PSA Test
PSA Test a Thing of the Past? MONDAY, May 10 (HealthDayNews) — The PSA test, long the gold standard for deciding who should have a biopsy for prostate cancer, may have outlived its usefulness for the most part.
Stanford University researchers say PSA (prostate specific antigen) levels bear little relationship to the severity of a cancer these days. They presented their finding May 9 at the American Urology Association’s annual meeting in San Francisco.
“”We need to recognize that PSA is no longer a marker for prostate cancer,”" said study author Dr. Thomas A. Stamey, a professor of urology at Stanford University School of Medicine. “”We urgently need to find a new marker for prostate cancer, and that marker must be proportional to how much cancer you have.”"
“”We have been so thorough and effective in screening for prostate cancer over this 20-year period that PSA no longer has a relationship to prostate cancer,”" Stamey said. “”Because we all develop the cancer, we’re now removing prostates from men whose cancer is so small that they do not need the procedure. We’re finding all these little cancers that are never going to be a danger to the patient.”"
“”In smaller cancers, the PSA test is not relevant anymore,”" Stamey explained. “”You might as well biopsy a man because he has blue eyes.”"
PSA is a protein produced by the cells of the prostate gland. Because blood levels of the antigen tend to rise as the gland enlarges, it has been used for years as a test of whether a person needs a biopsy for cancer. The test, however, is not foolproof.
“”People’s perceptions [are] that if your PSA is a certain level, you’re very likely or you do have prostate cancer, and that is incorrect,”" said Dr. Mark Soloway, chairman of the department of urology at the University of Miami School of Medicine.
“”The PSA test is a very good test. It’s not a perfect test, especially in younger men,”" added Dr. Jay Brooks, chief of hematology/oncology at the Ochsner Clinic Foundation in New Orleans.
To see how the efficacy of the PSA test might have waned, researchers in Stamey’s lab reexamined every prostate that had been removed since 1983 (1,317 of them) and compared the size of the cancer with blood PSA levels. None of the cancers had been treated with chemotherapy, radiation, or hormones before surgery.
Each cancer was rated on eight or 10 different parameters thought to indicate how aggressive the cancer was, including the size of the tumor and its grade.
Stamey then divided the samples into four five-year periods to see what had happened to the qualities of the cancers over time.
“”What we showed was that in the first five years, the cancers were related to the level of serum PSA,”" Stamey said. “”Then in the next five years, they were still bad but not as bad as the first five years. Then in the third five-year period, they were better and better. And in the last five years ending Jan. 1 of this year, the cancers were so small they had no relationship to serum PSA.”"
Twenty years ago, 80 percent of cancers were detected by digital rectal examination; only 20 percent of cancers are now detected that way, Stamey explained.
Instead, PSA levels today are driven by benign enlargement of the prostate, a condition that does not usually require surgery.
The concept that the PSA test is not foolproof is not an entirely new one. “”The point is well taken that in microscopic disease, the volume of cancer is clearly overshadowed by the volume of noncancer, so that the cancer cannot be the cause of the elevated PSA,”" said Dr. John Phillips, physician-in-charge of urologic oncology at Beth Israel Medical Center in New York City.
The question now is what can replace it. “”People are trying to find other ways of finding cancer,”" Phillips added.
As a matter of fact, University of Pittsburgh researchers who presented at the same conference reported that additional testing for a protein called early prostate cancer antigen (EPCA) might mean prostate cancer could be detected as many as five years earlier than with just the PSA test.
“”We would like a perfect test that would only find biologically significant cancers,”" Soloway said. “”Today we can’t distinguish between those with indolent cancer and those whose cancers threaten their life. We need another way. That’s going to be a difficult task.”"
In the meantime, the American Urological Association issued a statement that, for the time being, the PSA test in combination with a digital rectal exam and a full medical history is the best way to determine when a biopsy might be necessary
Probiotics for Health
Probiotics for Health By S.K. Dash, Ph.D.
Many health-conscious consumers today want to know when they should take probiotics. They ask whether they should wait until they are sick. If so, they ask, which illnesses respond best to probiotics? Or should they take a preventive approach and take probiotics before they get sick? What about use of probiotics with antibiotics? Today, there is no doubt that taking probiotics is as essential as a multivitamin to your health. So my reply to such questions is that a daily supplement should always be taken to maintain healthy immune and digestive function — but the supplement amount should be increased during times of stress and illness. But let’s start at the beginning.
Probiotics — What Are They?
The concept of ingesting live microorganisms for the purpose of improving one’s intestinal health and general well being can be traced back well before the beginning of the Twentieth Century to earlier eras when most foods were nonrefrigerated and instead preserved with fermentation. But the current practice of using beneficial organisms to improve and sustain health is now referred to as probiotic supplementation. Although numerous types of bacteria (and yeasts) are currently being marketed as probiotic cultures throughout the world, the two most commonly used ones are Lactobacillus and Bifidobacterium.
Probiotics — A Health Essential?
Consumers rarely consider how essential healthy bacterial populations are to their health. But the fact is that a healthy ratio of beneficial to pathogenic bacteria residing within the gastrointestinal tract is essential to good health and influences not only digestive health but also immune function, detoxification, and women’s vaginal health. Unfortunately, great numbers of people today no longer have optimally balanced ratios of beneficial to pathogenic bacteria in their body, thus allowing the “”bad guys”" to gain the upper hand. This is very dangerous and one of the reasons that digestive illnesses, as well as other types of illnesses, are becoming so prevalent. Medically prescribed antibiotic use is certainly one of the most important causes of this change in our natural flora, with travel to foreign lands a close second. But beyond these detrimental impacts on our gastrointestinal health, we face many other daunting challenges to our bacterial balance. Unless one consumes organic dairy products, for example, one is almost certainly consuming traces of antibiotics and sulfa drugs, which have a disruptive effect on bowel ecology. Our highly processed food supply has also denied our bodies the opportunity to ingest beneficial bacteria as we once did through food fermentation (widely used before refrigeration). Our water also tends to be highly chlorinated which, although important from a public health perspective, has drawbacks for individual health when it comes to adversely impacting our body’s bacterial populations. When the body’s bacterial populations are upset, many kinds of illness can result. So for daily maintenance and in times of illness it just makes sense to use a quality probiotic formula.
Prevention and Treatment of Diarrhea and Constipation: Antibiotic-associated diarrhea can be attributed in part to imbalances in intestinal microflora. Bifidobacteria have been used to successfully treat intestinal disorders and in the prevention of rotaviral diarrhea in children and adults. In fact, taking a probiotic formula with antibiotics is now considered to be standard medicine in many countries. But antibiotics and probiotics must be taken a few hours apart. Constipation is a significant problem for many people, especially the elderly. Researchers have shown that enhancing Bifidobacteria in the large intestine of constipated elderly individuals provides a significant laxative effect.
Ulcer Therapy: If you’re taking antibiotics to treat your ulcer, you should be using probiotics along with your doctor’s prescribed antibiotics. That’s the message from researchers reporting in the February 2001 issue of Digestion. Frequently, nausea, bloating, diarrhea, taste disturbances and loss of appetite are side effects from use of antibiotics to eradicate Helicobacter pylori, the bacterium thought to be the causative agent in gastric ulcers. This latest study involving 120 ulcer patients shows that persons given both antibiotics and probiotics experienced markedly reduced incidence of bloating, diarrhea and taste disturbances compared to persons given only antibiotics, and most persons given the natural remedy experienced no side effects.
Enhanced Immune Function: Most of our immune cells are produced within the gastrointestinal tract and much of our protection against orally ingested pathogens (such as salmonella) is the result of a healthy gastrointestinal environment. There is perhaps no greater protection against such food-borne pathogens than the use of probiotics to sustain this healthy environment. Recent studies show that Lactobacilli and Bifidobacteria can stimulate both general immunity and also specific antibodies to certain pathogens.
Lactose Intolerance: Dairy foods are a very important part of a healthy diet, but many of us suffer from some symptoms of lactose intolerance. Studies have shown that strains of Lactobaccilli and Bifidobacteria reduce symptoms of lactose malabsorption.
Establishment of Healthy Flora: in Babies and Infants Premature infants generally take longer to establish a characteristic intestinal flora, which can render them more susceptible to certain intestinal infections. Various strains of Bifidobacterium administered to premature infants results in populations of beneficial bacteria becoming established more quickly in their intestines compared to a control group. You will also likely find that children susceptible to middle ear infections enjoy better health when they are given probiotics (DDS®-Junior Probiotic for Children).
Editor’s Note: Dr. S. K. Dash is among the world’s leading experts today in the field of probiotics. Dr. Dash is founder of America’s leading probiotic company UAS Labs.
See the full unabridged version of this article at www.freedompressonline.com.
References Armuzzi, A., et al. “”Effect of Lactobacillus GG supplementation on antibiotic-associated gastrointestinal side effects during Helicobacter pylori eradication therapy: a pilot study.”" Digestion, 2001;63:1