Two large randomized trials published in the New England Journal of Medicine dealt two further devastating blows to the idea of using the total prostate-specific antigen (tPSA) blood test to screen for cancer. I say tPSA to differentiate it from the less-commonly tested free PSA (fPSA) or complexed PSA (cPSA).
In the slightly positive trial, conducted in several countries in Europe, 182,160 men were either tested for tPSA every so often or not and monitored for whether or not they developed prostate cancer. Those who were tested had a 20% decreased rate of death due to prostate cancer after an average of 9 years of follow-up. Unfortunately, this meant that 1,410 men had to be screened and 48 had to be treated (mostly with radical prostatectomy) to save one life from prostate cancer. The expense and adverse effects due to this level of intervention indicates just how ineffective the tPSA screening was in this study. Also, the death rate from all causes did not appear to be decreased by tPSA testing.
In the second study, 76,693 men in the US were either tested for tPSA periodically or not. After between 7-10 years of follow-up, there was no difference in prostate cancer death rates between the two groups. The overall rate of death due to prostate cancer was extremely small, just 94 men.
At this point, with two other clinical trials previously having found the same lack of efficacy of tPSA screening, it seems fair to say this test should be abandoned for most men. The latest guidelines from the American Cancer Society call for men to discuss with their doctors whether to screen. This makes little sense, as most men do not have the background in statistics or research to understand the studies, and presumably their doctors do and should no in most cases the test is ineffective. Men with a close family member who died of prostate cancer before the age of 65 years might still benefit from tPSA screening, but most others will not.
Andriole GL, Grubb RL III, Buys SS, et al. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med 2009;360:1310-9.
Schröder FH, Hugosson J, Roobol MJ, et al. Screening and prostate-cancer mortality in a rnadomized European study. N Engl J Med 2009;360:1320-8.
Last updated 11 Jan 2011
Inguinal hernias are quite common in men. They occur in the groin area and are well-known to be associated with improper lifting technique. A hernia of this type is when a piece of small intestines moves through a weakness in the muscular wall of the body. Most do not cause any symptoms like pain or discomfort, and most others cause only mild symptoms.
If a hernia is causing severe pain, or has visibly moved into the scrotum or canal between the abdomen and scrotum (known as the inguinal canal), then surgery may be essential. If sudden, sharp, unrelenting pain occurs in the groin area then emergency care should be sought, as the hernia is said to have incarcerated or gotten blocked. This can be life threatening in very rare cases and should NOT be ignored in hopes it will “go away on its own.”
Hernia Surgery and Its Problems
Many times a hernia is only detected during that annoying exam at the doctor’s office, or because of mild pain or bulging that goes away by just pushing. Though for many years it was believed surgery corrected all minor hernias without lasting bad effects, large studies say otherwise. In the biggest to date, over 700 men with very mild hernias were randomly either treated with either surgery or no treatment. After 2-4.5 years, there was no difference in pain levels or number of men who had acute blockages!
Rates of chronic pain after hernia repair surgery are often said to be as low as 5% by surgeons. The actual rates turn out to be more like 30-40% in studies in which thousands of men are sent questionnaires 1-3 years after surgery. Furthermore, most surgeons do not ask about sexual side effects of the procedure. One study found that of 1,015 Danish men who underwent hernia surgery, 22% had pain during sex for years afterward.
Once mesh is placed to keep intestines from herniating, it is also very difficult to remove later if there is a problem. There is also the nagging question of whether having a piece of plastic mesh in your body for several decades is a good idea, but no one seems to have assessed the long-term hazards.
Alternatives to Surgery
The main alternative to hernia surgery is to watch and wait. As noted in the large trial above, such watchful waiting was just as effective as surgery. The goal is simply to make sure pain isn’t progressing or that the hernia doesn’t get stuck and blocked.
Everyone should be careful how they lift. Breathe out, and lift using the knees and not the back. This prevents a build-up of pressure in the abdomen during lifting, which squeezes the intestines and can contribute to herniation. It’s a hard habit to get into but it pays major dividends, particularly since it is free.
Simply applying pressure with the hand over the weakened are when standing up or sitting down can also potentially help prevent herniation. It may occasionally be embarrassing to do but in private is a good habit to get into.
Hernia trusses, belts or supports are devices specially made to apply continuous pressure to the herniation area. These used to be very uncomfortable and not very effective, but now at least one company has developed a much better product (I have no connection with them). The Support Company in England (www.thesupportcompany-uk.com) can provide a custom-fitted, comfortable device known as the Flat Pad to prevent the need for surgery.
For herbal, hydrotherapy, and other suggestions that may help prevent a hernia from worsening or relieve minor pain, make an appointment with Dr. Yarnell today. He can also help you determine if you have a sufficiently severe problem that surgery is actually necessary.
Aasvang EK, Bay-Nielsen M, Kehlet H (2006a) “Pain and functional impairment 6 years after inguinal herniorrhaphy” Hernia 10(4):316-21.
Aasvang EK, Møhl B, Bay-Nielsen M, Kehlet H (2006) “Pain related sexual dysfunction after inguinal herniorrhaphy” Pain 122(3):258-63.
Fitzgibbons RJ Jr, Giobbie-Hurder A, Gibbs JO, et al. (2006) “Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial” JAMA 295(3):285–92.
Fränneby U, Sandblom G, Nordin P, et al. (2006) “Risk factors for long-term pain after hernia surgery” Ann Surg 244(2):212-9.
It’s a common scenario: you get a routine screening test for prostate cancer, the prostate-specific antigen or PSA test, and it comes back elevated. What to do?
First, if you have symptoms, it is more likely that you have an enlarged prostate (BPH) or prostatitis causing the elevation. Find out first if this is the case, treat these problems (there are effective naturopathic approaches for both, or else using drugs or surgery if necessary) and repeat the PSA test only after they have been resolved. If they cannot be resolved, then the PSA test is probably useless as a cancer screening test for you. Getting a prostate biopsy in such circumstances does not appear warranted without some other evidence besides PSA that there might be cancer present.
If you don’t have symptoms, then either wait and retest in 1–3 months or get a urine PCA-3 urine test. Up to 50% of repeat PSA levels come back normal without any treatment. The PCA-3 urine test requires a prostate exam, and has the great benefit of not being affected by BPH or prostatitis. It is more expensive than PSA, but this should change as more of them are done. If the PCA-3 comes back <35, then no biopsy should be done. If it comes back >35, then a prostate biopsy is warranted along with either an endorectal MRI or color Doppler ultrasound of the prostate, two imaging tests that give a broader, more holistic view of the prostate than just a biopsy.
There is growing reason to think that urine PCA-3 testing might be a better option than serum PSA testing over all, and that perhaps the PSA test shouldn’t even be used anymore for screening. See other posts for discussions of the many, many problems with the PSA test.
Before getting a biopsy, be sure to take modified citrus pectin and to have a plan of what you will do depending on the results. Waiting to see what happens and then deciding on a course of action usually leads to poor choices based on fear rather than good choices based on knowledge without emotions clouding the issues. As much as possible, your entire family should be involved in such decision making. Come in for a consultation with Dr. Yarnell if you would like help in making pre-biopsy decisions, for a PCA-3 test, or to get help with any aspect of prostate cancer screening
Hessels D, Schalken JA (2009) “The use of PCA3 in the diagnosis of prostate cancer” Nature Rev Urol 6:255-61.
Singh R, Cahill D, Popert R, O’Brien TS (2003) “Repeating the measurement of prostate-specific antigen in symptomatic men can avoid unnecessary prostatic biopsy” BJU Int2003;92(9):932-5.
Stamey TA, Caldwell M, McNeal JE, et al. (2004) “The prostate specific antigen era in the United States is over for prostate cancer: what happened in the last 20 years?” J Urol 172(4 Pt 1):1297-301.
Chronic kidney disease (CKD) is the term used to describe the gradual and progressive loss of kidney function . The underlying causes of CKD can be numerous, though unfortunately (understatement) they are often overlooked. It’s not uncommon for early to mid-stage CKD patients to be delivered a diagnosis, to then be told there’s nothing to be done but wait for the disease to progress (ie wait for their kidneys to fail). Usually in the meantime they will be put on an ACE inhibitor to control their hypertension, if that. And so begins the waiting game for dialysis, without having even considered the underlying causes.
Standard diagnostic tests for CKD include urinalysis and blood work. If no symptoms are present, oftentimes no more than this cursory work-up is conducted before the patient is basically told to just wait until dialysis is needed. If the patient doesn’t have diabetes, hypertension or heart disease, then the shoulders are shrugged and the patient is counseled to wait and see. This is a travesty, as there is much that can be done during these early stages to aid and even reverse the process with the use of naturopathic and herbal medicine. The need for dialysis can be prevented. The key is finding out what is really going on, and for this, additional tests are often needed.
At Naturopathic Northwest Urology, we usually recommend that at least a kidney ultrasound be performed, and in many cases a kidney biopsy as well, for patients diagnosed with CKD. These additional tests can help determine the underlying causes of disease, particularly autoimmune diseases (glomerulonephritis of various types), polycystic kidney disease, kidney tumors, or chronic/recurrent infections. Even patients with known, long-standing diabetes or hypertension (both well-established and common causes of CKD) are not simply assumed to have CKD due to these conditions, but proven so by ruling out other possible causes and assessing the features of the kidney damage going on. Other testing is often undertaken, depending on what is found, to find the causes of the causes (for example, many patients with IgA nephropathy and other types of glomerulonephritis have a problem called leaky gut which needs to be addressed if the CKD has any hope of being slowed or reversed).
Once a more accurate picture has been obtained, then herbal and nutritional medicine has much to offer in terms of slowing the disease process, providing tissue support, and decreasing or halting the rate of decline. Of course everyone’s case is different and there is no perfect guarantee of results. Herbal protocols are personalized and fine-tuned according to the specific clinical picture and every effort is made to achieve success. We have had numerous patients avoid the need for dialysis by following a customized naturopathic treatment plan.
ReferencesDesruelles J, Delmon A. Clinical trial of treatment of azotemic conditions with an injectable extract of Lespedeza capitata. Lille Med 1969;14(2):83–87 [in French].
Moreillon JJ, Bowden RG, Deike E, et al. The use of an anti-inflammatory supplement in patients with chronic kidney disease. J Complement Integr Med 2013; 10(1): 1–10.
Singh RG, Rajak M, Ghosh B, et al. Comparative evaluation of fosinopril and herbal drug Dioscorea bulbifera in patients of diabetic nephropathy. Saudi J Kidney Dis Transpl2013;24(4):737–742.
Treasure J. Urtica semen reduces serum creatinine levels. J Amer Herbalists Guild2003;4(2):22–25.
Yarnell E. Naturopathic Urology and Men’s Health (Wenatchee, WA: Healing Mountain Publishing), 2001.
IgA nephropathy is a condition that is considered to be of unknown cause (“idiopathic” in medical terminology) that causes kidney damage. Over time, this condition can get worse and the kidneys can suffer varying degrees of damage (though some people get better even without treatment). The condition is common in North America, though much more common in the Mediterranean region and Asia.
Most often IgA nephropathy is detected incidentally in a routine urine test when blood or protein is found. Sometimes it is first noted after a cold or flu episode that leads to blood in the urine. Very rarely the condition starts out as acute failure of the kidneys.
Naturopathic medicine offers a unique ability to work with the totality of your situation. We can help you assess and monitor your condition, help figure out some of the possible underlying causes and treat those, as well as offering natural supportive and corrective treatments. We can work with and even prescribe most of your medications if necessary. We can work with your other providers to determine if some medications might not be needed or doses reduced.
What Causes IgA Nephropathy?IgA nephropathy is a classic example of a condition in which someone with a genetic predisposition only develops a problem when exposed to one of several potential environmental triggers (thus a “two-hit” condition). It is now known that people who develop IgA nephropathy have a genetic problem with attaching certain sugars to their A type immunoglobulins (antibodies), or IgA, subtype 1. IgA1 antibodies are very unusual in humans for being blood proteins that have so-called O-linked sugars. The enzymes that control which sugars are attached to the IgA1 are mutated in such a way that not very many galactose sugars are attached. The results if the IgA1 don’t work very well. This is only an issue if the body calls out for production of a lot of IgA1: the environmental trigger.
Many studies point to the fact that people with IgA nephropathy have allergic reactions to food (Kovacs, et al. 1996; Coppo, et al. 1991). A particular problem is a reaction to wheat, which is different than celiac disease (Almroth, et al. 2006; Laurent, et al. 1987). These reactions are one of the potential environmental triggers that stimulates lots of IgA1 to be made. They stick onto food proteins but don’t do anything useful. The resulting immune complex (IgA1-antigen complex) then floats through the blood and ends up sticking in the kidneys, provoking inflammation and damage.
Not all patients with IgA nephropathy have food allergies. As noted above, infections are also a common trigger of IgA1 production and thus provoking IgA nephropathy. Getting blood in the urine during an acute infection is known technically as “synpharyngitic hematuria” and is a major hallmark of this condition not seen in most other diseases. Anyhow, it is critically important that the possibility of food reactions be investigated and any problem foods removed to prevent the condition from progressing. The process of determining the foods that we use at Northwest Naturopathic Urology is called an elimination-challenge diet, but if for some reason that can’t be done then there are some much less reliable tests that can be done. Testing for antibodies to gliadin, the compound in wheat that most often triggers an allergic reaction damaging the kidneys, is usually done to help decide whether to remove wheat from the diet.
The way the elimination-challenge diet is done is very important. It is critical to realize that many food reactions are delayed, and also there is no predicting for any single patient what food or foods will be a problem, so just avoiding common antigens (like wheat, gluten, or dairy) is not sufficient. Short eliminations without challenges are also a problem because many reactions are delayed, and there may be no noticeable symptoms (so using urine protein testing is critical to monitor the process). Speaking with Dr. Yarnell about how to properly do an elimination/challenge diet is advised.
Another part of the problem that often underlies IgA nephropathy is known as leaky gut syndrome. In this case, food molecules are absorbed that shouldn’t be, which can trigger the reactions that damage the kidney. A simple urine test is done to determine if this is a problem and whether natural treatments such as glutamine are indicated to help fix the leakiness.
Other Natural Treatments
Several studies have shown that high-doses of fish oil can help decrease the severity of the disease (Hogg, et al. 2006). Most people who treat themselves use far too little to make a difference. We can help you figure out the optimal dose for your body size.
A number of herbal medicines have been used effectively in our practice to help prevent and even reverse some of the kidney damage that occurs in people with IgA nephropathy. Some of the most important herbs of this type include Lespedeza capitata (round-head lespedeza) leaf and flower, Rheum palmatum (rhubarb) root (used at a low-dose to prevent diarrhea), and Parietaria judaica (pellitory-of-the-wall) herb. These herbs are extremely safe. We generally develop an individualized herbal formula to address your condition and help protect your kidneys.
There are several natural therapies, including magnesium and the powerful herb Rauvolfia serpentina (Indian snakeroot), that can help us manage any high blood pressure you may have naturally, Sometimes this allows patients to avoid medications for blood pressure, and sometimes they are used in combination for optimal effects.
Some vitamins may also be helpful for your situation, though this requires analysis of your symptoms and how long you have had the condition to determine.
Does It Work?
In the past year we have had four IgA nephropathy in the past year (2009). Three of them had relatively mild or early disease, without symptoms other than protein or blood in the urine. Urine protein levels declined or became normal in all three after elimination-challenge diet and with high-dose fish oil and herbal medicines (and occasionally a couple of other supplements). No one has developed any complications attributable to treatment or IgA nephropathy.
One patient seen for the past seen initially in 2006 had severe disease (present for over 20 years, with high blood pressure and significantly reduce kidney function). She was able to maintain at a functional level for those entire three years until finally she had to go on dialysis. Conventional doctors all said there was nothing she could do but wait until she had to go on dialysis, then get a transplant. Though ultimately in her case this was not prevented, it was at least delayed significantly. Who knows what might have happened if she had seen a naturopathic doctor before the condition got completely out of control.
Almroth G, Axelsson T, Müssener E, et al. (2006) “Increased prevalence of anti-gliadin IgA-antibodies with aberrant duodenal histopathological findings in patients with IgA-nephropathy and related disorders” Uppsala J Med Sci 111(3):339–52.
Coppo R, Amore A, Roccatello D, et al. (1991) “Role of food antigens and alcohol in idiopathic nephritis with IgA deposits” Minerva Urol Nefrol 43(3):171-4.
Hogg RJ, Fitzgibbons L, Atkins C, et al. (2006) “Efficacy of omega-3 fatty acids in children and adults with IgA Nephropathy is dosage- and size-dependent” Clin J Am Soc Nephrol 1: 1167–72.
Kovacs T, Mette H, Per B, et al. (1996) “Relationship between intestinal permeability and antibodies against food antigens in IgA nephropathy” Orv Hetil 137(2):65-9 [in Hungarian].
Laurent J, Branellec A, Heslan JM, et al. (1987) “An increase in circulating IgA antibodies to gliadin in IgA mesangial glomerulonephritis” Am J Nephrol 7(3):178-83.
Many patients have the concern that Serenoa repens (saw palmetto) extracts might interfere with the measurement of PSA and thus block a prostate cancer diagnosis. Many double-blind trials have shown no effect of saw palmetto on total PSA.
This was the conclusion of the authors of a systematic review of clinical trials on standardized extract of saw palmetto (Gerber and Fitzpatrick 2004). One of the largest trials ever conducted on saw palmetto extract, involving over 1,000 men, found no effect of the herb on PSA (Carraro, et al. 1996). A review of a smattering of high-quality clinical trials over the years, including the longest-running trial yet (at 24 months) confirms the lack of interference (Andriole, et al. 2013; Bent, et al. 2006; Djavan, et al. 2005; Marks, et al. 2001). So far I know of only one clinical trial that assessed the effect of saw palmetto on free PSA (Willetts, et al. 2003). No effect was noted compared to placebo.
The confusion over this issue comes from the fact that finasteride (Proscar) and dutasteride (Avodart) both artificially lower the total PSA reading by approximately 50% (Thompson, et al. 2007; Andriole, et al. 2006). While it is not known for sure why this occurs, I suspect it is because these drugs reduce the size of the prostate, and thus production of PSA by normal cells. They do not affect production by cancer cells.
A potentially critical difference between these drugs and saw palmetto is that, based on studies in humans, the drugs inhibit 5-alpha-reductase 80% compared to 32% for saw palmetto (Marks, et al. 2001). It is also likely that saw palmetto’s other actions besides inhibiting 5-alpha-reductase may contribute to its lack of falsely inhibiting PSA.
While saw palmetto was once just dismissed in mainstream medicine an inferior herbal version of these drugs, this is clearly not true. Saw palmetto works by many mechanisms and not just by blocking the 5-alpha-reductase enzyme as these drugs do, and is clearly just as effective as these drugs with vastly fewer adverse effects and for much less money (Gordon and Shaughnessy 2003).
SummarySaw palmetto does not artificially interfere with measurement of total or free PSA.
ReferencesAndriole GL, McCullum-Hill C, Sandhu GS, et al. (2013) “The effect of increasing doses of saw palmetto fruit extract on serum prostate specific antigen: analysis of the CAMUS randomized trial” J Urol 189(2):486-92.
Andriole GL, Marberger M, Roehrborn CG (2006) “Clinical usefulness of serum prostate specific antigen for the detection of prostate cancer is preserved in men receiving the dual 5alpha-reductase inhibitor dutasteride” J Urol 175(5):1657-62.
Bent S, Kane C, Shinohara K, et al. (2006) “Saw palmetto for benign prostatic hyperplasia” N Engl J Med 354:557-66.
Carraro JC, Raynaud JP, Koch G, et al. (1996) “Comparison of phytotherapy (Permixon®) with finasteride in the treatment of benign prostatic hyperplasia: A randomized international study of 1,098 patients” Prostate 29:231-40.
Djavan B, Fong YK, Chaudry A, et al. (2005) “Progression delay in men with mild symptoms of bladder outlet obstruction: A comparative study of phytotherapy and watchful waiting” World J Urol 23(4):253-6.
Gerber GS, Fitzpatrick JM (2004) “The role of a lipido-sterolic extract of Serenoa repens in the management of lower urinary tract symptoms associated with benign prostatic hyperplasia” BJU Int 94:338-44.
Gordon AE, Shaughnessy AF (2003) “Saw palmetto for prostate disorders” Am Fam Phys67:1281-3.
Marks LS, Hess DL, Dorey FJ, et al. (2001) “Tissue effects of saw palmetto and finasteride: Use of biopsy cores for in situ quantification of prostatic androgens” Urology 57:999-1005.
Thompson IM, Pauler Ankerst D, Chi C, et al. (2007) “Prediction of prostate cancer for patients receiving finasteride: Results from the Prostate Cancer Prevention Trial” J Clin Oncol 25(21):3076-81.
Willetts KE, Clements MS, Champion S, Ehsman S (2003) “Serenoa repens extract for benign prostatic hyperplasia: A randomized controlled trial” BJU Int 92:267-70.
I was recently interviewed by Lauren Noel, ND of San Diego on her radio show online, and you can listen in to the recording of it now. We discussed prostate health and problems, sexual dysfunction, and many other topics, all from a naturopathic perspective of course. Check it out here.
This is a July 30, 2007 recording of a live call-in show I was on regarding prostate health. Watch it for free any time by clicking on the link below.
Naturopathic Perspective: Prostate Health
Prostate cancer cells, like many types of cancer (notably breast), have a different metabolic system than healthy cells. Healthy cells primarily use oxygen to make energy, which also requires a lot of the molecule known as citrate. Prostate cancer cells do not; instead they use a system that doesn’t require oxygen and doesn’t use citrate but instead uses choline (Johansson, et al. 2009). Avoiding foods high in choline may be important for reducing the risk of existing prostate cancer from getting worse/more aggressive.
There are many imaging techniques that take advantage of this fact to look for prostate cancer around the body, including what is known as magnetic resonance spectroscopy (a fancy form of MRI) and positron emission testing (PET) that uses radioactive choline (Scheenen, et al. 2004). This is further evidence of the importance of choline to prostate cancer cells, and why avoiding it in the diet might therefore be a good idea.
Two large epidemiological trials have looked at the connection between high choline foods and prostate cancer aggravation (Richman, et al. 2012 and 2010). High intake of eggs and chicken were particularly associated with increased risk of men who already had prostate cancer developing aggressive disease (as evidenced by the cancer spreading or killing them among other bad outcomes). These studies were done prospectively, which is strong, but they were not randomized clinical trials so they cannot definitively prove that it was the choline or the foods that contain them that caused. It is important to note that so far, no one has shown that choline increases the risk of getting prostate cancer in the first place, this is really just about worsening existing cancer.
For many decades natural medicine experts have advocated a more vegetarian diet for men with prostate cancer. This was based around research showing that high animal-product diets (except fish) tended to both cause and worsen prostate cancer, and that vegetarian diets were helpful (Ornish, et al. 2005). While a lot of effort focused on red meat, preserved meats (lunch meats, sausages, bacon, etc.) and burned meats (as the burning process creates a lot of carcinogens), it is now getting clearer that poultry and eggs may be just as bad if not worse.
The highest choline-rich foods are:
Men with prostate cancer are urged to eat what is known as a pescovegan diet (no animal products except fish; no simple sugars; most foods in the diet should be vegetables, fruits, nuts and legumes) most of the time based on the totality of existing information. Supplements that contain choline or phosphatidylcholine should be avoided. This information is not perfect and further studies could weaken this recommendation, but for now it looks like the best advice. Every man should consult with their natural medicine expert who knows both prostate cancer and nutrition to determine if this diet is optimal for them. Men who are losing a lot of weight with advanced cancer may in particular not do well on a diet like this. But most others will, even if they can only follow it some of the days of the week and not all.
ReferencesJohansson M, Van Guelpen B, Vollset SE, et al. (2009) “One-carbon metabolism and prostate cancer risk: Prospective investigation of seven circulating B vitamins and metabolites” Cancer Epidemiol Biomarkers Prev 18(5):1538-43.
Ornish D, Weidner G, Fair WR, et al. (2005) “Intensive lifestyle changes may affect the progression of prostate cancer” J Urol 174(3):1065-9; discussion 1069-70.
Richman EL, Kenfield SA, Stampfer MJ, et al. (2012) “Choline intake and risk of lethal prostate cancer: Incidence and survival” Am J Clin Nutr 96(4):855–863.
Richman EL, Stampfer MJ, Paciorek A, et al. (2010) “Intakes of meat, fish, poultry, and eggs and risk of prostate cancer progression” Am J Clin Nutr 91(3):712-21.
Scheenen TW, Klomp DW, Roll SA, et al. (2004) “Fast acquisition-weighted three- dimensional proton MR spectroscopic imaging of the human prostate” Magn Reson Med 52:80–88.
Several classes of common medications lower serum total prostate-specific antigen (PSA) levels according to a 2010 publication by Chang, et al. Statins, non-steroidal anti-inflammatory drugs (NSAIDs), and thiazide diuretics, among the most commonly used drugs in the world, all significantly lowered tPSA in this analysis of 1,864 American men over the age of 40 years. Use of a thiazide and a statin together for 5 years led to a 36% reduction in tPSA levels. Calcium channel blockers actually eliminated this effect of statins on tPSA. It is unknown how these medications cause this effect. It is possible these drugs have been interfering with this test as effective screening by artificially suppressing tPSA levels, or that they may actually be treating prostate cancer in some way. More research is needed on this crucial matter.
ReferencesChang SL, Harshman LC, Presti JC Jr. Impact of common medications on serum total prostate-specific antigen levels: Analysis of the National Health and Nutrition Examination Survey. J Clin Oncol 2010;28(25):3951-7.