By Dr. Mercola
Prostate cancer is one of the most common cancers in men, but it is not as deadly as breast cancer.
According to the latest statistics from the American Cancer Society, an estimated 240,890 men will be diagnosed with prostate cancer this year, and just over 33,700 men may die from it, so only one in seven diagnosed with it will die from it.
Overall, American men have a one in six chance of being diagnosed with prostate cancer at some point in their lives, or one in 42 chance of dying from it..
Most cases of prostate cancer do not occur until after men turn 50, but in recent years there has been a steady rise in the percentage of men in their 30s and 40s with both prostate problems and prostate cancer, primarily as a result of poor diet and increasing environmental pollution.
Unfortunately, investigations over the years have discovered serious flaws with the PSA test used to diagnose prostate cancer.
And the U.S. Preventive Services Task Force—which has also declared women in their 40s don't need mammograms—may soon recommend that men not get screened for prostate cancer using the PSA test.
Researchers are also questioning the conventional treatments of prostate cancer, which include surgical removal of the prostate gland and radiotherapy, as they may not be necessary for most men.
All in all, I think this really highlights the necessity to employ preventive strategies, which I will discuss at the end of this article.
Moderate to High Certainty PSA Test Does More Harm than Good, Task Force Says
The prostate-specific antigen test (PSA test), analyzes your blood for prostate-specific antigen (PSA), a substance produced by your prostate gland. When higher-than-normal levels of PSA are detected, it is believed that cancer is present.
However, the PSA test has been criticized as useless for a number of years now. For example, back in 2004, Stanford University News reported:
"The most commonly used screening tool for detecting prostate cancer – the PSA test – is virtually worthless for predicting men's risk of contracting the disease, medical school researchers have determined. Stanford scientists studied prostate tissues collected in the 20 years since a high PSA test result became the standard for prostate removal. They concluded that as a screen, the test indicates nothing more than the size of the prostate gland."
The U.S. Preventive Services Task Force is now planning on recommending a "D" rating for PSA testing, meaning that "there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits." A review of studies has shown that the PSA blood test yields "small or no reduction" in prostate cancer deaths.
As reported by CNN:
"The report adds that PSA testing is 'associated with harms related to subsequent evaluation and treatments.' ... The problem is that many of the cancers that get detected are so small and slow-growing, they'll never be harmful, and doctors have a difficult time discerning the quick, harmful cancers from the slow, harmless ones."
The PSA Test for Prostate Cancer is Deceptive
Today, many experts agree that PSA testing is unreliable at best and useless at worst for accurately diagnosing prostate cancer. Many also agree that routine PSA blood tests often lead to over-diagnosis of prostate cancer, resulting in unnecessary treatments. Similar to mammograms, the PSA screen has become little more than an up-sell technique. The false positive rate is high, and the bulk of the harm is a result of subsequent unnecessary treatments.
According to the American Cancer Society: "There can be different reasons for an elevated PSA level, including prostate cancer, benign prostate enlargement, inflammation, infection, age, and race," all factors that make PSA test results confusing, leading to potential for unnecessary treatment and suffering when tests are elevated. Getting a PSA test reduces your lifetime risk of dying from prostate cancer from three percent to just 2.4 percent, so the difference is negligible.
Drs. Boyle and Brawley of the International Prevention Research Institute, Lyon, France have said,
"The real impact and tragedy of prostate cancer screening is the doubling of the lifetime risk of a diagnosis of prostate cancer with little if any decrease in the risk of dying from this disease."
Complications of ill advised prostate cancer treatments include urinary incontinence and erectile dysfunction. Both of these conditions are difficult to reverse and can significantly decrease your quality of life.
Prostate Biopsies Can Result in Dangerous Infections
A positive PSA test will typically lead to a biopsy—which has also come under increasing scrutiny and criticism in recent years. On the one hand, the procedure itself may cause acute or long-term harm, and on the other, the rate of false negatives is high.
There are over one million prostate cancer tissue biopsy procedures performed annually in the U.S. Approximately 25 percent of these tissue biopsies are reported "positive," indicating the presence of prostate cancer. The remaining 75 percent are reported "negative." One-third of the men with initial "negative" results for prostate cancer actually do have prostate cancer that was missed by the biopsy.
A prostate biopsy involves inserting fine needles into the prostate gland. But specialists have begun to worry about a recent, significant increase in the risk of complications from the procedure. In particular, they are concerned about hard-to-treat bloodstream infections that can require weeks of treatment. Over the past decade, the rate of hospital admissions in Ontario, Canada, for serious infections caused by prostate biopsy increased four-fold.
Earlier this summer, the NPR reported:
"Doctors all over the world are increasingly concerned about post-biopsy infections. At last week's annual meeting of the American Urological Association, there were 10 reports on the phenomenon ... The underlying problem, many say, is the spread of antibiotic-resistant microbes."
Prostate biopsies inherently pose a risk for infection because:
- The needles that collect a tiny piece of prostate tissue can transport bacteria through your rectal wall into the prostate and bloodstream, and/or
- The needles can spread harmful bacteria present in your gut into your bloodstream
Many Cancer Screenings Don't Save Lives and May Cause Cancer
A recent article featured on PreventDisease.com brings up yet another problem with the PSA test:
"Perhaps most concerning, the PSA test frequently identifies something that qualifies as cancer under a microscope but acts nothing like cancer in real life. That is to say, the large majority of PSA-discovered "cancers" would never cause any problem whatsoever if they went undetected. Finding something through screening invariably leads to treating it through conventional means which cause cancer themselves."
An underlying issue that needs to be addressed is that both breast- and prostate cancer screenings (mammography and PSA testing respectively) fail to address prevention. Although they are commonly viewed as "preventive" measures, they're nothing of the sort. Furthermore, they both appear to result in increased risk of mortality.
The article on PreventDisease.com also includes the following shocking statistics about breast- and prostate cancer screening:
"In a Swedish study of 60,000 women, 70 percent of the mammographically detected tumors weren't tumors at all. These "false positives" aren't just financial and emotional strains, they may also lead to many unnecessary and invasive biopsies. In fact, 70 to 80 percent of all positive mammograms do not, upon biopsy, show any presence of cancer.
When it comes to prostate cancer, a 20-year study from Sweden suggests that screening for prostate cancer does not reduce the risk of death from the disease. In fact, many men receive false-positive results and overtreatment, adding an element of risk to widescale screening, researchers report in the March 31 online issue of the BMJ.
"In the light of our findings, I would say that the benefit from screening is not sufficient to support mass screening," said study author Dr. Gabriel Sandblom, an associate professor at the Karolinska Institute in Stockholm."
Screens and Treatments Involving Radiation Promote Cancer
Cancer screens like mammography and radiation treatment of either breast- or prostate cancer are not benign tests and treatments. It's important to understand that radiation exposure causes genetic mutations in cells, and is also known to switch off a tumor suppressing gene. According to PreventDisease.com:
"[N]ew research from the Lawrence Berkeley National Laboratory in America (a US Government facility) has shown that radiation both changes the environment around breast cells, and increases the risks of mutation within them; a mutation that can be passed on in cell division. Four to six weeks after exposure to radiation at a level below that of a screening mammogram, breast cells started to prematurely age.
This results in their inability to send certain chemical messages into their immediate environment, which then filled with pre-cancerous mutated cells also from the radiation.
Paul Yaswen, a cell biologist and breast cancer research specialist with Berkeley Lab's Life Sciences Division says "our work shows that radiation can change the microenvironment of breast cells, and this in turn can allow the growth of abnormal cells with a long-lived phenotype that have a much greater potential to be cancerous."
Yawsen stated that radiation specialists have been slow in understanding these concepts. "Many in the cancer research community, especially radiobiologists, have been slow to acknowledge and incorporate in their work the idea that cells in human tissues are not independent entities, but are highly communicative with each other and with their microenvironment."
Despite the Evidence, Many Cling to the PSA Test
Shannon Brownlee, author of Overtreated, recently wrote an insightful article for Time Magazine on this topic as well. Many men are responding with outrage at the news that the PSA test will no longer be recommended. Many prostate cancer survivors credit the PSA test with saving their lives.
"The trouble is most men who get treated didn't have a cancer that needed treating," Brownlee writes. "So while a given man may believe fervently that early treatment saved his life, there's a better than even chance that he would have been fine even if his cancer had been left well enough alone.
We never hear from the men who died from their prostate cancer treatment or biopsy. And there have been plenty of them. The mortality rate during or shortly after prostate surgery is estimated to be 1 in 200, according to a study published in the Journal of the National Cancer Institute. We also don't hear much from the men who are suffering from incontinence, impotence, or both, the devastatingly common side effects of treatment."
This is probably to be expected. If it was you, how willing would you be to tell the world that you're now incontinent and impotent as a result of opting to get tested for prostate cancer? These are personal details that few men are willing to share.
How to Maintain Optimal Prostate Function and Help Prevent Prostate Cancer
Men over 70 have a 50/50 chance of developing an enlarged prostate, known as benign prostate hyperplasia (BPH). This is not the equivalent of prostate cancer. However, you do need to address this issue, and unfortunately, the conventional route includes drugs. It's important to know that some of these drugs actually carry a warning label that if you have benign prostate hyperplasia, the drug may increase your cancer risk, and/or may promote a much more aggressive form of cancer.
For more information about this, please review this previous article on prostate health, which includes an informative interview with Dr. Rudi Moerck. Diet is a factor that can greatly impact your prostate health and help prevent enlarged prostate and prostate cancer.
You'll want to eat as much organic (preferably raw) food as possible, and liberally include fresh herbs and spices, such as ginger. Make sure to limit carbohydrates like sugar/fructose and grains as much as possible to maintain optimal insulin levels, which will help reduce your cancer risk in general. Highly processed or charcoaled meats, pasteurized dairy products, and trans fats correlate with an increased risk for prostate cancer and should also be avoided.
There are also a number of more specific nutritional therapies that are particularly beneficial for avoiding and/or treating prostate cancer.
- Include prostate-healthy foods in your daily diet: Foods that support prostate health include vegetables and fruits rich in antioxidants, vitamins, cartenoids like astaxanthin, and lycopene. One 2009 study identified tomatoes, cauliflower, broccoli and green tea as being particularly beneficial against prostate cancer
- Try saw palmetto: The medical literature contains about 100 clinical studies on saw palmetto for prostate health and reduced incidence of prostate cancer. Trying saw palmetto before you resort to a drug is well worth it, considering the stern warnings that accompany some of these drugs. According to Dr. Moerck, saw palmetto in combination with pumpkin seed or lycopene may be an even more potent combination.
Beware that quality is very important when selecting a saw palmetto supplement. Most brands on the market are ineffectual because they use the inactive form of the plant.
The highest quality products are the organic supercritical-extracted saw palmetto oils, which are very dark green in color. Only one or two out of every 20 brands will be of this high quality. Dr. Moerck recommends a daily dose of 320 mg of saw palmetto oil (supercritical CO2 extract). Keep in mind that saw palmetto is a fat soluble supplement, so it will not absorb well unless you take it in conjunction with a little bit of fat. I recommend taking it with eggs, which contain phospholipids that enhance absorption of fat soluble nutrients.
- Optimize your vitamin D levels, ideally by exposing your bare skin to natural sun light on a regular basis. (Your skin also synthesizes vitamin D sulfate, which may account for many of vitamin D's potent health benefits, so sun exposure is really the ideal way to optimize your levels and get the greatest overall health benefits.) Evidence suggests that vitamin D may be one of the most potent variables associated with a lower risk of prostate cancer.
There are well over 800 scientific studies confirming the link between vitamin D deficiency and multiple types of cancers, including prostate cancer. For example, according to a 2005 study, men with higher levels of vitamin D in their blood were half as likely to develop aggressive forms of prostate cancer as those with lower amounts. Another study published two years ago found that men with higher levels of vitamin D in their blood were seven times less likely to die from prostate cancer than those with lower amounts.
Testing your vitamin D levels is done by a simple blood test. Anything below 20 ng/ml is considered a serious deficiency state, which will increase your risk of breast- and prostate cancers.
The optimal value that you're looking for is between 50-70 ng/ml. However, research has suggested that maintaining a slightly higher level of 70-100 ng/ml may be optimal for cancer prevention. If you can't get regular sun exposure, you may want to consider using a safe tanning bed (one that uses electronic rather than magnetic ballasts and has less, not more, UVA than the sun produces). If these are unavaialble you can opt for an oral vitamin D3 supplement. Keep in mind that when using a supplement, regular testing becomes even more important to make sure you're staying within therapeutic range.
- Consider a vitamin K2 supplement: Another nutrient that has been found to offer significant protection against prostate cancer is vitamin K2. For more information about that, please refer to this previous article. Although I don't typically recommend taking a lot of supplements, vitamin K is one you may want to seriously consider because many people don't get nearly enough of it on a daily basis through the foods they eat.
- Exercise your body, and your prostate: Having a well-rounded exercise regimen is essential for overall health, and is now becoming more widely accepted as a critical piece of cancer prevention and treatment. Having sex on a regular basis, which exercises your prostate specifically, is also important.
- Check your testosterone levels: Contrary to popular belief, restoring testosterone levels in aging men does not appear to promote prostate cancer—on the contrary! According to meticulous research by Dr. Abraham Morgentaler, MD, author of Testosterone for Life, men with low testosterone are the ones at greater risk. For an interesting article that contains a lot more information about this, read Dr. Morgentaler's report Destroying the Myth About Testosterone Replacement and Prostate Cancer.
It explains how unfortunate assumptions have led to a dogmatic belief that testosterone replacement increases your risk of prostate cancer—a belief that might now be preventing many men from being optimally healthy. If you are low you can consider trans rectal DHEA cream. I personally use about 50 mg twice a day, and it has done wonders to optimize my testosterone levels as DHEA is converted to testosterone in your body.
Ideally, you'll want to pay close attention to your prostate health early on—avoid waiting until you're in your 60's. Incorporating the lifestyle recommendations discussed above can help you prevent prostate problems from developing in the first place.