Like breast cancer, very little real progress has been made in the treatment of prostate enlargement and prostate cancer. Yes, there are many new types of treatments available, but aside from surgery to remove a cancer that hasn’t metastasized yet, not one treatment has been convincingly shown to significantly prolong life or reduce the numbers of men who are dying of prostate cancer. In fact, the Journal of the American Medical Association (JAMA) of June 28, 2000, carried an article comparing treatment recommendations by radiation oncologists and urologists for men with moderately well differentiated, localized prostate cancer and greater than a 10-year life expectancy based on age. In such cases, 92 percent of urologists recommended radical prostatectomy (removal or the prostate gland), whereas 72 percent of radiation oncologists recommended radiation treatments. An accompanying editorial points out that the treatment advice is determined by the services the doctor provides rather than by any clear-cut evidence of the superiority of either treatment, or even whether or not either treatment is any better than watchful waiting.

The PSA Count

One of the biggest areas of misunderstanding in prostate cancer has been the PSA count. Prostate specific antigen (PSA) is produced within the prostate gland and within breast tissue. (Therefore the phrase PSA is not correct, since it is not specific to the prostate.) The function of PSA is finally becoming clarified – when abnormal crowding of normal cells in the prostate occurs, the cells produce more PSA which inhibits angiogenesis of its neighboring cells. Angiogenesis is the growth of blood vessels leading to a cancer tumor. Think of it as developing supply lines to feed an army. Since cancer cells grow more rapidly than normal cells, they tend to crowd against normal cells. One of the hallmarks of cancer cells is that they will induce angiogenesis that will increase the flow of blood to them. The anti-angiogenesis function of PSA is a defense against abnormally grwoig cells in the prostate. Firm massage of normal prostate cells will increase PSA levels in the prostate. Thus, PSA is a marker for increased crowding of normal prostate cells.

Unfortunately, conventional medicine uses PSA levels as a marker for prostate cancer. However, most “occult” prostate cancer occurs without elevating the PSA level. Some people even think that PSA elevation is bad and should be reduced. An example is the company that produced a drug called PCSpes which inhibits PSA production and causes breast development. In the past, I have challenged that company to produce evidence that using the drug will lower the mortality or extend the survival of men using the drug. No such evidence exists, to my knowledge. This is an example of blaming the messenger rather than understanding the message. Recently PCSpes, supposedly and herbal product, was found to contain a mixture of pharmaceutical drugs and was taken off the market.

Conventional doctors often use PSA levels to determine treatment options. The facts are that prostate cancer patients in countries who have abandoned PSA tests have the same or better survival rates as countries that use PSA tests. In Sweden, for example,

Physicians rarely screen for prostate cancer or use radical therapies, choosing watchful waiting instead. Despite this, mortality rates for prostate cancer have declined in Sweden. In the U.K, prostate cancer mortality rates are similar to the U.S., even though PSA screening is not routinely performed. In older men, when most prostate cancer occurs, the cancer is slow-growing and early intervention may be of little consequence. An interesting incidence (equivalent to PSA screening) and subsequent changes in mortality in regions using common treatment recommendations. They found no association between the intensity of PSA screening and subsequent decreases in prostate cancer mortality.

Further, good references show that men early in the course of their prostate cancer generally have low testosterone levels and little or no elevation of PSA.

As men age, their testosterone and progesterone levels fall. Theses are the two hormones known to be anabolic – meaning that they produce energy, rather than using up energy, such as estrogen and insulin do. With the fall of testosterone and progesterone, cellular energy wanes. Only the cancer cell, with its ability to create angiogenesis, retains its high energy. When a testosterone-deficient man has his testosterone restored, normal cells then have more energy and, thus, can produce more PSA. This is why PSA tends to rise a bit when testosterone is restored. The PSA is a defense factor and the increased PSA inhibits angiogenesis of the cancer cells. If one’s PSA rises a bit after the testosterone is brought up to normal physiological levels of a younger man, it is not a sign that the cancer is growing, but instead, is a sign that the normal cells have becoe stronger in fighting against the cancer cells.

Maintaining good levels of both progesterone and testosterone should be the goal of men for preventing and for treating prostate cancer.