PSA test rise and fall, prostate-specific antigen test - natural ways to lower, herbs, vitamins, supplements, Is PSA testing necessary after age 75, or earlier? by Ray Sahelian, M.D.
January 1 2017

A PSA test, introduced in 1986, 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, it 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, 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 assays give different results on the same blood sample. This is an obstacle to recommending uniform 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.

Natural ways to lower PSA levels with dietary supplements, food, herbal preparations
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.
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.

Green tea drinking could reduce inflammation in the prostate gland and lower PSA level.

A mix of dietary supplements including antioxidants and plant-based estrogens may slow the rise of a biomarker for prostate cancer progression in some men. The study of 37 men with the disease found that 6 weeks on the supplements generally lowered patients' levels of male sex hormones, which fuel prostate cancer growth, and, in some patients, put the brakes on rising levels of prostate-specific antigen. PSA is a protein produced by the prostate gland; rising PSA levels in a man's blood can signal cancer or, in men already diagnosed with the disease, cancer progression. However, the PSA effects seen in this study do not necessarily mean the supplement was hindering the men's tumors from growing, according to the study authors. The question of whether the change in patients' PSA rise translates into a change in tumor size "remains unresolved," they report in the International Journal of Cancer. But more "thought-provoking" is the possibility that diet changes could help lower a man's risk of developing prostate cancer, said lead study author Dr. Ries Kranse, of Erasmus Medical Center Rotterdam in the Netherlands. The supplement mixture he and his colleagues studied included a powder-based drink that contained green tea extract, a soy extract supplying estrogen-like compounds called phytoestrogens, and antioxidants such as lycopene. Patients also used margarine spiked with cholesterol-fighting plant sterols and the antioxidants vitamin E and selenium. The men in the study, all of whom had prostate cancer and rising PSA levels, used the supplements for 6 weeks; each also used inactive, or placebo, supplements for another 6 weeks. Kranse and his colleagues found that the patients' male hormone levels were lower when they were on the supplement compared with when they were taking the placebo. In the 21 men who showed a dip in a hormone measure called the free androgen index, the supplement also appeared to slow rising PSA levels. When these men were on the placebo, it took an average of 36 weeks for their PSA levels to double, versus 115 weeks with the supplement. This finding, according to Kranse, suggests that if the supplement proves capable of slowing or stopping tumor growth, it would be through the hormonal effects of the estrogen-like compounds. If this is the case, he said, a "dietary intervention" could eventually serve as an alternative to certain hormone-suppressing drugs used in prostate cancer treatment. The current findings are in line with studies of the general population that suggest diets rich in antioxidants and phytoestrogens may lower the risk of prostate cancer. Fruits and vegetables are prime antioxidant sources, while phytoestrogens are found in foods such as soybeans and soy products, whole grains and flaxseed. International Journal of Cancer, February 20, 2005.

Q. Does saw palmetto reduce PSA levels? What about tongkat ali? And also Prostate Power Rx.
   A. 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 but it seems that it does not have a major influence. I have seen no such studies with Tongkat Ali and we have not done any with Prostate Power Rx regarding PSA levels.

J Urol. 2013. The effect of increasing doses of saw palmetto fruit extract on serum prostate specific antigen: analysis of the CAMUS randomized trial. No affect was seen on serum prostate specific antigen more than placebo, even at relatively high doses.

Pomegranate extract not of benefit
Prostate Cancer Prostatic Dis. 2015. A randomized, double-blind, placebo-controlled study of the effects of pomegranate extract on rising PSA levels in men following primary therapy for prostate cancer. Compared with placebo, pomegranate extract did not reduce the rate of PSA rise in prostate cancer patients after therapy.

Latest guidelines and recommendations:
Incidence rates for localized- and regional-stage prostate cancer continued to decline 2 years following the recommendation by the U.S. Preventive Services Task Force against prostate-specific antigen (PSA) testing in all men. “Convincing evidence demonstrates that the PSA test often produces false-positive results [and] false-positive PSA test results are associated with negative psychological effects, including persistent worry about prostate cancer,” the task force stated in a recommendation published in October 2011 and finalized in May 2012. Immediately following the recommendation, there was a significant decline in early-stage cancer incidence rates among men 50 years or older, according to an analysis of data from the Surveillance, Epidemiology, and End Results (SEER) program.

Surg Clin North Am. 2015. Prostate Cancer Screening and the Associated Controversy. Prostate cancer is the most common malignancy diagnosed in men and the second leading cause of cancer death for men in the United States. Widespread use of prostate-specific antigen (PSA) screening led to a decrease in mortality; however, PSA screening may have led to overdiagnosis and overtreatment of clinically insignificant cancers. The US Preventive Services Task Force (USPSTF) released a statement recommending against the use of PSA, which was met with concern from professional organizations.

Urology Oncol. Feb 1 2014. Prostate cancer biomarkers: An update. Many aspects of prostate cancer diagnosis and treatment could be greatly advanced with new, effective biomarkers. Prostate-specific antigen (PSA) has multiple weaknesses as a biomarker, such as not distinguishing well between cancer and benign prostatic hyperplasia or between indolent and aggressive cancers, thus leading to overtreatment, especially unnecessary biopsies.

2013 - The United States Preventive Services Task Force does not advise men to get this routine test since it does not save lives over all and often leads to more tests and treatments that needlessly cause pain, impotence and incontinence. Moreover it leads to increased anxiety and stress. If you are over age 60 and already have a health condition such as heart disease, diabetes, moderate to severe high blood pressure, etc, having the test done will not extend your lifespan. An unhealthy 60-year-old, for instance, may simply not live long enough to reap the benefits of removing slow-growing prostate tumors.

A 2011 study from Sweden found screening did not significantly reduce prostate cancer deaths over two decades of follow-up, but it did result in the detection of more cases of the cancer and more treatment. Study researcher was Gabriel Sandblom, MD, of Stockholm's Karolinska Institute.

Prostate help: a test that can help you avoid unnecessary prostate biopsies. When you've already had a biopsy and your PSA remains high, the PCA3 urine test can help you and your doctor to decide if another biopsy is really needed Harvard Mens Health Watch. July 2013.

Discoverer of PSA Test says it is overused
Dr. Richard Ablin of the University of Arizona, who discovered the PSA test now says that routine screening has become "a hugely expensive public health disaster." He says the screening procedure is too costly and ineffective. "I never dreamed that my discovery four decades ago would lead to such a profit-driven public health disaster," wrote Richard Ablin in a commentary for The New York Times. The annual bill for PSA screening is at least $3 billion, with much of it paid for by Medicare and the Veterans Administration. "As I've been trying to make clear for many years now, PSA testing can't detect prostate cancer and, more important, it can't distinguish between the two types of prostate cancer - the one that will kill you and the one that won't, instead, the test simply reveals how much of the prostate antigen a man has in his blood." A high PSA reading is usually followed by a biopsy, which is a sample of the prostate tissue taken and examined for signs of a tumor. Physicians have routinely recommended PSA tests to men over 50 in the belief that early diagnosis and aggressive treatment for any cancer is better than standing by and doing nothing. But prostate cancer can often be a slow-growing tumor and men will often die of something else before the cancer becomes dangerous. Prostate cancer treatments, including surgery or radiation, can cause incontinence and erectile dysfunction in about a third of patients. Many men also experience bowel problems. March 2010.

Monitoring PSA level for Prostate Cancer
PSA tests for prostate cancer, are they necessary?
2009 - Screening for prostate cancer is a controversial topic since the tests can find and diagnose serious cancers in a few men but cause needless worry and expense for the vast majority who may end up getting treated for tumors that enlarge too slowly to do any harm. Dr. H. Gilbert Welch of the VA Outcomes Group in White River Junction, Vermont, reports routine screening for prostate cancer has resulted in more than 1 million U.S. men being diagnosed with tumors who might otherwise have suffered no harmful effects from them. The increased diagnosis rate more than tripled in men aged 50 to 59 and increased more than a sevenfold in men under age 50.And while prostate cancer deaths have declined since the introduction of PSA testing, about 20 men had to be diagnosed and treated for every one who benefited. Doctors have routinely recommended PSA screening in men over 50 based on the assumption that early diagnosis and treatment is better than standing by and doing nothing. All current forms of treatment -- surgery, radiation or hormone therapy -- can cause harm, resulting in impotence and incontinence in about a third of patients, Just being told you have cancer can do harm, causing anxiety and feelings of vulnerability. A U.S. expert panel last year urged doctors to stop screening men over 75, but doctors still disagree about the right approach to PSA screening. Two large studies -- one in Europe and one in the United States -- that aimed to settle the matter produced conflicting results. Instead of discarding the PSA test, one solution may to simply watch and wait for signs the tumor is growing. A study of more than 51,000 men published in September 2009 in the Journal of Clinical Oncology found men diagnosed with low-risk tumors who waited were still doing fine an average of eight years after diagnosis -- and some as many as 20 years later.
    Comments: Different doctors have different recommendations regarding the necessity and timing of PSA tests. Since there is a wide range of opinions on this topic, much depends on you, the patient, and your personal feelings about testing or not testing. Men will need to weigh the potential benefits and risks of PSA testing and what works for them and their lifestyle and overall approach to health maintenance.

2009 - PSA testing not needed for men over 75
Men who are 75-80 years old and have a low prostate specific antigen PSA level -- that is, less than less than 3 nanograms per milliliter -- are unlikely to develop life-threatening prostate cancer during their remaining life span. It is suggested that these older men no longer have PSA testing done. The advantage to this approach is that id reduces cost of screening and follow up, and the worry of patients who are told they have higher than normal blood PSA tests. Journal of Urology, April 2009.

2008 -- Should you have a PSA test if you are over 75?
A few years ago my dad was found to have a high PSA test. He was 74 at the time. He underwent multiple visits to the doctor over the next few months with repeated PSA tests and exams, and eventually a biopsy indicated he had a small prostate cancer. I remember my dad calling me several times a month during that period constantly asking my thoughts on how he should proceed with radiation or other treatments for his cancer. My dad had a preexisting heart condition known as atrial fibrillation. I suggested he not undergo any treatment for the small cancer but just to follow the PSA levels. His doctor had agreed with my opinion. His PSA test stayed relatively the same over the next few years and the prostate cancer did not grow larger. My dad died at 78 from a heart rhythm problem. Ever since the discovery of the high PSA level, he was constantly worried about this prostate gland. What good did it do to have this PSA test at his age? It only led to more doctor visits, a painful prostate gland biopsy, and constant worry. Maybe the constant worry even made his heart weaker.
   Last month, The U.S. Preventive Services Task Force advised that "The benefits of prostate cancer treatment based on routine SPA screening in men over age 75 "are small to none." However, treatment often causes "moderate-to-substantial harms," including erectile dysfunction and bladder control and bowel problems. Doctors should stop routine prostate cancer screening of men over age 75 because there is more evidence of harm than benefit, a federal task force advised on a hotly debated topic."
   A study has found that older men who already have early-stage prostate cancer are not taking a big risk by not treating it right away. The vast majority are alive 10 years later without significantly worrying symptoms or die of other causes. Annals of Internal Medicine, August 2008.

PSA masked by finasteride or Proscar
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.

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.

Questions
Q. As a prostate cancer survivor since 2005, I want to thank you for your newsletter, it greatly helped me while in recovery from my radical prostatectomy. Since that time, I have been a prostate cancer advocate, especially for young men and low income men. I was 52 at the time of surgery. My PSA of 3.5 was within age adjusted averages, but had doubled in 18 months. At surgery, my cancer had spread outside my prostate, but the good news was my Gleason score was 3+3, or 6. A friend with the same circumstances (same age, same PSA score, same surgeons, surgery 1 week after mine, cancer outside the prostate), had a Gleason score of 9. He died about 2 weeks ago from prostate cancer, a 3 year survivor at the time of death. After surgery he had two rounds of radiation, continuous hormone treatment and 2 years of continuous chemotherapy. This brings me to my suggestion regarding your newsletter, since there is SO MUCH misinformation regarding prostate cancer. Your current newsletter describes your father's experience at age 75. I tend to agree. The flip side of that situation is the intransigence of the medical community to start recommending PSA testing for all males, BEGINNING at age 40. The most tragically fatal prostate cancer deaths are in relatively young men with relatively low PSA scores, but high Gleason scores at the time of biopsy. If one waits until the age of 50 to start PSA testing like my friend did, it may be too late to stop aggressive prostate cancer. Watching baseline changes starting at age 40 affords so much more opportunity for a cure. It also prevents needless biopsy procedures.
   A. There is a debate in the medical community regarding the ideal age at which one should first have prostate cancer screening. The American Cancer Society suggests men over the age of 50 to visit their doctor and have a digital rectal examination and PSA test. Some doctors suggest men who are at high risk for prostate cancer – such as African-American men or those with a strong family history diagnosed with prostate cancer prior to age 60 – should begin screening before age 50.

Five years ago, I underwent a nerve-sparing retropubic prostatectomy. Initially, my PSA dropped to 0.00 and from January 2005 through January 2007, remained below 0.05. Beginning in May 2007, my PSA began steadily climbing from 0.07 to 0.37 this past week. All the while, my Urologist has offered nothing but IMRT, Androgen Therapy, or Chemo as solutions -- I know, standard of care, standard of care. At this point, I'm not interested in nukes and poisons. The chainsaw (surgery) was bad enough. I have pretty much found myself on my own. I have tried Graviola, Modified Citrus Pectin, Soy products, lots of green tea, curcumin, quercetin, alpha-lipoic acid, acetyle-l-carnatine, boron, resveritrol -- yet, here I am, on what appears to be a one-way trip to the radiation table.

Just an inquiry for your professional opinion what you think about Prostate Biopsies. My yearly physical PSA has varied respectively in years 2005 (3.3), '06 (4.2), '07 (3.8), '08 (4.8), 1/09 (5.4), & 10/09 (6.0) my doctor sent me to a Urologist for a 2nd opinion examination. Last year’s urologist appointment indicated a "slightly" swollen prostate and a decision to wait 3-4 months to see if PSA continues to rise before considering conducting a biopsy. Well, PSA did rise to 6.0 reading. Had Urologist appointment today (12-31-09) with his D.R.E. exam and opinion. His comment was swollen prostate with 35% chance of prostate cancer. He suggested a biopsy be done (scheduled 1-27-09) to confirm if cancer is present which I really question if I want to punch holes into suspected prostate areas just to prove benign or malignant cells present. I would like to delay scheduled biopsy until April 2010  while at same time aggressively look into alternative treatment (ie; Cesium Chloride + T-UP product, etc., etc.) to try change pH & lower PSA reading rather than suffer the possible side-effect consequences of punching (12-14) holes into the my Prostate gland. If PSA reading indicates higher reading through a simple blood test in March, 2010 a biopsy can be conducted . If not higher, then I would continue on with treatment being followed. Just an inquiry to see if you have an "effective" alternative medicine protocol for treating elevated PSA readings to give more insight towards my making a correct decision.
    Suggestions on maintaining a healthy prostate are listed on the prostate gland page that you can review with your doctor.

If your PSA level has elevated during a course of a year (for example from 4.9 to 5.6) . However during that same period of time multiple DRE exams have shown that there were no abnormalities, would you avoid a Biopsy considering some of the potential side effects? What other than Prostate cancer can cause your PSA level to rise? What can cause inflammation?
   There is a downside to overtesting which leads to these types of dilemmas.