Prostate cancer is the second most common cancer ^a and the fifth leading cause of cancer death in men ^b worldwide. In the United States, it is the most prevalent cancer and the second leading cause of cancer death in men ^c . The five-year overall survival in metastatic prostate cancer patients aged ≥ 75 years is 13.6% ¹ . Androgen deprivation therapy (ADT), either by means of bilateral orchiectomy or the administration of a gonadotropin-releasing hormone (GnRH) agonist or antagonist, is the mainstay of treatment for metastatic prostate cancer ² . In most metastatic prostate cancer patients, ADT is initially effective, but its response is not sustained and patients ultimately progress to castration resistance ³ .

In recent years there has been a growing awareness of oriental meditative approaches for health and wellness in the West. Deeply rooted in thousands of years of Chinese cultural history, Qigong is a traditional Chinese mind-body practice that uses qi (vital energy) and consciousness cultivation to achieve an optimal health state. Falun Gong (FLG) is a unique type of ancient qigong practice based on the principles of “truthfulness–compassion–tolerance”. The practice of FLG includes reading the main teachings, Zhuan Falun ^d and performing five sets of slow, gentle, meditative exercises ^e .

Recently, we prospectively followed a terminal stage IV prostate cancer patient in his eighties, who relapsed after ADT and then began practicing FLG. This is the first well documented castration-resistant prostate cancer case whose survival was significantly prolonged after practicing FLG.

An 80-year-old Chinese man was a retired professor at a university in the USA. He presented to a urology clinic in 2014 complaining of bone pain, fatigue, and an elevated prostate specific antigen (PSA; ranging from 94.7 to 126.6 ng/ml; normal range: 0.6–12.4 ng/ml for 75–79 years born in China ⁴ ) for one year. He had a 20-year history of hypothyroidism treated with Synthroid™ (75µg/day), a hernia operation in 2003, and an implanted pacemaker in 2011. He had been diagnosed with benign prostate hyperplasia in 2004 and his baseline PSA values ranged from 4.1 to 8.6 ng/ml between 1996 and 2006. There was a family history of cancer. The patient required the aid of a walker to ambulate. Digital rectal exam (DRE) revealed a “very hard, very nodular and fixed prostate.” PSA was 468 ng/ml on presentation. Transrectal ultrasound image showed the prostate to be 63×57×53 mm ³ with disrupted capsule, abnormal inhomogeneous peripheral zone, scattered calcifications, and no median lobe. The prostate biopsy pathology report revealed an adenocarcinoma with a Gleason Score 9 (4+5 or 5+4) in all lobes with 40–80% cancer infiltration ( Figure 1). Whole-body bone scan was highly suspicious for numerous osseous metastases in the lumbar and thoracic spine as well as in the left iliac bone of the pelvis, some areas of the sacrum and in the left 9th rib ( Figure 2). CT scan findings were consistent with the bone scan ( Figure 2). The patient was diagnosed with terminal stage IV, M1b metastatic prostate adenocarcinoma with extensive (≥5) bone metastases. His treating physician predicted that without effective treatment he would have a life expectancy of only 6 months.

The patient was started on degarelix (240mg, 80mg, 80mg at month intervals) and bicalutamide 50mg daily. Survival was monitored by symptoms and serum PSA. Quality of life (QoL) was assessed with the SF-8™ questionnaire ( Table 1). Psychosocial functioning was evaluated using an adapted, simplified six-part questionnaire that assessed the patient’s status of positive thinking, happiness, altruism, emotional control and purpose of life. All these parameters have been systemically researched in a number of mindfulness psychological studies and commonly used in psychosocial functioning outcomes ⁵ ( Table 2).

The patient’s bone pain was gone within 5 days. After five weeks, his PSA dropped to 4.5 ng/ml. At week 14, degarelix was replaced with leuprolide acetate at a dose of 22.5 mg quarterly. PSA levels remained at 0-0.2 ng/ml until week 68. At week 80, his PSA rose to 1.4 ng/ml, and his physician discontinued bicalutamide due to suspicion of cancer relapse. PSA continued to increase to 2.4 ng/ml at week 84 and to 3.7 ng/ml at week 89. ( Figure 3, Table 3)

The physician planned to use abiraterone acetate plus prednisone or enzalutamide if the PSA rose to 10 ng/ml. The patient was not pleased with either choice because of the increased risk of side effects and limited survival benefits. ADT was then discontinued. At week 89, the patient began practicing FLG. When he watched the FLG video for the first time, the patient reported that he felt as if substantial high energy matter was plugged into his two lower legs. He could sense the flow of energy and the warmth induced by the energy during practicing. In the past, during cold winter nights, the patient had a tendency to get cramps in his legs. To prevent this, he had been using a hot water bottle under the quilt while sleeping for many years. Soon after starting to practice FLG, the patient reported he did not need a hot water bottle anymore.

At week 94, the patient’s PSA reversed its increasing trend by dropping to 0.6 ng/ml ( Figure 3, Table 3). At week 106, he no longer needed the assistance of a walker. At weeks 130 and 133, no osseous metastases were seen on either CT or whole-body bone scan ( Figure 2). At week 151, DRE revealed that the prostate was softer and smaller than before.

Following ADT, the patient experienced adverse events including right foot swelling, wheezing, and hot flashes for about one year, all of which, the patient reported, had gradually disappeared after practicing FLG.

The patient’s QoL improved greatly with FLG practice ( Table 1). He was even able to go up a 14-step stairway without stopping halfway or developing shortness of breath with exertion on stairs he had before practicing FLG ( Extended data: Video S1). Additionally, the patient reported the following sequential trend of psychosocial functioning improvement: starting FLG practice, finding the purpose of life, developing positive thinking, having a better temperament, experiencing symptom improvement, feeling happier and less depressed, and becoming more altruistic ( Table 2). At week 219, based on the extended survival, absence of symptoms, disappearance of bone metastases, improved QoL and psychosocial functioning, his treating physician assessed that his prostate malignancy was “clinically, under control” and “his overall functional status is excellent.” The patient reported to be living a healthy life with good physical and mental status. He shared his experience as a terminal cancer survivor in the hospital support group as well as with the local medical community.

On week 228, the patient had a car accident which resulted in a severe neck injury and decreased ability to walk. On week 263, the patient was found dead at home from unknown causes. Three days before his death, he had spoken with us and denied any signs or symptoms of cancer relapse.

The case presented here is a castration-resistant metastatic prostate cancer patient in his eighties. Prostate cancer patients receiving ADT inevitably develop castration-resistance within a median relapse time of 18 months ⁶ due to prostate cancer cells developing mechanisms to proliferate despite castrate levels of testosterone. M1 castrate-resistant prostate cancer patients with a high number of skeletal metastasis (≥5) have a considerably poorer progression-free survival of 8.4 months and overall survival (OS) of 18.7 months, compared to patients with 1-4 bone metastases ⁷ .

The terminal prostate cancer patient in our case had a Gleason Score 9, a PSA of 468 ng/ml, and high number of bone metastases (≥5). Even with an initial response to ADT treatment, he still became castration resistant. After starting FLG practice, his PSA came down, he could walk independently, and his bone metastases disappeared within a short time frame. After developing castrate resistance and stopping ADT, he survived for an additional 174 weeks (40.6 months), which is far longer than the reported OS of 18.7 months in patients with similar clinical conditions ⁷ . The close temporal relationship between FLG practice and significant cancer improvement and the absence of any other treatment after starting FLG practice suggest that FLG practice resulted in a holistic and beneficial effect in this terminal prostate cancer patient. Moreover, the patient reported a good QoL free of cancer symptoms until he died of a non-cancer related cause, possibly due to the sequela of his severe car accident and/or his pacemaker-related cardiac condition.

As the pituitary-gonadal system is usually restored within 4 to 12 weeks after leuprolide acetate is discontinued ^f , the later rise in the patient’s most recent PSA level might reflect his baseline PSA levels of 20 years ago. Additionally, PSA levels are also known to increase with age. A cohort study (the Concord Health and Ageing in Men Project, CHAMP) involving a representative sample of 1434 eligible community-dwelling men with no diagnosis of prostate cancer reported a 5 ^th to 95 ^th percentile range of 0.6–12.4 ng/ml of serum PSA level in men aged 75–79 and born in China ⁴ .

While there are anecdotical testimonies from terminal cancer patients revealing they survived longer than expected after practicing FLG ^{8, 9} , this is the first case report documented with detailed medical records. According to the canon of traditional Chinese medicine, the Yellow Emperor’s Classic of Medicine, people may enjoy a long, disease-free life by cultivating the mind and following upright moral principles ¹⁰ . The emerging discipline of psychoneuroimmunology has begun to disclose the relationship between psychological, neurological and immunological systems. For example, eudaimonic well–being is found to be associated with decreased expression of transcriptional response to adversity profile involving inflammation mediated neoplastic diseases ¹¹ , decreased tumour growth and progression–related norepinephrine ¹² . The patient presented here experienced symptom improvement soon after reading Zhuan Falun and accepting the principles of “truthfulness–compassion–tolerance”, suggesting that the improvement of moral and spiritual character also plays a significant role in the improvement of health.

We describe in detail for the first time in the medical literature, the clinical course of a terminal prostate cancer case with relapse to ADT followed by FLG practice, an ancient Qigong practice originating from China. Most of the patient’s prostate cancer signs and symptoms disappeared quickly after FLG practice, accompanied with greatly improved psychosocial functioning and quality of life. We conclude that this terminal prostate cancer case gained clinical benefits through practicing FLG. Although the mechanism by which FLG practice caused improvement is not yet well understood, its effects are identifiable and measurable. Thus, the practice of FLG deserves more investigation by the medical community.

“My name is XXX. I had a teaching career as an Organic Chemistry Professor for 37 years at XXX before retiring in 2000. In May of 2014, I became a final stage, metastatic prostate cancer patient with bone pain, a 468 PSA, and an estimated life expectancy of less than half a year. I also required the aid of a walker to ambulate. After 19 months of androgen deprivation therapy (ADT), my cancer relapsed. Shortly prior to that relapse, I was very fortunate to have discovered a relatively new but rapidly growing mind and body cultivation practice known as Falun Gong that came originally from China.

On January 2016, I began to seriously engage in FLG cultivation practices involving reading moral teachings from a principle guidebook of Falun Dafa entitled “Zhuan Falun” and performing five different sets of Qigong exercises daily. A little over a month later, my PSA reversed its rising trend and dropped immediately to 0.6. Three months after that, I took my last Lupron treatment, thus ending the ADT therapy. After another five months, a new bone scan revealed the disappearance of metastases lesions. Today, I have been off any medicine, including cancer fighting medicine for 22 months. I am a healthy person with normal quality of life, no bone pain, full of energy, better tempered, more optimistic and positive. My own experience so far has demonstrated to my own satisfaction that cultivation of mind and body through practicing Falun Gong can be an effective healing and cost-effective way of combating cancer which is also free of undesirable side effects…

The magical effect of practicing Falun Gong had on my health made me appreciate the importance of elevating one’s moral character to be in tune with the fundamental characteristics of the universe, namely, truthfulness, compassion, and tolerance. It also made me realize that there may very well be a set of supernormal science on human body that is quite unique, subtle, and highly deserving of greater attention and further studies by modern scientists.”

Patient’s Signature, July 2018

Wednesday, July 2018: Patient seen on July XX. Overall, he is doing well. He is not depressed. He has no pain. He is currently on no medical therapy for his prostate cancer. He is optimistic and functional. All other systems reviewed and otherwise negative.

Assessment: Prostate malignancy: Clinically, under control. His overall functional status is excellent. Patient is comfortable with his spiritual approach to care.

Written informed consent for the publication of this case report and any associated images was obtained from the patient before his death.