboratorytests, and appropriate imaging techniques

152 ALTERNATIVE & COMPLEMENTARY THERAPIES—JUNE 2002

Patients had refused prior surgery or radiation because of their anxiety about the procedures and fear of complications.

0

2

4

6

8

10

12

14

16

18

0 3 6 9 12 months

mL/sec

Figure 1. Peak urinary flow rate in 121 (66%) of 184 patients with prostate cancer before and aftertransurethral hyperthermia and complete androgen blockade. A marked increase was observedafter treatment.

Table 2. Objective Results as Demonstratedin Prostate Glands of 184 Patients After TUH with CAB

Tumor stage Number of patients Gland smaller Gland softer No change in gland Gland larger or harder

T1, NO-1 MO 16 5 8 8 0T2b, NO, MO 32 15 21 11 0T1-4, Nx, MO-x 136 81 77 55 0Total 184 101 (55%) 101 (55%) 74 (40%) 0

Rectal examinations were performed 6 weeks after treatment; TUH = transurethral hyperthermia; CAB = complete androgen blockade.

(CAT scans, magnetic resonance imag-ings, bone scans, and positron emissiontomography scans).

Results

Six (6) weeks after treatment withTUH and CAB, 55 percent (101 of 184) ofthe subjec ts had smal ler and so ft erprosta te glands , as noted via rec ta lexamination, and 40 percent had no pal-pable change (see Table 2). Prostate vol-ume was reduced from an average of 33mL to 25 mL in early stage disease andfrom 56 to 33 mL in advanced cases (seeTable 3), which was confirmed by tran-srectal sonography. In addition to reduc-tion in size, the disappearance of typicalsigns of cancer and the appearance ofscar tissue in place of the tumors wereobserved.

Ten patients were randomly biopsiedand 8 of 10 (80 percent) were negative forPC. Subjective complaints, such as micturi-tion, poor flow rates, voiding dysfunction,residual volume, incontinence, and nocturiawere reduced, as shown in Figures 1 and 2.

The average flow rate increased from 8mL to 14 mL at 3 months, rose to 17 mL at6 months after treatment, and remained at15 mL at months 9 and 12 (Figure 1).

The average residual volume, whichwas measu red by u l t ra sound, wasreduced f rom 120 mL to 60 mL at 3months and remained at 40 mL at 6months, 9 months, and 12 months aftertreatment (Figure 2). Voiding time was reduced an average

of 70–42 seconds at 6 months. Although5 patients had had total urinary reten-

tion, all patients improved to the degreethat their catheters could be removed.The subjective and objective micturitionparameters improved significantly inmore than 60 percent of the patients.Three (3) months after treatment, the

total number of remissions observed was91 of 184 (49.5 percent), the total numberof partial responses was 28 of 184 (15.0

ALTERNATIVE & COMPLEMENTARY THERAPIES—JUNE 2002 153

Subjective and objective micturition parameters improved significantly in more than 60 percent of the patients.

0 3 6 9 12

mL

0

20

40

60

80

100

120

Figure 2. Residual urine volume in 64 (35%) of 184 of patients with prostate cancer before andafter transurethral hyperthermia and complete androgen blockade. There was a marked reduc-tion of residual volume after treatment.

Table 3. Prostate Volume After TUH and CAB in 184 Patients with PC

Number of Volume (mL) Average volume Volume (mL) Volume (mL)Tumor stage patients before treatment (mL) at 3 months after 6 months at 9 months

T1, NO-x, MO 16 30 28 27 25T2a-b, NO-1, MO 32 34 29 25 22T1-4, Nx, MO-x 136 56 41 36 33

There was a significant reduction of prostate volume noted in patients with all stages of disease.TUH = transurethral hyperthermia; CAB = complete androgen blockade; PC = prostate cancer.

percent), no change or progressive dis-ease was 29 of 184 (15.2 percent); andprogressive disease was 36 of 184 (19.6percent) (Table 4). Patients at the earlieststage of PC, with stages T1, NO, MO, 16of 16 (100 percent), had complete remis-sions. Patients with early stage disease,T2 a-b, NO, MO, 32 of 32 (100 percent),had complete remissions. Patients withlate-state disease, 43 of 136 (31.6 per-

cent), had complete remissions (Table 4).In patients at the later stages of PC, T1-4,Nx, MO-x, 43 of 136 (31.6 percent) hadcomplete responses, 28 of 136 (20.5 per-cent) had partial responses, 29 of 136(21.3 percent) had no change and no pro-gression of disease, and 36 of 136 (26.4percent) had progressive disease.The total response of all groups was 91 of

184 (49.5 percent), complete response; 28 of

184 (15 percent), partial response; 29 of 184(15.2 percent), no change (and no progres-sive disease); and 36 of 184 (19.6 percent),progressive disease. Remission was verifiedby imaging techniques and laboratory tests. In those patients who experienced com-

plete remission 91 of 184 (49.5 percent),the PSA value progressively dropped onaverage from 750 ng/mL to 200 ng/mL at3 months, to 30 ng/mL at 6 months, andto <5 ng/mL at 9 and 12 months (Figure3). As reported in earlier literature,10,12

hyperthermia is effective for loweringPSA levels to normal in patients whorespond to treatment.

All patients who did not live near theclinic were instructed to seek follow-upsby their urologists and to have follow-upreports sent to the clinic. The clinic fol-lowed all local patients. While it is often-times difficult, if not impossible, to followpatients for 5 years, 38 of the 43 patientswith late stage PC who had completeremissions were followed for 5 years withno serious symptoms after 5 years. Two(2) patients died of causes unrelated toPC. Five (5) patients had local recurrencesand were treated with TUH and CABwith complete remission observed andconfirmed via biopsy, laboratory tests,and appropriate imaging analysis.

154 ALTERNATIVE & COMPLEMENTARY THERAPIES—JUNE 2002

One hundred percent of patients with early stage prostate cancerexperienced complete remission during the twelve-month observation period.

Table 4. Response of 184 Patients with PC to TUH and CAB

Tumor stage Number of patients CR PR NC PD

T1, NO-x, MO 16 16 (100%) N/A N/A N/AT2a-b, NO, MO 32 33 (100%) N/A N/A N/AT1-4, Nx. MO-x 136 43 (31.6%) 28 (20.5%) 29 (21.3%) 36 (26.4%)Total 184 91 (49.5%) 28 (15%) 29 (15.2 %) 36 (19.6)

Note: Of the 184 patients, 141 (76%) responded to treatment, 36 (19.5%) had no response. All patients with early stage disease, 16 of 16 (100%) and 32 of 32 (100%) responded to treatment.

PC = prostate cancer; TUH = transurethral hyperthermia; CR = complete remission; PR = partial response; NC = no change; PD = progressive disease; N/A = not applicable.

0

100

200

300

400

500

600

700

800

0 3 6 9 12 months

PSA ng/mL

Figure 3. The prostate specific antigen (PSA) value before and after treatment with transurethralhyperthermia and complete androgen blockade. The value dropped slightly and was normal inall cases of complete remission (in 91 patients; 49.5 percent).

Apparently, this combined treatmentdoes not make PC resistant to subsequenttreatment unlike radiation and chemothera-py. Sixteen (16) of the 16 patients who hadearly stage PC were followed and 2 died ofcauses unrelated to PC. None of thesepatients had recurrences within this 5-yearperiod. Urinary incontinence and impotencewere not reported side-effects as a result ofthis treatment. While libido decreased insome patients during CAB therapy, libidoreturned to pretreatment levels (or betterthan pretreatment levels in some patients)after cessation of CAB therapy.

Discussion

TUH to the prostate combined with CABproduced excellent results for patients withearly stage PC, with 100 percent experienc-ing complete remission during the 12-month observation period. For early stagePC, removal of the prostate gland and/orradiation plus androgen blockade is thecurrent conventional treatment of choice.However, this treatment modality carriessignificant risk of producing incontinenceand/or impotence. In addition, survival ofthese patients appears to be similarwhether they are treated or untreated, cast-ing some doubt upon enhancement of sur-vival.

TUH is an effective, yet nonaggressive,treatment that improves micturitionparameters and selectively kills PC cellswithout damaging surrounding tissue.Radiation therapy is not as selective andsecondary cancers are not uncommonconsequences of radiation therapy.

Surgery carries the greatest risk of pro-ducing incontinence and impotence rela-tive to radiation therapy. TUH therapycarries none of these risks but ratherreduces all PC symptoms.

In our study sample, all patients wereable to have catheters removed, evenpatients with late-stage disease who didnot respond to treatment. CAB appearsto augment TUH therapy, given the over-all response rate of 184 patients, mostnotably, the 100-percent remission inpatients with early stage PC, a result thathas not been reported in previous stud-ies.Early adjuvant hormonal therapy has

been shown in retrospective studies tohave a significant impact on time to pro-gression and to cause specific survival inpatients with seminal-vesicle invasionand limited lymph-node disease whoundergo radical prostatectomy.16 Hor-monal therapy plus TUH appears to be aviable alternative to radical prostatectomyfor patients with PC. Furthermore, unlikesurgery or radiation, TUH appears tohave a direct impact on lymph-node inva-sion perhaps via production of HSP andimmune activation.

The authors fee l strongly that themajor benefit of TUH using radiofre-quency is the ability of this therapy toraise prostate temperature to 47ºC–49ºC.It has been shown that optimal “killing”temperatures are at or above 43ºC. Mostof the studies reviewed did not exceedtemperatures of 43ºC.10–15 Also, duringthe 30-minute treatment sessions, the43ºC temperature was maintained for ashort time—less than 5 minutes.10–15

Finally, most of the studies only per-formed one hyperthermia treatment for3 0 minutes as the tre a tment pro to -col10–15 with or without concurrent radi-ation treatment. None of the studies hadintraprostate temperatures between47ºC and 49ºC for 2–3 treatments lasting1 hour per session,10–15 as described inthis study. Time and temperature are

both factors for optimizing hyperther-mia treatment,10 the results of this TUHwith CAB study.

Masunaga and colleagues studied thethermal clearance rate (TCR) of manydifferent types of tumors, using localhyperthermia.17 Tumors were heatedtwice per week for 30–60 minutes persession up to a total of 2–11 sessions.Blood flow in the tumors was evaluatedfrom the rate of TCR. Changes in TCRwere closely related to average tumor-center temperature, changes in tumornumber (as evaluated by CAT scan), andtumor response.

When smaller and more superfic ialtumors were treated by hyperthermia,c omb i n e d w i t h r ad i a t i o n a n d/o rchemotherapy that consis ted of manyheating sessions, and during which a highaverage tumor-center temperature wasachieved, a better tumor response wasobtained. The better the tumor responsewas, the higher the local control ratebecame. The specific survival rates ofpatients who had good tumor responseswere higher than those of patients whohad poor tumor responses.17

It is clear that higher intratumor tem-perature and maintenance of intratumortemperature for a longer per i od of time can achieve greater results. Unlikes u rg e r y an d r a d i a t i o n , TUH a l s oenhances immune function, inducesapoptosis in PC cells only, and producesHSPs that assist in tumor recognition byunshielding tumors and making themmore susceptible to immune-systemattack.

TUH also significantly lowers PSA tonormal levels in patient responders asreported previously.10,12 While 3 sessionsof hyperthermia reduced signs and symp-toms of PC in 53 percent of patients with

ALTERNATIVE & COMPLEMENTARY THERAPIES—JUNE 2002 155

Higher intratumor temperature and maintenance of intratumor temperature for a longer period of time can achieve greater results.

advanced PC in these studies, no com-plete remissions were reported, although2 of the 15 patients had bone metastasesdisappear.

This TUH with CAB study showed that31.6 percent of patients with advancedPC had complete remissions, 20.5 percenthas partial remissions, and 21.3 percenthad no progression of disease.

Future Research

Because all patients at early stage PC inthis study responded to this treatmentprotocol with 100-percent remission inthis group, the authors agree that TUHwith CAB is an excellent first-line thera-py with far less risk than more aggressivetherapy involving prostatectomy. Whilethe results patients with later stage PCwere still as good as or better than con-ventional therapy, there are also fewerside-effects associated with this treat-ment. In addition, unlike what occurswith adjuvant chemotherapy and radia-tion, patients do not appear to developresistance to subsequent treatment if thisbecomes necessary.

However, it is important to find waysto increase the remission and responserate in patients with la ter-stage PC.Immunotherapy may be the missing linkas reported by Szmigielski,15 and, inGermany, there are many product sapproved for augmenting immune func-tion in patients with cancer. The addi-tion of immunotherapy to this treatmentprotocol has yielded promising resultsat the Klinik St. Georg for patients withlate stage PC. Immunotherapy is used aspart of the clinic’s protocol for treatingmany types of early and late stage can-cer, producing excellent results. Futureresearch will be directed toward adding

immunotherapy to the treatment proto-col for patients with later stage PC, withthe hope of achieving statistically signif-icant results. n

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Friedrich R. Douwes, M.D., is the founder anddirector of the Klinik St. Georg IntegrativeCancer Treatment Center, Bad Aibling, Ger-many. Shari Lieberman, Ph.D . , C .N.S . ,F.A.C.N., is a research scientist and industryconsultant in New York City.

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There are fewer side-effects associated with this treatment.