The Pros and Cons of PSA testing – Should you get a PSA test for prostate screening?

The Pros and Cons of PSA testing – Should you get a PSA test for prostate screening?

For anyone with concerns about prostate health today, sorting through the different guidelines and recommendations for screening, testing and treatment can be overwhelming, and tough to make sense of. This is even more true in recent years, as expert opinions and “best practices” on prostate health continue to shift with new research findings.  

So if you are struggling with prostate issues, where do you start?  

Prostate problems, including enlarged prostate and cancer, are on the rise… and these issues bring up a number of critical questions for men’s health. To begin with, researchers and prostate health experts have steadily been moving away from relying only on the PSA test (prostate specific antigen), due to concerns about test accuracy and the increased risk of unnecessary or invasive procedures, like a prostate biopsy.   

According to the American Cancer Society, around 248,000+ men will be diagnosed with prostate cancer in 2021, and more than 34,000+ are estimated to die of the disease this year. In fact, North America has some of the highest prostate cancer incidence rates in the world. Other related conditions, such as prostatitis (prostate inflammation) and benign prostatic hyperplasia (BPH—prostate enlargement) cause pain and uncomfortable symptoms.   

While PSA testing used to be the ‘gold standard’ of prostate risk assessment, it may not be the best solution for accurate testing of prostate health risks. If a PSA test isn’t the best for checking prostate health, what are the alternatives? And even when a biopsy confirms cancer is present, where do you go from there?  

While we know advanced research will lead to new treatments, we need better solutions today. Is a PSA test enough to help prostate patients?  

The Pros and Cons of the PSA Test  

What is a PSA test?  

A PSA test or prostate specific antigen test is a blood test that screens mainly for prostate cancer. For many years, the PSA test was considered the best way to keep track of prostate health and potential changes that can signal cancer or other prostate problems. The prostate specific antigen is a protein produced by the prostate gland, normally in very small amounts. When PSA rises beyond the normal range, it can indicate a potential problem in the prostate, like the development of cancer. However, PSA can also rise due to chronic inflammation and infection, creating a complication in interpreting PSA results.  

Is a PSA test accurate? 

The PSA test was once considered a lifesaver because it helped detect prostate cancer before other tests. However,  research suggests that widespread PSA testing as a screening measure does not necessarily improve prostate cancer outcomes.  

Why PSA testing may not improve prostate cancer outcomes:  

1) The PSA test alone does not measure prostate cancer aggressiveness. Many prostate cancers grow slowly and may never pose a threat to life or health. A relatively benign cancer can pose little threat to your health, but it can also mutate into a more aggressive form over time, particularly if exposed to toxins, free radicals and oxidative stress. In this case, a test may be helpful, but it is not a complete picture. 

2) The PSA test may also have trouble identifying aggressive cancers early. In other words, the test may be too quick to detect slow-moving cancers (leading to potentially invasive interventions) and too slow to detect aggressive ones (allowing a deadly, fast-growing cancer to gain a foothold). The level of PSA may not actually reflect the extent of disease and can sometimes be misleadingly low.   

Despite these observations, the PSA test is still an important tool when used with other prostate diagnostic methods to provide a more comprehensive diagnosis. Health providers and patients should also understand how PSA test results can change, according to various factors.  

PSA levels can be influenced by: 

  • medications 
  • seasonal variations  
  • time of the day 
  • sexual activity 
  • intense exercise like bicycle riding 
  • the actual size of the prostate (BPH can result in a higher reading)  

It is also important to repeat PSA tests at the same time of day and with the same laboratory, as methods for detecting PSA vary from one lab to another and can’t be accurately compared.  

Prostate Patient Testing and Treatment 

When treating a prostate cancer patient with elevated PSA, or when seeing a patient with prostate complaints and elevated PSA, it’s useful to follow up on the PSA test results, but we shouldn’t rely on it. We can lower PSA by reducing the prostate volume with specific supplement and dietary approaches, or by decreasing inflammation or eliminating prostate infections. Reducing inflammation of the prostate is an essential component of strategic prostate cancer treatment because it lowers the risk of the cancer mutating into a more aggressive form.   

What are Other Tests for Prostate Health? 

There are many other diagnostics that can provide greater context for the PSA. Prostatic acid phosphatase (PAP) is a more traditional prostate test which complements the PSA test.  PAP elevation may indicate that the cancer has metastasized to the bones and can point to the tendency for a more aggressive cancer in general, even in the absence of evident metastasis.   

Hormone Testing  

Comprehensive hormone testing is critical for providing a more complete, individualized picture of the possible influences affecting the prostate. For example, men with higher testosterone levels respond more favorably to treatment. Estrogen is also a factor, as increasing levels of the hormone in men can correlate with increases in prostate cancer, as well as more aggressive disease. This is also true of prolactin. Patients should be tested for the hormones progesterone, DHEAS and DHT (dihyrdrotestosterone), a metabolite of testosterone that is stronger and leads to stimulation of prostate cells.  

Additional Prostate Tests 

There are a number of important, non-hormonal prostate markers that are also useful.  

Carcinoembryonic Antigen (CEA) or insulin-like growth factor type-1 (IGF-1) levels, if elevated, may indicate cancer aggressiveness or other underlying conditions needing attention.  

Prostate Cancer Gene 3 (PCA3) is a gene-based test, that can help determine a patient’s risk for prostate cancer. This is a simple test done by collection of a urine sample following a digital rectal stimulation by a doctor or practitioner. This test can be used to follow up low risk prostate cancers and may replace the risky practice of annual biopsies as part of the watchful waiting/active surveillance approach.  

Other genetic tests of the biopsy tissue itself are becoming available which can provide further information about aggressiveness on a gene expression level.   

Imaging should play a key role in diagnosing. MRI, MRI-S, PET, CT, color Doppler ultrasound and bone scans can all help determine the severity of prostate cancer. The field of prostate cancer imaging is constantly evolving with newer, more accurate methods in development.   

What Increases the Risk of Prostate Cancer?  

Galectin-3: Recognized Prostate Cancer Biomarker  

Galectin-3 (Gal-3) is a master alarm protein produced by the body in response to injury, infection and other stressors. With over 3,000 published studies, Gal-3 is increasingly recognized as a key driver of chronic disease, because it controls the inflammatory cascade and fuels the development of fibrosis (uncontrolled scar tissue build up) leading to organ failure. Gal-3 is also called “The Guardian of the Tumor Microenvironment” because it is actively involved in tumorigenesis, cancer proliferation/metastasis, and immune evasion.  

Because Gal-3 aggressively fuels chronic inflammation, it has been recognized as an active marker for prostatitis, BPH—and prostate cancer. A study published in The American Journal of Pathology showed that controlling levels of Gal-3 inhibited prostate cancer metastasis.1 A study published in Oncotarget reported that the Gal-3 blood test is an important compliment to better interpret PSA test results. Researchers found Gal-3 at higher levels in the prostate serum of patients with prostate cancer.2  

What Promotes Prostate Health and Prevents Cancer Risks?  

Modified Citrus Pectin: Advanced, Clinically Proven Prostate Support 

Within the fast-growing body of research on Gal-3 in cancer and other conditions, one natural therapeutic ingredient has become recognized in the published literature as the most-researched Gal-3 inhibitor: Modified Citrus Pectin (MCP). With over 70 published studies, this original and researched form of MCP is the only available agent shown to enter the bloodstream from the GI tract, and bind to excess Gal- 3 in the circulation and at specific problem areas throughout the body.  
  
A number of studies have found that modified citrus pectin inhibits cancer—including prostate cancer.   

  • A 1995 animal study, published in the Journal of the National Cancer Institute, found that MCP blocked prostate cancer adhesion to endothelial cells, reducing lung metastasis by 50 %.3  

  • A 1999 clinical study presented at the International Conference on Diet and Prevention of Cancer in Finland found that prostate cancer patients who received MCP significantly slowed down their PSA doubling time.4  

  • A 2003 phase II clinical study published in Prostate Cancer and Prostatic Diseases analyzed the effects of MCP in men with biochemical relapse of prostate cancer after local therapy. Results showed that 5 grams of MCP three times per day for one year slowed PSA doubling time in 70% of subjects.5   

  • A 2007 clinical study published in Clinical Medicine: Oncology found that  cancer patients with advanced solid tumors who were treated with MCP stabilized and experienced improved quality of life.6  

  • The most recent study is a double-blind clinical study, published 2019 in European Urology Open Science, demonstrating that this MCP effectively slowed cancer progression in patients with biochemically relapsed prostate cancer.7 

These recent clinical results come from a multi-center Phase IIb clinical trial in a group of prostate cancer patients who received localized treatment for their cancer and experienced a non-metastatic relapse (biochemical relapse) of the tumor. 18 months of treatment with 15 grams per day of MCP showed significant improvement against prostate cancer. 65% of subjects had no disease progression, and 50% of subjects had a lower PSA, or PSADT lengthening time, compared to their baseline 18 months prior.  

Modified Citrus Pectin Enhances Chemotherapy  
Modified citrus pectin has also been shown to increase the efficacy of certain chemotherapy drugs and reduce side effects. For example, Doxorubicin (Dox) is an effective anti-cancer drug, but it’s also a very toxic one with the potential to cause severe heart and immune damage. While the compound can be useful in treating advanced prostate cancer patients, the issue is dosage-dependent toxicity. Due to its high toxicity, it can be difficult to give patients a sufficient dose to inhibit the cancer without causing significant side effects.  
  
However, a study published in the journal Cell Biology International showed that combining Dox with modified citrus pectin increased the anti-cancer activity of both agents. MCP synergistically enhanced the cytotoxic effects of Dox in both androgen-dependent and androgen-independent prostate cancer, allowing for a significant reduction in the dosage of Dox.8 

Supporting Your Prostate Health 

One of the keys to success in integrative cancer treatment—not just prostate cancer but many others as well—is the strategic application of individualized protocols based on a diverse range of diagnostic and therapeutic approaches. The Gal-3 prostate biomarker is a unique example of both. It serves as an important diagnostic tool and is becoming a powerful therapeutic target for numerous conditions—from prostate cancer to nearly every other type of cancer; cardiovascular disease, kidney disease, and much more. When it comes to supporting prostate health, modified citrus pectin is recognized for its ability to block pro-cancer, metastatic, pro-inflammatory and pro-fibrotic actions—making it an important tool in the treatment of prostate cancer and numerous chronic conditions.   

Sources 

1. Wang Y, Nangia-Makker P, Tait L, Balan V, Hogan V, Pienta K, Raz A. Regulation of prostate cancer progression by galectin-3. Am. J of Pathol. 2009 Apr; 174 (4): 1515-23.  

2. Balan V, Wang Y, Nangia-Makker P, Kho D, Bajaj M, Smith D, Heilbrun L, Raz A, Heath E. Galectin-3: a possible complementary marker to the PSA blood test. Oncotarget. 2013 Apr;4(4):542-9.  
  
3. Pienta KJ, Naik H, Akhtar A, Yamazaki K, Replogle, TS, Lehr J, Donat TL, Tait L, Hogan V, Raz A.  Inhibition of spontaneous metastasis in a rat prostate cancer model by oral administration of modified citrus pectin. J Natl Cancer Inst 1995 87(5):348-53  
  
4. Strum S, Scholz M, McDermed J, McCulloch M, Eliaz I. Modified citrus pectin slows PSA doubling time: a pilot clinical trial. Paper presented at: International Conference on Diet and Prevention of Cancer. May 1999. Tampere, Finland.  
  
5. Guess B, Scholz M, Strum S, Lam RY, Johnson HJ, Jennrich RI. Modified citrus pectin (MCP) increases the prostate specific antigen doubling time in men with prostate cancer: A Phase II clinical trial. Prostate Cancer Prostatic Dis. 2003;6(4):301-4  
  
6. Azémar M, Hildenbrand B, Haering B, Heim ME, Unger C. Clinical benefit in patients with advanced solid tumors treated with modified citrus pectin: a prospective pilot study. Clinical Medicine: Oncology 2007 Dec (1): 73–80.  

7.  Dresler, H. et al. Long term effect of PectaSol-C modified citrus pectin treatment in non-metastatic biochemically relapsed prostate cancer patients: Results of a prospective phase II study. European Urology Supplements, Volume 18, Issue 11, e3467. 
  
8. Tehranian N, Sepehri H, Mehdipour P, Biramijamal F, Hossein-Nezhad A, Sarrafnejad A, Hajizadeh E. Combination effect of PectaSol and Doxorubicin on viability, cell cycle arrest and apoptosis in DU-145 and LNCaP prostate cancer cell lines. Cell Biol Int. 2012 Jul 36(7):601-10.