Are you concerned about prostate health and confused about all the recent controversies? You’re not alone; prostate health can be difficult to sort out. Issues related to the prostate, including cancer, are increasing; and they generate a series of questions, some of them currently unanswerable. With recent data challenging the prostate specific antigen (PSA) test’s efficacy, what are the alternatives? And even when a biopsy confirms cancer is present, where do you go from there?
These issues are of great importance. According to the American Cancer Society, about 239,000 men will be diagnosed with prostate cancer this year; more than 29,000 are estimated to die annually of the disease. In fact, North America has one of the highest prostate cancer rates in the world. Other related conditions, such as prostatitis and benign prostatic hyperplasia (BPH), cause pain and discomfort and reduce quality of life.
The Reality Of The PSA Test
The PSA test has been the gold standard for monitoring prostate health for many years. Under normal circumstances, PSA is a protein produced by the prostate gland in very small amounts. A rising PSA beyond normal limits indicates a need to investigate the prostate further. Elevated PSA, in addition to indicating possible prostate cancer, can also result from chronic inflammation and infection, posing another complication in interpreting PSA results.
For many years, the PSA test was considered a lifesaver. However, new research suggests that widespread testing does not necessarily improve prostate cancer outcomes. There are many reasons for this.
First, the PSA test does not measure prostate cancer aggressiveness. Many prostate cancers grow slowly and may never pose a threat to life or health. Still, a relatively benign cancer can mutate into a more aggressive form over time, particularly if exposed to high oxidative stress, environmental toxins, heavy metals and an abnormal hormonal profile, including a high estrogen-to-testosterone ratio.
Furthermore, the PSA test may not reveal the early development of aggressive cancers. In other words, the test may be too quick to detect slow-moving cancers and too slow to detect aggressive ones. So the level of PSA may not actually reflect the extent of disease and can sometimes be misleadingly low.
Clinical Implications
This does not mean that the PSA test lacks clinical significance. Rather, it means that the test must be taken in context with complementary diagnostics, patient history and the nature of PSA test results. For example, clinicians should understand the variability of the test. PSA results can be influenced by medications, seasonal variations, time of the day the test is performed, recent sexual activity, intense exercise like bicycle riding and, very importantly, the size of the prostate. Benign enlargement of the prostate known as BPH (benign prostatic hypertrophy) can result in a higher reading that does not indicate cancer. In repeated testing, it is also very important to perform the tests at the same time of day and with the same laboratory; methods for detecting PSA vary from one lab to another and make comparisons tricky.
When treating a prostate cancer patient with elevated PSA or when seeing a patient with prostate complaints and elevated PSA, I consider it useful to follow up on the PSA, but I don’t rely on it. The PSA can be lowered by reducing the prostate volume, by decreasing inflammation or by eliminating prostate infections. Reducing inflammation of the prostate is an essential component of strategic prostate cancer treatment; it reduces the risk for mutations into a more aggressive cancer and lowers the risk of metastasis.
There are many other diagnostics that can provide important context for the PSA. Prostatic acid phosphatase (PAP) is a more traditional prostate test that complements the PSA test. PAP elevation may indicate that prostate cancer has metastasized to the bones and generally can point to a tendency for a more aggressive cancer to develop even in the absence of evident metastasis.
Hormone Testing
I consider extensive hormone testing to be critical for providing a more complete individualized picture of the possible influences affecting the prostate. For example, men with higher testosterone levels respond more favorably to treatment. Estrogen is also a factor: Increasing levels of the hormone in men can correlate with increases in prostate cancer, as well as more aggressive disease. This is also true of prolactin. Patients should also be tested for the hormones progesterone, DHEAS (Dehydroepiandrosterone sulfate) and DHT (dihyrdrotestosterone, a metabolite of testosterone that is stronger and leads to stimulation of prostate cells). Botanical compounds, nutrients and other approaches can then be used as needed to help reduce excessive hormonal influences.
Other Diagnostics
There are a number of important, non-hormonal markers that are also part of my testing protocols. Carcinoembryonic antigen (CEA) or insulin-like growth factor type-1 (IGF-1) levels, if elevated, may indicate cancer aggressiveness or other underlying conditions needing attention.
Prostate cancer gene 3 (PCA3) test, a recently developed gene-based test, can help elucidate a patient’s risk for prostate cancer. This is a simple test done by collection of a urine sample following a digital rectal stimulation by a doctor or practitioner. This test can be used to follow up low volume and low Gleason score prostate cancer and may replace the risky practice of annual biopsies as part of the watchful waiting/active surveillance approach. Other genetic tests of the biopsy tissue itself are becoming available; they can provide further information about aggressiveness on a gene expression level.
In addition, imaging should play a key role in diagnosing and staging the disease. MRI, MRI-S, PET, CT, color Doppler ultrasound and bone scans can all help determine the severity of the cancer. The field of prostate cancer imaging is constantly evolving with newer, more accurate methods in development. One of the key principles in addressing prostate cancer is maximum diagnosis and minimum intervention.
An Active Bio-Marker
Galectin-3 is a protein produced in a number of sites in the body. This protein is becoming increasingly recognized as an important marker for, as well as a promoter of, many chronic diseases. When present at normal levels, galectin-3 regulates cellular growth and cell-to-cell communication. However, elevated galectin-3 levels are produced at sites of inflammation and injury and can indicate a number of disease conditions, including cardiovascular disease and cancer. Galectin-3 is pro-inflammatory and is actively involved in numerous processes related to inflammation, fibrosis, tumorigenesis, proliferation and metastasis.
Because galectin-3 aggressively fuels chronic inflammation, it can also serve as an active marker for prostatitis and BPH. These conditions reduce quality of life and also put patients at greater risk for cancer.
A study published in 2009 in The American Journal of Pathology showed that reducing levels of galectin-3 inhibited prostate cancer metastasis. Furthermore, Modified Citrus Pectin is currently gaining increased recognition in this area of treatment, because it is the only proven natural galectin-3 blocker available, and it is shown in clinical studies to benefit prostate patients.
Sorting Through The Signs
Maintaining a healthy prostate and treating the prostate can be challenging. Located deep in the pelvis, surrounded by muscles and nerves, the prostate can be difficult to reach surgically. In addition, its close proximity to the urethra, bladder and important nerves increases the chance of collateral damage from treatments and procedures. To complicate matters, prostate conditions can be indistinct and difficult to diagnose. The significance of the standard PSA test is being questioned, and there are currently no alternative tests or simple answers to this evolving controversy.
My feeling is that the PSA test has its use in the context of a more complete evaluation. Working with a skilled health practitioner who has experience in integrative prostate care can help you sort through these issues and design an individualized program to benefit prostate and overall health for the long term.
