Monday, March 25, 2019

Lifestyle Changes Do a Number on PSA Values

Simple, temporary lifestyle changes may be able to spare men with mildly increased prostate-specific antigen (PSA) levels from having to endure a prostate biopsy, results of a controlled study suggest.

Men who avoided eating spicy foods, drinking alcohol or coffee, and riding a bicycle had a repeat PSA reading approximately 1.5 ng/mL lower than their first reading a median of 8 weeks earlier.

Nearly half of men who adopted the lifestyle changes had a drop-in PSA below the minimum threshold for biopsy, reported Alexandre Zlotta, MD, director of Uro-Oncology at Mount Sinai Hospital and professor of surgery (urology) at the University of Toronto, Ontario, Canada.
In an interview with Medscape Medical News here at the European Association of Urology (EAU) 2019 Congress, Zlotta said that spicy food has something in common with alcohol, caffeine, and biking. "Spicy food induces inflammation, and inflammation directly translates into increase in PSA," he said.

Zlotta explained that repeat biopsy decisions are not based on a single PSA but that the new intervention might be a good idea before a repeat PSA test.

Although PSA is a fairly sensitive marker for prostatic enlargement, it has poor specificity for prostate cancer. Nonmalignant conditions such as benign prostate hypertrophy and inflammation can cause PSA elevations that are large enough raise suspicion of prostate cancer and trigger a biopsy, the investigators noted.

To see whether specific lifestyle modifications could affect serum PSA levels in asymptomatic men with PSA levels from 2 to 10 ng/mL and normal digital rectal exam (DRE), the authors conducted a retrospective study of 189 men. The sample included 67 men who adopted lifestyle changes and 122 matched controls who did not. Men with suspicious DRE findings or who were taking 5-alpha reductase inhibitors were excluded from the study.

The lifestyle intervention involved abstinence from spicy foods, alcohol, caffeine, and bike riding for a minimum of 8 weeks before repeat PSA testing.

There were no significant differences at baseline between the intervention and control groups in family history of prostate cancer, age (median 59 vs 60 years), median prostate volume (42.0 vs 46.5 cc), median total PSA values (5.20 vs 5.68 ng / mL), or median free-to-total PSA ratio values (0.16 vs 0.15).

The authors found that those in the lifestyle modification group had significantly lower total PSA on repeat testing a median of 8 weeks from the first test (3.50 vs 5.09 ng / mL P less than .0001), as well as a greater decrease from baseline in total PSA (1.38 vs 0.44 ng / mL P less than .0001).

My Take:
A few years ago the PSA fell out of favor as many urologists used an elevated PSA as the sole criteria to perform prostate biopsies. Thirty-three percent of men undergoing this procedure experience side effects including pain, fever, bleeding, infection and transient urinary difficulties.

The problem was never the test but the rush to perform a biopsy. As this study points out, the Prostatic Specific Antigen (PSA) is not that specific. Any form of systemic inflammation can elevate the PSA.

Bottom Line:

The PSA is a valuable test when properly interpreted. I recommend men over the age of 45 have the test performed every two years. Gradual elevation is considered normal with age, especially if the digital exam shows mild prostate enlargement. However, any significant elevation should trigger more frequent testing and lifestyle modification to reduce inflammation.

Source: March 18, 2019 NIH

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