Proper PSA testing isn’t just safe—it’s lifesaving

The subject of PSA testing comes up almost every day in my practice. And I have written about it many times here in my Reality Health Check and in my monthly newsletter, Logical Health Alternatives. So you may already know that despite any controversy surrounding it, I believe PSA testing is a reasonable guide and a valuable screening tool.

It’s one thing to decline performing PSA tests in a practice. But recommending against them is a textbook case of throwing out the baby with the bathwater… all because trigger-happy physicians can’t bother to be prudent with the results.

It’s really a shame. Because the fact is, overtreatment risks associated with PSA testing are easy to address. And according to a new study, a few simple lifestyle changes may ward off harmless PSA elevations—and ultimately prevent unnecessary biopsies because of it.

Simple precautions prevent needless biopsy

PSA levels are a reliable indicator for benign prostatic hyperplasia (prostate enlargement), and prostatitis (an inflamed prostate). Neither of these conditions are malignant—but they can push PSA levels high enough to raise suspicions of cancer.

The trouble is that PSA levels are not a reliable marker for prostate cancer. Rather, they are one piece of the bigger puzzle. So the resulting biopsies “just to be safe”—especially from doctors who are super aggressive to begin with—set off a string of unnecessary interventions that can expose men to unnecessary risks ranging from urinary incontinence to sexual dysfunction.

But all you have to do, according to this new research, is avoid eating spicy foods, drinking alcohol or coffee, or riding a bike for about eight weeks prior to testing…. and your PSA results should lower by about 1.5 ng/ml.

Why these changes? Because according to researchers, the one thing all of these lifestyle factors have in common is their ability to increase—you guessed it—inflammation. And inflammation directly translates into elevations in PSA.

Just to be clear, this study was done on men with PSA levels ranging from 2 to 10 ng/mL and a normal digital rectal exam reading (a simple test used to check the prostate). This is a group that is pretty low risk anyway, so I can’t imagine why any of them would be candidates for biopsy in the first place.

But again, if doctors were already making rational decisions based on PSA results, studies like this wouldn’t even be necessary. And in my mind, it’s not even the most important of the findings…

PSA testing works if you work it

Here’s the part that really grabbed my attention: Not only were more men spared unnecessary biopsies, but prostate cancer detection rates were actually higher in the men that made these small lifestyle changes. And I can’t think of better proof of the value of proper PSA testing.

Unfortunately, as often happens, the conclusions from this study are very different from mine. Their main concern was, and I quote: “Are you going to start asking patients what kinds of food they eat or ask them to change their diets and come back in 2 months for another test?”

To me, the answer to that question has always been a simple and resounding YES. And the fact that any doctor would suggest otherwise accounts for most of what’s wrong with modern American medicine.

I said it above, and I’ll say it again. There are so many things that can temporarily elevate PSA levels. Infection. Inflammation. Even sex, which is why I also tell my patients to abstain from ejaculation for 3 to 5 days prior.

Needless to say, it’s important to first rule those things out before you move forward with a biopsy. It’s simple due diligence on the doctor’s part… and it can spare patients a whole host of complications.

In a perfect world, the foolhardy doctors ordering biopsies like they’re pizzas would get the boot. And they’d be replaced with smarter, more confident practitioners who understand the value of PSA testing and are willing to do the work required to treat patients effectively.

But in this one, I guess we’ll just be lucky to get a much-needed injection of common sense.

P.S. In the January 2017 issue of my Logical Health Alternatives newsletter (“Why the government’s backpedaling on PSA again—and how you can make the most of this lifesaving prostate test”), I discussed the importance of PSA testing, as well as a handful of other tests that will help offer a bigger picture of your prostate health.

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Source:

“Lifestyle Changes Do a Number on PSA Values.” Medscape Medical News, 03/18/2019. (medscape.com/viewarticle/910528)