Why Should I Manage
My Rising PSA?
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By: John King
Whether you have “PSA-creep”, BPH or prostate cancer this article will explain why it is important to manage that rising PSA level as well as providing strategies to do so.
As men and women age our hormones naturally shift away from their healthy youthful balance to one which is more conducive to the promotion of disease. Often the first symptoms men will notice of this hormone shift are those of Benign Prostatic Hyperplasia (BPH); frequent nighttime urination, urinary hesitancy and or painful urination. Unfortunately by this time a man’s prostate is most likely significantly enlarged. BPH can set the stage for the development of prostate cancer (as well as becoming incredibly annoying and inconvenient), so it’s important to get control of that rising Prostate Specific Antigen (PSA) as soon as possible. To fully understand why PSA management is so important we must understand what PSA is and is not.
Prostate Specific Antigen or PSA is a proteolytic enzyme produced by epithelial prostatic cells. Its function is to break down the high molecular weight protein of the seminal coagulum into smaller polypeptides which further liquifies semen making it easier for sperm cells to swim and reach an egg for fertilization. Since PSA is secreted by both normal and malignant cells it is not necessarily an indication of prostate cancer (although malignant prostate cells secrete more PSA than benign cells). I like to think of PSA as an indicator of overall prostate health. PSA may be elevated as a consequence of aging, prostatitis, prostate trauma, BPH and or prostate cancer.
If you were to ask your urologist if you should try and lower your rising PSA he may tell you that there is no value in trying to lower it. He may also tell you that suppressing PSA masks disease progression and in doing so will make it more difficult to treat. New research has shown this line of to be reasoning to be specious and that letting a rising PSA run rampant only hastens disease progression. This is where it can become confusing for many. Remember, PSA is not specific to cancer and an elevated or rising PSA can be caused by various factors. When your PSA is on the rise (but under 4.0 ng/mL) your urologist may tell you not to worry, “We’ll just watch it for now.”. Ironically, when that PSA hits 4.0 ng/mL your urologist becomes very concerned about cancer and you are now biopsy bound! My question is, “Why not do something about that rising PSA before the biopsy threshold is reached?”.
Now let’s take a look at what goes on inside the prostate and how letting a rising PSA level run rampant promotes further disease.
As stated previously, PSA is a proteolytic enzyme produced by both normal healthy prostate cells as well as malignant cells. In a normal healthy prostate, PSA is mostly confined to the prostatic ducts and very little PSA escapes into the bloodstream. In this case, PSA blood levels are typically less than 1.0 ng/mL. In the case of infection or injury to the prostate inflammation causes cell membranes to become more permeable and some PSA escapes into the bloodstream. A temporary rise in blood PSA levels is seen but returns to baseline as overall cell integrity is not compromised.
In the case of prostate cancer malignant cells are secreting more PSA than normal cells. Over time, this higher intracellular PSA level begins to breakdown cell membranes. In this setting PSA (a proteolytic enzyme) actually begins to digest prostate cell membranes. This causes inflammation which makes cell membranes more permeable allowing more PSA to escape into the bloodstream and surrounding tissue. When this occurs the enzyme activity of PSA starts to breakdown the extracellular matrix of the prostate and eventually the prostate capsule itself. As more malignant cells form, PSA levels rise promoting more inflammation, causing more PSA leakage and so on. Inflammation is a known cause of cancer making this a most undesirable scenario. Important to note, prostate cells are particularly susceptible to gene mutation which makes the management of inflammation all that more important.
As you can see, prostate cancer sets the stage for its own proliferation through a never-ending cycle of PSA secretion and inflammation. Unless something is done to break this self-promoting cycle, PSA levels will continue to rise. Eventually the integrity of the prostate capsule will be compromised allowing cancer cells to escape into the bloodstream. This is how metastasis of prostate cancer occurs.
Now that you have a better understanding of PSA and its relationship to inflammation and cancer; why wouldn’t you want to try and lower that rising level? Below are five nutraceuticals that are commonly used to lower PSA. Each of these substances helps to lower PSA in its own unique way. Using a variety of substances simultaneously provides for a synergistic effect and increased efficacy.
Saw Palmetto is a dwarf palm that grows wild throughout the southern United States and Caribbean. The dried berries of this shrub are used for medicinal purposes, typically maladies of the prostate. Saw palmetto is a powerful inhibitor of 5-alpha reductase, the enzyme that converts testosterone to dihydrotestosterone (DHT). DHT is the primary hormone implicated in prostate cancer as it is up to 10 times more powerful than testosterone in stimulating prostate cell growth. Suppressing DHT can have a profound PSA-lowering effect sometimes lowering PSA by as much as half. Saw palmetto has also been shown to induce apoptosis (pre-programmed cell death) in prostate cancer cells.
Nettle Root has long been used as a remedy for maladies of the prostate. It too blocks 5-alpha reductase activity although to a lesser degree than saw palmetto. The real value of nettle root is in its ability to inactivate sex hormone binding globulin (SHBG). By inactivating SHBG free testosterone is increased thereby displacing DHT preventing its binding to testosterone receptors in the prostate. Having a higher blood level of free testosterone is actually cancer-preventative since it does not promote abnormal prostate cell growth as does its metabolite DHT. Nettle root also possesses a third mechanism by which it helps to lower PSA, aromatase inhibition. Aromatase is the enzyme responsible for converting testosterone to estradiol (E2), the most potent form of estrogen. As men age aromatase activity tends to increase raising estradiol levels to potentially unhealthy levels. This is not desirable because as estradiol rises, protective free testosterone declines. Additionally, estradiol sensitizes prostate tissue to the detrimental effects of DHT. Since aromatase is produced mostly in adipose tissue losing weight can go a long way in reducing estrogen levels.
Curcumin is the predominant anti-cancer phenol found in turmeric. Cancer cells do not exhibit normal apoptosis. As normal cells systematically die and are replaced with healthy cells, cancer cells live on to produce more abnormal cells. Curcumin activates the gene that controls apoptosis thereby instructing cancer cells to self-destruct leaving healthy cells to survive and thrive. Curcumin does this job so effectively that a number of pharmaceutical companies are pursuing synthetic analogs of curcumin as chemotherapy drugs. Other recent studies have shown that curcumin may “reprogram” prostate cancer cells in a way that makes them less likely to metastasize as well as making them more susceptible to the effects of radiation therapy.
Boron is metalloid micromineral that is essential for human health but is often forgotten. In fact there isn’t even a Recommended Daily Allowance (RDA) for boron. But don’t let this fool you as inadequate boron intake has far reaching health consequences as illustrated by this article published by the National Institute of Health. Building on my synergistic approach, boron assists in maintaining prostate health by preserving its integrity. Boron significantly inhibits the enzymatic activity of PSA helping to protect the prostate from inflammation and “self-digestion”. Additionally, boron reduces two other inflammatory biomarkers, C-Reactive Protein (CRP) and Tumor Necrosis Factor Alpha (TNF-a) helping to quell the fires of inflammation. Insulin-like Growth Factor 1 (IGF-1) is another hormone implicated in prostate cancer. PSA has the ability to “free” IGF-1 by releasing it from its binding protein BP-3. Boron inhibits the ability of PSA to break this bond depriving prostate cancer cells of yet another growth factor. As an added bonus, boron also enhances the body’s utilization of Vitamin D which has profound anti-cancer effects.
Lycopene is a carotenoid, usually derived from tomatoes, that has powerful antioxidant properties. Unlike other carotenoids, lycopene is not converted to Vitamin A within the body. Given that prostate cells are more prone to DNA damage than other cells it is not a surprise that a powerful antioxidant like lycopene would be useful in the treatment of prostate cancer. With doses of only 10mg, lycopene has been shown to shrink both primary and secondary tumors of the prostate. A study utilizing 30mg of lycopene daily revealed that lycopene reduced a blood marker of DNA damage by over 20%. Further analysis of prostate tissue revealed significant reductions in DNA factors that contribute to prostate cancer. Lycopene also induced apoptosis in prostate cancer cells and hyperplastic prostate tissue. PSA levels also declined by over 17%.
There are many strategies one can employ to lower a rising PSA, from various supplements to lifestyle changes. Utilizing a synergistic approach increases efficacy for any strategy you wish to employ. It may take some time to lower your PSA so stick with it, consistency is your key to success! If you are a man over 40 and do not know your PSA number, you should. Early intervention is the key to preventing prostate cancer.
To take advantage of the RESOURCES page where you can access the Prostate Cancer Risk Calculator and PSA Doubling Time calculator, please become a member by going to the REGISTER tab. If you would like assistance developing a customized plan to lower your PSA please feel free to contact me.
Best in Health,
John
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