UNSTABLE PSA
- From: "DP" <deanper@xxxxxxxxxxxxxx>
- Date: Sat, 13 Aug 2005 17:11:56 -0400
From: "DP" <deanper@xxxxxxxxxxxxxx>
Subject: Re: Unstable PSA:
Date: Saturday, August 13, 2005 5:05 PM
Hi Curtis,
I have a large prostate. Large enough to cause me to have complete
retention about 3 times and had to have a catheter hence the reason for the
PVP at that time my prostate was 90 grams which I 'm sure will support a
4.95 PSA probably a lot bigger now . I have had yearly DRE and Psa free
tests since 1997 but none since PVP I kind of relaxed after PVP but I'm
going to have to get back into it and see what is going on. "Thanks Curtis"
for the valuable information Dean, <PALMER_ENT@xxxxxxxxx> wrote in message
news:4121-42FE559D-584@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
> hi dean - as a general rule, the only thing in the prostate supplements
> that does much is saw palmetto. why? because it is a natural form of
> estrogen and will reduce the effects of the psa and prostate symptoms
> some. of course, if you are the person taking the pills and they
> provide some relief, you aren't going to be worried about what the pills
> could be masking, which is the reason for the higher psa.
>
> as fred (redbeard) pointed out on the low psa of 1.0 or less of a
> healthy prostate at age 21, the psa will climb as we age but if you
> check the acceptable standard for psa levels, you will find that they
> are wanting to reduce the standard of 4.0 to 2.4 as a cutoff point
> before other actions are taken.
>
> if you had a free psa taken in 1997, then you are ahead of the game
> because you have a base number to relate to if you have the free psa
> test taken again.
>
> yes, you could have a large prostate with BPH to account for the higher
> number. but just for a reference point. the normal prostate size is
> between 20 to 30 grams. when mine hit the path. table, it weighed in at
> 55 grams -almost twice the size of a normal one.
>
> the 5.0 + psa number is something to keep an eye out for and calls for
> close monitoring - which you are doing, so from that view point, you are
> to be congratulated.
>
> here's a warning that is issued by a doctor on saw palmetto.
>
> i hope this info helps.
>
> ~ curtis
>
> Saw Palmetto Warning : Problems with Detecting Prostate Cancer?
> The purpose of this letter is to alert physicians and the general public
> to the potential implications regarding the detection and treatment of
> prostate cancer involved with the use of an alternative supplement sold
> in health food stores called saw palmetto. Prostate cancer is the most
> commonly diagnosed cancer in American men. In 1996, an estimated 317,100
> new cases of prostate cancer, and 41,400 deaths from prostate cancer
> will be found, among men in the United States. It is the second most
> common cause of death in men older than 55. Early detection is the most
> important factor for cure! We are detecting prostate cancer within the
> past decade with increasing frequency, and many patients with this
> condition are receiving such treatments as radical prostatectomy and
> radiation therapy for cure.
> Although refinements in PSA-based testing have contributed substantially
> to the increased detection rate of prostate cancer, the incidence of
> disease was increasing dramatically even before the detection of PSA was
> possible. Self medication for prostate disorders has increased
> throughout the US and the rest of the world. Saw palmetto in particular
> raises concerns for urologists regarding their ability to diagnose and
> treat prostate cancer. I have seen many patients who have placed
> themselves on this herb. Its use is advised in advertisements and other
> marketing for treatment and prevention of benign prostatic hyperplasia
> (BPH), prostatitis, and "urinary difficulty" in men.
> The extract comes from the berries of the palm tree saw palmetto
> (Serenoa Repens, Serenoa Serrulata), which is indigenous in the Atlantic
> southeast coast of North America from South Carolina to Florida and
> native to the West Indies.The plant grows six to 10 feet tall, with a
> crown of large spiny-leaves that form a circular, fan-shaped outline.
> The berries are deep red-brown or black and are oblong and about one
> inch long. The extract from these berries is cheap and easy to purchase.
> Word has been spread via direct marketing, as well as by advertisements
> in magazines and throughout the Internet. Reports, mostly in the
> European literature, suggest that use of saw palmetto can decrease the
> size of the prostate and improve urinary symptoms (dose dependent) after
> months of use.[1] No "well done" long-term, double-blind,
> placebo-controlled studies of saw palmetto have been done to date.[2]
> Although saw palmetto does not affect certain hormonal levels, there is
> clinical evidence, however, to suggest that its mechanism of action is
> similar to that of the commonly prescribed prostate drug finasteride
> (Proscar). For example, several animal studies[3, 4] suggest that saw
> palmetto has a similar effect on competitively inhibiting the binding of
> dihydrotestosterone (DHT) and blocking the conversion of testosterone to
> DHT, via its inhibition of 5-alpha reductase.
> Saw palmetto's primary therapeutic action is to inhibit 5-alpha
> reductase in forming DHT and to a lesser extent, 3-alpha reductase, and
> to block the action of DHT to receptors on prostate cells via
> 3-ketosteroid reductase. Research has also shown an anti-inflammatory[5]
> and antiestrogenic[3, 6,7] effect of Serenoa Repens. Use of saw palmetto
> in >patients with BPH results in reduction in the size of the
> prostate.[5 ] With finasteride, however, studies have shown that 6 to 12
> months of >treatment with 5 mg of finasteride daily can reduce prostate
> volume, DHT, and prostate-specific antigen (PSA) levels by 50
> percent.[8] Therefore, any patient placed on finasteride must have a
> baseline PSA and digital rectal examination.The mechanism of action
> mimics the pharmacologic action of finasteride, which has recently been
> documented to be of little physiologic value compared with a placebo or
> alpha blockers.[9] The purified extract of saw palmetto contains 85% to
> 95% fatty acids and sterols. Unfortunately, there are many forms of this
> extract on the market, containing additives and many combinations of
> other herbs, vitamins, and minerals. Consequently the consumer does not
> know exactly what he is purchasing. Saw palmetto has been used in Europe
> for more than 20 years. Research there, however, has included clinical
> studies showing its clinical urologic effects versus a placebo. [10]
> Only one study measured the PSA levels prematurely after 3months "the
> treatment did not significantly alter PSA concentrations in these
> patients."[13] However 5-alpha reductase inhibitors will reduce the PSA
> levels by average of 50% after 6-12 months of use, invalidating this
> study on PSA. Consequently of most significance is the lack of well
> planned "long term clinical studies" concerning the effects of saw
> palmetto on "lowering the PSA" levels after 6-12 months! Any
> interference with PSA makes this test useless as a diagnostic tool for
> prostate cancer.
> The use of saw palmetto is not regulated by the FDA (its use falls under
> the guidelines for food supplements). In my own clinical practice, I
> have seen many patients on saw palmetto who were embarrassed to bring
> this to my attention. I have also noticed a dramatic drop in PSA levels
> when patients have been on this herb for many months, making my clinical
> diagnostic determination of prostate cancer more complex. Any 5-alpha
> reductase inhibitor--whether saw palmetto or finasteride--will reduce
> PSA significantly. I quote Dr. Julian Whitaker in his book, Prostate
> Report-Prevention and Healing[11]: "When one of my patients has an
> elevated PSA, I don't rush him off for a biopsy. Instead, I encourage
> him to go on a low-fat diet, and I prescribe a daily course of serenoa
> repens extract, 360 mg a day, along with zinc and a regimen of
> antioxidant vitamins and minerals. We then recheck his PSA level
> periodically, and it has been my clinical experience that, in many
> cases, the PSA gradually falls." This is an example of how an underlying
> condition, possibly prostate cancer, can potentially be concealed by
> losing the sensitivity of the PSA diagnostic test. Although refinements
> in PSA-based testing have contributed substantially to the increased
> detection of early prostate cancer, the incidence of the disease is
> increasing dramatically although the detection by PSA-incidence is
> alling since 1992. [12] Possibly the confusion in the literature about
> when to and who to treat prostate cancer has contributed to this
> decline. So has the introduction of medical therapy with 5-alpha
> reductase inhibitors and herbs introduced during the same time period.
> The most disturbing aspects of self-treatment with such herbal remedies
> are their potential effects in masking PSA, which has revolutionized our
> ability to pick up prostate cancer. If one curtails the ability to
> detect prostate cancer by PSA, many cancers will progress undetected
> until it is too late, resulting in Stage D Disease.
> As a clinical urologist, I feel that the public deserves and has the
> right to know these possible consequences--further research is needed. I
> am not saying that saw palmetto or finasteride should never be used, but
> only that they should be used with careful medical supervision and after
> obtaining a baseline PSA and digital rectal exam. Although saw palmetto
> is an herb, we must treat it as a medicine. Since saw Palmetto can act
> as a 5-alpha reductase inhibitor, thereby potentially interfering with
> PSA levels in men and decrease prostate cancer detection, it is
> imperative that men get a baseline PSA level (as is recommended by the
> FDA for Finasteride, but not for the unregulated use of Saw Palmetto).
> Men self -medicating themselves with this herb are not aware of this
> detrimental effect. We are in a new world where patients are more
> inclined to self-treat their medical conditions with alternative means.
> I believe that there is some merit to this, with proper guidance by
> qualified individuals. The escalating cost of medicines in the US has
> provoked Americans to seek more cost-effective approaches, which is one
> of the many dilemmas that our present health care system has to address
> promptly. Doctors need to be better educated about nutrition and
> alternative medicine. Physicians in the US are not informed about
> alternative botanical medicine; we are far behind the European community
> in this regard. I believe that there are many benefits to botanical
> treatments for many ailments when combined with nutritional approaches.
> We must discover the alternative approaches that are accessible to us,
> while simultaneously using these remedies when appropriate and combining
> them with conventional medical treatment. We must start to incorporate
> this into our medical schools and residency programs so that we maintain
> the doctor-patient relationship. To render a proper diagnostic
> evaluation, doctors and patients must communicate with each other, which
> means that patients should inform their doctors about their use of any
> over-the-counter vitamins, minerals, or herbs. A man who treats himself
> may have a fool for a patient!
> Arnaldo F. Trabucco, M.D
> Department of Surgery, Division of Urology
> Catholic Medical Center of Brooklyn & Queens
> St. Johns Hospital
> Elmhurst, NY
> References:
> 1. Weisser H., Tunn S., Behnke B., Krieg M.: Effects of the sabal
> serulata extract IDS 89 and its subfractions on 5 alpha-reductase
> activity in human benign prostatic hyperplasia. Prostate 1996;
> 28:300-306.
> 2. Lowe F., Ku J.: Phytotherapy in treatment of benign prostatic
> hyperplasia: A critical review. Urology 1996; 48:12-20.
> 3. Carilla E., et al: Binding of Permixon, a new treatment for prostatic
> benign hyperplasia, to the cytosolic androgen receptor in the rat
> prostate. J. Steroid Biochem 1984; 20:521-523.
> 4. Sultan C., et al: inhibition of androgen metabolism and binding by a
> liposterolic extract of serenoa repens B in human foreskin fibroblasts.
> J. Steroid Biochem 1984; 20:515-519.
> 5. Di Silverio F., et al: Plant extracts in BPH. Minerva Urol Nefrol
> 1993; 45:143-149.
> 6. Di Silverio F., et a.: Evidence that Serenoa Repens extract displays
> antiestrogenic activity in prostatic tissue of benign prostatic
> hypertrophy. Eur. Urol 1992; 21:309-314.
> 7. Briley M., et al: Permixon, a new treatment for benign prostatic
> hyperplasia, acts directly at the cytosolic androgen receptor in rat
>>prostate. Br. J. Pharmacol 1983; 79:327.
> 8. Stoner E.: 5 Alpha-reductase inhibitors/finasteride. Prostate suppl.
> 1996; (6): 82-87.
> 9. Lepor H., Willford W.D., et al: The efficacy of terazosin,
> finasteride, or both in benign prostatic hyperplasia. Veterans
> Administration Cooperative Studies Benign Prostatic Hyperplasia Study
> Group. N. Engl. J. Med. 1996; 335:533-539.
> 10. Dreikorn K., Schonhofer PS: Status of phytotherapeutic drugs in
> treatment of benign prostatic hyperplasia. Urologe A 1995 Mar; 34(2):
> 119-129.
> 11. Whitaker J.: The Prostate Report--Prevention and Healing, chapter 7,
> p 44. 1994, Phillips Publishing, Inc.
> 12. Stephenson R., et a.: "The fall in incidence of prostate carcinoma:
> On the down side of a prostate specific antigen induced peak in
> incidence"--Data from the Utah Cancer Registry. Cancer 1996; 77:
> 1342-1348.
> 13.Braeckman J.: The extract of sereona repens in the treatment of
> benign prostatic hyperplasia: a multicenter open study.Current
> Therapeutic Research (Vol. 55, No. 7,July, pp 776-785) 1994.
>
> knowledge is power - growing old is mandatory - growing wise is optional
> "Many more men die with prostate cancer than of it. Growing old is
> invariably fatal. Prostate cancer is only sometimes so."
> http://community.webtv.net/PALMER_ENT/doc
>
.
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