John Kofel was devastated when a biopsy last October showed he had metastatic prostate cancer. Having had a daughter diagnosed with breast cancer in her 30s, he knew firsthand the nightmare cancer can become.
After Kofel made a follow-up visit to an oncologist, his mood changed from shock to anger, not that he had cancer, but at his doctor.[related_articles location=”left” show_article_date=”false” article_type=”automatic-primary-section” curated_ids=””]“He was very discouraging, in general,” Kofel recalled. “‘You might have 31 months to live.’ … Leaving, I was clearly dazed. I thought, ‘I’m a dead man.’”
He also knew that doctor wasn’t for him. (Memo to all cancer patients: If you learn nothing else from this ongoing journal, make sure you have doctors fighting for you.)
Kofel soon after sought a second opinion and was referred to Dr. Edward (Ted) Eigner, of Urology Associates, who changed his life.
“It was like night and day,” Kofel said. “He said, ‘Yes, you have metastatic cancer, but it’s a very solvable, meaning controllable, issue. … It’s very treatable.’”
The bioposy of his prostate, after all, showed only four of 12 samples positive for cancer, with a spread to the pelvic bone and one femur. With newfound optimism, Kofel became obsessed about researching a game plan to fight the cancer. He revamped his diet, including what he drank (now exclusively alkaline water), and began taking a list of supplements that fills an 8- by 11-inch notebook page — single spaced. And, in December, he began ingesting oils derived from marijuana plants.
“I’m trying to leave no stone unturned, attacking it from all sides,” Kofel said.
The cannabis oils he uses contain concentrated amounts of two plant compounds: tetrahydrocannabinol (THC), the psychoactive component of marijuana that gets you high, and cannabidiol (CBD), a non-intoxicating substance that has gained fame for its purported medicinal benefits.
“The combination of both (CBD and THC) causes apoptosis; cannabis tends to go to cancer cells weakened due to chemotherapy and causes them to kill themselves,” Kofel said.
“There is data to suggest cannabis can kill cancer cells in the lab,” said Cindy O’Bryant, a professor at the University of Colorado Skaggs School of Pharmacy. “It appears to affect cancer cells and not normal cells, unlike chemotherapy does, but this is happening in a dish, in the lab, not the human body. Getting it in people to see if it has an effect, therein lies the problem.”
The truth is, as much as is known about cannabis and its effects on the human body, little is known regarding its safety and effectiveness in fighting cancer.
Interest on the rise
Drive west toward Denver when exiting the University of Colorado Cancer Center in Aurora, and you’ll soon pass a marijuana dispensary, Altitude, on your right. A dozen or so more dispensaries dot Colfax Avenue before you reach downtown.
In a state where marijuana has become omnipresent, perhaps it’s not a surprise that 53 of 185 cancer patients who filled out a recent survey at the CU Cancer Center said they use some type of marijuana product. That’s 28.6 percent, almost double the rate of marijuana usage of those 18 years or older in Colorado (17 percent), according to CU. The voluntary, anonymous survey, conducted by O’Bryant, showed the vast majority of the patients (81 percent) who use marijuana are doing so to treat side effects of their cancer treatment, such as fatigue, loss of appetite, irregular sleep and pain. Around 19 percent say they are using marijuana to treat the cancer itself.
Interest in the issue is clearly on the rise.
“We’re getting more and more questions about it as regulatory issues become more relaxed,” O’Bryant said. “Not necessarily older patients who are asking, but sons and daughters are asking about it.
“Patients view it as a natural product, so it’s safe, but we really don’t know how it interacts with other drugs.”
She would like to know, as would many of her colleagues, but with the federal government having classified cannabis as a Schedule I drug in the Controlled Substances Act, research hospitals such as CU are stymied.
“Our neurology department has been a big supporter (of research),” O’Bryant said. “We would like to do more research in current cancer patients. But there are a lot of hoops to jump through. To work with the FDA, to bring a drug to market, we have to take on liability… We get federal funds, so there’s always trepidation research funding could be negatively affected.”
Uncertainty and confusion
One of the most frustrating aspects of having cancer is the uncertainty: the uncertainty of what will happen next, yes, but also the uncertainty of which drug sequencing or treatment option offers the best hope. Often it’s simply a gut call, a best guess. You can now add “Could cannabis possibly help?” to the list.
Confusion about cannabis and cancer is deepened by a lack of scientific evidence, despite wild, anecdotal claims of its curative powers found on the internet.
For now, Kofel, who lives in Aurora, will keep doing what he’s doing. Twice a day, he takes CBD and THC oils orally via a dropper. He gets the oils, which are bottled as a tincture, from a local provider.
“Do your homework; get good stuff from reliable people,” said Kofel, 72, who has a medical marijuana card.
Upon his diagnosis last fall, he was immediately put on Lupron, a drug used to reduce the production of testosterone, which feeds prostate cancer, and lower a man’s prostate-specific antigen (PSA). He soon after underwent chemotherapy (docetaxel), six rounds. His PSA has dropped from 82 to 0.22. (PSA is a protein produced by the prostate; any number above 4.0 is cause for concern.)
“My doctor told me, ‘Whatever you’re doing, it’s working,’” he said.
He’s planning to start radiation Monday to deliver what he hopes is a final, knockout blow.
“No one is using the word cure,” Kofel said. “But my mind-set is I can cure this.”
Web site: curetoday.com
Book: Being Mortal: Medicine and What Matters in the End, by Atul Gawande
One of an occasional series about cancer, from a patient’s perspective.
This story was first published on DenverPost.com
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