First of all do not panic. In fact the scientist who discovered PSA, Richard Ablin, wrote an article in Medscape on how the test is being abused. In his opinion PSA best shows cancer progression but is NOT a good indicator of cancer in the first place.
As a hormone specialist, I’ve been following a few middle-aged men with creeping PSA’s for years now. They have chosen not to have a biopsy because of the likelihood of spreading encapsulated cancerous cells and possibly causing malignant disease. The body as it ages has to deal with cells going crazy — otherwise known as cancer or mutated DNA. White blood cells known as lymphocytes eradicate the abnormal cells or encapsulate the tissue. All normal aging process.
Prostate Specific Antigen or PSA is a measurement of protein produced by the prostate, usually measured in ng/dl. PSA elevates with enlarging prostates, either from inflammation, infection or testosterone deficiency. Prostates look for more testosterone, thus all aging men have lower levels of testosterone than they did as youths and the prostate enlarges to “suck” up more testosterone to convert to the active form—dihydrotestosterone.
If your PSA is elevated than you must also have your percent free PSA measured. The amount FREE or unbound by protein in the blood serum is the percentage of how much PSA circulates free compared to the total PSA.
Men with 15-25% of their PSA free (unbound) are considered within normal limits.
Over 25% PSA free (known as free PSA or fPSA) usually indicates an enlarged prostate.
Less than 15% free PSA is suspicious for dysplasia or early cancer.
Less than 7% is highly suspicious of cancer
The percent free PSA should be checked before any invasive testing. That’s why the scientist who discovered PSA was so disturbed. So many men undergo unnecessary biopsies based on a test that was never meant to be used as a screening test.
It’s like using a Ca125 to screen all women for ovarian cancer. It means very little in the general population but for those with ovarian cancer, it is a highly sensitive marker of cancer growth. If we used this test on women like we use PSA on men, many would undergo unnecessary surgery because Ca125 can elevate for many other gynecological inflammatory conditions.
If you are going to have your PSA levels measured than be sure and ejaculate within a week of the test but no sooner than 3 days for the most accurate result. AND never have a PSA test after a digital rectal exam. Touching the prostate will raise circulating PSA levels.
For marginally elevated PSA levels (4-10) with low percentage free PSA, I recommend a prostate ultrasound, not a biopsy. Being surgeons, urologists favor biopsies as standard care. You can ask for a prostate ultrasound without biopsy so the urologist can determine if your PSA corresponds to the volume of your prostate.
I am concerned about spreading early disease and try to boost my patients’ immune system to help them eradicate crazy cancer cells themselves prior to biopsy. Natural Killer Cells (NKC) are the white blood cells responsible for eradicating abnormal growth including cancer. NKCs can be counted and their activity measured. I use a laboratory in Germany (Biofocus) that specializes in evaluating NKC activity and does stimulation tests to determine what supplements or drugs increase NKC activity.
The newest thinking in PSA testing is to follow an elevated PSA under 10 for three months and watch the progression.
A urine PCA3 level is a noninvasive option to help rule in prostate cancer, meaning elevated levels will confirm prostate cancer, but a low level does not necessarily rule out prostate cancer.
The most precise way to image the prostate is with an MRI usually done at a university specialty imaging center. Prostate MRI’s are much more accurate in determining the need for biopsy as well as exactly where to obtain tissue samples if a biopsy is indicated.
The prostate can be further evaluated by a special MRI technique to determine if lesions do exist and using the MRI with ultrasound, a biopsy can be precise. Fortunately, we now have this technology. Unfortunately very few urologists do MRI guided biopsy.
So if your PSA is elevated, breathe. Then do some investigation as to the cause.
• Do you have a strong family history of prostate cancer? If so, then follow your PSA and if rapid elevation seek specialist care for further investigation (ultrasound and possible biopsy)
• Do you have signs and symptoms of testosterone deficiency? (low libido, erectile dysfunction, insomnia, night sweats, anxiety, depression, poor muscle tone, low energy, brain fog) If so, then get tested by a hormone specialist.
• Are you experiencing signs of an enlarged prostate? (frequent urination, nocturia, difficulty voiding or emptying your bladder, weak urinary stream, rectal pain or heaviness following ejaculation) If so, then you may need a urine analysis, then a digital rectal exam followed by a post exam urine analysis. The two urine tests are compared to differentiate between bladder and prostate infections.
I have used testosterone replacement therapy in my male patients with subsequent lowering of PSA levels. I have had excellent results with Genesis Gold®* in harmonizing male hormone levels for those men who do not wish to use hormone replacement therapy (HRT). And for those who do use HRT, Genesis Gold® helps them metabolize hormones safely and can help decrease their dose, so less is more.*
An added benefit of using Genesis Gold®* as a foundation formula is the boost to immune function. Supporting the stressed and aging immune system helps the body fight disease including cancer. I designed it to provide foundational support and help metabolize and detoxify endogenous hormones safely.
Saw Palmetto, pygeum, pumpkin seed oil, and beta-sterol can also help decrease prostate inflammation and lower PSA.
Being an integrative practitioner, I like to address the triad of mind-body-soul health. I find that men with prostate issues are more likely to lack a creative outlet in their lives. When our time to procreate is over, we energetically need a means for healthy creative expression. Some of my male patients have discovered that they are quite talented artists; others find that creating a garden, remodeling a room, rebuilding an engine to be creative outlets. Volunteering to coach young athletes, lead boy scouts, build stages for youth productions provide a creative outlet for many of my retired patients. Some find that being involved with their grandchildren helping to create healthy families to be their best creation ever. A healthy sex life with a loving partner does wonders to boost self-esteem, hormone production, and lower prostate inflammation.
Helping men become healthy – body, mind and soul – is my focus. Sometimes an elevated PSA is the first clue that they need a holistic tune-up. Helping my male patients find the gift in their dis-ease begins their journey to wholeness.
May your Hormones be in Harmony,
Deborah Maragopoulos MN FNP
Intuitive Integrative Health
*Statements not evaluated by the FDA