Active surveillance

is often used to mean monitoring the cancer closely, with a plan to treat it if tests show it’s starting to grow more quickly. Usually, this approach includes doctor visits with a prostate-specific antigen (PSA) blood test about every 6 months and a digital rectal exam (DRE) about once a year.



Prostate biopsies and imaging tests may be done every 1 to 3 years as well. Exactly how often tests are done can be tailored to some extent, based on each man’s situation and preferences.

If test results change, you have to start with the treatment options to try to cure the cancer on as earlier possible stage.

Observation (watchful waiting)

is sometimes used to describe a less intense type of follow-up that includes fewer tests and that relies more on changes in a man’s symptoms to decide if treatment is needed. This is more likely to be a good option for men who are older and/or have other serious health problems.  

Chemo drugs for prostate cancer are typically given into a vein (IV) as an infusion over a certain period of time. There are some drugs, which are given as a pill.

Sometimes, a slightly larger and sturdier IV might be put into a vein to give chemo.

These are known as central venous catheters (CVCs), central venous access devices (CVADs), or central lines.

They are used to put medicines, blood products, nutrients, or fluids right into your blood.

They can also be used to take out blood for testing. There are many kinds of CVCs available. The most common types are the port and the PICC line.

Chemotherapy is given in cycles, with each period of treatment followed by a rest period to give patient time to recover from the effects of the drugs.

Cycles are most often about 3 weeks long. The schedule varies depending on the drugs used.

Some drugs (the chemo) is given only on the first day of the cycle. With others, it is given for a few days in a row, or once a week.

Then, at the end of the cycle, the chemo schedule repeats to start the next cycle.

How long patient will be given chemo depends on how well it’s working and what side effects patient might have.

Chemotherapy uses powerful cancer-killing medicine to treat cancer. There are several ways of chemotherapy to treat lung cancer:

• given before surgery to shrink a tumour, which can increase the chance of successful surgery (this is normally used and done as part of a clinical trial)
• given after surgery to prevent the cancer returning
• used to relieve symptoms and slow the spread of cancer when a cure is not possible
• combined with radiotherapy
• Chemotherapy treatments are usually given in cycles.

A cycle involves taking chemotherapy medicine for several days, then having a break for a few weeks to let the therapy work and for your body to recover from the effects of the treatment.

The number of cycles you need will depend on the type and grade of lung cancer.

Most people need 4 to 6 cycles of treatment over 3 to 6 months.

Prostate cancer is one of the most common types of cancer in men, most often affecting middle-aged and elderly men. Prostate cancer develops slowly and may progress for years without any symptoms; the initial manifestations of the disease appear at stage 2 or later. The primary diagnostic measure for suspected prostate cancer is a PSA blood test. If the result is unsatisfactory, the team of specialists from The Zdenko Kos Foundation and doctors from the hospital where you will be admitted will additionally perform magnetic resonance imaging (MRI) and a transperineally MRI-guided prostate biopsy.

Most clinics perform a transrectal puncture biopsy of the prostate gland. However, it provides doctors with an accurate diagnosis in only 30-35% of cases, so the medical team prefers a transperineally MRI-guided biopsy. With this method, the reliability of diagnostic data reaches 100%. This approach allows the patient to avoid unnecessary invasive procedures.

To detect prostate cancer metastases, the department's doctors use Ga-68 PSMA PET/CT instead of a CT scan and bone scintigraphy, which not so long ago were considered the standard methods of prostate cancer staging. It has already been proven that, among all diagnostic methods, Ga-68 PSMA PET/CT allows for the most accurate detection of prostate cancer metastases in any location.

Standard and innovative prostate cancer treatments are divided in three treatment groups:

• Treatment of prostate cancer and bladder cancer
• Irreversible electroporation (IRE)
• Combination treatment with irreversible electroporation and electrochemotherapy (IRECT)
• Combination treatment with irreversible electroporation and immunotherapy
• Photodynamic therapy (PDT)
• Combination treatment with photodynamic therapy and immunotherapy
• Treatment of benign prostatic hyperplasia
• GreenLight laser therapy
• Rezum water vapor therapy
• Other treatment methods

As for the treatment of prostate cancer, the Zdenko Kos Foundation is proud to offer patients innovative and minimally traumatic methods to combat oncology. The gold standard of prostate cancer treatment is a prostatectomy (prostate removal surgery). For patients with unresectable tumours, doctors offer irradiation. The department's doctors use revolutionary new types of treatment, the effectiveness of which is comparable to prostatectomy and radiation therapy. At the same time, these new treatment procedures help the doctors eliminate the development of complications after the completion of therapy, namely erectile dysfunction and urinary incontinence, which are almost unavoidable with classic prostatectomy or radiation therapy.

NanoKnife irreversible electroporation (IRE):

Is a promising low-traumatic method for prostate cancer treatment, and the medical team working with The Zdenko Kos Foundation have vast experience in its use. The essence of the method consists in the selective ablation (destruction) of cancer cells by the powerful electric field of the NanoKnife device.

The medical team specialists at different hospital working with The Zdenko Kos Foundation around the Europe have successfully performed more than 4,200 IRE procedures. This method provides excellent results and helps patients with advanced stages of prostate cancer.

Irreversible electroporation is performed under general anaesthesia, does not require extensive tissue incisions, and is more than just tolerated. Unlike prostatectomy and radiatiotherapy, IRE practically eliminates the risk of erectile dysfunction. Also, during the entire period of application of this treatment method, none of the patients developed postoperative urinary incontinence. Normal hospital stay for IRE treatment is only 3 days.

Irreversible electroporation and electrochemotherapy (IRECT):

for patients with prostate cancer. In these cases, the effect of the IRE procedure is enhanced by simultaneously applying electrical current and low-dose chemotherapy to cancer cells. Irreversible electroporation increases the permeability of the cell wall, which allows chemotherapy drugs to easily penetrate cancer cells and effectively destroy them. The combination IRECT method may be indicated for patients with high-grade tumours, patients with cancer that has invaded the rectum or bladder wall, and patients with complex focal prostate cancer recurrences after surgery, HIFU, or radiation therapy.

Irreversible electroporation with immunotherapy treatment:

In this case, the effect of IRE is enhanced by activating the patient's anti-cancer immunity. The immune system is "trained" to recognize cancer cells by antigens located on their surface. During irreversible electroporation, tumour antigens are released in large quantities, and it is easier for the immune system to recognize them, subsequently destroying the cancer cells.

Photodynamic therapy (PDT):

Is regularly performed for the treatment of prostate cancer and bladder cancer. This treatment uses photosensitizers and light sources of a certain length. The photosensitizer accumulates in the cancer cells and does not threaten healthy tissues. After the accumulation of the photosensitizer, the tumour is irradiated with light of a certain wavelength. As a result, chemical processes are launched that lead to the formation of active oxygen radicals. Oxygen radicals are toxic to cancer cells, so they can easily destroy them. In addition, PDT triggers an anti-cancer immune response by causing dying tumour cells to release specific antigens that the patient's immune system recognizes, resembling a vaccination mechanism. Tumour antigens allow the natural killer cells of the immune system to recognize and eliminate tumour cells in the patient's body.

Benign prostatic hyperplasia - GreenLight laser therapy and the Rezum procedure:

If untreated, the disease causes serious bladder voiding dysfunction, frequent nocturnal urination, and elevated PSA levels in the blood, which in turn potentially threatens the development of prostate cancer.

Minimally invasive procedures for prostate adenoma treatment are GreenLight laser therapy and the Rezum procedure.

The hospital stay for such treatments is 1-2 days.

Unlike the standard transurethral resection of the prostate, GreenLight and Rezum are bloodless procedures. In addition, innovative GreenLight and Rezum treatments eliminate the risk of developing erectile dysfunction and urinary incontinence.



Integrative complementary and alternative medicine (CAM) methods work efficiently along with standard chemotherapy, radiation therapy, immunotherapy, etc.

CAM therapies are mainly pointed at the following aims:

• Enhancing action of the conventional treatment methods, restoring patient`s own immune system
• Prevention or alleviation of unpleasant side effects of the conventional treatment methods
• Prevention of tumour dissemination
• Prevention of disease relapses
• Adherence to healthy lifestyle principles (eating habits, physical activity)
• Adherence to anti-stress activities
• Improving patient`s quality of life in general

For most patients CAM methods seem to be more attractive than the traditional medicine ones, as they are mainly natural, don`t have serious side effects and provide additional benefits during the course of traditional treatment. However, each treatment method or medical product may have individual risks, and CAM methods are not an exception.

Each new treatment method should be considered individually, but there are certain common principles for all CAM methods:

You should always remember that terms “natural” and “safe” are not 50:50. Each method should be discussed with your treatment physician in advance. Even in case some of your acquaintances has already successfully applied the method, this doesn`t necessarily mean, that you`ll receive the same result. The response is strictly individual, you should not forget about this.

You should investigate factors that affect safety of the desirable CAM method. If this is a product, like an herbal supplement or homeopathic remedy, you should check availability of high-quality product in your country and avoid counterfeit remedies. Also, action of some products may interfere with the effect of other drugs, both prescription or over the counter.

If we are talking about physical practice, like acupuncture, massage or chiropractic care, you should pay attention to the qualification of the correspondent healthcare practitioner. Your complementary healthcare practitioner should be ready to work in one team with your primary healthcare provider (oncologist, radiologist, surgeon).

You should investigate independent information on the effectiveness of the desirable CAM method. Unfortunately, statements of manufacturers or providers of CAM approaches may be based on the somewhat biased view of the scientific data. It is always better to search for clinical trials` results and look at independent reviews. If the provider or manufacturer offers “guaranteed cure for all patients” or “secret effective ingredient”, it is highly unlikely to find the scientific data and evidence-based approach underlying this method.

CAM methods include principally diverse techniques, so a qualified physician always has several options and possibility to elaborate individual treatment scheme. The most widespread methods with proven effectiveness are described below.

Some patients would like to believe in the effectiveness only of non-official and non-conventional methods of treatment. Such treatments leads to unfavourable results:

• Absence of therapeutic effect
• Missing time and late treatment start
• Disease progression with metastasis to distant organs

Healthy nutrition and dietary supplements

Nutrition allows to maintain a healthy body mass. This is important, as patients with cancer often lose weight, sometimes up to cachexia development, when a tumour consumes huge amount of the essential nutrients.

Competent dietary changes decrease fatigue from radiotherapy or chemotherapy, as these treatment methods kill certain number of healthy cells, as well. They help patients to get necessary energy and go through the treatment successfully.

Dietary supplements and nutrition changes support natural digestive process, often disturbed due to cancer intoxication and medications` side effects. They alleviate nausea, acid reflux, discomfort in the abdomen, and gas formation.

Melatonin as supplement, is more than helpful in sleep disturbances. Along with providing healthy sleep and good restoration of the organism during the night, melatonin positively influences function of the immune system responsible for fighting against cancer.

Vitamin D and calcium are important for maintaining good state of bones. Calcium exchange and vitamin D level are disturbed by both oncological process and side effects of treatment.

Restoring these parameters significantly improves state of skeleton and long-term results of treatment. In addition, vitamin D influences cell growth, improves immune function, and reduces inflammatory responses.

There is no strict and standard diet for all patients with lung cancer. And even more, individual need in nutrients may change during the course of treatment. Dietitians and nutritionists elaborate individual dietary plan for each clinical situation and adjust it to the patient`s current needs.

The general recommendations for all patients would be:

• You should have 5-6 small meals during the day rather than 2-3 large meals. It is better to have at least a small snack once you feel hungry.
• You should eat at the table and avoid lying down immediately after the meal. This will help in fighting against acid reflux and stimulating normal digestion process.
• You should give preference to high-calorie food and drinks and avoid non-nutritious ones. The volume of food you can eat per meal is limited, so it is better to provide organism with maximum amount of necessary nutrients.
• If you have problems with stool, namely constipation, it will be useful to eat high-fibre foods. This group of foods includes berries, avocados, peas, apples, bananas, carrots, etc.
• Your food should always be tasty, so you may use herbs and spices during cooking.

Homeopathic remedies

Homeopathic remedies include extremely small doses of certain plant extracts and minerals, which help in restoring natural ability of the human body to fight against cancer cells. Another name of the modern homeopathic approach is homotoxicology. This means that homeopathic remedies induce exacerbation of the disease symptoms and thus lead to enhancing body’s natural protective mechanisms.

A number of clinical trials has been conducted in order to investigate effectiveness and safety of homeopathic treatment. For example, results of preclinical Indian in vitro (performed in the laboratory conditions) study showed that homeopathic Sulphur induces apoptosis (destruction and death) in non-small cell lung carcinoma cell line. Sulphur is totally non-toxic substance, which is normally present in many food products – cabbage, broccoli, garlic and onion, fish, meat, eggs, etc. Nevertheless, once carefully transformed into the homeopathic remedy, Sulphur obtains surprising ability to destroy non-small cell lung carcinoma cells on the molecular level.

Although homeopathic remedies are natural and non-toxic, the treatment should be performed only by qualified homeopath. Administration of wrong drug or incorrect dose can minimize curing potential of the remedy or, vice versa, cause to strong and serious exacerbation of the symptoms. It is also important to estimate the most intricate peculiarities of the treatment effect and adjust treatment scheme in a proper way.

Beta-glucans administration

Most healthcare professionals, which closely deal with oncological disorders, state that cancer is primarily a disease of the immune system. Indeed, hundreds of oncological cells daily arise in human organism, but strong and healthy immune system successfully eliminates all of them. Impaired immune system fails to kill pathologically changed cells and tumour arises. Thus, enhancing the immune system is the essential part of anti-cancer treatment. When talking about non-chemical remedies, beta-glucan is the most effective immunomodulatory substance.

Beta-glucans have been administered in terms of immunoadjuvant therapy for cancer for decades, but this potent remedy is available only in limited number of countries. Technically beta-glucan is a component of cells walls in fungi, yeast, grain and seaweed. This is a large molecule, which is not totally digested in the gastrointestinal tract. Beta-glucans are captured by the cells of the intestine and are actively transported to the inner intestinal layers, where white blood cells are located. Beta-glucans activate particular white blood cells, namely macrophages and lymphocytes, which are responsible for the cellular and humoral (with the help of antibodies) immunity providing. More beta-glucans are obtained from the blood, more defence mechanisms are activated. Finally, significant amount of activated white blood cells becomes capable of fighting against lung cancer.

Important and highly favourable feature of beta-glucans administration is a natural character of the immune response. Beta-glucans are immunomodulators, not immunostimulators. This means that there is no risk of the immune system overstimulation, which can lead to the development of autoimmune disorders. Safety and clinical potential of beta-glucans have been researched in numerous clinical trials in different countries. This molecule is the most investigated natural immunomodulator all over the world.

Positive clinical effects of beta-glucans are not restricted to anti-cancer immunity stimulation. Beta-glucans simultaneously prevent metastasis, reduce stress, stimulate healing of the wounds, lower levels of blood sugar and cholesterol, and protect against concomitant infections. Sources of beta-glucans are quite widespread; the question is only in technical complexity of manufacturing high quality product.

Integrative medicine in lung cancer

Herbal supplements

Using herbal supplements for the lung cancer treatment has transformed into the separate branch of medical science – herbal medicine (or phytomedicine). Herbal medicine uses different parts of plants, decoctions, extracts or complex mixtures of diverse plants. Modern pharmaceutical industry actively uses herbal drugs, as well. The difference is in the way of handling the vegetable material. Herbalists (specialists in herbal medicine) prefer to preserve delicate natural chemical balance of the plant, not extracting separate active ingredients. There are few types of herbal medicine, as this science has been known in different countries for many centuries. The main schools of the herbal medicine is the Chinese.

Chinese herbal medicine is a significant part of a complex treatment approach – Traditional Chinese Medicine (TCM). Along herbal medicine, TCM includes acupuncture, massage, and breathing and movement exercises. Main idea of TCM is restoring the disturbed by lung cancer flow of energy in a patient`s body. Herbalists from this school believe that different plants affect different parts of the body or different energy channels.

There are more than 133 herbal substances that have been used in TCM to fight against lung cancer.

Herbal medicine uses different forms of vegetable remedies depending on the desirable effect and point of application.

The most common remedies:

• Tinctures – alcohol solutions of different plant parts
• Tablets with active substance in a powder form
• Dry and liquid filled capsules
• Raw herbs, that are prepared right before the intake in the form of tea
• Creams or ointments for the external use (as a symptomatic treatment or in case of complications)

Some of herbs are used solely on the basis of long-term empirical experience; action of others has been investigated in case studies and clinical trials.

The most commonly administered herbs (mainly from Chinese and Indian medicine) include:

• Astragalus. Roots of this plant appear to inhibit tumour growth and spreading. One more positive effect is enhancing action of chemotherapy and reducing its immunosuppressive properties.
• Nan Sha Shen (American silvertop root) has antibacterial properties and helps in fighting concomitant infections. This plant reduces inflammation and lowers level of cancer-promoting compounds in blood, as well.
• Gan Cao (licorice root) is administered for the symptomatic treatment, as it relieves cough and shortness of breath.
• Poria (fu ling) is also a herb for symptomatic treatment. Poria acts like natural diuretic and helps patients with oedema. In addition, it improves night sleep.
• Oldenlandia diffusa (snake-needle grass) has pronounced anti-cancer action. First of all, it directly kills cancer cells. In addition, it helps own immune system of a patient to find and destroy oncological cells. Few studies have demonstrated anti-inflammatory effects of Oldenlandia diffusa, as well.
• Asparagus root action has been investigated only on mice. Nevertheless, it has shown anti-cancer activity in mice with lung cancer.
• Rasagenthi Lehyam has also demonstrated anti-cancer properties – its compounds suppressed cancer cells multiplication and caused their death (apoptosis).

There is also "medical marijuana" which stands aside herbal medicine. Compounds of this herb (cannabinoids) enhance work or central nervous and, which is more important, immune system. Several studies have shown that cannabinoids are effective in treatment of nausea and vomiting, frequent side effects of radiation and chemotherapy. Also cannabinoids stimulate appetite in patients with cancer intoxication and cachexia. It should be noted, that despite all medical benefits use of cannabinoids and marijuana is illegal in certain countries.