Statin use affects prostate cancer screening results

 

Summary:

Prostate cancer screening results differ in men taking cholesterol-lowering statin drugs compared with non-users, a study finds. In statin users, screening did not increase the incidence of prostate cancer as it did in other men.

Date:

November 29, 2021

Source:

Tampere University

FULL STORY

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Prostate cancer screening results differ in men taking cholesterol-lowering statin drugs compared with non-users, a study conducted at Tampere University in Finland finds. In statin users, screening did not increase the incidence of prostate cancer as it did in other men.

The study found the clearest difference in low-risk cancer, which is often overdiagnosed due to screening. The number of low-risk tumours found in screening was significantly lower in statin users. However, statin use caused no difference in the detection of high-risk cancers. In the screened group, prostate cancer mortality was slightly lower than in the unscreened group, both in men taking statins and other men.

"The study provides significant new information because statin use is very common and the effects of prostate cancer screening have not been previously evaluated in relation to statin use," says Professor Teemu Murtola from the Faculty of Medicine and Health Technology at Tampere University.

The study was published in the JAMA Oncology journal on 24 November 2021.

The findings may be explained by the fact that statin use improves the accuracy of prostate cancer screening. This means that screening detects dangerous types of cancer in these men as well as in others, but in statin users, there is less of the so-called overdiagnosis, which means the detection of low-risk prostate cancers that do not pose a health threat due to their very slow growth rate.

Another possible explanation could be that men who use statins are a select group who already actively use health services and have had PSA tests outside systematic screening. In those cases, the additional screening done in the study does not have such a great impact.

The study was based on data from the Finnish Prostate Cancer Screening Trial which started in 1996-1999. A total of about 80,000 men were included in the study, of whom just under 32,000 were screened with the PSA test every four years. The project was carried out jointly by Tampere University and the University of Helsinki and the Helsinki and Tampere University Hospitals.

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Story Source:

Materials provided by Tampere University. Note: Content may be edited for style and length.

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Journal Reference:

1. Arla Vettenranta, Teemu J. Murtola, Jani Raitanen, Paavo Raittinen, Kirsi Talala, Kimmo Taari, Ulf-Håkan Stenman, Teuvo L. J. Tammela, Anssi Auvinen. Outcomes of Screening for Prostate Cancer Among Men Who Use Statins. JAMA Oncology, 2021; DOI: 10.1001/jamaoncol.2021.5672

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Tampere University. "Statin use affects prostate cancer screening results." ScienceDaily. ScienceDaily, 29 November 2021. <www.sciencedaily.com/releases/2021/11/211129105542.htm>.

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10 ways to lower your PSA levels

Men are usually told they should have their PSA (prostate-specific antigen) level measured beginning between ages 40 and 50, depending on their ethnicity and family history.

Craig Cooper

Why is it recommended you have your PSA checked? An elevated PSA can be an early indication that something is not quite right with the prostate, such as the possibility of prostatitis, an enlarged prostate, or prostate cancer, while a lower PSA is a strong indication of good prostate health. However, an elevated PSA can be associated with other situations that don’t directly involve prostate health, such as a reaction to medication, a urinary tract infection, recent catheterization or ejaculation, or inflammation of the prostate associated with a sports injury or age.

In any event, it’s best to get a PSA test so you and your doctor can decide whether any action is necessary. As a general course of action, you can help ensure a healthy prostate by following certain lifestyle guidelines.

Eat more fruits, vegetables and nuts

Although several hormones have an impact on the prostate, one in particular—DHT, or dihydrotestosterone — promotes prostate inflammation and stimulates insulin-like growth factor-1 (IGF-1), a hormone that can promote abnormal cell growth and cancer. Certain foods contain substances shown to naturally inhibit DHT. One of those substances is lycopene, which is found in carrots, mangoes, tomatoes, and watermelon.

A National Institutes of Health study noted that lycopene inhibits IGF-I growth in prostate cells by reducing DHT-modulated IGF-I production. Other food substances that inhibit DHT include L-lysine (in almonds, peanuts, pecans, walnuts), and zinc (in cashews, kale, spinach, wheat germ, white mushrooms, and supplements). Make a point to include several of the mentioned foods in your diet every day.

Add some pomegranate to your diet

Whether you enjoy pomegranate juice, the tasty pulp and seeds, or prefer the supplement, be sure to include this fruit in your diet more often. Research at Johns Hopkins has shown that this phytonutrient-rich fruit can reduce the rate of PSA doubling in men who have prostate cancer. Overall, the doubling time increased from 11.9 months at baseline to 18.5 months after treatment with pomegranate extract. Since pomegranate is rich in sugar, taking a supplement may be better than having the fruit on a regular basis.

Exercise more

Staying physically active on a regular basis can help lower your PSA levels. Aerobic activities, such as walking, running, cycling, and rowing, are encouraged as well as some resistance exercise to help strengthen and tone muscles. A highly recommended exercise approach is HIIT (high-intensity interval training), which is perfect for men who want to maximize their exercise benefits in a minimal amount of time.

A study in the Annals of Occupational and Environmental Medicine looked at the PSA levels and physical activity of nearly 2,000 healthy males and found that “PSA levels were significantly higher among the group with hypertension or the group of individuals that did not exercise regularly or group of office workers who were considered to have lesser physical activities.”

Lose weight

Some contradictory evidence surrounds the association between overweight and obesity and PSA. On the one hand, excess weight is associated with a greater risk of prostate cancer, prostatitis, and enlarged prostate, all conditions also associated with an elevated PSA. However, several studies point to lower PSA levels in healthy overweight and obese men, including a new study in the International Journal of Clinical and Experimental Medicine. Overall however, losing weight is the more logical and healthful step for the prostate and your general health.

Take aspirin

Several studies have indicated that use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce PSA levels. A University of Arizona study, for example, found that this effect was especially significant among men who had never smoked. Before taking aspirin, however, talk to your healthcare provider about whether it is safe for you to do so and the optimal dose for you.

Eat more tomatoes

Tomatoes are an important source of the potent antioxidant lycopene, which has been shown to reduce PSA levels and lower a man’s risk of prostate cancer. Lycopene is released from tomatoes when they are cooked, so you get the most benefit from enjoying stewed tomatoes, tomato soup, tomato-based pasta sauces, and tomato juice. One caution, however: don’t eat tomatoes that have been canned, as they may have been exposed to BPA (bisphenol-A) in the lining of the can, a chemical that disrupts your endocrine system and may contribute to prostate cancer. Fresh is definitely best when it comes to this fruit.

Reduce or avoid foods that harm the prostate

You may be surprised at how many common foods irritate the prostate and can contribute to a rise in PSA levels and an enlarged prostate. Here are some of the foods and beverages that fall into this category:

• Foods that contain acrylamide, such as French fries and potato chips (the two biggest offenders) and doughnuts
• Foods rich in saturated fats
• Excess alcohol
• Nonfermented soy products such as tofu and edamame, which can raise estrogen levels
• Microwave popcorn
• Nonorganic potatoes, meats, and dairy products
• Canned foods, especially tomatoes, which are acidic and more likely to leach bisphenol A (a hormone disruptor) from the lining of the cans
• And these 8 worst foods for prostrate health.

Reduce animal protein intake

Meat, poultry, and dairy foods are typically high in protein and also trigger the release of a substance called insulin-like growth factor-1 (IGF-1). When you consume a considerable amount of these high-protein foods, the body makes a lot of IGF-I and can use some of it promote cancer growth, including prostate cancer.

A study in Cancer Epidemiology, Biomarkers and Prevention reported that IGF-I levels were elevated among animal protein eaters but not among plant protein consumers. In fact, eating plant protein seemed to reduce IGF-1 levels. If you do eat animal protein, be sure to choose organic products that have not been raised with antibiotics or any other hormones.

Try quercetin and pollen

Both quercetin and pollen have demonstrated properties that promote and support prostate health, including anti-inflammatory and antioxidant abilities, especially in the management of the inflammatory condition known as prostatitis. In addition, a new study in Urology looked at the effect of an anti-inflammatory combination (consisting of quercetin, nimesulide, saw palmetto, and bromelain) taken daily for three months by men with PSA values of 7.2 ng/mL or 7.3 ng/mL at baseline. By the end of the study, the combination had effectively and safely reduced PSA levels from 7.3 ng/mL to 4.6 ng/mL among men who had prostate inflammation. Both quercetin and pollen can be taken separately, but they also can be found together in supplement formulas designed to support prostate health.

Follow The Prostate Diet

Men who want to help keep PSA levels low, support overall prostate health, and fight inflammation are encouraged to follow The Prostate Diet. The diet has 10 foundations which, if you follow them consistently, should reward you with a healthy prostate and overall health as well. Post them where you can refer to them until they become a habit.

• Eat lots of fruits and vegetables, organic whenever possible
• Consume healthy fats—monounsaturated, omega-3 fatty acids
• Choose plant protein over animal protein
• Drink green tea often
• Choose whole, natural foods over refined, processed foods
• Include foods rich in omega-3 fatty acids (e.g., cold water fatty fish, walnuts, algae)
• Avoid or significantly limit certain foods and supplements (see “Reduce or avoid foods that harm the prostate”)
• Choose prostate cancer killing foods and supplements, such as tomatoes, green tea, and vitamin D
• Stay well hydrated with pure water
• Consider taking natural supplements that support prostate health

Sources

1. Algotar AM et al. Effect of aspirin, other NSAIDs, and statins on PSA and PSA velocity. Prostate 2010 Jun 1; 70(8): 883-88

2. Allen NE et al. The associations of diet with serum insulin-like growth factor 1 and its main binding proteins in 292 women meat-eaters, vegetarians, and vegans. Cancer Epidemiology, Biomarkers and Prevention 2002 Nov; 11(11): 1441-48

3. Gallo L. The effect of a pure anti-inflammatory therapy on reducing prostate-specific antigen levels in patients diagnosed with a histologic prostatitis. Urology 2016 Aug; 94:198-203

4. Kim SH et al. Serum prostate-specific antigen levels and type of work in tire manufacturing workers. Annals of Occupational and Environmental Medicine 2014 Nov 4; 26(1): 50

5. Liu X et al. Lycopene inhibits IGF-I signal transduction and growth in normal prostate epithelial cells by decreasing DHT-modulated IGF-I production in co-cultured reactive stromal cells. Carcinogenesis 2008 Apr; 29(4): 816-23

6. Paller CJ et al. A randomized phase II study of pomegranate extract for men with rising PSA following initial therapy for localized prostate cancer. Prostate Cancer and Prostatic Disease 2013 Mar; 16(1): 50-55

7. Zhang J et al. An inverse association of obesity and prostate-specific antigen in elderly males. International Journal of Clinical and Experimental Medicine 2016; 9(9): 18746-53

http://easyhealthoptions.com/10-ways-lower-psa-levels/

What are my surgical options for an enlarged prostate?

For men who have exhausted nonsurgical methods and natural therapies to manage an enlarged prostate, there are more than a dozen surgical options available.

Craig Cooper

These choices fall into one of two categories: minimally invasive procedures, in which no incisions are made in the skin; and invasive procedures, most of which involve surgically removing the affected part of the prostate gland.

Which of the following surgical options for an enlarged prostate may be the right one for you? That’s a decision you should make along with your physician. Here’s some information on the techniques so you can initiate a conversation with your doctor to help you make your selection.

Transurethral Resection of the Prostate (TURP). This invasive procedure is typically used for men who have a prostate that is larger than 30 grams and/or their symptoms are severe. TURP is done under general or spinal anesthesia and involves passing a thin wire loop through the urethra to the prostate, where the doctor slices away the excess prostate tissue. Post-surgery hospitalization is about two days.

The majority of men (70-85%) experience symptom relief, and the effects usually last for 15 years or longer. At least 25 percent of men experience retrograde ejaculation following TURP, while other common side effects include erectile dysfunction (3-35%), urinary tract infections (5-10%), and urinary incontinence (5-10%).

Transurethral Incision of the Prostate (TUIP). Men who have a slightly enlarged prostate (less than 30 g) may consider TUIP. Physicians perform this invasive procedure by passing a narrow instrument through the urethra to the junction of the prostate and bladder. The instrument delivers an electrical current or laser beam that cuts muscles in the bladder neck, which then allows urine to flow more freely.

Symptom relief is achieved in about 80 percent of men who have TUIP. Retrograde ejaculation can affect up to 55 percent of men following the procedure, while up to 25 percent experience erectile dysfunction. Ten percent of men need a repeat TUIP in about 15 years.

Photoselective Vaporization of the Prostate (PVP). You may better know this surgical procedure as Green Light laser. Surgeons guide a fiberoptic device through the urethra to the prostate and vaporize the excess tissue with a laser. At the same time, the device cauterizes the area, making the procedure virtually bloodless. Therefore, PVP can be a suitable option for men who take blood thinners.

Overnight hospitalization is usually not necessary. Typical side effects may include bloody urine, turning when urinating, retrograde ejaculation, and a frequent need to urinate. Symptom relief typically occurs within a day or two of the procedure.

Holmium Laser Ablation of the Prostate (HoLAP) and Holmium Laser Enucleation of the Prostate (HoLEP). The first procedure is similar to PVP except it uses a different type of laser. Side effects are minimum; although some men experience urinary incontinence, it is permanent in less than 1 percent of men 12 months after the procedure. Erectile dysfunction, bladder perforation, and sepsis are rare.

The HoLEP procedure takes HoLAP one step further. After the surgeon passes a flexible fiber through the urethra to the prostate gland, holmium laser is used to destroy the prostate tissue. Then anither instrument is used to grind up the tissue, which makes it easier to remove. All that’s left behind is the empty prostate capsule.

Most men experience retrograde ejaculation following HoLEP, as well as urinary incontinence, which resolves in all but 1 to 2 percent of men. Urethral stricture occurs in about 5 percent of men.

Transurethral Vaporization of the Prostate (TVP). Men whose prostate is 30 grams or less are best suited for this procedure. A minute electrified cylindrical loop or roller is passed through the urethra to the prostate, where it vaporizes excess prostate tissue. Simultaneously, blood vessels in the prostate are cauterized, which reduces bleeding. Post-procedure hospitalization can range from 1 to 3 days.

Common side effects of TVP can include retrograde ejaculation, erectile dysfunction, blood in the urine, and clotting. Because TVP has a low risk of bleeding, men who are taking blood thinners are good candidates.

Simple Prostatectomy. Only 2 to 3 percent of men with an enlarged prostate undergo a simple prostatectomy, which is removal of the prostate. This surgical option for treating BPH is usually reserved for men who have a severely enlarged prostate, bladder damage, or other significant health problems. The procedure can be done in one of three ways: open retropubic, open suprapubic, and laparoscopic. The latter approach requires the least recovery time and is the least painful.

Complications associated with a simple prostatectomy may include bleeding, accumulation of urine in the penis or scrotum, and encapsulated urine. Up to 90 percent of men experience retrograde ejaculation, but urinary incontinence is rare while erectile dysfunction occurs in 2 to 3 percent of men who have suprapubic prostatectomy.

Urolift System. This treatment approach is the only one developed thus far that involves implanting devices into the prostate rather than eliminating excess prostate tissue. Specifically, tiny implants are placed in the lobes of the prostate to prop open the urethra. The procedure can be performed in a doctor’s office under local anesthesia.

The Urolift System is for men who have a small to moderate size prostate. Research has shown that men who choose Urolift System don’t experience erectile dysfunction or retrograde ejaculation following the procedure and that less than 8 percent of men need additional treatment for BPH.

Transurethral Microwave Thermotherapy (TUMT). This office-based procedure utilizes heat to destroy excess prostate tissue in men with a prostate that is 20 grams or larger. Once the physician passes a tiny microwave generator through the urethra to the prostate, high-temperature microwaves eliminate the offending tissue.

Men typically can go home the same day as the procedure and experience relief from symptoms within a few days to weeks, although complete improvement can take up to 90 days. About one quarter of men complain of urinary tract symptoms following the procedure, while other side effects occur less often and can include urinary tract infections, narrowing of the bladder neck, and retrograde ejaculation. TUMT tends to be more effective than medication but less successful than TURP.

Transurethral Needle Ablation (TUNA). Men who have a prostate of 60 grams or less and who have urinary obstruction symptoms are the best candidates for TUNA, which your doctor can perform in the office. The procedure involves passing a special catheter through the urethra to the prostate, where radio waves are used to destroy extra prostate tissue.

Compared with TURP, men who choose TUNA experience fewer sexual complications and less bleeding following the procedure. However, nearly one third of men need retreatment after five years.

Transurethral balloon dilation (TUBD). The unique feature of TUBD is that rather than cutting or destroying excess prostate tissue, it involves pushing it away from the urethra. This procedure has been mostly shelved because it’s associated with serious complications and its benefits have been unsatisfactory. However, some experts have revived and redesigned the procedure, which is now known as transurethral split of the prostate (TUSP). You might ask your doctor about the status of TUSP.

High-Intensity Focused Ultrasound (HIFU). This noninvasive treatment for an enlarged prostate uses ultrasound to heat and eliminate excess prostate tissue. Rather than reach the prostate via the urethra, however, HIFU involves using a probe that enters the rectum to deliver the treatment. Men typically can go home within a few hours of having the procedure.

One year after treatment, there was a 63 percent improvement in symptom scores in one study. Compared with TURP, “overall the results compare favorably,” according to researchers at Case Western Reserve University. Urinary retention, transient urinary incontinence, urinary tract infections, and erectile dysfunction occur in less than 10 percent of men.

Interstitial Laser Therapy (ILT). At one time, interstitial laser therapy was used more often, but high infection rates and irritating urinary tract symptoms, along with the introduction of newer methods, have made ILT less popular. However, it may still be an option for men with a large prostate who would rather choose a less invasive procedure may select ILT.

During the procedure, which can be done under local anesthesia, a cystoscope is passed through the urethra to the prostate, where laser burns away the tissue. Retrograde ejaculation and erectile dysfunction typically are not a problem with ILT.

Prostate Artery Embolization (PAE). This is a recent addition to the surgical options for an enlarged prostate. PAE can accommodate prostates up to and greater than 80 grams, so a wide range of men may be helped. In a recent (November 2016) meta-analysis and systematic review, the authors evaluated 12 studies involving 840 men. During the 24-month follow-up, there were significant improvements in peak urinary flow rate, quality of life scores, International Index of Erectile Function scores, and postvoid residual volume.

The risk of urinary incontinence, erectile dysfunction, and bleeding is less than that associated with other treatments for an enlarged prostate. However, PAE is still relatively new, requires special skills, and is not widely available, as the individuals most qualified to perform the procedure are interventional radiologists.

Focal Laser Ablation (FLA). Focal laser ablation is a new technique in which clinicians coagulate rather than vaporize the extra prostate tissue. The procedure involves guiding a laser fiber optic through the rectum to the prostate, at which time the surgeon treats the tissue, leaving behind scar tissue that the body absorbs.

As the body absorbs the scar tissue, symptoms of BPH improves over a period of weeks. Focal laser ablation is associated with minimal side effects and has not been shown to cause erectile dysfunction, urinary incontinence, retrograde ejaculation, urinary traction irritation, or infections.

Stents. One usually associates stents with the heart or legs, where they are placed to help keep arteries open to facilitate blood flow. When stents are used in men with an enlarged prostate, the coil-like or spring-like devices hold the urethra open so urine can flow more easily. Stents may be an appropriate option for high-risk patients (e.g., elderly men) or those who want to avoid other surgical procedures.

Stents for an enlarged prostate have a high complication rate, including infections, pain, urinary incontinence, breakage, pain, and stone formation, which can in turn block the urethra. Although they are effective in up to 90 percent of men, they are not a long-term solution.

References

1. Bouza C et al. Systematic review and meta-analysis of Transurethral Needle Ablation in symptomatic benign prostatic hyperplasia. BMC Urology 2006 Jun 21; 6:14

2. Enlarged prostate. New York Times.

3. Hitt E. Transrectal high-intensity focused ultrasound safe, effective for BPH. Medscape Medical News 2003 Apr 29

4. Hoffman RM et al. Microwave thermotherapy for benign prostatic hyperplasia. Cochran Database of Systematic Review 2012 Sep 12; (9):CD004135

5. Huang W et al. Treatment of benign prostatic hyperplasia using transurethral split of the prostate with a columnar balloon catheter. Journal of Endourology 2015 Mar; 29(3): 344-50

6. Sexual dysfunction no longer inevitable when treating enlarged prostate. 2014 Nov 3

7. Wang XY et al. Efficacy and safety of prostate artery embolization on lower urinary tract symptoms related to benign prostatic hyperplasia: a systematic review and meta-analysis. Clinical Interventions in Aging 2016 Nov 11; 11:1609-22 

http://easyhealthoptions.com/surgical-options-enlarged-prostate/

What causes PSA to rise?

Before you have your prostate-specific antigen (PSA) level checked, it’s a good idea to know what causes PSA to rise. Why? 

Craig Cooper

One, you should know there are many situations or reasons directly unrelated to the prostate that can cause PSA to rise. Therefore, if you know about these factors before you go for your PSA test you and your healthcare provider can take them into account when assessing your test results. That way you can be assured of a more accurate reading from your blood test and avoid any unnecessary follow up tests, like a biopsy.

Two, an elevated PSA does not necessarily mean you have prostate cancer. In fact, there are other prostate-related situations associated with a rise in PSA, so don’t let the fear of prostate cancer prevent you from getting your PSA level checked.

PSA levels can rise for reasons related to the prostate, but there are actually more situations that are not directly related to prostate health that can cause PSA to rise. The factors in the latter category typically are temporary causes. Here are eight reasons why you may experience a rise in your PSA levels:

Enlarged prostate. The presence of an enlarged prostate (aka, benign prostatic hyperplasia, BPH) is associated with a rise in PSA. An enlarged prostate is a benign and treatable condition and should be diagnosed by a physician.

Prostatitis. Inflammation of the prostate is another benign condition that is characterized by a rise in PSA. Again, it is a treatable condition and should be diagnosed by a doctor, since there are several forms of the disease and an accurate diagnosis is necessary to ensure effective treatment.

Prostate cancer. An elevated (generally, 4.0 ng/mL or higher) PSA is not an accurate indicator of prostate cancer. In fact, men with a low PSA can be diagnosed with prostate cancer while those with a high level can be completely cancer free.

Recent sexual activity. Engaging in sexual activity within 48 to 72 hours of having your PSA checked may result in an artificially elevated reading.

Riding a bike. Some research has indicated that strenuous bicycling riding can cause a slight rise in PSA level. Although the study findings are mixed, it’s best to avoid riding a bike for about 48 hours before a PSA test. The same effect on PSA levels may occur if you spend a significant amount of time riding a motorcycle, riding lawnmower, all-terrain vehicle, or horse.

Digital rectal exam. Having a DRE within 24 to 48 hours of a PSA test may result in a mild rise in PSA. If you are having both a PSA test and a DRE, have your blood drawn first.

Medical procedures. One of the most common medical procedures associated with a rise in PSA is placement of a urinary catheter. A prostate biopsy or a bladder or prostate examination that involves passing a scope into the urethra also can cause an increase in PSA levels. Wait for about two to three weeks before having a PSA test if you have had these procedures. Research also has indicated that a colonoscopy can result in an elevated PSA for seven days or more post procedure in some men.

Urinary tract infection. A urinary tract infection can cause inflammation of the prostate and result in a rise in PSA. If you know you have a urinary tract infect, wait until the infection has completely cleared before having a PSA test. Most urinary tract infections respond well to a course of antibiotics.

For more great posts on male health, check these out:

Top 3 foods for better male sexual health

8 worst foods for prostate health

Sources

1. Cetinkaya ZA et al. Serum levels of prostate specific antigen are elevated after colonoscopy. Tohoku Journal of Experimental Medicine 2010 Nov; 222(3): 183-86

2. Jiandani D et al. The effect of bicycling on PSA levels: a systematic review and meta-analysis. Prostate Cancer and Prostatic Disease 2015 Sep; 18(3): 208-12

http://easyhealthoptions.com/causes-psa-rise/