A PSA test measures the level in the blood of prostate specific antigen, an enzyme produced by the prostate gland. It is generally used as an initial screening test to detect prostate cancer. Like so many serum tumor markers, PSA is produced by both normal and cancerous glands. In men with prostate cancer, the serum levels can be elevated with both localized and advanced or disseminated disease. PSA levels are generally proportional to the volume of the cancer. Like any laboratory test, there is a significant overlap between PSA levels found in cancer and benign prostatic hyperplasia. Thus, it is important to obtain sequential levels in low or borderline elevated values. A rise in the PSA level as compared to an earlier measurement is an ominous sign. If you have an interest in a natural supplement that has a number of herbs and nutrients for prostate health, see Prostate-Power-Rx.
   Different PSA assays give different results on the same blood sample. This is an obstacle to recommending uniform PSA limits for prostate biopsies. Therefore, if you have a PSA test done in one lab, it is quite possible that another lab may give you a different reading which could vary by up to 20 to 30 percent.

Monitoring PSA level for Prostate Cancer
August 2007 - More frequent screening for prostate cancer detects more tumors, but fails to cut the number of aggressive tumors detected in between scheduled screenings. Dutch and Swedish researchers tracked 55 to 65 years old men who every two years were given a PSA blood test for prostate cancer. Over a 10-year period ending in December 2005, detection of any form of prostate cancer was higher among the men who were screened more frequently - 13 percent - compared to men who were screened less often - 8 percent. However, tthere was no statistically significant difference in the two groups in the number of aggressive tumors that appeared between the times when the tests were conducted. This brings to question the need to screen men frequently for prostate cancer. Less aggressive screening may be just as effective. Journal of the National Cancer Institute.

August 2006 - A man's prostate specific antigen, or PSA, level after seven months of hormone therapy for advanced prostate cancer predicts how long he would survive, according to a study conducted by the Southwest Oncology Group and led by researchers at the University of Michigan Comprehensive Cancer Center. The study evaluated 1,345 men with prostate cancer that had spread to distant parts of the body. The men were treated with seven months of androgen deprivation therapy, a treatment designed to block the effects of hormones on the cancer. PSA levels were monitored throughout the treatment. The researchers found that men whose PSA dropped below 4.0 ng/ml had a quarter the risk of dying compared to those whose PSA was more than 4.0. Aug. 20, 2006 issue of the Journal of Clinical Oncology. The researchers found 69% of the men maintained a PSA level of less than 4.0 ng/ml after seven months of treatment and 43% had an undetectable level of PSA at that time. Patients whose PSA was higher than 4.0 at the end of seven months survived 13 months, while patients whose PSA dropped below 4.0 but above 0.2 lived 44 months and those whose PSA was undetectable, below 0.2 ng/ml, lived 75 months. The men in the study were enrolled in a phase 3 SWOG trial in which they would receive additional treatment after the seven months of initial hormone therapy. That study seeks to accrue 1,512 men. The patient's PSA level before beginning treatment must be at least 5.0 ng/ml to qualify for the study.

November 2006 - The rate at which a man's PSA rises may be more important than any absolute level for identifying men who will develop life-threatening prostate cancer while their disease is still curable. But PSA can also rise as a man's prostate gland grows with age and in prostate cancer infections, and some men with cancer have low PSA levels. So the test is considered imperfect. Men are advised to get a digital rectal exam, in which the doctor checks the size of the prostate, which is normally about the size of a walnut and located internally between the testes and the anus. Cancer can only be diagnosed with a biopsy, a tiny sample of prostate tissue.

Frequency of PSA Testing - too often?
Too many elderly men in poor health are undergoing PSA screening. In this group, the known harms of PSA screening, such as additional procedures for false-positive results, almost certainly outweigh the very slim chance of receiving a survival benefit. "Not a single professional organization, physicians' group, or prostate cancer advocacy group advocates PSA screening for frail, elderly men, and yet we are doing it," lead author Dr. Louise C. Walter, from the San Francisco VA Medical Center, said in a statement. Researchers assessed PSA screening among 597,642 male veterans, 70 years of age or older, who were seen at a VA Medical Center in 2002 and 2003. None of the subjects had a history of prostate cancer, elevated PSA levels, or prostate cancer symptoms. The subjects were divided into four age groups: 70 to 74, 75 to 79, 80 to 84, and 85 years of age or older. In addition, an assessment of any conditions or illnesses was conducted to divide the subjects into three health categories: best, average, and worst. Fifty-six percent of the men underwent PSA screening in 2003, the report indicates. PSA screening dropped with advancing age, yet there was little difference in screening rates between men in the best health category and those in worst health category. In the oldest age group, men in worst health category actually had a slightly higher screening rate than those in best health category: 36 percent vs. 34 percent. Some subgroups of patients in the worst health category had screening rates over 60 percent. Further analysis showed that health status had only a minor effect on PSA screening and was actually less influential than certain nonclinical factors, such as marital status and region of the country. "We need to educate the public more about the downsides of screening tests," Walter noted. "This is isn't about cost-cutting. It's about not doing harm by not subjecting people to tests and procedures they don't need." Journal of the American Medical Association, November 15, 2006.

PSA masked by finasteride
A concern has been raised that finasteride use for baldness or BPH can make it more difficult to diagnose prostate cancer with the PSA test. Dr. Anthony D'Amico, the lead author of the study from Brigham and Women's Hospital in Boston, recommends that middle-aged men taking Propecia have their PSA levels multiplied by two in tests to account for the difference since Propecia influences PSA level. Merck says information advising patients who undergo a serum PSA test to tell their doctor if they are taking Propecia has been included for consumers since initial product approval.
   In an earlier trial of a drug called Proscar, which contains a higher dose of finasteride, PSA levels were also lowered as well as the risk of prostate cancer. But men taking Proscar who developed cancer had a more aggressive disease. D'Amico and Dr. Claus Roehrborn, of the University of Texas Southwestern Medical Center in Dallas, studied the impact on PSA levels on 355 men ages 40 to 60 years old who took Propecia for one year. The research was funded by Merck and the findings are reported in the journal Lancet Oncology.

PSA and vitamin D
Rise in prostate-specific antigen in men with untreated low-grade prostate cancer is slower during spring-summer.
Am J Ther. 2006 Sep-Oct;13(5):394-9. Mount Sinai Hospital, Toronto-Sunnybrook Regional Cancer Center, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Canada.
To test the hypothesis that the rate of rise in prostate-specific antigen ( PSA ) is slower during the spring-summer than during the rest of the year, we used PSA data from a prospective single-arm cohort study of men who had been followed to characterize a watchful observation protocol with selective delayed intervention for clinically localized, low-to-intermediate grade prostate adenocarcinoma. The rate of PSA increase was calculated as the visit-to-visit slope of log (PSA) against time, from 1 calendar-quarter visit to the next. These results are consistent with the vitamin D hypothesis that the higher 25-hydroxyvitamin D levels associated with spring and summer have a desirable effect on prostate biology. The therapeutic implication is that vitamin D supplementation in the range of 2000 IU/d, a dose comparable to the effect of summer, can benefit men monitored for rising PSA.

BMI and PSA
A very high body mass index (BMI) can be a confounding factor when evaluating a man's results from the prostate specific antigen PSA test. However, it may be possible to compensate for a high body mass index (BMI) when looking at the PSA reading. Overweight and obese men have a higher risk of developing prostate cancer. Obese men have been shown to have larger and less dense prostates. They also tend to have lower serum PSA levels because the protein is spread throughout a larger body mass. This means that although a man might show a normal or near normal PSA reading, he could, in fact, be at a significant risk of cancer. Researchers analyzed data on 647 men with PSA readings of ± 10 ng/mL. The men underwent digital rectal exams, and their prostate volumes were calculated using prostate ultrasounds. PSA density was calculated by dividing the PSA score by prostate volume. The study found that a man's PSA density decreased significantly as his BMI increased. However, a man's risk of cancer increased dramatically when his PSA density was compared with what a normal PSA density might be expected to be. For example, among men whose BMI was < 25 (ie, normal range) and whose prostate density was more than twice what would be expected in a matched control (ie, somebody of normal size and weight, and with normal PSA) his odds of developing cancer would be 1.71 (ie, a 71% greater risk of developing cancer). If the man's BMI was > 25 and his PSA density was double the normal level, the odds ratio of him developing cancer would increase to 2.09 -- more than a 2-fold risk of cancer. Being able to adjust for a man's BMI and PSA reading would be clinically important because the PSA level becomes more meaningful, and the man and his doctor would have a more accurate idea of what his risk of cancer might be. At the same time, the man could also be spared the trauma of a biopsy. The dramatic rise in the prevalence of obesity in the US makes this particularly relevant, since gaining a truer understanding of an obese man's PSA level could save him from needing to undergo a biopsy and spare the healthcare system the expense of these unnecessary procedures.

PSA Questions
Q. Does saw palmetto reduce PSA levels? What about tongkat ali?
   A. The PSA test is often used to screen for prostate cancer. PSA is a protein made only by prostate cells. PSA levels rise as tumor cells multiply. I have not seen enough studies regarding the association between saw palmetto use and PSA test levels to have a firm understanding of this good question at this time. Same with tongkat ali.

Q. I am taking testosterone in a shot every 14 days. The dose is 150 ml of 300 mg/ml. i was taking twice that and it raised my psa from 3.0 to 5.7. Will Passion Rx affect the psa if taken in low doses?
   A. We have not tested Passion Rx long term to see whether it has an influence, pro or con, on PSA levels. Most of the time people take Passion Rx at most 2 or 3 days a week so we don't think it has much of an influence.

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