Why Choose Alternative Cancer Treatments? (9)

PSA tests, biopsies & prostate cancer

Welcome to page nine of “Why Choose Alternative Cancer Treatment?” addressing the question of the usefulness of PSA tests and screenings for prostate cancer.

Prostate test 'all but useless'
Researchers say men put at risk of impotence

by Sarah Boseley, health editor, The Guardian, Saturday September 11, 2004

Thousands of men may have unnecessarily undergone an invasive operation to remove their prostate, sometimes suffering impotence and incontinence as a result, because of a screening test which was yesterday written off as all but useless.

The PSA test is a blood test that measures levels of prostate specific antigen, a protein produced by the prostate gland. It will tell doctors that a man has a prostate cancer, but scientists in the US said yesterday that in many cases the man can live with the cancer and the treatment may be worse than the cure.

"The PSA era is over," said researchers at Stanford University school of medicine in their paper in the Journal of Urology.

The team studied prostate tissues collected over 20 years, from the time it first became standard to remove prostates in response to high PSA levels. Thomas Stamey, who led the research, said they concluded that the test indicated nothing more than the size of the prostate gland. "Our study raises a very serious question of whether a man should even use the PSA test for prostate cancer screening any more," he said.

Professor Stamey said he had also come to believe that the PSA test was not a useful predictor of the amount or severity of prostate cancer.

He said raised levels of the protein only reflected a condition known as benign prostatic hyperplasia - a harmless increase in prostate size.

Tumours found 20 years ago were generally so large they generated PSA levels high enough to provide a reasonably good measure of cancer severity. But he said that, as screening became more commonplace, many cancers were being caught earlier and were usually smaller, not generating sufficient PSA to be a good indicator of severity.

He said prostate cancer was a disease all men got if they lived long enough so, given the excuse to carry out a biopsy, doctors were most likely going to find cancer.

Prof Stamey said the PSA was still useful in monitoring patients after removing the prostate as an indicator of cancer that had spread to other parts of the body.

"Our job now is to stop removing every man's prostate who has prostate cancer," he said. "We originally thought we were doing the right thing, but we are now figuring out how we went wrong. Some men need prostate treatment but certainly not all of them."

There have been more doubts over the PSA test in the UK, with the result that the NHS has opted to give men information to allow them to choose to have it if they are concerned, rather than instituting a national screening programme. But an increasing number of doctors are doing it.

Chris Hiley of the Prostate Cancer Charity said a PSA test that proved positive was likely to lead to a biopsy, and since 80% of men in their 80s and even 8% of men in their 20s had prostate cancer, it was quite likely that cancer would be detected. Men without symptoms who chose to have a test in the first place were probably then more likely to opt for surgery rather than the "watchful waiting" that some experts advocate.

"The intuitively obvious thing is that if you can get in and take the prostate out, things will be fine and dandy, but large numbers of men will be having operations they don't need," said Dr Hiley. Some will be impotent and incontinent because of the nerves that are severed to remove the prostate and any cancerous tissue.

No other test will detect a cancer in a man without symptoms, and some of those with symptoms will be inoperable. Some 10,000 men die of prostate cancer each year.

© Guardian Newspapers Limited 2004

An M.D./naturopathic physician comments

Like so much of what we do, the true benefit, if any, is likely to be confined to a very few patients. One of the major problems in clarifying the discussion lies in getting 'authorities' to clearly define the exact nature of the 'benefit' they claim for the test. For instance, 'early detection of a tumor' is not of benefit unless this leads to a genuine improvement in the quality of life, over that which would have been expected if the tumor had not been detected early.

Stanford researcher declares 'PSA era is over' in predicting prostate cancer risk

by Mitzi Baker (Office of Communication & Public Affairs), 10 Sep 2004

STANFORD, Calif. - The PSA test, commonly used as a screening tool for detecting prostate cancer, is now all but useless for predicting prostate cancer risk, according to Stanford University School of Medicine researchers. A study of prostate tissues collected over 20 years - from the time it first became standard to remove prostates in response to high PSA levels to the present - reveals that as a screen, the test now indicates nothing more than the size of the prostate gland.

"The PSA era is over in the United States," said Thomas Stamey, MD, professor of urology and lead author of the study published in the October issue of the Journal of Urology. "Our study raises a very serious question of whether a man should even use the PSA test for prostate cancer screening any more."

The PSA test measures prostate specific antigen, a protein normally produced by the prostate gland. Stamey published the original findings in 1987 in the New England Journal of Medicine showing that increased blood PSA levels could be used to indicate prostate cancer. However, through the years, Stamey has come to believe that the PSA test is actually not a useful predictor of the amount or severity of prostate cancer. He said elevated levels of that protein actually reflect a condition called benign prostatic hyperplasia, a harmless increase in prostate size.

Stamey explained the change in correlation over the years by noting that the tumors encountered 20 years ago were generally so large they generated PSA levels high enough to provide a reasonably good measure of cancer severity. Now that screening is more commonplace in this country, many cancers are being caught earlier and are usually smaller - not generating enough PSA to be a good indicator of severity.

Prostate cancer is the most common cancer in men. Stamey cited a 1996 study in which researchers examined the prostates of healthy men who died from trauma, finding that 8 percent of those in their 20s already had prostate cancer. The American Cancer Society estimates that nearly a quarter of a million cases of prostate cancer will be diagnosed in the United States this year alone, and one in six men will be diagnosed with the disease at some point in their lives.

Stamey said prostate cancer is a disease "all men get if we live long enough. All you need is an excuse to biopsy the prostate and you are going to find cancer."

However, the risk of dying from prostate cancer is very low compared with lung cancer, which is the leading cause of cancer-related death in men, he said. "Almost every man diagnosed with lung cancer dies of lung cancer, but only 226 out of every 100,000 men over the age of 65 dies of prostate cancer, which is a rate of .003 percent," he said, referring to National Cancer Institute statistics.
But compare Dr. Johanna Budwig lung cancer healing testimonials, Asparagus: cancer recoveries and remissions: lung cancer cure testimonial and Full recovery from lung cancer and massive heart attack without chemotherapy/drugs/surgery.

Stamey explained the basic dilemma as such: men whose PSA levels are above 2 ng/ml frequently undergo biopsy, which will almost always find cancer, but this does not necessarily mean that prostate removal or radiation treatment is required. "What we didn't know in the early years is that benign growth of the prostate is the most common cause of a PSA level between 1 and 10 ng/ml," he said.

To figure out the PSA test's usefulness in determining which cancers warrant radiation or surgery, Stamey and his team from Stanford's Department of Urology set out to document what was actually found following prostate removal, such as the volume and the grade of the cancer - two indications of the cancer's severity. They then compared those findings to aspects that could be determined prior to surgery, such as how many of the cancers could be felt by rectal examination and the patient's blood PSA level.

For the study, they used prostate tissue samples collected by professor John McNeal, MD, who has examined more than 1,300 prostates removed by different urologists at Stanford in the last 20 years. The researchers divided McNeal's data into four five-year periods between 1983 and 2004 and looked at the characteristics of each cancer. They found that over time, there was a substantial decrease in the correlation between PSA levels and the amount of prostate cancer - from 43 percent predictive ability in the first five-year group down to 2 percent in the most recent one.

However, the Stanford researchers concluded that the PSA test is quite accurate at indicating the size of the prostate gland, meaning that it is a direct measure of benign prostatic hyperplasia. And Stamey pointed out that it is still very useful for monitoring patients following prostate removal as an indicator of residual prostate cancer that has spread to other parts of the body.

"Our job now is to stop removing every man's prostate who has prostate cancer," said Stamey. "We originally thought we were doing the right thing, but we are now figuring out how we went wrong. Some men need prostate treatment but certainly not all of them."

If the PSA test is no longer useful, the question remains as to the best course for detecting prostate cancer. Stamey recommends a yearly digital rectal exam for all men over 50. "If a cancer is felt in the prostate during a rectal examination, it is always a significant cancer and certainly needs treatment," he said.

Unfortunately, he added, even large cancers often cannot be felt during rectal examination. His group is currently working on finding a blood marker that could indicate more aggressive forms of the cancer that can invade the body.

Other researchers who contributed to this work are Mitchell Caldwell, Rosalie Nolley, Marci Hemenez and Joshua Downs. The study was funded by donations to Stamey's Prostate Cancer Research Fund at Stanford.

Print Media Contact: Mitzi Baker, mitzibaker at stanford.edu (650) 725-2106
Broadcast Media Contact: M.A. Malone, mamalone at stanford.edu, (650) 723-6912

Addenda & comments

According to an unverified source writing on the subject of “PSA levels not a reliable indicator of prostate cancer”:

“The first article in a major journal questioning PSA validity was in the New England Journal of Medicine studying 18,882 men in a prevention trial. Of these 9,459 were randomly assigned to be a placebo control and undergo a yearly PSA test. Of these 2,950 men age 62-91 never recorded a PSA level higher than 4 ng/ml or a positive digital rectal exam. No indication of Cancer. These men underwent a biopsy after 7 years in the study. The results surprisingly showed that 15% of these men had positive needle biopsies for cancer. Since the area of the needle sample is limited to that area of the prostate in the direct line of the needle, this is an understatement. Of them another 15% had high-grade cancer. This is a little over 2% of those with low PSAs under 4 having a high-grade cancer. Dr. Thomas Stamey, MD, the original promoter of the PSA test, published an article in the Journal of Urology, October 2004; 172(4):1297-1301 with the title 'The Prostate Specific Antigen era in the United States is over for prostate cancer: what happened in the last 20 years.' The reading was taken too seriously and the aggressive treatments that PSA screening was used to justify were not helpful.

If you still want to use PSA at all, he recommends that you focus on the % of Free PSA. Usually if cancer is present PSA is more likely to be complexed with other blood proteins. The higher the % of FREE PSA compared to total PSA, the better. If the PSA is rising but the % of Free Floating PSA compared to PSA is also rising chances are cancer does not exist. Dr. Rowen feels vitamin D levels are much more important in measuring prostate cancer risk. International experts are calling for an increase in the RDA for vitamin D. Daily doses of at least 10,000 IU show no evidence of toxicity.
He measures Vitamin D as 25-hydroxyvitamin D. His ideal blood level is 45-50 ng/ml or 115-128 nmol/L [others go much higher than this, such as 40-80 ng/ml etc.]. He recommends a D3 supplement or Cod Liver Oil of 4,000 IU daily plus common sense exposure of skin to the sun.”

Compare Vitamin D in the Treatment and Therapy of Prostate Cancer and Vitamin D Supplementation During Seasons Lacking in Sunshine May Slow Down Prostate Tumor Growth.

Other comments re unreliability of PSA tests

“Dr. Bard [of cancerscan.com] said that he has had people with a reading of 900 and no cancer and some with less than 3 who did.”

“While PSA is something to be aware of, it is becoming less and less of a reliable indication of cancer.
If one sees a regularly rising PSA it does mean something needs to be 'checked'. It is a symptom, not a cause. Nobody died from an elevated PSA.
What needs to be done is to do what has been proven to be successful against Cancer and let the PSA adjust accordingly. People have been diagnosed with PC even though they never had a PSA above 4. One can have an elevated reading after a cystoscopic exam or a day or two after sex or from any number of causes! It's a symptom, not a cause and it isn't cancerous tumor.”

“Monitoring PSA is becoming increasingly suspect at being an almost useless exercise. People with readings below the 'magic' 4 are often found to have cancer and people with PSA above 4, are not. Yet the number 4 is used as the baseline.”

And Cliff Beckwith, a 15-year prostate cancer survivor thanks to a “light” version of Dr. Johanna Budwig’s diet and prayer, reports: “A man walked into the office of a Urologist in Knoxville, TN some years back with a PSA of 7000 and was still functioning. I wasn't there. That is what I was told.”

Note by Healing Cancer Naturally

According to eminent alternative & conventional cancer treatment researcher Lothar Hirneise and other researchers, prostate cancer is, generally speaking, one of the most innocuous cancers one can have. In fact, many men who die of other causes are found at autopsy to have had prostate cancer, safely encapsulated for decades by the wisdom of their body. More at Budwig diet prostate cancer healing testimonals "Notes by Healing Cancer Naturally" and Are you being advised to get radiation therapy for prostate cancer?.

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