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The Prostate Problem

If you’re a man who has ever gotten a prostate-specific antigen (PSA) screening, you know it’s a “must-have” test for guys over 50. But there’s a debate that’s been raging for years over the test’s ability to save lives. And now, two opposing studies have muddied the waters on the value of this routine test even more – leaving American men wondering if the test is really worth taking.

While an elevated PSA reading may indicate a life-threatening cancer, it may also detect slower-moving tumors that would never cause death. Because doctors can’t yet tell the difference, treatments are often ordered that can impair men’s quality of life – causing many experts to worry that the PSA test is overused.

The Problem With PSA

If you’ve never had a PSA screening, here’s the 411 on this popular prostate test. The prostate produces a substance known as Prostate Specific Antigen (PSA). A small amount of this antigen continuously leaks into the bloodstream, and levels can be easily measured. Since high levels of PSA can be associated with prostate cancer, most doctors rely on this test, combined with a rectal exam, to screen their patients for prostate cancer.

Routinely measuring PSA levels as a way to spot potential prostate cancer began in the early 1990s and quickly gained status as the “gold standard.” The logic behind the simple blood test was that the earlier you could spot prostate cancer, the better the chance of survival. It’s a belief most doctors still subscribe to.

On the other hand, the American Cancer Society does not currently recommend routine PSA screening for all men. Here’s why: Raised PSA levels simply indicate there’s a problem with your prostate. While that could mean cancer, it could also be a sign of a prostate infection or an enlarged prostate. Or it could mean nothing at all since PSA levels also go up after some medical procedures, particularly after a digital rectal exam. Smoking, your diet, weight changes, and the use of calcium supplements an also cause unreliable PSA readings.

Unfortunately, too many doctors automatically schedule a biopsy based on just one PSA screening. This is totally unnecessary. PSA levels, like your blood pressure, can go up and down based on a variety of factors. Scientists at the University of Texas found that men who are overweight or obese typically have lower PSA counts – even if cancer is present. Bladder infections can also upset PSA levels. Certain medications, like the hair loss drug finasteride, can lower your PSA level, while stress can raise it. And something as simple as changing your diet can impact your PSA.

To get the whole picture, several PSA screenings should be done before more radical measures are taken. And that’s where these two studies come in.

Study Stupor

While both studies appeared in a recent issue of the New England Journal of Medicine, that’s where the similarities end. The first study, which followed more than 76,000 American men for seven years, found that getting regular PSA screenings did not reduce prostate cancer deaths. But the other study, which included 182,000 European men, found that getting tested reduced the risk of dying from prostate cancer by 20 percent.

So which study is right? Who knows? What I can say is this: The never-ending debate over the virtues of PSA screenings is enough to make any man crazy! But there are some guidelines that can help you decide if you really need to get tested. The most important is family history. You have a higher risk of developing prostate cancer if the men in your family had the disease, especially if they were diagnosed before they turned 55. If your father or brother developed prostate cancer, your risk is doubled.

Race can also be a risk factor. More African-American men are struck by prostate cancer than their Asian counterparts. Blacks also have a higher risk of dying of the malignancy. If you have either of these risk factors, you should definitely schedule a PSA test by the time you celebrate your 45th birthday.

What if you’re an older man? Some cancer experts say that, if you have had normal PSA readings in the past, you can stop testing at age 70. But, if previous tests show rising PSA levels, keep getting screened at least annually. If you’re eventually diagnosed with prostate cancer, be aware that most prostate cancers are confined to the prostate itself and grow very slowly. If you’re over 75, consider “watchful waiting” – a situation where your doctor keeps very close tabs on the cancer’s progression. It can be a good alternative to aggressive treatment, which can carry the risk of incontinence and impotence.

Pro-Active Protection

In the midst of all this confusion, there is some good news. Mother Nature has provided men with an arsenal of tools to protect against prostate cancer. Here are three of the most effective:

Vitamin D:  A growing number of studies link the “sunshine” vitamin to a lower risk of prostate cancer. One observational study of 19,000 men found that those with the lowest levels of vitamin D have a 70 percent higher risk of developing prostate cancer than those men who got enough of this nutrient. Without enough vitamin D, prostate cells can multiply too quickly and promote both prostate enlargement and cancerous tumors. Yet between 20 and 80 percent of all Americans have low enough levels to classify them as vitamin D deficient. Make sure you’re getting enough by taking 1,000 IU of supplemental vitamin D per day to help prevent cancer.

Lycopene:  This nutrient is a powerful antioxidant and the source of the red coloring in tomatoes. In a study of over 40,000 health professionals, Harvard researchers found that lycopene slashed the risk of prostate cancer by 35 percent. In another study, researchers discovered that the risk of developing prostate cancer – especially aggressive cancer – decreased in men taking 50 mg. of supplemental lycopene daily. They also noted that a high level of lycopene in the blood was associated with low PSA levels. To boost your lycopene levels, take at least 6.5 mg. per day.

Beta-Sitosterol:  This compound is found in a wide variety of plants, including prostate-friendly herbs like saw palmetto, pumpkin seed, and Pygeum africanum. A study of malignant prostate tumors showed that beta-sitosterol decreased cancer cell growth by 24 percent and boosted the rate that the cancer cells died fourfold. The researchers concluded that beta-sitosterol worked both directly and indirectly to halt the growth and spread of prostate cancer cells. To get the most protection possible, take 130 mg. of beta-sitosterol daily. Just be aware that plant sterols can interfere with beta-carotene and vitamin E absorption. Make sure to take a multivitamin to avoid a deficiency.

One Last Thing

If you do decide to get a PSA screening, it’s also smart to have some idea what the results mean. What’s high? What’s low? The National Cancer Institute has created the following four categories to help your doctor determine your risk of prostate cancer.

Normal   0-4 ng/ml

Slightly Elevated  4-10 ng/ml

Moderately Elevated  10-20 ng/ml

Highly Elevated  20+ ng/ml

ng/ml = nanograms per milliliter

If your levels are elevated, don’t panic! And don’t let your doctor automatically schedule a biopsy. As I mentioned earlier, there are a lot of reasons your PSA may be higher than normal.

A higher-than-normal PSA reading simply means that two things need to happen. First, if your doctor hasn’t done so, make sure he conducts a digital rectal exam (DRE). During a DRE, your doctor inserts a lubricated, gloved finger into the rectum and feels the prostate for hard, lumpy, or abnormal areas. Pressure may be applied with the doctor’s other hand to the pelvic area so that he can feel for tenderness or abnormalities such as enlargement or growths. There can be some mild discomfort or pain during a DRE, since the doctor must press firmly on the prostate. This pressure can also make you feel like you need to urinate. But, even though it may not be on your “Top 10″ list of fun things to do this year, it beats the heck out of getting a biopsy, which can be painful, risky, and potentially unnecessary.

The second thing you need to do is to request at least one more PSA screening before proceeding to more aggressive testing. Since prostate cancer is a slow-growing cancer, most men with higher than average levels can afford to take at least one additional test, preferably a few weeks after the original screening. Overall, PSA is fairly reliable over time, and both you and your doctor can get a much better picture of what’s really happening inside your prostate if several PSA tests can be compared.

While you’re waiting for your next screening, there are a number of things you can do to improve a troubled prostate. Start by cleaning up your diet. Avoid dairy and highly processed foods, and opt for healthy whole foods. You can also begin to take the supplements mentioned above.

Research Brief

Recently I told you how lutein can protect against age-related macular degeneration. Well, it turns out that this eye-friendly antioxidant can also tackle more mundane problems. A new study from China shows that taking lutein for 12 weeks protected computer users’ eyes from becoming sensitive to long-term exposure to the light from computer monitors.

This is great news for folks like me who spend hours in front of their computers. But, to get this protection, the study found that you need higher-than-average amounts of lutein – six to 12 mg. daily. Along with taking a lutein supplement, you can increase your levels by eating more green, leafy vegetables and egg yolks.

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