THE WILD WEST OF PSA TESTING

HOW EFFECTIVE ARE STRATEGIES TO LOWER PSA READINGS?  By: Dr. Roberta Kline

PSA, or prostate-specific antigen, is a protein produced by prostate cells. It can be elevated when these cells increase in number and is a common screening test for prostate cancer. Studies have shown that up to 75% of men with elevated PSA levels do not have prostate cancer on biopsy, however, and up to 50% of prostate cancers are overdiagnosed. [1]

This means that most of the time, an elevated PSA is due to other causes not related to cancer, including normal aging and benign prostatic hypertrophy (BPH). Inflammation caused by prostatitis, trauma, or vigorous exercise, as well as sexual activity, can also impact PSA levels. In addition, PSA levels can vary with ethnicity, weight, diabetes, and certain medications. [1, 2]

REDUCING PSA LEVELS
Because the consequences of elevated PSA levels in the absence of prostate cancer can include increased surveillance and unnecessary biopsies, anxiety, and can even impact the ability to get life insurance, there is a need for more information on how to lower PSA levels and, indeed, whether this correlates with improved health.

Many supplements, dietary, and lifestyle choices have been promoted to lower PSA levels. However, the research is often contradictory and often linked together with prostate cancer risk; thus, knowing which strategies to reduce PSA are based on science can be challenging. Genetic expression is helping us untangle the complexity.

GENETICS OF PSA
While a small number of cases of prostate cancer are due to rare genetic mutations, most are related to more common errors in genes called SNPs. These SNPs create small alterations in biochemistry and biology linked to the risk of prostate cancer, but this risk is modifiable by dietary and lifestyle choices and environmental exposures over that person’s lifetime. [3]  It turns out this holds true for PSA levels as well. 

Researchers evaluating PSA levels in men without prostate cancer found that up to 30-40% of the variation in PSA levels could be attributed to underlying SNPs in multiple biological systems including hormone metabolism, DNA repair, inflammation, cancer promotion and suppression, and oxidative stress. [3,4]

(L) Image source: Kachuri L et al. PSA-associated variants identified on GWAS.

EPIGENETICS OF PSA
Asian men have the lowest rate of prostate cancer, followed by Native and Latin American men, then Caucasian men, with African American men having the highest. Risks associated with elevated PSA also vary with ethnicity. Second-generation Japanese men in the U.S. will have the same rate of prostate cancer as Caucasian men, indicating that a combination of genetics and diet/lifestyle plays a role. [5]

EPIGENETICS MAY PROVIDE A CRUCIAL LINK
Epigenetics gives us the ability to change how our genes express in response to our environment. As with our DNA, epigenetic changes can be inherited. But unlike our DNA, these epigenetic changes are dynamic. This is one of the key mechanisms by which changes in diet, lifestyle, and environment can create changes in health and well-being.

Epigenetic alterations associated with diet, exercise, smoking, trauma, or stress have been linked to elevated PSA levels as well as to prostate cancer. These can potentially be reversed by interventions addressing these factors. [6] Epigenetic testing may also be effective as a future screening tool, as it has been shown to reduce false positives of PSA tests in initial research.  [7]

THE ROLE OF OXIDATIVE STRESS AND INFLAMMATION
Oxidative stress and chronic inflammation are linked to most chronic diseases including prostate cancer. [8] They are also linked with elevated PSA and are influenced by numerous factors, including diet, exercise, and stress – all of which “talk” to genes, influencing gene expression that can promote health or disease.

Early childhood stress and chronic stress are linked to increased inflammation and oxidative stress by altering gene expression, which can increase both PSA levels and prostate cancer. Combining mindfulness-based stress reduction (MBSR) and a plant-based diet has been shown to lower PSA levels [9] as has regular exercise. [10]

Plant-based diets, such as the Mediterranean Diet, include an abundance of foods rich in nutrients, antioxidants, and anti-inflammatory compounds, which are associated with beneficial gene expression that supports health. These include colorful fruits and vegetables, cruciferous vegetables, healthy fats, legumes, and whole grains, along with minimal amounts of processed foods and sugar. Conversely, diets low in these healthy foods but rich in saturated fats, processed foods, alcohol, and sugar are associated with adverse changes in gene expression that promote disease.

While research has shown the impact of various foods and diets on inflammation and oxidative stress, translating this into specific recommendations for reducing PSA is more challenging. One reason is that foods contain many different components that are often synergistic, and untangling these to isolate specific components often proves difficult. Another reason is that we are often looking at the wrong measurement.

SUPPLEMENTS: WHAT WORKS?
Designing studies to evaluate the role of diet, supplements, and lifestyle in specific health issues, including PSA levels, is often fraught with challenges. This often translates into contradictory results that can be quite confusing, especially without knowing how to interpret the research. 

Evaluating multiple studies, one review found no evidence that intake of individual nutrients or supplements containing lycopene, vitamin E, cruciferous vegetables, soy/isoflavones, green tea, polyphenols, fish/marine omega-3, coffee, or vitamin D were significantly associated with PSA levels. [6] Another found that levels of Vitamin A, B2, C, D, E, alpha-carotene, selenium, lycopene, lutein + zeaxanthin, beta-cryptoxanthin, and folate were not associated with PSA levels, although low Vitamin D and low serum albumin were associated with elevated PSA levels. [10]

These results may reflect the limitations of applying the pharmaceutical model to nutritional supplements, as they often work synergistically. Consistent with this, the Pomi-T study showed that a specific supplement combining pomegranate, green tea, broccoli, and curcumin reduced PSA among men with prostate cancer. [11]

Antioxidants are not limited to vitamins and minerals. The most powerful antioxidants are phytonutrients. Phytonutrients, also known as polyphenols, can also have anti-inflammatory activity, affect epigenetics, and influence gene expression. Resveratrol, curcumin, sulforaphane, EGCG, quercetin, apigenin, genistein, silymarin, and anthocyanins are all examples. When evaluating the impact of antioxidants on oxidative stress, DNA damage provides a better assessment than individual nutrient status. Research shows that as these phytonutrients restore normal antioxidant status, they lower PSA levels along with inflammation. [12]

(L) Image source: Li, W., Chen, H., Xu, B., et al. (2023). Research progress on classification, sources and functions of dietary polyphenols for prevention and treatment of chronic diseases. Journal of Future Foods, 3(4), 289-305. https://doi.org/10.1016/j.jfutfo.2023.03.001

THE SOLUTION
Putting this all together, reducing PSA levels needs to incorporate multiple elements to have the best effect. The combination of a Mediterranean-type Diet, regular exercise, and stress management, along with the incorporation of specific supplements, can beneficially affect gene expression to reduce PSA levels and potentially prevent progression to prostate cancer.

References

1) Bernal-Soriano, M. C., Parker, L. A., López-Garrigos, M., et al (2019). Factors associated with false negative and false positive results of prostate-specific antigen (PSA) and the impact on patient health: Cohort study protocol. Medicine, 98(40). https://doi.org/10.1097/MD.0000000000017451

2) Grammatikopoulou, M. G., Gkiouras, K., Papageorgiou, S. Τ., et al (2020). Dietary Factors and Supplements Influencing Prostate-Specific Antigen (PSA) Concentrations in Men with Prostate Cancer and Increased Cancer Risk: An Evidence Analysis Review Based on Randomized Controlled Trials. Nutrients, 12(10), 2985. https://doi.org/10.3390/nu12102985

3) Karunasinghe, N., Minas, T. Z., Bao, B., et al. (2022). Assessment of factors associated with PSA level in prostate cancer cases and controls from three geographical regions. Scientific Reports, 12(1), 1-16. https://doi.org/10.1038/s41598-021-04116-8

4) Kachuri, L., Hoffmann, T. J., Jiang, Y., et al (2023). Genetically adjusted PSA levels for prostate cancer screening. Nature Medicine, 29(6), 1412-1423. https://doi.org/10.1038/s41591-023-02277-9

5) Hinata, N., & Fujisawa, M. (2022). Racial Differences in Prostate Cancer Characteristics and Cancer-Specific Mortality: An Overview. The World Journal of Men's Health, 40(2), 217-227. https://doi.org/10.5534/wjmh.210070

6) Labbé, D. P., Zadra, G., Ebot, E. M., et al (2015). Role of diet in prostate cancer: The epigenetic link. Oncogene, 34(36), 4683-4691. https://doi.org/10.1038/onc.2014.422

7) Pchejetski, D., Hunter, E., Dezfouli, M., et al. (2023). Circulating Chromosome Conformation Signatures Significantly Enhance PSA Positive Predicting Value and Overall Accuracy for Prostate Cancer Detection. Cancers, 15(3), 821. https://doi.org/10.3390/cancers15030821

8) Rago, V., & Di Agostino, S. (2023). Novel Insights into the Role of the Antioxidants in Prostate Pathology. Antioxidants, 12(2), 289. https://doi.org/10.3390/antiox12020289

9) Dovey, Z., Horowitz, A., & Waingankar, N. (2023). The influence of lifestyle changes (diet, exercise and stress reduction) on prostate cancer tumour biology and patient outcomes: A systematic review. BJUI Compass, 4(4), 385-416. https://doi.org/10.1002/bco2.237

10) Lin, Y., Zhu, X., Aucoin, A. J., Fu, Q., Park, J. Y., & Tseng, S. (2023). Dietary and Serum Antioxidants Associated with Prostate-Specific Antigen for Middle-Aged and Older Men. Nutrients, 15(15). https://doi.org/10.3390/nu15153298

11) Thomas, R., Williams, M., Sharma, H., et al. (2014). A double-blind, placebo-controlled randomised trial evaluating the effect of a polyphenol-rich whole food supplement on PSA progression in men with prostate cancer—The UK NCRN Pomi-T study. Prostate Cancer and Prostatic Diseases, 17(2), 180-186. https://doi.org/10.1038/pcan.2014.6

12) Naghii MR, Hedayati M, Mofid M (2015) Antioxidants therapy: An alternative for androgen deprivation therapy (ADT) to decrease prostate-specific antigen (PSA) level. 2: DOI: 10.15761/ICST.1000132

Prostate Scan Now: Episode 1 (Host: Cousin Sal Banchitta - Ret FDNY FF)

 

My name is Sal Banchitta- aka- Cousin Sal. I've had an incredible 30+ year career in the NY Fire Department, what so many of considered to be the best job in the world. There is no other profession that even comes close to the rewards of being a city firefighter. We were the first and last line of defense to protect this great city from any catastrophe and aligned with a special family of the most unique and remarkable men and women is truly the ultimate blessing. 

PROSTATE SCAN NOW: I welcome you to view our pilot episode in support of proactive checkups and Prostate Health!  I'm speaking to all my dude-friends in their 50's who need to start taking their health more seriously, while applauding those who have stayed on top of early detection and prevention. One such person is my latest hero in this- Mr. Barrie Kolstein. Check out our feature on this great motivator and role model!

STATS ABOUT PC:

"Prostate cancer is the second-leading cause of cancer death in American men, behind only lung cancer."  (Source- American Cancer Assoc)

"...leading cause of cancer death among men in the US, with 94 men dying from it every day." (Source: pcf.org)

"More than 3.3 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today". (Source- American Cancer Assoc)

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Can we still Trust PSA Blood Test Readings?

Disclaimer: The information (including, but not limited to text, graphics, images and other material) contained in this article is for informational purposes only. No material on this site is intended to be a substitute for professional medical advice or scientific claims. Furthermore, any/all contributors (both medical and non-medical) featured in this article are presenting only ANECDOTAL findings pertaining to the effects and performance of the products/technologies being reviewed - and are not offering clinical data or medical recommendations in any way. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, never disregard professional medical advice or delay in seeking it because of something you read on this page, article, blog or website.”

This section originally published 8/26/20 @ The American Council on Science and Health (www.acsh.org)  Patient-Specific Anxiety: "My PSA was 22. I had a biopsy; it was benign...GOOD! The biopsy showed inflammation, so I had a (surgical) biopsy I didn’t need... BAD!  There has to be a better way!” 

Evolution of NON-INVASIVE PROSTATE DIAGNOSIS 

Prostate cancer, now considered the most common cancer in men, especially African-Americans (6-NIH), was rare until the 1950’s. Earlier, a blood test identifying prostate specific antigen (PSA was developed for use in “rape kits” to provide criminal evidence in court) was never designed as the screening tool for prostate cancer that it has become  today. Our national guidelines recommend screening with PSA for men age 55 to 69, a recommendation that 40% of men follow. But what happens after a PSA test is termed positive?

In 2012 the U.S. Preventive Services Task Force (USPSTF) recommended against routine PSA screening for prostate cancer due to the risk of over-diagnosis and over-treatment with most prostate cancer remaining asymptomatic. The panel concluded that the potential benefit of testing did not outweigh the risk of harm, arguing against continued screening except for those with known risk factors and a life expectancy greater than 10 years. Screening may have indeed reduced the rate of death from prostate cancer by an estimated 20%, but it was also associated with a high risk of overdiagnosis (diagnosis in men who would not have clinical symptoms in their lifetime).  This means that PSA testing would have saved about 60,000 lives but some 900,000 men would have undergone the undue injury of an unnecessary surgical biopsy. 

THE BIOPSY is an invasive procedure removing a small section of tissue and examination for cancer cells.  It remains the gold standard in diagnosing prostate cancer. Biopsies are now performed in an office setting, using topical or sedation anesthesia. It involves using a needle to obtain tissue from the prostate through the rectum. Twenty five years ago the routine biopsy protocol called for six needle cores. Because it was performed without imaging, it missed many cancers deep within the prostate. The number of tissue samples taken was expanded to 12 and even up to 96 cores at some centers. Needle biopsies cause serious complications in 1% of patients - even fatal outcomes have recorded. Infection which can require prolonged antibiotic therapy is the most common problem. Nowadays biopsies are guided, meaning that doctors use imaging through ultrasound or MRI  to direct the needles to areas of concern. 

CALLING FOR A DIAGNOSTIC UPGRADE: The strategy of relying on a (PSA) blood test as the precursor to a biopsy required significant reassessment.  Though approved by the FDA in 1986 as the gold standard for monitoring cancer relapses, increasing reports continue to indicate that elevated PSA levels in over 70% of men show a false positive reading- and does not conclude a malignant cancer. (NIH ref). Because of the inaccuracies of the PSA test and the risk of side effects, many centers are now using imaging solutions like ultrasound 3-D Doppler and MRI before considering a biopsy.

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First Responder Gets Checked for Enlarged Prostate

NYCRA's own "COUSIN SAL" BANCHITTA, Retired FDNY FF and Cancer Prevention Advocate for the F.A.C.E.S. (Firefighters Against Cancers and Exposures) "Get Checked NOW!" program often partners with Dr. Robert Bard's clinical research team to explore the latest in diagnostic and therapeutic health innovations.

In August of 2023, Sal joined a group of four men over 50 on an exploratory and clinically monitored study applying PEMF (Pulsed Electromagnetic Frequency) to address BPH (Benign prostatic hyperplasia) or enlarged prostate gland. According to Yale Medicine, "about 50% of men between the ages of 51 and 60 have BPH, and that number jumps to 70% among men aged 60 to 69 and around 80% of men over 70 years of age".[1]

This exploratory concept was under a collaboration between Dr. Robert Bard (seasoned diagnostic imaging specialist), Russell Allen (executive director of Wellness Now!)" and Dr. Lennard Gettz (research coordinator of IPHA/ Integrative Pain Healers Alliance). In expanded technical collaboration with Mr. Patrick Ziemer (AuraWell PEMF), this panel launched the exploratory concept of employing a non-invasive alternative solution to reduce prostate size as part of improving men's overall health. "Historically, we have observed the growing success of PEMF on a wide variety of physiological disorders... joining the strength of Dr. Bard's imaging capacity to monitor and validate real-time treatment progress, we have united to launch this micro study... that may someday change the face of how prostate disorders may be managed", states Dr. Noelle Cutter, IPHA Senior Medical Editor & clinical research specialist.

Use of ultrasound imaging has been Dr. Bard's "scanner of choice" when it comes to analyzing and diagnosing a wide array of complex health disorders, from cancer tumors to inflammatory disorders. As a beta tester for developers of ultrasound feature upgrades, Dr. Bard has published an expanded set of findings in support of PEMF regenerative benefits.  His latest pilot study provided quantitative evidence about PEMF-induced micro-tissue and vascular reactions, thanks to his creative use of echocardiography. "Over the years, I have gained significant confidence in Pulsed Bioenergy therapeutic innovations", states Dr. Bard. "...through strategic imaging, we can visibly and quantifiably identify the smallest veins dilating and the contractility of the tissue being energized- appearing as pulse vibrations in the form of the undulating surface line of the muscle. This is how we can illustrate the path of ENERGY MEDICINE in real-time action".

PILOT STUDY ON THE ROAD

Sal Banchitta, one of four volunteers took home the Nova-HD (by AuraWell PEMF) from the Bard Diagnostic Imaging center in NYC. All case studies are instructed to use the PEMF device as directed- applying electromagnetic exposure via the provided PEMF coil for an est. 20 minutes 2x a day. "Aside from the clicking sound of the power source device, what I learned about PEMF is that it's widely known to be painless and has no known side effects", says Mr. Banchitta. "I also learned this technology to offer so much by ways of pain relief and cell regenerative therapy".

Unlike the other participants of the study, Sal was scheduled to go on a coastal road trip for business immediately after his PEMF consult. The clinical panel found this to be an ideal situation to conduct the test from the drivers seat.  "Adult Americans spend a major portion of their lives behind the wheel... proving how to integrate PEMF treatments while driving could be a great way to optimize use of one's travel time", stated Patrick Ziemer.

TREATMENT "ON THE GO"

Because I had a limited amount of time and a tight travel schedule, I chose to take advantage of the situation by bringing the PEMF into my truck- and it was easy! I installed an a 110 AC outlet to plug in the device. Sitting on the PEMF coil is the same here as it is in my recliner chair at home. The coil was soft and absolutely comfortable and it wasn't an impediment to my driving at all. I used it for about an hour each day and I had a lot of hours to kill. 

SAL'S HEALTH JOURNEY

I have always been a proponent of early detection- especially when it comes to prostate cancer. Four years ago, my annual retirement exam started with a blood test. My primary found my PSA was slightly elevated, so I was then sent to the urologist as standard operating procedure.  Before you know it, I received a report of a "slightly" enlarged prostate which put me into what felt like an automated track to getting a biopsy.  Getting a biopsy without an MRI or any type of imaging made the needle work a complete and painful shot in the dark. Getting poked 12+ times in what felt like complete guesswork was terrible experience. In the end, we found that the biopsy could have been avoided if the PSA reading gave more information, and a more accurate assessment. As a member of a family predisposed to cancer, the stress of waiting for the biopsy, then actually undergoing the procedure thinking I MAY have have cancer or not was completely an unfair ordeal to put anyone through.  

Meanwhile, this is what launched my journey to support prostate health- including why I am now driving with a PEMF coil on my drivers seat!

(End of Part 1)

https://www.yalemedicine.org/conditions/enlarged-prostate-benign-prostatic-hyperplasia-bph#:~:text=But%20because%20enlarged%20prostate%2C%20or,over%2070%20years%20of%20age.