In our integrative medical wellness clinic, we support a significant number of integrative and alternative cancer patients, suffering from a wide range of various cancer diagnoses. One of our frequently seen cancers is Prostate Adenocarcinoma, as well as Prostate Adenocarcinoma metastasized to the bone, often the hip or pelvis. I would like to spend a few minutes talking about prostate testing and give you some great information on various tests that exist. Getting the right test may help save your life or the life of a loved one or friend. If you have questions, as always feel free to reach out.

One of the most important tests in men's health is testosterone, but often forgotten and equally as important for those greater than 40 years old is the prostate-specific antigen (PSA). This biomarker serves as one of the functional medicine doctor's most important tools for evaluating the health of their male patients.

World-wide, prostate cancer is the fifth leading cause of death and the second-most frequent cancer diagnosis in men. Over one million new prostate cancer diagnoses are made every year, however we know that prostate cancer is unfortunately very hard to detect in its early, asymptomatic stages. This fact is underscored by the truth that 30-70% of autopsies of men over 60 show evidence of prostate cancer developing, despite the fact they died from unrelated causes.

These facts help to underscore the importance of monitoring our male patient's prostate health in functional medicine and helping to ensure they don't trend towards a cancer diagnosis. Measuring serum or blood levels of PSA is among the best methods to do so.

The Prostate-Specific Antigen Test

PSA, the most abundant protein synthesized in the prostate gland, is a protease enzyme that helps to liquefy male ejaculate to facilitate fertilization.

In normal health individuals, this protein stays within the prostate itself, which is why an individual with a healthy prostate will typically have PSA levels in lab testing of less than 1.0 ng/ml. When the prostate is cancerous, unfortunately, blood PSA levels rise significantly. Not only do prostate cancer cells produce PSA, this protein's enzyme activity can break through the prostate cell walls, eventually leading to the spread of the cancer.

This helps emphasize the importance of measuring a male patient's PSA levels over time, helping to track any risk of developing cancer.

Optimal levels

The standard of care in allopathic medicine considers a Total PSA level below 4.0 ng/ml as normal. Functional Medicine practitioners like our clinic, however, will look for lower levels in patients in optimal health. Studies have shown that 22% males with total PSA between 2.6 and 4.0 have a "significant" prostate cancer risk (Journal of Urology, Jan 1 2005, Volume 174 Issue 6). Because of these studies, I would encourage the functional range of PSA ideally showing levels below 2.6 ng/ml.

With the ultimate goal of preventing disease rather than treating it, I recommend testing for PSA once a male is in his mid 30s, helping us to catch any early cases and serving as a baseline to evaluate prostate health over the aging process.

Key Facts

Obese patients are less likely to show elevated levels of Total PSA even in the presence of prostate cancer. If you are obese, you may want to look at additional cancer biomarkers to help confirm the presence of cancer if concern presents itself. Also, it's important to understand that Total PSA doesn't need to be elevated for there to be prostate cancer present.

There are several additional tests you can consider running when this is the case. Cancer cells cells produce specific proteins and enzymes that play a role in the growth, spread, and metastasis of tumors. We can measure many of these proteins and enzymes, often known simply as biomarkers, in the blood. An increase in cancer tumor growth or size is usually accompanied by an increase in these biomarkers. Some specific biomarkers to consider running for prostate cancer risk are listed here:

Prolactin

Prolactin is a hormone produced in the pituitary glands of both men and women. Pioneering work by researchers at Georgetown University Medical Center show that prolactin serves as a local growth factor for prostate cells. Normal levels of prolactin in men are 2.17 to 17.7 ng/ml.

D-Dimer

Because prostate cancer can cause higher risk of thrombosis, it's a good idea to keep track of D-dimer levels, a sensitive marker of coagulation. D-dimer can indicate if the patient has an existing blood clot or a risk of clotting. Most doctors would read levels between 0-1 as acceptable and clot free, however again as a functional medicine trained practitioner, I like to see D-Dimer levels below .40, within the optimal range.

Fibrinogen

This is a very important test in predicting cancer development or progression. I use this test for all my cancer patients. Fibrogen is the precursor of fibrin. Research suggests that cancer cells use fibrin to coat themselves in order to slow down their recognition by the immune system.

Like D-dimer, fibrogen can also be a good predictor of blood clots. Patients with cancer often show an increase in blood clotting or increased coagulation with fibrinogen elevations playing a key role. Certain medications such as heparin and natural supplements such as turmeric (contains curcumin), ginger, vitamin E, gingko biloba and grape seed extract have been shown to improve survival rates. Fibrinogen levels optimally should be below 300 mg/dl.

C-Reactive Protein (CRP)

It is known that inflammation is involved in cancer development and progression. CRP are two of the inflammatory markers that have been most strongly connected with prostate cancer. Research shows that high C-reactive protein levels in men are associated with a 40% higher risk of prostate cancer. Furthermore, high levels of CRP may be responsible, in part, for creating an environment for cancer to develop and progress. I like to see CRP levels below 0.50 mg/L for men and women, optimally.

Insulin and Metabolic Syndrome

There appears to be a link between insulin resistance and prostate cancer. As a result, it's a great idea to keep an eye on fasting glucose, hemoglobin A1C, C-peptide, and lipid panels.

There is more and more research coming out on preventing, tracking, and treating prostate cancer. This article is truly only an introduction to the topic of blood testing for prostate disease, with the aim of opening patient eyes regarding the tools that currently exist. I encourage all our male readers to speak with their primary care physicians or our clinic to help ensure you get the tests you need to evaluate your prostate health properly.

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References

Nevalainen, M. Researchers Discover Effective Method For Killing Prostate Cancer Cells, AScribe News, Inc. May, 2003, Georgetown University Medical Center

Stark, JR., IL-6, CRP Levels Tied to Prostate Cancer Development, Lethality, American Association for Cancer Research's Frontiers in Cancer Prevention Research Meeting in Boston, Nov. 2006., Reuters Health Information 2006.