- As one of the leading screening tools for prostate cancer, the PSA test is recommended routinely for men 50 years of age and above—but this test is far less accurate and specific than you may think
- Screening for prostate cancer can lead to false positives, and the diagnostics and treatments that may result are not risk-free
- A multitude of factors can increase and decrease your PSA levels regardless of the presence or absence of cancer
- It’s possible to lower PSA levels through adjustments to your nutrition and other lifestyle changes
Prostate cancer is the second most common cancer in men. The prostate is a walnut-sized gland in the male reproductive system and is located below the bladder and in front of the rectum. This type of cancer is so prevalent that experts estimate that 1 in 8 men will be diagnosed with prostate cancer at some point in their life.
As men near age 50, chatter starts growing about screening for prostate cancer through a PSA test. PSA stands for Prostate-Specific Antigen. It is a protein produced exclusively by the prostate and is measured in a simple blood test. Of all the prostate cancer markers studied, PSA is considered the most predictive for prostate cancer. Generally, a high PSA level points to prostate cancer, but as you’ll learn below, it’s not that simple. As one of the most common cancers in men, let’s tackle 5 of the biggest myths about PSA.
1. If your PSA levels are low, you don’t have prostate cancer
Unfortunately, screening for prostate cancer using PSA has significant limitations. The ideal prostate-specific antigen level in men without prostate cancer is generally less than 4 nanograms/milliliter (ng/mL). But a low or normal PSA level does not necessarily rule out prostate cancer. One study of 18,882 men enrolled in a prostate cancer prevention trial had their PSA checked once a year for seven years. At the end of that period, 15.2% of men with a normal PSA level tested positive for prostate cancer on a biopsy! Of those individuals, 14.9% went on to be diagnosed with high-grade prostate cancer (Gleason 7 and above; Gleason is the grading system used to evaluate prostate cancer prognosis) (1). This study naturally raised a lot of concerns about the ability of the PSA test to accurately detect the presence of cancer.
The unreliability of the PSA test is one reason why the FDA recommends a digital rectal exam (DRE) in combination with a PSA blood test—however, DREs are also notoriously unreliable, to the extent that many urologists choose not to perform them at all. A meta-analysis study demonstrated this unreliability showing that DREs accurately detected prostate cancer in only 41% of patients (2).
PSA may be helpful when combined with other methods of risk assessment for cancer, like the Prostate Health Index (PHI), which combines total PSA, free PSA, and pro-PSA. Research has shown that using the PHI could reduce unnecessary biopsies by as much as 38.4% for prostate cancers and 55.4% for high-grade prostate cancer diagnoses (3). This demonstrates that PSA by itself may not be as reliable for cancer diagnosis, and a holistic risk assessment should be addressed.
Certain medications and supplements can also falsely decrease your PSA levels and mask the presence of cancer. Medications such as dutasteride (Avodart) or finasteride (Proscar), used for benign prostatic hyperplasia (BPH), can decrease PSA levels. Other medications that lower PSA includes aspirin, cholesterol-lowering drugs such as atorvastatin (Lipitor), or thiazide diuretics such as hydrochlorothiazide (Microzide). Even certain herbs and vitamins can falsely reduce PSA levels. For this reason, it’s important to tell your doctor about all the medications you’re taking—both prescription and over-the-counter.
Most urologists will point to a biopsy as the gold standard for detecting prostate cancer, but even that method is not foolproof and is connected to potentially serious side effects. In a study of 90 established prostate cancer patients, researchers found that the commonly used 12-core biopsy missed the diagnosis in over 30% of the cases (4). Given that biopsies sample only small areas of the prostate, such false negatives are not surprising, and for suspicious cases, physicians often have to perform repeated biopsies to detect cancer. In cases where the PSA level remains normal despite the presence of cancer, your doctor may not even know to recommend a biopsy because of the lack of a positive biomarker test or associated symptoms.
So, what to do? A suspicious PSA value or an incorrect biopsy report can, of course, feel worrisome. Please understand that most prostate cancers are slow-growing and are associated with very high survival rates. So, while it is important that you stay on track working with your doctor or urologist, it is equally important that you don’t feel disheartened or lose hope. It is a great time for you to research alternative ways of improving your overall health following the 7 Key Principles of Cancer Therapy! (5)
2. PSA is specific to prostate cancer
PSA is specific to the prostate but is not necessarily specific to prostate cancer—this means a PSA level above 4 doesn’t always mean there’s cancer or malignancy! Just as certain medications can falsely decrease PSA, certain factors can also falsely elevate PSA. This is not to say that you should ignore a high PSA level, but understand that everyday actions can independently raise PSA as well.
First, as a part of normal aging, PSA levels tend to rise whether you have prostate cancer or not. An average PSA level for a 40-year-old may be 2.5 ng/mL, but for a 70-year-old, it may be as high as 6.5 ng/mL—both could be perfectly normal. However, this steady rise with age usually happens very slowly, so if you see a sudden elevation in your PSA levels, you should take it seriously.
Even everyday actions can raise PSA levels, such as vigorous exercise or riding a bicycle. Although not confirmed, it’s hypothesized that bicycle riding may put physical pressure on the prostate. For these reasons, your doctor may tell you to abstain from ejaculation or exercise for 1-2 days before a PSA test.
Other factors that raise PSA levels include BPH, inflammation, intercourse, or masturbation. A digital rectal exam could also temporarily raise PSA levels, which is why your urologist will ask for a PSA test to be done before the physical exam. Medications such as testosterone can also affect PSA levels, so as mentioned above, inform your doctor of all the medicines you’re taking.
Finally, chronic infections are also a very common reason for elevated PSA levels. Frequently, these conditions may be asymptomatic, and the pathogens causing chronic infections in the prostate very often do not show up in standard cultures. To account for this, a comprehensive diagnostic technique should include a deeper analysis of the patient’s rise in PSA, ranging from simple explanations like exercise to the evaluation of rare prostatic autoimmune diseases (6, 7).
3. Detecting prostate cancer will increase your chances of survival
With most cancers, early detection is key to increasing survival. But, counterintuitive as it may be, this is not necessarily the case for prostate cancer. This type of cancer differs from others because it is almost inevitable with age. If every man over the age of 85 were to have a biopsy of their prostate, chances are that 100% would have it. There’s even an old saying, “Some men die from prostate cancer, but all old men die with it.”
In some cases, early detection of prostate cancer may cause more harm than good. Finding and treating a slow-growing tumor that is unlikely to be life-threatening is called “overtreatment.” Overtreatment needlessly exposes patients to the serious side effects of biopsies, chemotherapy, radiation, or surgery. These side effects can be invasive and life-altering, such as urinary incontinence, persistent diarrhea, or sexual dysfunction. All in all, this is why many experts don’t recommend men screen for PSA if over the age of 70—because there’s little to gain in the early detection of this mostly low-risk cancer.
Research confirms the negative effect of overtreatment. One study looked at 731 men with prostate cancer—one group had the prostate surgically removed, and the other did nothing, just watched and waited. Surprisingly, the mortality rate was 3% higher in the surgery group compared to the group that did nothing! (8) Another study looked at 2 groups of 38,000 men—one group regularly had their PSA levels checked, while the other had their levels checked less frequently or not at all. After seven years, the mortality rate between the two groups was the same (9).
Patients with advanced disease without an increase in Gleason score may show lower levels of PSA and still have a progression of disease with metastasis — this speaks to a lack of understanding of how metastasis works in prostate cancer. While markers for other cancers can be more accurate in assessing the stage of disease in the presence of bone metastasis, PSA may remain at an acceptable level despite the presence of micrometastases in bone tissue (10-12).
Keep in mind that high-grade prostate cancers are aggressive, fast-growing, and deadly, and for this reason, indicators of prostate cancer should be taken seriously. In the case of elevated PSA levels or evidence of cancer, work with your physician to determine your options and individual risk level. In addition, seek an integrative physician who can look at your health from a whole-body perspective, helping you reduce the onset or progression of cancer through a comprehensive, holistic assessment and suitable lifestyle modifications.
4. All men older than 55 should have their PSA screened regularly
Many people want to know—at what age do you need a prostate exam? The answer is that it depends. The decision of when, or even if, you screen for prostate cancer is an individual one. Many experts recommend screening for individuals over the age of 40 if they have a high risk of prostate cancer, such as African American men or those with a family history of prostate cancer.
As for men 55-69 years old, the answer is a little less clear. Nowadays, most experts recommend making an informed decision with your doctor after discussing the risks and benefits of screening. The benefits of screening include finding an aggressive prostate cancer that would have otherwise spread to other parts of your body. But the risks of screening are as mentioned above—discovering and then overtreating cancer that may be asymptomatic and not life-threatening. Ultimately, the decision is up to you! (13)
5. There’s nothing you can do about an elevated PSA level
An elevated PSA level can be frightening. Fortunately, there are a few easy things you can do to lower your PSA levels naturally. The first way to start is through nutrition, and many PSA-lowering guidelines are already built into the Garden Food Plan®. This powerful anti-cancer nutritional lifestyle is designed to prevent and treat cancer, and by following it, you set a solid foundation to help your body heal.
Specific PSA-lowering guidelines include eating lean proteins such as fish, particularly those rich in omega-3 fatty acids such as salmon, cod, and herring. Lycopene, a natural compound found in red fruits and vegetables, can also lower PSA levels. Lycopene is in foods such as tomatoes, watermelons, and apricots. In one study, patients who ate 50g of tomato paste every day for ten weeks saw a 10% decrease in their PSA levels (14).
Vitamin D can also lower PSA levels (15). Vitamin D is naturally found in eggs, fatty fish, and certain types of mushrooms. Getting enough vitamin D through the diet alone can be challenging, but a vitamin D supplement can be just as effective as dietary vitamin D at lowering PSA levels (to prevent cardiovascular issues, your vitamin D supplement must be taken alongside a vitamin K2 supplement). EGCG, a compound in green tea, also has many health benefits. In addition to helping with weight loss and lowering the risk of developing cardiovascular disease or type 2 diabetes, it can also reduce PSA levels! In one study of almost 50,000 men in Japan, green tea consumption caused a dose-dependent reduction in the incidence of prostate cancer—the more green tea, the less the risk of prostate cancer! (16)
Aside from nutrition, regular exercise and maintaining healthy body composition metrics can also decrease PSA levels. Three hours of moderate to vigorous physical activity a week is associated with a 61% decrease in prostate cancer mortality! (17) As mentioned above, avoid vigorous physical activity for a few days before PSA screening, as this can falsely raise your PSA level. In addition, if you are diagnosed with conditions such as BPH or prostatitis, work with your urologist—these conditions occur independently of cancer but can result in significantly high PSA levels.
The last PSA-reducing strategy—relax! High stress negatively impacts PSA levels, depresses the immune system, and encourages cancer development (18). Meditation, mindfulness, spending time in nature, getting more high-quality sleep, laughing more—all these activities can decrease stress and, by extension, your PSA levels.
Disclaimer: This article is intended for informational purposes only and is not intended to diagnose or guide treatment. Any medical decisions should be made in consultation with the support and guidance of a licensed physician.
- Screening Tests for Prostate Cancer. (2021). American Cancer Society. https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/tests.html
- Naji, L., et al., Digital Rectal Examination for Prostate Cancer Screening in Primary Care: A Systematic Review and Meta-Analysis. Ann Fam Med, 2018. 16(2): p. 149-154.
- Chiu, P.K., et al., Prostate health index (PHI) and prostate-specific antigen (PSA) predictive models for prostate cancer in the Chinese population and the role of digital rectal examination-estimated prostate volume. Int Urol Nephrol, 2016. 48(10): p. 1631-7.
- Serefoglu, E.C., et al., How reliable is 12-core prostate biopsy procedure in the detection of prostate cancer? Can Urol Assoc J, 2013. 7(5-6): p. E293-8.
- Jimenez, A., Hope For Cancer: 7 Principles to Remove Fear and Empower Your Healing Journey. 2019, Austin, TX: Envision Health Press.
- Langston, M.E., et al., Sustained influence of infections on prostate-specific antigen concentration: An analysis of changes over 10 years of follow-up. Prostate, 2018. 78(13): p. 1024-1034.
- Motrich, R.D., et al., Autoimmune prostatitis: state of the art. Scand J Immunol, 2007. 66(2-3): p. 217-27.
- Wilt, T.J., et al., Follow-up of Prostatectomy versus Observation for Early Prostate Cancer. N Engl J Med, 2017. 377(2): p. 132-142.
- Ilic, D., et al., Screening for prostate cancer. Cochrane Database Syst Rev, 2013(1): p. CD004720.
- Semra Ozdemir, A.R.E., Fulya Koc Ozturk, Beril Su Ozdemir Predictive value of standard serum markers for bone metastases in prostate cancer. African Journal of Urology, 2021. 27.
- Murray, N.P., et al., Redefining micrometastasis in prostate cancer – a comparison of circulating prostate cells, bone marrow disseminated tumor cells and micrometastasis: Implications in determining local or systemic treatment for biochemical failure after radical prostatectomy. Int J Mol Med, 2012. 30(4): p. 896-904.
- Bretton, P.R., et al., Detection of occult micrometastases in the bone marrow of patients with prostate carcinoma. Prostate, 1994. 25(2): p. 108-14.
- Schaeffer, E.M., et al., Prostate specific antigen testing among the elderly–when to stop? J Urol, 2009. 181(4): p. 1606-14; discussion 1613-4.
- Edinger, M.S. and W.J. Koff, Effect of the consumption of tomato paste on plasma prostate-specific antigen levels in patients with benign prostate hyperplasia. Braz J Med Biol Res, 2006. 39(8): p. 1115-9.
- Beer, T.M., et al., Double-blinded randomized study of high-dose calcitriol plus docetaxel compared with placebo plus docetaxel in androgen-independent prostate cancer: a report from the ASCENT Investigators. J Clin Oncol, 2007. 25(6): p. 669-74.
- Kurahashi, N., et al., Green tea consumption and prostate cancer risk in Japanese men: a prospective study. Am J Epidemiol, 2008. 167(1): p. 71-7.
- Hackshaw-McGeagh, L., et al., Prostate cancer – evidence of exercise and nutrition trial (PrEvENT): study protocol for a randomised controlled feasibility trial. Trials, 2016. 17(1): p. 123.
18. Salleh, M.R., Life event, stress and illness. Malays J Med Sci, 2008. 15(4): p. 9-18.