Compared to testosterone, it can be easy to forget about the crucial role that prostate-specific antigen (PSA) plays in men’s health. However, this biomarker’s levels in the blood serve as one of functional medicine practitioners’ most important tools for ensuring the health of their male patients.
Globally, prostate cancer is the fifth leading cause of death and the second-most frequent cancer diagnosis in men. More than a million new prostate cancer diagnoses are made every year, yet it is notoriously difficult to detect in its early, asymptomatic stages. The silent-but-deadly nature of prostate cancer is underscored by the fact that 30% to 70% of autopsies of men over 60 show histological evidence of prostate cancer, despite their deaths from unrelated causes.
That’s why it’s crucial for us, as practitioners of Functional Medicine, to monitor our patients’ prostate health and ensure they’re not trending towards a cancer diagnosis. Measuring serum levels of PSA is among the best methods to do so.
PSA, the most abundant protein synthesized in the prostate gland, is a serine protease enzyme that helps to liquefy male ejaculate to facilitate fertilization.
Under healthy conditions, this protein stays within the prostatic ducts, which is why an individual with a healthy prostate will typically have less than 1.0 ng/ml of PSA in their blood. When the prostate is cancerous, however, blood PSA levels rise markedly. Not only do prostatic cancer cells tend to produce PSA, but this protein’s enzymatic activity can also break up the extracellular matrix, ultimately facilitating the spread of cancer.
Thus, measuring the levels of this biomarker and doing so over time can provide us with insights into the health of our patients’ prostate and its risk of becoming cancerous.
Most doctors will consider a Total PSA level below 4.0 ng/ml as normal. Functionally oriented doctors, however, will look for lower levels in patients in optimal health. A Journal of Urology study reported that 22% of patients with Total PSA levels between 2.6 and 4.0 ng/ml had “significant” prostate cancer, as revealed by biopsy.
Therefore, Total PSA blood tests should ideally show levels below 2.6 ng/ml. With the ultimate goal of preventing disease rather than treating it, we recommend testing for PSA early, at around the age of 35. Not only will this enable you to catch any early cases, it also serves as a baseline to evaluate trends in your patients’ prostate health as they continue to age.
Obese patients are less likely to have elevated levels of Total PSA even when they have prostate cancer. If your patient is obese, you may want to track additional biomarkers related to cancer in general and prostate cancer in particular.
Additionally, Total PSA doesn’t need to be elevated for there to be prostate cancer — if you’ve reason to suspect your patient is suffering from a prostate condition but their Total PSA levels aren’t elevated, consider running additional tests.
Serum levels of Total PSA are useful, but you can gain more insight into your patient’s health by tracking their prostate-specific antigen velocity (PSAV), prostate-specific antigen doubling time (PSADT) and prostate-specific antigen density (PSAD).
PSAV
Measuring PSA over time enables you to calculate its rate of change, or PSAV. Levels of PSA can be on the higher side for a long time without corresponding prostate cancer, but sudden, sharp increases in the biomarker make it far more likely that prostate cancer is a factor.
PSADT
PSADT represents the length of time it takes for PSA levels to double. Men with prostate cancer tend to see a PSADT of 48 months. Men with optimal prostate health shouldn’t see any appreciable rise in PSA, but a PSADT of less than 12 years should direct practitioners to pay more attention to their patients’ prostate health.
PSAD
The PSAD metric is another useful means of assessing a patients’ likelihood of prostate cancer. Practitioners should determine — either radiologically or through ultrasound — the size of the prostate and divide that figure by the patient’s levels of PSA in their blood. A PSAD over 0.15 ng/cc is associated with prostate cancer.
PSA levels alone aren’t enough to diagnose prostate cancer — like so many other biomarkers, they’re best evaluated in the context of a full Functional Blood Chemistry Analysis, FBCA. That’s why Optimal DX offers an annual FBCA Mastery Training Program that comprehensively discusses the various biomarkers practitioners can test for in their patients’ blood, their significance, and their holistic context — including those biomarkers that may help in a prostate cancer diagnosis.