PSA Testing Should Begin at Age 40: British study finds
James Meschino DC, MS, ROHP
A landmark study published in the British Medical Journal has shown that a man’s PSA level, assessed in his early to mid 40’s, is highly predictive of future development of prostate cancer. PSA stands for prostate specific antigen. Cancer cells secrete PSA into the bloodstream, thus a high PSA raises the suspicion of prostate cancer. However, other factors can increase blood PSA levels to a mild to moderate degree, as well, such as infection, prostate enlargement (benign prostatic hyperplasia or BPH) and recent ejaculation. Although prostate cancer suspicion has traditionally been reserved for men with a PSA level above 4 ng/ml, British researcher showed that for men age 45-49 yrs a PSA level of about 1.5 ng/ml or higher (top 10% percentile) was linked to 44% of future deaths of prostate cancer over the 25-30 year study period.
The British study also showed that the risk of developing metastatic prostate cancer within 15 years is close to three-fold higher for men in the top level PSA at age 45-49 and close to ten-fold higher at age 51-55. This suggests that starting to perform PSA screening after age 50, which is customary, would leave a significant proportion of men at elevated risk of later being diagnosed with metastatic prostate cancer, which is incurable at this point in time. The British study suggests that it may be wise to begin screening men at age 40. Any man with a PSA level at or above 1.4 ng/ml should be monitored very closely (1).
In addition to close monitoring these men should also be educated about the link between diet and lifestyle, which have been shown to be linked to 75-80% of prostate cancer cases (2) As many studies have shown that diet, lifestyle and certain supplements can influence develop and progression of prostate cancer, providing men with evidence-based dietary, lifestyle and supplementation strategies to combat prostate cancer should be included in consultations with all men regarding prostate health, especially with men who are shown to be at high risk (3-9).
I recently had a patient in his early 50’s whose PSA rose from 1.4 ng/ml to 2.6 ng/ml within a 12 month period. He refused to have the recommended biopsy, fearing bleeding, pain, and infection from the procedure. I devised a supplement program for him, based on current research, along with dietary modifications. Within 9 months the lifestyle program I designed for him lowered his PSA back down to 1.4 ng/ml, while showing steady reductions in the PSA level at the 3, 6 and 9 month follow-up assessments. His family doctor and urologist were most impressed with the results. Below you find the exact diet and supplementation program I recommended. This lifestyle plan is not a replacement for prostate cancer assessment and conventional treatment, but should be part of an attempt to lower PSA levels in high-risk patients and as the adjunctive nutritional management in patients with diagnosed prostate cancer.
Adjunctive Nutrition and Supplementation Recommendations For Men with Prostate Cancer or a PSA Level Above 2.5 (if over 50 yr), or PSA Level at or above 1.4 (if 40-49 yr), or a PSA Velocity that has Increased Abruptly Within a One year Period (more than 0.35 ng/ml)
Dietary and Lifestyle Prescription:
- No red meat, pork, lamb, duck
- No deep fried foods, no foods that are cooked to completion via pan-frying in oil
- No cheese, no milk or yogurt above 1% milk fat, no egg yolks, no butter, no cream, no mayonnaise
- No frozen yogurt or ice cream
- No sugar, honey or brown sugar in coffee or espresso
- No alcohol of any kind (including red wine)
- Eat at least one cruciferous vegetable per day (broccoli, cabbage, Brussels sprouts, kale, bok choy, cauliflower)
- Eat soy products if possible (stir fry tofu with mixed vegetables, edamame, roasted soy nuts, soy milk)
- No high fat pastries (cheat with a biscotti, or low fat muffin)
- Eat beans and peas daily if possible – including vegetarian lentil soup
- 8 ounces of pomegranate juice per day
- Need 30 mins of aerobic exercise at least 4 days per week for insulin and glucose control – these influence the rate of cell division and growth.
- Adeeva Multiple Vitamin and Mineral – 2 caplets, twice per day
- Adeeva Nature’s Essential Oils – 3 capsules per day
- Adeeva Immuno-Detox Prime – 3 capsules, twice per day
- Adeeva Prostate 40 Plus – 2 capsules, twice per day
- Adeeva Sleep-E Natural (with melatonin) – 4 capsules, one hour before bedtime
- Lycopene – 20 mg per day
- Modified Citrus Pectin – 5 gms, three time daily – can mix into protein shake as well as juice
- Vitamin E Succinate – 1600 IU per day
- Vitamin D – 10,000 IU per day for one month, then 5,000 IU per day thereafter
- Ground flaxseed – 50 gms (2 heaping tablespoons) once per day – mix into Adeeva Protein Shake
- Soy Isoflavones – 200 mg per day
- 14 mushroom blend (mushroomharvest.com) – 2 teaspoons per day (4 grams) mixed into non- fat yogurt
- J. Vickers, D. Ulmert, D. D. Sjoberg, C. J. Bennette, T. Bjork, A. Gerdtsson, J. Manjer, P. M. Nilsson, A. Dahlin, A. Bjartell, P. T. Scardino, H. Lilja. Strategy for detection of prostate cancer based on relation between prostate specific antigen at age 40-55 and long term risk of metastasis: case-control study.BMJ, 2013; 346
- Willet W. Estimates of cancer deaths avoidable by dietary change. J Natl Cancer Instit 1996;86(14):p948
- Hussain M, Banerjee M, Sarkar FH et al. Soy isoflavones in the treatment of prostate cancer. 2003. Nutr and Cancer, 42;2: 111-117
- Woo TCS, Choo R, Jamieson M et al. Pilot Study: Potential role of vitamin D (cholecalciferol) in patients with PSA relapse after definitive therapy. Nutrition and Cancer. 2005, 5;1: 32-36
- Partin AW, Pound CR, and Rootselar CV. Natural history of progression after PSA elevation following radical prostatectomy: Update. J Uorl. 2003, 169 (4 suppl): 935
- Vaishampayan U, Hussain M, Seren S, Sarkar F, Fontana J et al.Lycopene and Soy Isoflavones in the Treatment of Prostate Cancer. Nutri and Cancer.2007; 59 (1): 1-7
- Ornish Dean et al: Intensive lifestyle changes may affect the
progression of prostate cancer. The Journal of Urology Vol.
- Demark-Wahnefried Flaxseed Supplementation (Not Dietary Fat Restriction) Reduces Prostate Cancer Proliferation Rates in Men Presurgery.CancerEpidemiol Biomarkers Prev 2008;17(12):3577–87)
- Matlaga BR, Hall MC, Stindt D, Torti FM. Response of hormone refractory prostate cancer to lycopene. J Urol 2001;166:613.